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2019 HSR&D/QUERI National Conference Abstract

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4050 — Veterans' attitudes towards service-connection claims: Identifying potential targets to increase Veterans' access to care

Lead/Presenter: Suzanne Spinola,  New England MIRECC, VA Connecticut Healthcare System, West Haven
All Authors: Spinola S (New England MIRECC, VA Connecticut Healthcare System, West Haven; Department of Psychiatry, Yale School of Medicine), Fenton, B (Pain Research, Informatics, Multimorbidities, & Education (PRIME), Center of Innovation VA Connecticut Healthcare System, West Haven) Black, A (Yale University; VA Connecticut Healthcare System, West Haven) Rosen, M, I (Mental Health Service Line, VA Connecticut Healthcare System, West Haven; Department of Psychiatry, Yale School of Medicine)

Objectives:
The service connection (SC) evaluation is an important gateway to VA medical treatment, and claimants' attitudes about the process likely impact their impressions of VA care and vice versa. The SC evaluation process can be complex and lengthy. Prior work has assessed knowledge, expectations, and motivations among Veterans applying for SC for PTSD. Extending that research, this project examined whether Veterans' attitudes are specific to PTSD claimants or apply also to Veterans filing claims for musculoskeletal disorder (MSD). Veteran-specific factors (other than type of claim) associated with attitudes towards SC claims were also identified.

Methods:
Participants were OEF/OIF/OND Veterans filing SC claims for PTSD (n = 218) or MSD (n = 257). A modified Disability Application Appraisal Inventory (m-DAAI) was used to assess knowledge, attitudes, and beliefs pertaining to the SC process. Multiple regression models tested the effect of claim type on each DAAI subscale. Model covariates included Veteran clinical, demographic, financial and claim-related characteristics.

Results:
Claim type was significantly associated with DAAI-measured attitudes. Veterans submitting a claim for PTSD had more negative expectations about the process (p < .001), and viewed the financial benefits (p < .001) as less important for filing a claim than those submitting a claim for MSD. Depression severity was independently and positively associated with negative expectations (p < .001), financial importance (p < .001), and validation of condition (p = .002). In addition, race/ethnicity was significantly associated with knowledge (p < .001), whereby White veterans were more knowledgeable about the process compared to Black and Hispanic veterans.

Implications:
The finding that depression is significantly associated with attitudes and beliefs about the SC process suggests that depression screens might be administered as part of the CandP process to identify Veterans who may need extra support and access to mental health services. Providing educational materials, previously tested with different racial/ethnic groups, to all claimants prior to their CandP appointment may ease the burden of the SC process.

Impacts:
Identifying needs of veterans during their initial contact with the VHA (for SC evaluation) would foster a Veteran-centric experience. Preparing Veterans for the claims process would increase its palatability and efficiency.