Implications of Race Adjustment in Lung-Function Equations.

BACKGROUND: Adjustment for race is discouraged in lung-function testing, but the implications of adopting race-neutral equations have not been comprehensively quantified. METHODS: We obtained longitudinal data from 369,077 participants in the National Health and Nutrition Examination Survey, U.K. Biobank, the Multi-Ethnic Study of Atherosclerosis, and the Organ Procurement and Transplantation Network. Using these data, we compared the race-based 2012 Global Lung Function Initiative (GLI-2012) equations with race-neutral equations introduced in 2022 (GLI-Global). Evaluated outcomes included national projections of clinical, occupational, and financial reclassifications; individual lung-allocation scores for transplantation priority; and concordance statistics (C statistics) for clinical prediction tasks. RESULTS: Among the 249 million persons in the United States between 6 and 79 years of age who are able to produce high-quality spirometric results, the use of GLI-Global equations may reclassify ventilatory impairment for 12.5 million persons, medical impairment ratings for 8.16 million, occupational eligibility for 2.28 million, grading of chronic obstructive pulmonary disease for 2.05 million, and military disability compensation for 413,000. These potential changes differed according to race; for example, classifications of nonobstructive ventilatory impairment may change dramatically, increasing 141% (95% confidence interval [CI], 113 to 169) among Black persons and decreasing 69% (95% CI, 63 to 74) among White persons. Annual disability payments may increase by more than $1 billion among Black veterans and decrease by $0.5 billion among White veterans. GLI-2012 and GLI-Global equations had similar discriminative accuracy with regard to respiratory symptoms, health care utilization, new-onset disease, death from any cause, death related to respiratory disease, and death among persons on a transplant waiting list, with differences in C statistics ranging from -0.008 to 0.011. CONCLUSIONS: The use of race-based and race-neutral equations generated similarly accurate predictions of respiratory outcomes but assigned different disease classifications, occupational eligibility, and disability compensation for millions of persons, with effects diverging according to race. (Funded by the National Heart Lung and Blood Institute and the National Institute of Environmental Health Sciences.).

Disability Claims for Female Veterans Exposed to Contaminated Water at Marine Base Camp Lejeune.

INTRODUCTION: Between 1953 and 1987, over one million Veterans were exposed to contaminated water at Marine Corps Base Camp Lejeune, North Carolina. We examined the relationship between toxicant exposure and subsequent disability ratings in female veterans. MATERIALS AND METHODS: Comparisons were made between females stationed at Camp Lejeune and from Marine Corps Base Camp Pendleton, California who were not known to have been exposed to these toxicants, between 1975 and 1985, using data from the Agency for Toxic Substances and Diseases Registry and VA data. RESULTS: A total of 4,491 (52%) females from Camp Lejeune and 2,811 (47%) from Camp Pendleton used VA health care between October 1, 1999 and February 17, 2021. Approximately 51% of Camp Lejeune females were exposed to toxicants. More than half (50.6% and 53.9% from Lejeune and Pendleton, respectively) had a disability rating ≥10%. Females who were Black, Hispanic, officers, or had longer duration in camp were more likely to have a disability rating, whereas females exposed to toxicants were less likely to have a disability rating. When the regression was redone examining the predictors of disability due to any of 8 presumptive conditions associated with toxicant exposure, the only significant variable was having been at Camp Lejeune (odds ratio [OR], 2.5, 95% CI, 1.3-4.7). Toxicant exposure was not significant when only Camp Lejeune females were included in the model. CONCLUSION: Little attention has been given to female veterans exposed to toxicants at Camp Lejeune. Although we did not find an association between exposure and disability ratings, reliance on service-connected disability codes and small numbers were limitations. Further examination using international code of diseases diagnostic codes may be warranted.

Comparison of attitudes towards the service connection claims process among veterans filing for PTSD and veterans filing for musculoskeletal disorders.

