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GEN 97-002 – HSR&D Study

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GEN 97-002
Gender Differences in Compensation and Pension Claims Approval for PTSD
Maureen Murdoch MD MPH
Minneapolis VA Health Care System, Minneapolis, MN
Minneapolis, MN
Funding Period: October 1997 - September 2000

BACKGROUND/RATIONALE:
Quality assurance reviews commissioned by the Veterans Benefits Administration (VBA) suggested that approval rates for disability claims related to personal assault and Post Traumatic Stress Disorder (PTSD), claims filed almost wholly by women, might have been too low. To address this concern, VBA developed an educational intervention designed to improve the development and success rate of PTSD claims filed on behalf of women.

OBJECTIVE(S):
(1) Compare success rates of veterans seeking disability benefits for combat-related PTSD to that of veterans seeking benefits for PTSD attributed to personal assault. (2) Determine if gender differences exist in the granting of disability benefits for PTSD and, if so, identify likely sources of variance. (3) Determine the efficacy of the VBA-sponsored educational intervention on claims approval rates.

METHODS:
We are conducting a quasi-experimental study in which applicants for PTSD-related disability benefits will be compared before and after the VBA educational effort. Differences in claims’ success rates for men and women will be compared after adjusting for stressor-type, PTSD symptomatology, work and role functioning, physical functioning, and social adaptability. In a separate analysis, women's claims’ success rates before and after the intervention will be compared. Hierarchical modeling will be used to control for regional differences in claims approval rates. Endogenous data will be collected by survey and linked to administrative data. A random selection of 2,700 men and women, respectively, who applied for PTSD disability benefits between December, 1994 and December, 1998. The sample provides 85 per cent power to detect a 10 per cent change (pre- v. post-) in claims' approvals.

FINDINGS/RESULTS:
The project establishes a model of mutually beneficial VHA and VBA collaboration while simultaneously exploring questions of interest to both. Our findings should help establish what factors are important in predicting the success of disability claims and should assess the effectiveness of educational teleconferences in improving claims development.

IMPACT:
This will be one of the largest studies ever conducted in individuals with PTSD, and it offers a wealth of clinical information about participants' functional status and health care utilization. Important epidemiological information pertaining to in-service stressors and post-military stressors will also be available. In addition, to our knowledge, this is the first time anyone has studied predictors of disability claims success in the VA system, and it will be important to see how various demographic variables influence the outcome. In this regard, we will be able to describe across-VISN differences in PTSD claims approval rates (if any) and try to identify likely sources of variance. We will also be able to estimate the effectiveness (if any) of the VBA's educational intervention. A positive study would support funding additional educational interventions, whereas a negative finding would suggest more efficacious methods need to be devised to improve claims development.

PUBLICATIONS:

Journal Articles

  1. Murdoch M, Bradley A, Mather SH, Klein RE, Turner CL, Yano EM. Women and war. What physicians should know. Journal of general internal medicine. 2006 Mar 1; 21 Suppl 3:S5-10.
  2. Murdoch M, Polusny MA, Hodges J, Cowper D. The association between in-service sexual harassment and post-traumatic stress disorder among Department of Veterans Affairs disability applicants. Military medicine. 2006 Feb 1; 171(2):166-73.
  3. Murdoch M, Hodges J, Cowper D, Sayer N. Regional variation and other correlates of Department of Veterans Affairs Disability Awards for patients with posttraumatic stress disorder. Medical care. 2005 Feb 1; 43(2):112-21.
  4. Murdoch M, van Ryn M, Hodges J, Cowper D. Mitigating effect of Department of Veterans Affairs disability benefits for post-traumatic stress disorder on low income. Military medicine. 2005 Feb 1; 170(2):137-40.
  5. Halek K, Murdoch M, Fortier L. Spontaneous reports of emotional upset and health care utilization among veterans with posttraumatic stress disorder after receiving a potentially upsetting survey. The American Journal of Orthopsychiatry. 2005 Jan 1; 75(1):142-51.
  6. Murdoch M, Polusny MA, Hodges J, O'Brien N. Prevalence of in-service and post-service sexual assault among combat and noncombat veterans applying for Department of Veterans Affairs posttraumatic stress disorder disability benefits. Military medicine. 2004 May 1; 169(5):392-5.
  7. Sayer N, Spoont M, Murdoch M. The Department of Veterans Affairs Disability Compensation Program: What providers should know. Federal practitioner : for the health care professionals of the VA, DoD, and PHS. 2004 May 1; 21(5):15-20.
  8. Arbisi PA, Murdoch M, Fortier L. MMPI-2 Validity and Award of Service Connection for PTSD During the VA Compensation and Pension Evaluation. Psychological Services. 2004 Mar 1; 1(1):56-67.
  9. Murdoch M, Hodges J, Hunt C, Cowper D, Kressin N, O'Brien N. Service connection for PTSD is not a gender issue. Medical care. 2003 Dec 1; 41(12):1417-1418.
  10. Murdoch M, Nelson DB, Fortier L. Time, gender, and regional trends in the application for service-related post-traumatic stress disorder disability benefits, 1980-1998. Military medicine. 2003 Aug 1; 168(8):662-70.
  11. Murdoch M, Hodges J, Cowper D, Fortier L, van Ryn M. Racial disparities in VA service connection for posttraumatic stress disorder disability. Medical care. 2003 Apr 1; 41(4):536-49.
Book Chapters

