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Publication Briefs

Majority of OEF/OIF Veterans with Traumatic Brain Injury also Diagnosed with Mental Illness and Head, Neck or Back Pain

VA is the single largest provider of healthcare services to OEF/OIF Veterans. These Veterans who receive VA healthcare carry a high burden of mental disorders, with PTSD being the most common. Survey findings also suggest that 15% to 20% may have mild traumatic brain injury (TBI), and pain is another high-frequency problem among this VA patient population. However, little is known about the co-occurrence of TBI, psychiatric disorders, and pain on a national level. Using VA data, this observational study examined the prevalence and VA healthcare costs of TBI with and without comorbid psychiatric illness and pain among 327,388 OEF/OIF Veterans who used VA healthcare services (inpatient or outpatient) during FY09. Investigators compared demographics and co-occurring mental health, head, neck or back pain diagnoses by clinician-diagnosed TBI status, as well as average costs.


  • In 2009, 22,053 (6.7%) of the 327,388 OEF/OIF Veterans who used VA healthcare received a diagnosis of TBI. Among this patient subgroup, the vast majority (89%) also had a psychiatric diagnosis (most frequently PTSD: 73%), and 70% had a diagnosis of head, neck or back pain. More than half had both PTSD and pain (54%). Overall, depression was the second most common (45%) mental health diagnosis.
  • Annual costs for OEF/OIF Veterans with TBI were four times greater than for those without TBI ($5,831 vs. $1,547), and costs increased as clinical complexity increased. For example, Veterans with TBI, PTSD, and pain demonstrated the highest median cost per patient ($7,974).


  • Findings are based on administrative data and, therefore, may be biased by documentation errors.
  • Data were not available on diagnoses for the 54% of OEF/OIF Veterans who did not use VA care.
  • Average cost estimates were based on VA healthcare use only.

The “Fiscal Year 2009 VA Utilization Report for OEF/OIF Veterans Diagnosed with TBI”, utilizing the data reported in this article, is available on the VA Intranet (VA network access only —

This study was funded through VA/HSR&D’s Polytrauma and Blast-Related Injuries Quality Enhancement Research Initiative (QUERI). Drs. Taylor and Sayer, and Ms. Hagel and Ms. Cutting are part of HSR&D’s Center for Chronic Disease Outcomes Research, Minneapolis, MN. Dr. Sayer also is Director of PT/BRI-QUERI. Dr. Carlson is a VA HSR&D Career Development Awardee (CDA 08-025). Dr. Cifu is VA’s National Director for Physical Medicine and Rehabilitation Services.

PubMed Logo Taylor B, Hagel E, Carlson K, Cifu D, Cutting A, Bidelspach D, and Sayer N. Prevalence and Costs of Co-Occurring Traumatic Brain Injury with and without Psychiatric Disturbance and Pain among Afghanistan and Iraq War Veteran VA Users. Medical Care January 4, 2012;e-pub ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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