Disability Compensation for Vietnam-Era Veterans with Diabetes is Associated with VA Patient Outcomes
BACKGROUND:
VA oversees the 2nd largest source of disability-related income assistance in the U.S.; in 2020, more than 5 million Veterans received a total of $91 billion in compensation for disabling conditions related to military service. This quasi-experimental study evaluated a July 2001 change in VA disability policy that qualified some Vietnam-era Veterans (those with “boots on the ground”) with diabetes for disability compensation. Specifically, the study examined the association between eligibility for disability compensation with mortality and hospitalizations. Investigators identified 14,247 Veterans with diabetes who served with “boots on the ground” (BOG) and 56,224 Veterans with diabetes who were “not on the ground” (NOG) during the Vietnam Era. The differences in these cohorts were estimated during early (July 1, 2001 to December 31, 2007), middle (January 1, 2008 to December 31, 2012), and later (January 1, 2013 to December 31, 2018) post-policy periods. Specific differences in the primary study outcomes (i.e., acute care hospitalizations and all-cause mortality) were estimated using data from VA, the Centers for Medicare & Medicaid Services, and the DoD. Secondary outcomes included receipt of disability compensation, amount of disability compensation (in 2018 dollars), outpatient physician visits, and acute hospital days. Investigators also examined patient demographics, as well as comorbidities.
FINDINGS:
- Among Veterans newly eligible for disability compensation, the annual proportion receiving disability compensation payments increased from 7% during the pre-policy period (January 1999 to June 2001) to 50% during the early period to 69% during the middle period to 76% during the later post-policy Despite increases, there was no evidence of lower mortality rates for these Veterans.
- Among Veterans concurrently enrolled in VA and Medicare, eligibility for disability compensation was associated with a substantial reduction in acute hospitalizations. Declines increased from 10% to 21%, coinciding with increased disability compensation and larger payments.
- Compared to non-eligible Veterans, eligible Veterans received $8,025, $14,412, and $17,162 more in annual disability compensation in the early, middle, and later post-policy periods, respectively.
- There was no evidence that the association between disability compensation and outcomes varied by race and ethnicity, socioeconomic status, or number of comorbidities at baseline.
IMPLICATIONS:
- Disability compensation payments may have important health benefits for Veterans.
LIMITATIONS:
- Investigators cannot exclude the possibility that eligible and non-eligible Veterans were differentially affected by other secular trends during the 17.5 post-policy period.
- Findings may not extend beyond VA disability compensation or conditions other than diabetes.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 17-912). Drs. Trivedi and Jiang are part of HSR&D’s Center of Innovation in Long-term Services and Supports for Vulnerable Veterans (LTSS), and Dr. Miller is part of HSR&D’s Center for Healthcare Organization and Implementation Research (CHOIR).
Trivedi AN, Jiang L, Miller D, et al. Association of Disability Compensation with Morality and Hospitalizations among Vietnam-Era Veterans with Diabetes. JAMA Internal Medicine. July 1, 2022;82(7):757-765.