ABSTRACT: Many veterans have negative views about the service connection claims process for posttraumatic stress disorder (PTSD), which likely impacts willingness to file service connection claims, re-file claims, and use Veterans Healthcare Administration care. Nevertheless, veterans have reported that PTSD claims are important to them for the financial benefits, validation of prior experience and harm, and self-other issues such as pleasing a significant other. It is unknown if reported attitudes are specific to PTSD claimants or if they would be similar to those submitting claims for other disorders, such as musculoskeletal disorders. Therefore, the purpose of this study was to compare attitudes and beliefs about service connection processes between veterans submitting service connection claims for PTSD and musculoskeletal disorders.Participants were Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans filing service connection claims for PTSD (n = 218) or musculoskeletal disorder (n = 257) who completed a modified Disability Application Appraisal Inventory. This secondary data analysis using multiple regression models tested the effect of demographics, clinical characteristics, and claim type on 5 Disability Application Appraisal Inventory subscales: Knowledge about service connection claims, Negative Expectations about the process, and importance of Financial Benefits, importance of Validation of veteran's experience/condition, and importance of Self-Other attitudes.The PTSD group assigned significantly less importance to financial benefits than the musculoskeletal disorder group. In addition, the subset of the PTSD group without depression had significantly more Negative Expectations than musculoskeletal disorder claimants without depression. Negative Expectations did not differ between the PTSD and musculoskeletal disorder groups with depression. Depression was significantly positively associated with Negative Expectations, importance of Financial Benefits, and importance of Validation.Most perceptions around seeking service connection are not specific to PTSD claimants. Depression is associated with having negative expectations about service connection claims and motivations to file claims. Addressing depression and negative expectations during the compensation and pension process might help veterans at this important point of contact with Veterans Healthcare Administration services.

Contribution of mental ill health during military service to postservice benefit claims in the UK.

OBJECTIVES: While most UK military personnel transition successfully into civilian life, some experience unemployment and disability, which may be partly attributable to in-service factors. This study aims to determine the degree to which in-service mental health problems impact on postservice benefit claims. METHODS: Using data from a cohort of 5598 recent leavers from regular service in the UK Armed Forces linked with data from the Department for Work and Pensions, we assessed associations between in-service mental health and postservice benefit claims, and the population attributable fraction (PAF) of benefit claims related to in-service mental health. An analysis with postservice mental ill health as mediator was performed to determine the degree to which the observed effects were a consequence of persistent illness, as opposed to remitted. RESULTS: Mental illness occurring in-service predicted both unemployment and disability claims, partly mediated by postservice health (23%-52% total effects mediated), but alcohol misuse did not. Common mental disorder (CMD) (PAF 0.07, 95% CI: 0.02 to 0.11) and probable post-traumatic stress disorder (PTSD) (PAF 0.05, 95% CI 0.01 to 0.09) contributed to unemployment claims. Probable PTSD was the largest contributor to disability claims (PAF 0.25, 95% CI 0.13 to 0.36), with a smaller contribution from CMD (PAF 0.16, 95% CI 0.03 to 0.27). CONCLUSIONS: In-service mental ill health gives rise to benefit claims. These effects are only partly mediated by postservice mental health, implying that in-service (or pre-service) mental issues have carry-over effects into civilian life even if remitted. Better prevention and treatment of in-service PTSD symptoms may well reduce postservice disability claims.

Repatriation for diseases or non-battle injuries (DNBI): long-term impact on quality of life.

INTRODUCTION: Throughout history, diseases and non-battle injuries (DNBI) have threatened deployed forces more than battlefield injuries. During the Dutch involvement in Afghanistan, the amount of DNBI that needed medical evacuation out of theatre (60%) exceeded the number of battle injuries (40%). The aim of this study is to explore the long-term quality of life (QoL) of Dutch service members that acquired a DNBI, warranting repatriation during their deployment to Afghanistan between 2003 and 2014. METHODS: Observational cross-sectional cohort study in a selected group of Dutch service members who deployed to Afghanistan 2003-2014 and were repatriated due to DNBI. Using the 36-item Short Form, EuroQol-6D, Symptom Checklist 90 and Post Deployment Reintegration Scale questionnaires, their outcomes were compared with a control group of deployed service members who did not sustain injuries or illnesses. RESULTS: Groups were comparable in age, rank, number of deployments and social status. There were significant differences found in terms of physical functioning, pain and health perspective. No differences were seen in emotional or psychological outcomes. CONCLUSION: The amount of military service members who contract a DNBI is significant and imposes a burden on the capacity of the medical support, readiness of deployed units and sustainability of ongoing operations. However, regarding QoL, being forced to leave their units and to be repatriated to their home country due to a DNBI seems to have no significant impact on reported psychological symptoms of distress and reintegration experiences. Future research should focus on more in-depth registration of illnesses and not combat related diseases and injuries and even longer-term outcomes.

