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2023 HSR&D/QUERI National Conference Abstract

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1084 — MST-Related PTSD: Gender and Race Differences in Service-Connection, and Comparisons to Combat Trauma

Lead/Presenter: Aliya Webermann,  COIN - West Haven
All Authors: Webermann AR (COIN – West Haven; Yale School of Medicine), ; Runels, Tessa (COIN – West Haven); Haskell, SG (Office of Women’s Health Services, Veterans Health Administration; Yale School of Medicine; COIN – West Haven); Rosen, MI (COIN – West Haven; Yale School of Medicine); Portnoy, GA (COIN – West Haven; Yale School of Medicine); Black, AC (COIN – West Haven; Yale School of Medicine)

Objectives:
Over 12,000 claims for PTSD due to military sexual trauma (MST) are submitted annually to the Veterans Benefits Administration (VBA). Little work has examined characteristics of veterans who apply for PTSD service-connections for MST, including rates of MST service-connection award or denial overall and across identity characteristics, and rates of PTSD service-connection award or denial for combat versus MST traumas. However, prior work has found lower awarding of PTSD service-connections for MST versus combat traumas, and for Black claimants versus White claimants. For MST specifically, men claimants have historically seen lower rates of MST service-connection awards relative to women claimants. The current study aims are: 1) Characterize a cohort of Veterans who applied for PTSD service-connections for MST, including rates of service-connection award, identity characteristics (e.g., gender, race, age), and MST type (i.e., harassment or assault); 2) Examine differences in rate of denial for PTSD service-connections for MST versus combat traumas; and 3) Examine differences in rate of denial for MST service-connections across identity characteristics and MST type.

Methods:
Analyses were conducted on a sample of 369,642 Veterans who applied for PTSD service-connections between October 1, 2017 and May 19, 2022 via VBA administrative data. Descriptive statistics were calculated. Chi-square and logistic regressions assessed denial of service-connection across type of stressor and participant characteristics, and effect sizes and odds ratios were calculated.

Results:
Across all PTSD claimants, MST claimants had a 2.4 times higher odds of having their service-connection denied compared to combat claimants (p < .001, Cramer’s V = .17, 95% CI = 2.32-2.50). Specific to MST claims, 31,803 participants submitted claims, 25.4% (N = 6,399) which were denied. Veterans reporting sexual harassment had a 2.6 times higher odds of being denied MST service-connection (47.1% denied) versus those reporting sexual assault (25.2% denied); p < .001, Cramer’s V = .15, 95% CI = 2.46-2.84. In logistic regression modeling of MST service-connection rates controlling for race and age, men claimants had a 1.7 times higher odds of MST service-connection denial compared to women claimants (p < .001, 95% CI = 1.66 – 1.87). Controlling for gender and age, Black claimants had a 1.4 times higher odds of MST service-connection denial compared to White claimants (p < .001, 95% CI = 1.31-1.47).

Implications:
Three-fourths of MST-related claims were awarded from October 2017-May 2022, providing these veterans with crucial monetary and healthcare benefits to ameliorate impacts of MST-related PTSD. However, disparities remain in the awarding of PTSD service-connections generally and for MST specifically. This includes higher rates of PTSD service-connection denial for MST claimants compared to combat claimants, and higher rates of MST service-connection denial for men and Black claimants (respectively) relative to women and White claimants (respectively). Future analyses should control for differences across these groups in PTSD symptom severity.

Impacts:
Disparities in awarding of claims for combat versus MST traumas, and for MST claims across gender and race, suggest the possibility of systemic barriers for MST claimants from particularly underserved backgrounds and/or who may underreport MSTs (e.g., men).