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2019 HSR&D/QUERI National Conference Abstract

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1003 — Disparities in Awarding VA Service-Connected Disability for PTSD for Active Duty Military Service Members from Conflicts in Iraq and Afghanistan

Lead/Presenter: Andrew Redd,  COIN - Salt Lake City
All Authors: Redd AM (IDEAS 2.0 Center, VA Salt Lake City Health Care System, Salt Lake City; University of Utah School of Medicine, Salt Lake City), Gundlapalli AV (Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0), Center, VA Salt Lake City Health Care System, Salt Lake City; University of Utah School of Medicine, Salt Lake City) Suo Y (Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, Salt Lake City; University of Utah School of Medicine, Salt Lake City) Pettey WBP (Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, Salt Lake City; University of Utah School of Medicine, Salt Lake City) Brignone E (VA Pittsburgh Healthcare System, Pittsburgh) Chin DL (School of Public Health, University of Massachusetts Amherst, Amherst) Walker LE (David Grant USAF Medical Center, Clinical Investigation Facility, Travis AFB) Poltavskiy EA (David Grant USAF Medical Center, Clinical Investigation Facility, Travis AFB) Janak JC (Department of Defense Joint Trauma System, Defense Health Agency, Joint Base San Antonio-Fort Sam Houston) Howard JT (Department of Kinesiology, Health and Nutrition, University of Texas at San Antonio, San Antonio) Sosnov JA (375th Medical Group, Scott AFB; Uniformed Services University of the Health Sciences, Bethesda) Stewart IJ (David Grant USAF Medical Center, Clinical Investigation Facility, Travis AFB; Uniformed Services University of the Health Sciences, Bethesda)

Objectives:
An important aspect of caring for Veterans is a national policy that provides them with disability benefit awards for loss of function/injury or mental health conditions that are a direct result of or are aggravated by their military service. These "service-connected disability benefits (SCDB)" are awarded by the Department of Veterans Affairs (VA) after an application is filed by the Veteran and a medical and mental health evaluation is conducted by the VA. As there is limited literature on this topic, we set out to explore and report on disparities in awarding post-traumatic stress disorder (PTSD) service-connected disability benefits (SCDB) to Veterans based on gender, race/ethnicity, and misconduct separation.

Methods:
DoD data on service members (SM) from VA-DoD Identity Repository (VADIR) who separated from active military service from October, 2001 through May 2017 were linked to VA administrative data on SCDB. Using adjusted logistic regression models, we determined the odds of receiving a PTSD SCDB conditional on a VA diagnosis of PTSD.

Results:
A total of 1,558,449 (79% of separating SM) had at least one encounter in VA during the study period (12% female, 4.5% misconduct separations). Females (OR 0.72) and Blacks (OR 0.93) were less likely to receive a PTSD award even though they were nearly equally likely to receive a PTSD diagnosis (OR 0.97, 1.01) in the VA. Other racial/ethnic minorities were more likely to receive an award and diagnosis, as were those with misconduct separations (award OR 1.3, diagnosis 2.17).

Implications:
Despite being diagnosed with PTSD at similar rates to their referent categories, females and Black Veterans are less likely to receive PTSD disability awards. Other racial/ethnic minorities and those with misconduct separations were more likely to receive PTSD diagnoses and awards. Further study is merited to explore variation in awarding SCDB.

Impacts:
This analysis identifies an addressable disparity in the delivery of disability benefits for both female Veterans and Black Veterans who have been diagnosed with PTSD. Awareness of the disparity should drive greater mindfulness among VA providers who make diagnoses and steer VA policies toward a more equitable conferring of SCDB awards.