Changes in Post-traumatic Stress Disorder Service Connection Among Veterans Under Age 55: An 18-Year Ecological Cohort Study.

INTRODUCTION: Mandatory, age-based re-evaluations for post-traumatic stress disorder (PTSD) service connection contribute substantially to the Veterans Benefits Administration's work load, accounting for almost 43% of the 168,013 assessments for PTSD disability done in Fiscal Year 2017 alone. The impact of these re-evaluations on Veterans' disability benefits has not been described. MATERIALS AND METHODS: The study is an 18-year, ecological, ambispective cohort of 620 men and 970 women receiving Department of Veterans Affairs PTSD disability benefits. Veterans were representatively sampled within gender; all were eligible for PTSD disability re-evaluations at least once because of age. Outcomes included the percentage whose PTSD service connection was discontinued, reduced, re-instated, or restored. We also examined total disability ratings among those with discontinued or reduced PTSD service connection. Subgroup analyses examined potential predictors of discontinued PTSD service connection, including service era, race/ethnicity, trauma exposure type, and chart diagnoses of PTSD or serious mental illness. Our institution's Internal Review Board reviewed and approved the study. RESULTS: Over the 18 years, 32 (5.2%) men and 180 (18.6%) women had their PTSD service connection discontinued; among them, the reinstatement rate was 50% for men and 34.3% for women. Six men (1%) and 23 (2.4%) women had their PTSD disability ratings reduced; ratings were restored for 50.0% of men and 57.1% of women. Overall, Veterans who lost their PTSD service connection tended to maintain or increase their total disability rating. Predictors of discontinued PTSD service connection for men were service after the Vietnam Conflict and not having a Veterans Health Administration chart diagnosis of PTSD; for women, predictors were African American or black race, Hispanic ethnicity, no combat or military sexual assault history, no chart diagnosis of PTSD, and persistent serious mental illness. However, compared to other women who lost their PTSD service connection, African American and Hispanic women, women with no combat or military sexual assault history, and women with persistent serious illness had higher mean total disability ratings. For both men and women who lost their PTSD service connection, those without a PTSD chart diagnosis had lower mean total disability ratings than did their counterparts. CONCLUSIONS: Particularly for men, discontinuing or reducing PTSD service connection in this cohort was rare and often reversed. Regardless of gender, most Veterans with discontinued PTSD service connection did not experience reductions in their overall, total disability rating. Cost-benefit analyses could help determine if mandated, age-based re-evaluations of PTSD service connection are cost-effective.

Disability Rating and 1-Year Mortality Among Veterans With Service-Connected Health Conditions.

OBJECTIVES: Military service is associated with an increased risk of disability and death after discharge. This study determined the relationships among characteristics, disability ratings, and 1-year mortality risks of veterans receiving compensation for service-connected health conditions (ie, conditions related to illnesses or injuries incurred or aggravated during military service). METHODS: This study included 4 010 720 living veterans who had ≥1 service-connected health condition and were receiving disability compensation on October 1, 2016. We obtained data on veteran demographic, military service, and disability characteristics from the Veterans Benefits Administration VETSNET file and on 1-year mortality from the Veterans Administration vital status file. We compared veteran characteristics and 1-year mortality rates within and between the following combined service-connected disability rating categories: low, 10% to 40% disability; medium, 50% to 90% disability; high, 100% disability. We used logistic regression analysis to determine the relationships between disability ratings and 1-year mortality rates. RESULTS: Of 4 010 720 veterans, 515 095 (12.8%) had high disability ratings, 1 600 786 (39.9%) had medium disability ratings, and 1 894 839 (47.2%) had low disability ratings. The 1-year mortality rates were 4.5% for those with high disability, 1.9% for those with medium disability, and 1.9% for those with low disability ratings. Compared with veterans with low disability ratings, veterans with high disability ratings had more than twice the odds of 1-year mortality (odds ratio = 2.45; 95% confidence interval, 2.40-2.50). CONCLUSIONS: The combined disability rating is an important determinant of short-term survival among veterans with service-connected health conditions. Veterans with a 100% disability rating comprise a highly select group with increased short-term risk of death due at least in part to their military service. Future studies assessing the relationships among combat exposure, age, duration of disability, disability ratings, and survival would be valuable.

