Murdoch M (Minneapolis COE), Hodges JS
(Minneapolis COE), Sayer N
(Minneapolis COE), Spoont M
(Minneapolis COE), Rosenheck R
(VA Connecticut Healthcare System), Griffin JM
(Minneapolis COE), Arbisi P
(Minneapolis VA Medical Center)
VA disability benefits aim to compensate and replace lost income for veterans injured during military service and facilitate their rehabilitation. PTSD is the most common mental disorder for which veterans seek VA disability benefits (service connection), but long-term, prospective data evaluating whether PTSD service connection meets VA aims are lacking. Since veterans cannot be randomized to receive or not receive disability benefits, we used propensity analysis to compare the PTSD symptom severity; work, role, social, and physical functioning; income; and employment status of veterans who applied for and did (SC+) or did not (SC-) receive PTSD service connection almost 10 years ago.
3,018 nationally representative veterans (women were oversampled) who applied for PTSD service connection between 1994 and 1998 were surveyed using validated instruments between 1998 and 2000 (Time 1) and again between 2004 and 2006 (Time 2). We stratified by propensity score to adjust for baseline/Time 1 differences between SC+ and SC- veterans.
85% returned Time 2 surveys. Sample characteristics were: 65% SC+; 50% male; 73% white; and mean age (Time 2), 55 +/- 1.6 years. After adjustment, SC+ and SC- veterans did not differ significantly in terms of their Time 2 PTSD symptom severity [mean (SE), 40.3 (2.0) v. 39.8 (2.1)]; work, role, or social functioning [mean (SE), 2.8 (0.1) for both]; or physical functioning [mean (SE), 29.7 (1.0) v. 29.1 (1.1)]. Although SC+ veterans were significantly less likely than SC- veterans to be working for pay (adjusted probability, 7.5% v. 13.8%, p < 0.05), their adjusted probability of reporting poverty was almost half that of SC- veterans (36% v. 64%, p < 0.0001).
After adjustment, PTSD service connection had little impact on symptom severity or functioning 10 years later. Compared to SC- veterans, SC+ veterans were less likely to report poverty despite being less likely to work for pay.
For veterans comparable at Time 1, PTSD service connection successfully replaced income and prevented poverty, but there was no evidence of a rehabilitative effect. That SC- veterans appeared to be at least as disabled as SC+ veterans but with twice their risks of poverty was concerning.