Health Services Research & Development

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HSR&D In Progress

April 2019

In This Issue: Improving Care for Veterans with Diabetes
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Impact of Disability and Health Benefits on Outcomes among Vietnam Veterans with Diabetes

Feature Article


All Veterans who had “boots on the ground” (BOG) in Vietnam, Cambodia, or Laos during the 1964 to 1975 period were deemed to be exposed to Agent Orange and, therefore, eligible for disability compensation and more generous health benefits, including zero medication copayments.

In July 2001, VA expanded the medical eligibility criteria for Vietnam-era Veterans to include diabetes as a service-connected condition. The change in policy was motivated by an Institute of Medicine (IOM) study of the association of Agent Orange (used during Vietnam War) with the onset of type 2 diabetes (Veterans and Agent Orange: Herbicide/Dioxin Exposure and Type 2 Diabetes, IOM, 2000). All Veterans who had “boots on the ground” (BOG) in Vietnam, Cambodia, or Laos during the 1964 to 1975 period were deemed to be exposed to Agent Orange and, therefore, eligible for disability compensation and more generous health benefits, including zero medication copayments. The approximately 55% of Vietnam-era Veterans who did not have BOG during the war (Not on Ground (NOG)) were ineligible for disability compensation due to diabetes. Prior work by members of this research team found that the 2001 policy change led to a 30% relative increase in income for Veterans with BOG relative to their NOG counterparts. The value of these benefits is further enhanced because they are not subject to federal taxes and are made in perpetuity irrespective of other employment income. The overall objective of this ongoing HSR&D study (2018-2021) is to examine the impact of this major change in VA policy that led to increased disability compensation and health benefits for some, but not all, Vietnam-era Veterans with diabetes. Specifically, investigators will examine whether increased disability and health benefits to Vietnam-era Veterans with diabetes:

  • Resulted in better control of glycosylated hemoglobin (HbA1c) and blood pressure – and increased adherence to medications,
  • Reduced micro- and macrovascular complications of diabetes, and/or
  • Lowered mortality.

Using 15 years of follow-up data (2001- 2016), investigators will examine the effects of increased annual income as well as more generous health coverage on a comprehensive set of short- and long-term outcomes of diabetes. Data regarding BOG status will come from the U.S. Army’s Office of Economic Manpower Analysis. These data will be merged with data on all Vietnam-era Army Veterans who were enrolled in the VA healthcare system as of July 2001, thereby providing investigators with detailed outcomes on medication adherence, glycosylated hemoglobin, blood pressure, diabetic complications, and mortality. The study population will include Veterans with a diagnosis of diabetes prior to July 2001 to avoid the potential bias that eligible Veterans who had BOG may have been motivated to be diagnosed with diabetes after the policy change. Investigators will then compare difference in outcomes between BOG Veterans and NOG Veterans—before and after the policy change (2001 and prior years vs. 2002 and later years).

Findings: No findings to report at this time; investigators are still gathering data.

Impact: This study will determine the extent to which disability compensation and more generous VA health benefits among Vietnam-era Veterans improved short- and long- term outcomes of diabetes. This contribution is significant because one-quarter of VA enrollees have diabetes, and the complications related to diabetes account for substantial morbidity and spending among Veterans.

Principal Investigator: Amal Trivedi, MD, MPH, is a former HSR&D Career Development Awardee, and is currently part of HSR&D’s Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans in Providence, RI.

Publications: No publications at this time.

View project abstract.

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