Understanding the impact of mild traumatic brain injury on veteran service-connected disability: results from Chronic Effects of Neurotrauma Consortium.

OBJECTIVES: Disability evaluation is complex. The association between mild traumatic brain injury (mTBI) history and VA service-connected disability (SCD) ratings can have implications for disability processes in the civilian population. We examined the association of VA SCD ratings with lifetime mTBI exposure in three models: any mTBI, total mTBI number, and blast-related mTBI. METHODS: Participants were 492 Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans from four US VA Medical Centers enrolled in the Chronic Effects of Neurotrauma Consortium study between January 2015 and August 2016. Analyses entailed standard covariate-adjusted linear regression models, accounting for demographic, military, and health-related confounders and covariates. RESULTS: Unadjusted and adjusted results indicated lifetime mTBI was significantly associated with increased SCD, with the largest effect observed for blast-related mTBI. Every unit increase in mTBI was associated with an increase in 3.6 points of percent SCD. However, hazardous alcohol use was associated with lower SCD. CONCLUSIONS: mTBI, especially blast related, is associated with higher VA SCD ratings, with each additional mTBI increasing percent SCD. The association of hazardous alcohol use with SCD should be investigated as it may impact veteran health services access and health outcomes. These findings have implications for civilian disability processes.

Sexual Assault and Disabling PTSD in Active Duty Service Women.

INTRODUCTION: Sexual assault in the military is a major concern and may result in significant health problems, such as post-traumatic stress disorder (PTSD). Those developing disabling PTSD symptoms may require a disability evaluation. We examined disability evaluation trends for service women with PTSD to better understand characteristics associated with inability to continue Active Duty service. METHODS: This is a retrospective review of disability reports and electronic medical records for 322 Active Duty women diagnosed with and treated for PTSD by psychiatrists and psychologists at a large military treatment facility between 2011 and 2014. Service women requiring medical disability evaluation for PTSD (n = 159) were included in the study as "IDES cases" (Integrated Disability Evaluation System - IDES). A similar number of women, randomly selected from those seeking care for PTSD but not requiring disability evaluation during the same period, were included in the "control" group (n = 163). Analyzes done to evaluate differences between groups (IDES cases vs. controls) included demographic and service-related characteristics, history of chronic pain, and PTSD index trauma types, such as pre-military trauma and military sexual trauma (MST). Logistic regression was performed to identify the factors associated with inclusion in IDES. RESULTS: MST was the most frequent PTSD index trauma in the IDES group (73.6% vs. 44.8% of control group) and the most significant factor associated with IDES inclusion (OR 2.6, p = 0.032). Those in the IDES group had significantly greater number of mental health visits for PTSD (IDES: m = 68.6 vs. controls: m = 29.6) and more frequent chronic pain history (IDES 40.9% vs. controls 19.6%) than those in the control group. Approximately 65% of women in both groups had a history of childhood abuse, but childhood abuse, as a PTSD index trauma, was negatively associated with IDES inclusion (OR 0.293, p = 0.006). CONCLUSIONS: Active Duty service women with PTSD and a MST index trauma are much more likely to require disability evaluation (IDES) than those with PTSD due to other trauma types. IDES evaluation for conditions such as PTSD may result in early termination of military service and is a potential downstream consequence of MST. Service women requiring greater numbers of mental health visits for PTSD treatment may benefit from a multidisciplinary approach to treating concurrent health conditions, such as chronic pain. Those providing care for service women should evaluate for MST, chronic pain and pre-military trauma, such as childhood abuse; and aggressively treat these conditions to prevent PTSD and disability.

Breast Cancer Treatment and Survival Among Department of Defense Beneficiaries: An Analysis by Benefit Type and Care Source.

