Regional variation and other correlates of Department of Veterans Affairs Disability Awards for patients with posttraumatic stress disorder.
BACKGROUND
Minnesota, Minneapolis, Minnesota. Posttraumatic stress disorder (PTSD) is a chronic disabling condition affecting more than 600,000 United States veterans and is the most common psychiatric condition for which veterans seek Veterans Affairs disability benefits. Receipt of such benefits enhances veterans' access to Veteran Affairs health care and reduces their chance of poverty.


OBJECTIVE
We sought to determine whether previously identified regional variations in PTSD disability awards are explained by appropriate subject characteristics (eg, differences in PTSD symptomatology or dysfunction) and to estimate the impact of veterans' PTSD symptom severity or level of dysfunction on their odds of obtaining PTSD disability benefits.


METHODS
We used a mailed survey linked to administrative data.


METHODS
Subjects included 4918 representative, eligible men and women who filed PTSD disability claims between 1994 and 1998.


RESULTS
A total of 3337 veterans returned useable surveys (68%). Before adjustment, PTSD disability claims approval rates ranged from 43% to 75% across regions. After adjustment, rates ranged from 33% to 72% (P <0.0001). Severer PTSD symptoms were associated with greater odds of having PTSD disability benefits (P <0.0001). Unexpectedly, poorer functional status was associated with lower odds of having benefits (P <0.0001). On average, clinical differences between veterans who did and did not have PTSD disability benefits were small but suggested slightly greater dysfunction among those without benefits.


CONCLUSIONS
An almost twofold regional difference in claims approval rates was not explained by veterans' PTSD symptom severity, level of dysfunction, or other subject-level characteristics. Veterans who did not obtain PTSD disability benefits were at least as disabled as those who did receive benefits.
Murdoch
Maureen
M
Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minnesota 55417, USA. Maureen.Murdoch@med.va.gov
Hodges
James
J
Cowper
Diane
D
Sayer
Nina
N
D000328:Adult; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D012737:Sex Factors; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology*; D014729:Veterans Disability Claims / Q000706:statistics & numerical data*