Trends in the epidemiology of disability related to traumatic brain injury in the US Army and Marine Corps: 2005 to 2010.

BACKGROUND: Traumatic brain injury (TBI) has been recognized as a major public health issue for several decades. Despite technological advancements in protective equipment and medical care available during recent military conflicts, TBI is the most common neurological condition among Soldiers and Marines evaluated for discharge from service. This study describes the demographic, service-related, and disability characteristics of Soldiers and Marines referred for combat-related TBI disability evaluation. METHODS: Cross-sectional analysis of Soldiers and Marines evaluated for combat-related disability between October 1, 2004 and September 30, 2010 was performed. Traumatic brain injury cases were identified using the Veterans Affairs Schedule for Rating Disabilities code for TBI and compared with other combat-related disabilities. RESULTS: Combat-related TBI disability rates have significantly increased in both the Army and the Marine Corps since 2005. Significantly more unfitting conditions are present on average in combat-related TBI cases than in other combat-related disability cases. Combat-related TBI disability cases are more likely to be medically retired than other types of combat-related disability. CONCLUSIONS: Because veterans with combat-related TBI disabilities are likely to require chronic care for TBI-associated medical conditions, disability evaluation policy and programs must ensure that combat-related TBI disabilities are accurately identified and compensated, and the potential long-term care needs are addressed.

Temporary disability retirement cases: variations in time to final disposition and disability rating by service and medical condition.

OBJECTIVE: Service members undergoing disability evaluation are placed on the temporary disability retirement list (TDRL) when their disabling medical condition(s) may change in severity over time. Information is sparse on the epidemiology of the TDRL population and factors influencing time spent on the TDRL or changes in compensation ratings before final disability outcome. METHODS: A cross-sectional study was conducted on U.S. Army, Navy, and Marine Corps personnel placed on the TDRL between fiscal years 2005 to 2009. RESULTS: Approximately 85% of cases were finalized at first re-evaluation and more than 75% were permanently retired. Overall, about 50% of cases retained the same disability rating throughout the process. Cases with medical conditions within two or more body systems were more likely to be permanently retired and receive a change in disability rating than those with medical condition(s) within a single body system. CONCLUSIONS: Most cases retained the same disability rating and were permanently retired by the first re-evaluation. Important areas of future research include cost-benefit analyses to determine if length of time currently allowable on the TDRL can be shortened or if repeated evaluations are necessary and exploration of specific medical conditions likely to change in severity over time.

Risk factors for disability retirement among healthy adults joining the U.S. Army.

OBJECTIVE: From 2001 to 2006, the Army deployed over 717,000 personnel to Iraq and Afghanistan, with over 15,000 troops wounded. Little is known about the impact of military and demographic factors, particularly deployment, occupation, and pre-existing medical status, on disability retirement. METHODS: A nested case-control study of first time, active duty personnel entering from 1997 to 2004. Cases, individuals granted a medical disability retirement from 1997 to 2006, were identified by the Army Physical Disability Agency. Five controls were matched by year of entrance to each case. RESULTS: Several factors were associated with increased risk of disability retirement, including sex, age, Hispanic ethnicity, body mass index, and military occupation; deployment was associated with a lower risk. CONCLUSIONS: The reasons for increased risk among some groups are unknown. The decreased risk associated with deployment probably reflects a "healthy warrior effect," whereas the increased risk for combat arms may reflect combat exposures among the deployed and more rigorous training among the nondeployed.