Maureen Murdoch1,2,3, Michele Roxanne Spoont4,5,6,7, Nina Aileen Sayer4,5,7, Shannon Marie Kehle-Forbes4,5,8, Siamak Noorbaloochi4,5. 1. Section of General Internal Medicine, Minneapolis VA Health Care System, One Veterans Drive (111-0), Minneapolis, MN, 55417, USA. Maureen.Murdoch@va.gov. 2. Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive (152), Minneapolis, MN, 55417, USA. Maureen.Murdoch@va.gov. 3. Department of Internal Medicine, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55455, USA. Maureen.Murdoch@va.gov. 4. Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive (152), Minneapolis, MN, 55417, USA. 5. Department of Internal Medicine, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55455, USA. 6. National Centers for PTSD, Pacific Islands Division, Department of Veterans Affairs, 3375 Koapaka Street, Suite I-560, Honolulu, HI, 96819, USA. 7. Department of Psychiatry, University of Minnesota Medical School, F282/2A West Building, 2450 Riverside Avenue S, Minneapolis, MN, 55454, USA. 8. National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA, 02130, USA.
Abstract
BACKGROUND: In 2011, the Department of Veterans Affairs (VA) strengthened its disability claims processes for military sexual trauma, hoping to reduce gender differences in initial posttraumatic stress disorder (PTSD) disability awards. These process improvements should also have helped women reverse previously denied claims and, potentially, diminished gender discrepancies in appealed claims' outcomes. Our objectives were to examine gender differences in reversals of denied PTSD claims' outcomes after 2011, determine whether disability awards (also known as "service connection") for other disorders offset any PTSD gender discrepancy, and identify mediating confounders that could explain any persisting discrepancy. METHODS: From a nationally representative cohort created in 1998, we examined service connection outcomes in 253 men and 663 women whose initial PTSD claims were denied. The primary outcome was PTSD service connection as of August 24, 2016. Secondary outcomes were service connection for any disorder and total disability rating. The total disability rating determines the generosity of Veterans' benefits. RESULTS: 51.4% of men and 31.3% of women were service connected for PTSD by study's end (p < 0.001). At inception, 54.2% of men and 63.2% of women had any service connection-i.e., service connection for disorders other than PTSD (p = 0.01) and similar total disability ratings (p = 0.50). However, by study's end, more men than women had any service connection (88.5% versus 83.5%, p = 0.05), and men's mean total disability rating was substantially greater than women's (77.1 ± 26.2 versus 66.8 ± 30.7, p < 0.001). History of military sexual assault had the largest effect modification on men's versus women's odds of PTSD service connection. CONCLUSION: Even after 2011, cohort men were more likely than the women to reverse initially denied PTSD claims, and military sexual assault history accounted for much of this difference. Service connection for other disorders initially offset women's lower rate of PTSD service connection, but, ultimately, men's total disability ratings exceeded women's. Gender discrepancies in service connection should be monitored beyond the initial claims period.
BACKGROUND: In 2011, the Department of Veterans Affairs (VA) strengthened its disability claims processes for military sexual trauma, hoping to reduce gender differences in initial posttraumatic stress disorder (PTSD) disability awards. These process improvements should also have helped women reverse previously denied claims and, potentially, diminished gender discrepancies in appealed claims' outcomes. Our objectives were to examine gender differences in reversals of denied PTSD claims' outcomes after 2011, determine whether disability awards (also known as "service connection") for other disorders offset any PTSD gender discrepancy, and identify mediating confounders that could explain any persisting discrepancy. METHODS: From a nationally representative cohort created in 1998, we examined service connection outcomes in 253 men and 663 women whose initial PTSD claims were denied. The primary outcome was PTSD service connection as of August 24, 2016. Secondary outcomes were service connection for any disorder and total disability rating. The total disability rating determines the generosity of Veterans' benefits. RESULTS: 51.4% of men and 31.3% of women were service connected for PTSD by study's end (p < 0.001). At inception, 54.2% of men and 63.2% of women had any service connection-i.e., service connection for disorders other than PTSD (p = 0.01) and similar total disability ratings (p = 0.50). However, by study's end, more men than women had any service connection (88.5% versus 83.5%, p = 0.05), and men's mean total disability rating was substantially greater than women's (77.1 ± 26.2 versus 66.8 ± 30.7, p < 0.001). History of military sexual assault had the largest effect modification on men's versus women's odds of PTSD service connection. CONCLUSION: Even after 2011, cohort men were more likely than the women to reverse initially denied PTSD claims, and military sexual assault history accounted for much of this difference. Service connection for other disorders initially offset women's lower rate of PTSD service connection, but, ultimately, men's total disability ratings exceeded women's. Gender discrepancies in service connection should be monitored beyond the initial claims period.
Authors: Maureen Murdoch; Michele Roxanne Spoont; Shannon Marie Kehle-Forbes; Eileen Mae Harwood; Nina Aileen Sayer; Barbara Ann Clothier; Ann Kay Bangerter Journal: J Trauma Stress Date: 2017-01-18
Authors: Rebecca K Sripada; Claire M Hannemann; Paula P Schnurr; Brian P Marx; Stacey J Pollack; John F McCarthy Journal: Health Serv Res Date: 2018-04-17 Impact factor: 3.402
Authors: Nina A Sayer; Emily M Hagel; Siamak Noorbaloochi; Michele R Spoont; Robert A Rosenheck; Joan M Griffin; Paul A Arbisi; Maureen Murdoch Journal: Psychiatr Serv Date: 2014-05-01 Impact factor: 3.084