Background: Use of treatment for breast cancer is dependent on the patient's cancer characteristics and willingness to undergo treatment and provider treatment recommendations. Receipt of breast cancer treatment varies by insurance status and type. It is not clear whether different benefit types and care sources differ in breast cancer treatment and outcomes among Department of Defense beneficiaries. Methods: The objectives of this study are to assess whether receipt of breast cancer treatment varied by benefit type (TRICARE Prime vs non-Prime) or care source (direct care, purchased care, and both) and to examine whether survival and recurrence differed by benefit type and/or care source among female Department of Defense beneficiaries with the disease. Study subjects were women aged 40-64 yr, diagnosed with malignant breast cancer between 2003 and 2007. Multivariable logistic regression analyses were conducted to assess the likelihood of receiving treatment by benefit type or care source. Multivariable Cox proportional hazard models were used to investigate differences in survival and recurrence by benefit type or care source. Findings: A total of 2,668 women were included in this study. Those with Prime were more likely to have chemotherapy, radiation, hormone therapy, breast-conserving surgery, surveillance mammography, and recurrence than women with non-Prime. Survival was high, with 94.86% of those with Prime and 92.58% with non-Prime alive at the end of the study period. Women aged 50-59 yr with non-Prime benefit type had better survival than women with Prime of the same age. No survival differences were seen by care source. In regard to recurrence, women aged 60-64 yr with TRICARE Prime were more likely to have recurrent breast cancer than women with non-Prime. Additionally, women aged 50-59 yr who used purchased care were less likely to have a recurrence than women who used direct care only. Discussion/Impact/Recommendations: To our knowledge, this is the first study to examine breast cancer treatment and survival by care source and benefit type in the Military Health System. In this equal access health care system, no differences in treatment, except mastectomy, by benefit type, were observed. There were no overall differences in survival, although patients with non-Prime tended to have better survival in the age group of 50-59 yr. In regard to care source, women who utilized mostly purchased care or utilized both direct and purchased care were more likely to receive certain types of treatment, such as chemotherapy and radiation, as compared with women who used direct care only. However, survival did not differ between different care sources. Future research is warranted to further investigate variations in breast cancer treatment and its survival gains by benefit type and care source among Department of Defense beneficiaries.

Increased risk of attempted suicide in Australian veterans is associated with total and permanent incapacitation, unemployment and posttraumatic stress disorder severity.

BACKGROUND: Military veterans have higher rates of suicidality and completed suicides compared to the general population. Previous research has demonstrated suicidal behaviour is higher in US combat veterans who are younger, suffer from posttraumatic stress disorder, depression and anxiety and score lower on measures of health. However, research on predictors of suicide for Australian veterans is limited. The aim of this study was to identify significant demographic and psychological differences between veterans with posttraumatic stress disorder who had attempted suicide and those with posttraumatic stress disorder who had not, as well as determine predictors of suicide attempts within an Australian cohort. METHODS: A retrospective analysis was conducted on 229 ex-service personnel diagnosed with posttraumatic stress disorder who had attended a Military Service Trauma Recovery Day Program as outpatients at Toowong Private Hospital from 2007 to 2014. Patients completed a battery of mental health self-report questionnaires assessing symptoms of posttraumatic stress disorder, alcohol use, anger, depression, anxiety and quality of life. Demographic information and self-reported history of suicide attempts were also recorded. RESULTS: Results indicated the average age was significantly lower, and the rates of posttraumatic stress disorder, anger, anxiety and depression symptoms were significantly higher in those veterans with history of a suicide attempt. Multivariate logistic regression analyses indicated posttraumatic stress disorder symptom severity, unemployment or total and permanent incapacity pension status significantly predicted suicide attempt history. CONCLUSION: Among a cohort of Australian veterans with posttraumatic stress disorder, psychopathology severity, unemployment and total and permanent incapacity status are significantly associated with suicidality. This study highlights the importance of early identification of posttraumatic stress disorder and psychopathology, therapeutic and social engagement, and prioritisation of tangible employment options or meaningful and goal-directed activities for veterans deemed unable to work.

Persistent Serious Mental Illness Among Former Applicants for VA PTSD Disability Benefits and Long-Term Outcomes: Symptoms, Functioning, and Employment.

