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INV 19-200 – HSR Study

INV 19-200
Is Protection of Disability Benefits Associated with Employment in Veterans with TBI and PTSD?
Terri Krangel Pogoda, PhD
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
Boston, MA
Funding Period: October 2019 - March 2024


Background: The Veterans Benefits Administration (VBA) and Social Security Administration (SSA) provide financial safety nets for those whose disabilities negatively impact employment. However, these disability payments may unintentionally dis-incentivize return to work (RTW) since safety net payments can be reduced if functional status increases. Hallmark injuries among Post-9/11 Veterans include traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD), which frequently co-occur and are associated with unemployment. Significance/Potential Impact: Our long-term goal for Phase II (separate research effort) is to determine whether protection of disability benefits is associated with RTW or increase in work hours among Veterans with TBI/PTSD. In support of Phase II, the aims of the current Phase I planning proposal are to implement the following. Specific goal(s) for Phase I: 1. Develop Department of Veterans Affairs (VA) intra-agency (Veterans Health Administration (VHA)-VBA) and interagency (VA, SSA) memoranda of understanding (MOU) and partnerships for disability benefits protection, defined here as: (a) current SSA and service-connected disability (SCD) rating/payment not being subject to reduction over a 5-year period, (b) wages earned will not count against the disability benefits after the 5-year period ends, © no change in other disability benefits eligibility that the Veteran is otherwise entitled to, and (d) the Veteran may still apply for disability benefit increases, regardless of RTW. 2. Develop agreement with Internal Revenue Service (IRS) to track Phase II Veteran sample. 3. Review deidentified, aggregated VA administrative data to identify dense regions of Veterans with SCD for Phase II sampling. 4. Foster collaboration with VHA Polytrauma/TBI System of Care and Therapeutic and Supported Employment (TSES) leadership to identify 12 VA medical centers (VAMC) that have the resources to provide: (a) treatment to address unmet physical/ psychological/psychosocial needs and (b) vocational rehabilitation. Long-term goal(s) for Phase II. Phase II protocol development will involve the expertise of health services researchers and health economists. Discussions will include methodology, sample size, Veteran and disability characteristics (e.g., TBI/PTSD, age, gender, SCD%, disability payments), and geographic factors that may impact RTW such as local labor market. The sample will include the target Veterans to receive disability benefits protection and a matched Veteran comparison group that will not receive this protection but will also be tracked concurrently. Key outcomes and analysis over the 5-year period will include: RTW (yes/no), type of job, change in and total number of hours worked, wages, increase in SCD rating (yes/no, % change), and VHA healthcare utilization. We will also develop survey/interview questions to understand Veteran perspectives on and experiences with this initiative. Innovation: Protecting disability benefits may be the platform necessary to assuage individual and family concerns and motivate Veterans to RTW or increase work hours. As part of this process, Veterans can confidently access the full range of VA health services (i.e. engage in therapy/treatment), including, if desired, vocational rehabilitation. As many Post-9/11 Veterans with TBI and PTSD are in their prime working years and have decades of potential productivity ahead of them, removing systemic disincentives to employment is imperative.

External Links for this Project

NIH Reporter

Grant Number: I01HX002911-01

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Journal Articles

  1. Katz IR, Resnick SG, Kasprow WJ, Boden MT, Cherkasova E, Fielstein EM, Trafton JA, Hoff RA. Using patient-reported outcome measures for program evaluation: Design and findings on intention-to-treat outcomes from the Veterans Outcome Assessment survey. Psychiatry Research. 2020 Sep 1; 291:113226. [view]
Journal Other

  1. Resnick SG, Oehlert ME, Hoff RA, Kearney LK. Measurement-based care and psychological assessment: Using measurement to enhance psychological treatment. Psychological Services. 2020 Aug 1; 17(3):233-237. [view]
  2. Resnick SG, Roe D, Salyers MP. Psychiatric Rehabilitation Journal in the era of COVID-19. [Editorial]. Psychiatric Rehabilitation Journal. 2020 Jun 1; 43(2):83-84. [view]

DRA: Mental, Cognitive and Behavioral Disorders, Brain and Spinal Cord Injuries and Disorders
DRE: TRL - Applied/Translational
Keywords: PTSD, Reintegration Post-Deployment
MeSH Terms: None at this time.

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