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2015 HSR&D/QUERI National Conference Abstract

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3124 — OEF/OIF/OND Veterans With Back Pain: Characteristics, and Predictors of Compensation and Pension Award

Sakr CJ, VA Connecticut, Yale; Slade MD, Yale; Black AC, VA Connecticut, Yale; Rosen MI, VA Connecticut, Yale;

Objectives:
Back pain is the most common cause of chronic non-cancer pain among Veterans and represents a highly prevalent condition among veterans receiving disability compensation through the VA. Veterans applying for compensation and pension (CandP) for back pain remain largely understudied. We described the characteristics of veterans applying for CandP for back pain at VA Connecticut, and identified predictors of service-connection ratings.

Methods:
The study was a cross-sectional analysis of data from OEF/OIF/OND veterans applying for CandP for back pain in fiscal year 2012 at VA Connecticut Healthcare System. Information was obtained through review of Veterans' electronic records. Variables of interest included: demographic characteristics, smoking status, use of illegal drugs, use of opioids, degree of pain reported, depression score, functional impairment, work status, and disability ratings, among others. Bivariate and multivariate models were developed. Generalized linear models were utilized for continuous outcomes while logistic regression was used for the binary outcome of functional impairment. The study protocol was approved by VA CT IRB.

Results:
The study sample comprised 178 Veterans. The majority were men (91%). The mean age was 36 years. Only 15% had normal weight, 42% were overweight and 43% were obese. The sample included current (39%) and former (20%) smokers, and 20% used opioids. The vast majority (75%) had a service compensation for back pain of 20% or less. Functional impairment was reported by 62% however 70% of the veterans were working at the time of their CandP examination. Work status and functional impairment were not associated in the bivariate analysis. In the multivariate model only pain predicted functional impairment (Odds Ratio 1.51, p < 0.005) and functional impairment predicted service connection (Odds Ratio 3.9, p < 0.0001). Functional impairment was a full mediator of the relationship between degree of pain and service connection. Work status was not associated with service connection in the multivariate analysis.

Implications:
Veterans reporting functional impairment are more likely to have higher service connection for back, independent of their work status.

Impacts:
The study is one of the first to provide insight into the factors accounting for service connection awards for pain.