Millions of U.S. veterans have returned from military service with posttraumatic stress disorder (PTSD), for which a substantial number receive U.S. Department of Veterans Affairs (VA) disability benefits. Although PTSD is treatable, comorbid serious mental illness (defined here as schizophrenia, schizoaffective disorder, and bipolar spectrum disorders) could complicate these veterans' recovery. Using VA administrative data, we examined the burden of persistent serious mental illness in a nationally representative cohort of 1,067 men and 1,513 women who applied for VA PTSD disability benefits between 1994 and 1998 and served during or after the Vietnam conflict. Self-reported outcomes were restricted to the 713 men and 1,015 women who returned surveys at each of 3 collection points. More than 10.0% of men and 20.0% of women had persistent serious mental illness; of these, more than 80.0% also had persistent PTSD. On repeated measures modeling, those with persistent serious mental illness consistently reported more severe PTSD symptoms and poorer functioning in comparison to other participants (ps < .001); their employment rate did not exceed 21.0%. Interactions between persistent serious mental illness and PTSD were significant only for employment (p = .002). Persistent serious mental illness in this population was almost 2 to 19 times higher than in the general U.S. POPULATION: The implications of these findings are discussed.

Comparability of health service use by veterans with multisymptom illness and those with chronic diseases.

OBJECTIVE: To compare health service utilization and disability claims among military personnel with multisymptom illness (MSI) (but no chronic diseases), those with chronic disease(s) and those without MSI or chronic diseases. MSI is also known as Gulf War illness. DESIGN: Cohort study. SETTING: Australia. PARTICIPANTS: In total, 1288 participants of a Gulf War veterans' study conducted in 2000-2003 (Wave-1) were followed up in 2011-2012 (Wave-2), aged on average 40 years. About 160 had MSI, 217 had chronic disease(s) and 911 had neither chronic disease(s) nor MSI. METHODS: At Wave-2, the cohort was linked to the national Medicare and Department of Veterans' Affairs (DVA) databases to obtain health service utilization and disability claims data recorded between 2001 and 2012. RESULTS: The likelihood of visiting a general practitioner (GP) (risk ratio [RR] = 1.04, 95% confidence interval [CI] = 0.92, 1.19) or visiting a specialist medical doctor (RR = 0.83; 95% CI = 0.54, 1.28) or hospitalizations (RR = 0.89; 95% CI = 0.61, 1.29) or) in the 12 months preceding Wave-2 or successfully claiming for DVA disability compensation (RR = 1.13; 95% CI = 0.86, 1.47) was similar for personnel with MSI and those with chronic disease(s). However, GP consultations, hospitalizations, specialist doctor consultations and disability claims were significantly higher among those with MSI than those without MSI/chronic diseases. CONCLUSIONS: Health service use and disability claims by personnel with MSI were comparable to those with chronic disease(s), but were in excess of those without MSI/chronic diseases. Hence recognition of the high health service use by personnel with MSI is important to ensure adequate provision of health services.

The Relationship Between Deployment Frequency and Cumulative Duration, and Discharge for Disability Retirement Among Enlisted Active Duty Soldiers and Marines.

BACKGROUND: The frequency and duration of deployments associated with increased morbidity is a significant concern for force health protection within the military population. Understanding the association between deployment and disability may provide a clearer understanding of factors adversely affecting U.S. military force readiness. METHODS: A case-control analysis was conducted using records on enlisted active duty personnel in the Army and Marine Corps who were evaluated for a musculoskeletal disability and received a final disability disposition between FY 2003 and 2012. The study compared deployment, deployment frequency, and total time deployed in personnel who received musculoskeletal disability retirement to those with a musculoskeletal disability discharge other than retirement. RESULTS: For females and males in either service, any deployment was associated with an increased risk of disability retirement (adjusted odds ratios [aOR] [95% confidence intervals (CI)]: males 1.76 [1.65-1.87]; females 1.41 [1.21-1.64]). Furthermore, increasing number of deployments (3+ deployments males aOR [95% CI]: 2.21 [1.92-2.53]) and time spent deployed (24+ months Army Males aOR [95% CI]: 2.07 [1.79-2.40]) significantly increased the odds for disability retirement. CONCLUSION: Increasing frequency and duration of military deployments has an increased risk of disability retirement in service members with a musculoskeletal disability. Further research on this relationship is needed in a more representative sample of the U.S. military population.

