Health and Disability Among Veterans

Purpose: With increasing numbers of service members transitioning out of the military, it is important to better understand veteran health and disability, both in terms of day-to-day experience of impairment and, perhaps more critically, their rating of disability as determined by the Veteran's Administration (VA). Obtaining an accurate VA disability rating is important not only for veterans' ability to access VA health and rehabilitative services, but also for financial support in cases where disability affects one's capacity to work. Therefore, the overall aim of this study is to explore how disability expresses itself among veterans, as well as how health affects disability differentially based on service era and measure of disability. Specifically, this study will address the following research questions:
1) How do disability ratings vary by service era and measure (VA rating as compared to a validated disability scale (WHODAS))?
3) How do three common contributors to veteran disability (TBI, mental health symptoms, and physical health symptoms) influence each disability measure?

Methods: Data come from a survey of veterans residing in two Southern California counties, collected during 2013-2014 and described in prior work (Kintzle, Schuyler, Ray-Letourneau, et al., under review). The analytic sample consists of 1,866 veterans, who were stratified by service era (“pre-9/11”, “post-911,” and a “mixed era” group defined as veterans between the ages of 31 and 60). The outcome measures are VA Disability Rating and WHO-DAS score. Covariates include 1) diagnosis of Traumatic Brain Injury (TBI); 2) diagnosis of PTSD and/or Depression; and 3) Physical symptoms (measured by PHQ-15). Regression analyses control for gender, marital status, income, MOS, and race and were conducted using SPSS.

Results: Pre-9/11 veterans had the highest VA disability ratings. Post-9/11 veterans had the highest levels of disability when assessed by an abbreviated version of the WHO-DAS (sample 1). The “mixed era” group had the highest disability when assessed by the full version of the WHO-DAS (sample 2). Therefore, rates of disability were not consistent across measurement type. Post-9/11 veterans reported higher levels of all three health problems (mental, physical, and TBI) than their older, pre-9/11 counterparts. Contributors to VA disability rating varied by cohort. Mental health issues contributed to pre-9/11 veterans' disability rating, while physical health and TBI were the significant contributors among post-9/11 and “mixed era” veterans. However, very different patterns were found to contribute to disability as measured by WHO-DAS scores.

Implications: Results of this study point to distinct profiles of health and disability based on veterans' era of service. For example, post-9/11 veterans may feel more impaired in terms of their day-to-day life and express higher rates of physical and mental health issues than prior cohorts of veterans. However, pre-9/11 veterans tend to have higher disability ratings as evaluated by the VA. This points to the need for a refinement of VA disability evaluation protocol as well as service delivery systems that are more attuned and responsive to the distinct health needs of each veteran cohort.