Sayer NA (Center for Chronic Disease Outcomes Research)
Spoont M (Center for Chronic Disease Outcomes Research)
Clothier B (Center for Chronic Disease Outcomes Research)
Nelson D (Center for Chronic Disease Outcomes Research)
To determine whether psychiatric symptoms, functioning and service utilization change in the weeks following the VA disability claim determination for Posttraumatic Stress Disorder (PTSD).
This was a cohort study of 102 veterans who filed original PTSD claims in the Upper Midwest. Claimants completed study material under supervision near the time of claim initiation and several weeks after notification of the claim determination. Study material included standardized measures of PTSD, depression, disability, somatic complaints and subjective well-being. Outpatient service utilization for the 260 days before claim initiation and after claim determination were extracted from VA administrative databases. Baseline sociodemographic characteristics of those awarded and denied PTSD service connection were compared using the chi-square and t-tests. Repeated measures analyses were used to examine changes in symptoms and functioning between and within award groups. Nonparametric tests were used to examine changes in service utilization.
With the exception of a marginal difference in income, those awarded (N = 61) did not differ from those denied (N = 41) PTSD disability status on any sociodemographic variable. Those awarded benefits, however, had more severe PTSD symptoms and marginally worse functioning at the time of claim initiation. They also were more likely to receive a diagnosis of PTSD during their disability examinations. Symptom levels and participation in mental health treatment did not change after claim determination among those denied PTSD service connection. In contrast, among those who received PTSD disability status, we observed an increase in somatic complaints and perceived disability, and indications of worse functioning after claim determination. Medical service use increased equally among those with awarded and denied claims. The proportion of mental health service users increased only among those with awarded claims.
There may be negative health outcomes associated with PTSD service connection in the weeks following claim initiation. The claims process itself, regardless of claim decision, facilitates access to VA medical care while PTSD service connection leads to greater participation in mental health treatment.
The VA needs more information about the impact of PTSD service connection on health outcomes and VA service use to identify and meet the needs of PTSD sufferers.