Health Problems during Compulsory Military Service Predict Disability Retirement: A Register-Based Study on Secular Trends during 40 Years of Follow-Up.

Disability retirement causes a significant burden on the society and affects the well-being of individuals. Early health problems as determinants of disability retirement have received little attention. The objective was to study, whether interrupting compulsory military service is an early indicator of disability retirement among Finnish men and whether seeking medical advice during military service increases the risk of all-cause disability retirement and disability retirement due to mental disorders and musculoskeletal diseases. We also looked at secular trends in these associations. We examined a nationally representative sample of 2069 men, who had entered military service during 1967-1996. We linked military service health records with cause-specific register data on disability retirement from 1968 to 2008. Secular trends were explored in three service time strata. We used the Cox regression model to estimate proportional hazard ratios and their 95% confidence intervals. During the follow-up time altogether 140 (6.8%) men retired due to disability, mental disorders being the most common cause. The men who interrupted service had a remarkably higher cumulative incidence of disability retirement (18.9%). The associations between seeking medical advice during military service and all-cause disability retirement were similar across the three service time cohorts (overall hazard ratio 1.40 per one standard deviation of the number of visits; 95% confidence interval 1.26-1.56). Visits due to mental problems predicted disability retirement due to mental disorders in the men who served between 1987 and 1996 and a tendency for a similar cause-specific association was seen for musculoskeletal diseases in the men who served in 1967-1976. In conclusion, health problems-in particular mental problems-during late adolescence are strong determinants of disability retirement. Call-up examinations and military service provide access to the entire age cohort of men, where persons at risk for work disability can be identified and early preventive measures initiated.

US Veterans' Use Of VA Mental Health Services And Disability Compensation Increased From 2001 To 2010.

There has been concern about the capacity of the Department of Veterans Affairs (VA) health care system to provide care for veterans returning from war zones in the Middle East and Afghanistan. We used two nationally representative surveys of US veterans in 2001 and 2010 to examine changes in the veteran population and veterans' use of health care services after a decade of war. The population was older and more diverse in 2010 than in 2001. In both years, veterans who served in the World War II era or earlier were more likely to have been exposed to combat-related trauma than veterans of more recent service eras. In 2010 veterans who served in the Persian Gulf War era (1990 through the wars in Iraq and Afghanistan) were more likely to have used VA mental health services and to have received VA disability compensation than veterans of previous service eras. Compared to veterans in 2001, those in 2010 were two times more likely to have used any VA health services and were more likely to have received VA disability compensation. These findings highlight changes in the veteran population over time that are important to consider in planning for future VA services.

Health and Health Care Service Utilization Among U.S. Veterans Denied VA Service-Connected Disability Compensation: A Review of the Literature.

UNLABELLED: The general consensus in studies of individuals seeking federal disability compensation is that individuals "denied" disability compensation are healthier than those "awarded." In contrast, studies of military veterans seeking U.S. Department of Veterans Affairs (VA) disability compensation suggest that those "denied" ("denied applicants") may be as impaired as those "awarded" ("awarded applicants"), and likely have critical, albeit unmet health care needs. Moreover, although social isolation among U.S. Veterans has received some attention, its broad influence on health and health care consumption among veterans "denied" VA disability compensation is not well understood. OBJECTIVES: To provide a more thorough understanding of "denied" applicants' health, health care utilization, and social conditions. METHODS: We reviewed published reports of health, health care utilization, and social isolation "relevant" to U.S. Veterans "denied" VA disability compensation. Among 122 research items initially reviewed, a total of 47 met our inclusion criteria and are summarized herein. RESULTS: Compared to veterans "awarded" VA disability compensation, those "denied" have poorer health, use less VA health care, and may experience social isolation. CONCLUSIONS: Veterans "denied" VA disability compensation may comprise a vulnerable subgroup of veterans in need of supportive services. Such needs may be addressed through evidence-based targeted outreach programs.

Long-Term Outcomes in Patients With Diabetes Mellitus Related to Prolonging Clopidogrel More Than 12 Months After Coronary Stenting.

