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2019 HSR&D/QUERI National Conference Abstract

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1100 — Predicting and Planning for Musculoskeletal Service-connected Disabilities in VA using Disability Separations for Active Duty OEF/OIF Service Members

Lead/Presenter: Adi Gundlapalli,  COIN - Salt Lake City
All Authors: Gundlapalli AV (IDEAS 2.0 Center, VA Salt Lake City Health Care System, Salt Lake City; University of Utah School of Medicine, Salt Lake City), Redd AM (Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0), Center, VA Salt Lake City Health Care System, Salt Lake City, 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:
Musculoskeletal (MSK) injuries and conditions are commonly seen among military Service Members (SM) and Veterans who served in Iraq and Afghanistan. With injuries being a hallmark of military service, the Department of Veterans Affairs (VA) has developed particular expertise in caring for short- and long-term sequelae of injuries and MSK arising from overuse and strain. As the recent conflicts in Iraq and Afghanistan are now extending to over 17 years and the medical needs of Veterans are expected to peak in the year 2035, the costs are estimated to be close to a trillion dollars. We explored correlates of award of MSK related service-connected disability benefits (SCDB) among SM seeking care in VA hospitals.

Methods:
DoD data on service members (SM) who separated from October 1, 2001 to May 2017 were linked to VA administrative data. Using adjusted logistic regression models, we determined the odds of receiving MSK SCDB.

Results:
A total of 1,558,449 (79% of separating SM) had at least one encounter in VA during the study period (7.8% misconduct separations). Overall, 51% of this cohort had at least one MSK SCDB (88% among disability separations, 48% among normal). Those with disability separations (as compared to normal separations) were significantly more likely to receive MSK SCDB (Odds ratio (OR) 2.37) as were females (compared to males, OR 1.15).

Implications:
While active duty SM with disability separations were more likely to receive MSK-related Service connected disability ratings in the VA, those with normal separations also received such awards. Identifying those at highest risk for MSK-related disability could lead to improved surveillance and prevention strategies in the Department of Defense and VA health care systems to prevent further damage and disability.

Impacts:
Careful forecasting of MSK-related VHA resources should include both Veterans who had disability separations and those who did not, though disability separations are a helpful predictor of VHA needs. With normal separations accounting for 75% of all separations, this signals an otherwise unexpected demand on resources in the VA and merits further study with the goal of preventing and mitigating injuries and strain while in the military.