  1. Murdoch M. Special Considerations: The compensation-seeking veteran with PTSD in: Post-Traumatic Stress Disorder: Implications for primary care: independent study course. In: Veterans Health Administration System-Wide Training Program, Dept of Veterans Affairs. The VA Employee Education System ed. 2002. 45-57 p.
Reports

  1. Murdoch M, Fortier L. Gender differences in VA disability benefits for PTSD after controlling for combat exposure. Washington, DC: 2000 Apr 14. 1-3 p. Report No.: 14.
Conference Presentations

  1. Murdoch M. PTSD disability benefits: A focus on gender. Paper presented at: National Academy of Sciences Public Annual Symposium; 2006 Jul 6; Washington, DC.
  2. Murdoch M, Polusny MA, Pryor J, Gackstetter GD, Hodges J, O'Brien N. Sexual trauma experiences among active duty men and women. Paper presented at: International Society for Traumatic Stress Studies Annual Symposium; 2005 Nov 1; Toronto, Canada.
  3. Murdoch M, Sayer N, Arbisi, P, Spoont M, Brown S, Rosenheck R. Disability and VA disability benefits: An emerging area of health research and policy focus. Paper presented at: VA HSR&D National Meeting; 2003 Feb 1; Washington, DC.
  4. Murdoch M, Halek K, Fortier L, van Ryn, Hodges J. Gender differences in compensation and pension claims approval for PTSD. Paper presented at: Health Issues of Military and Veteran Women Research Annual Symposium; 2002 Jun 1; Washington.
  5. Halek K, Fortier L, O'Brien N, Murdoch M. Can veterans with posttraumatic stress disorder (PTSD) be safely asked about their traumatic experiences using mailed surveys. Paper presented at: VA HSR&D National Meeting; 2001 Feb 1; Washington, DC.
  6. Murdoch M, Halek K, Fortier L. Functional status, rates of trauma, and personal hardships of women and men who applied for VA posttraumatic stress disorder (PTSD) disability benefits, 1994 to 1998. Paper presented at: VA HSR&D National Meeting; 2001 Feb 1; Washington, DC.
  7. Murdoch M, Halek K, Fortier L, vanRyn M, Hodges J. Service connection for posttraumatic stress disorder (PTSD) disability benefits depend on race and region but not on gender. Paper presented at: VA HSR&D National Meeting; 2001 Feb 1; Washington, DC.
  8. Murdoch M. Secular, gender, and regional trends in veterans' application and approval rates for service-related PTSD disability benefits. Paper presented at: Minneapolis VAMC / University of Minnesota Division of Health Services Research and Policy Annual Seminar; 2000 Feb 2; Minneapolis, MN.
  9. Murdoch M, Fortier L. Gender differences in VA disability benefits for PTSD after controlling for combat exposure. Paper presented at: VA HSR&D National Meeting; 1999 Feb 17; Washington, DC.


DRA: Military and Environmental Exposures, Health Systems
DRE: none
Keywords: PTSD, Women - or gender differences
MeSH Terms: Stress Disorders, Post-Traumatic, Women

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