BACKGROUND: Recent large clinical trials show lower rates of late cardiovascular events by extending clopidogrel >12 months after percutaneous coronary revascularization (PCI). However, concerns of increased bleeding have elicited support for limiting prolonged treatment to high-risk patients. OBJECTIVES: The aim of this analysis was to determine the effect of prolonging clopidogrel therapy >12 months versus ≤12 months after PCI on very late outcomes in patients with diabetes mellitus (DM). METHODS: Using the Veterans Health Administration, 28,849 patients undergoing PCI between 2002 and 2006 were categorized into 3 groups: 1) 16,332 without DM; 2) 9,905 with DM treated with oral medications or diet; and 3) 2,612 with DM treated with insulin. Clinical outcomes, stratified by stent type, ≤4 years after PCI were determined from the Veterans Health Administration and Medicare databases and risk was assessed by multivariable and propensity score analyses using a landmark analysis starting 1 year after the index PCI. The primary endpoint of the study was the risk of all-cause death or myocardial infarction (MI). RESULTS: In patients with DM treated with insulin who received drug-eluting stents (DES), prolonged clopidogrel treatment was associated with a decreased risk of death (hazard ratio [HR]: 0.59; 95% confidence interval [CI]: 0.42 to 0.82) and death or MI (HR: 0.67; 95% CI: 0.49 to 0.92). Similarly, in patients with noninsulin-treated DM receiving DES, prolonged clopidogrel treatment was associated with less death (HR: 0.61; 95% CI: 0.48 to 0.77) and death or MI (HR: 0.61; 95% CI: 0.5 to 0.75). Prolonged clopidogrel treatment was not associated with a lower risk in patients without DM or in any group receiving bare-metal stents. CONCLUSIONS: Extending the duration of clopidogrel treatment >12 months may decrease very late death or MI only in patients with DM receiving first-generation DES. Future studies should address this question in patients receiving second-generation DES.

VA Disability Compensation and Money Spent on Substance Use Among Homeless Veterans: A Controversial Association.

OBJECTIVE: There has long been concern that public support payments are used to support addictive behaviors. This study examined the amount of money homeless veterans spend on alcohol and drugs and the association between public support income, including VA disability compensation, and expenditures on alcohol and drugs. METHODS: Data were from 1,160 veterans from 19 sites on entry into the Housing and Urban Development-Veterans Affairs Supportive Housing program. Descriptive statistics and nonparametric analyses were conducted. RESULTS: About 33% of veterans reported spending money on alcohol and 22% reported spending money on drugs in the past month. No significant association was found between public support income, VA disability compensation, and money spent on alcohol and drugs. CONCLUSIONS: A substantial proportion of homeless veterans spend some income on alcohol and drugs, but disability income, including VA compensation, does not seem to be related to substance use or money spent on addictive substances.

Gender differences in VA disability status for PTSD over time.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is the most prevalent psychiatric condition for which veterans receive service-connected disability benefits from the U.S. Department of Veterans Affairs (VA). Historically, women have been less likely than men to obtain PTSD disability benefits. The authors examined whether these gender disparities have been redressed over time and, if not, whether appropriate clinical factors account for persisting differences. METHODS: This longitudinal, observational study was based on a gender-stratified, nationally representative sample of 2,998 U.S. veterans who applied for VA disability benefits for PTSD between 1994 and 1998. The primary outcome was change in PTSD service connection over a ten-year period. RESULTS: Forty-two percent (95% confidence interval [CI]=38%-45%) of the women and 50% (CI=45%-55%) of the men originally denied service connection for PTSD eventually received such benefits. Only 8% (CI=7%-10%) of women and 5% (CI=4%-6%) of men lost PTSD disability status. Compared with men, women had lower unadjusted odds of gaining PTSD service connection (odds ratio [OR]=.70, CI=.55-.90) and greater unadjusted odds of losing PTSD service connection (OR=1.76, CI=1.21-2.57). Adjusting for clinical factors accounted for the gender difference in gaining PTSD service connection; adjusting for clinical factors and demographic characteristics eliminated the gender difference in loss of PTSD service connection. CONCLUSIONS: Gender-based differences in receipt of PTSD service connection persisted in this cohort over a ten-year period but were explained by appropriate sources of variation. Further research on possible disparities in loss of PTSD disability benefits is warranted.