title: "Willful misconduct": how the US government prevented tobacco-disabled veterans from obtaining disability pensions.
abstract: In this descriptive case study, we analyze the unsuccessful struggle to access disability pensions by veterans sickened by tobacco use begun during service. Drawing on tobacco industry documents and other material, we show how the US government, tobacco industry, and veterans' organizations each took inconsistent positions to protect their interests. Congress and Department of Veterans Affairs leadership, concerned about costs, characterized veterans' smoking as "willful misconduct," thereby contradicting the government's position in a federal lawsuit that tobacco companies addicted smokers. Veterans' groups supported the pensions, despite previously defending smoking as a "right." The tobacco industry wavered, fearing liability. Securing pensions was complicated by the notion that smoking is primarily a personal choice. The US government should compensate veterans fairly and should abolish military practices that encourage tobacco addiction.
authors.affiliation: Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, CA 94118, USA. naphtali.offen@ucsf.edu
authors.forename: Naphtali
authors.initials: N
authors.lastname: Offen
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Smith
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Malone
mesh_terms: D054625:Healthcare Disparities / Q000331:legislation & jurisprudence*; D006801:Humans; D011057:Politics; D019460:Tobacco Industry / Q000191:economics / Q000331:legislation & jurisprudence; D014029:Tobacco Use Disorder / Q000191:economics*; D014481:United States; D014728:Veterans; D014729:Veterans Disability Claims / Q000191:economics / Q000331:legislation & jurisprudence*
references.citation: Mil Med. 2009 Aug;174(8):797-806
references.pmid: 19743733
references.citation: Am J Public Health. 2007 Dec;97(12):2199-203
references.pmid: 17971547
references.citation: Tob Control. 2006 Jun;15 Suppl 3:iii19-25
references.pmid: 16754942
references.citation: Nicotine Tob Res. 2004 Apr;6(2):349-55
references.pmid: 15203808
references.citation: Am J Health Promot. 2009 Mar-Apr;23(4):241-6
references.pmid: 19288845
references.citation: Am Econ Rev. ;96(1):176-94
references.pmid: 29125728
references.citation: Tob Control. 2001 Jun;10(2):96-104
references.pmid: 11387528
references.citation: Mil Med. 2008 May;173(5):441-7
references.pmid: 18543564
references.citation: Mil Med. 2005 Oct;170(10):874-80
references.pmid: 16435763
references.citation: Tob Control. 2007 Feb;16(1):38-46
references.pmid: 17297072
references.citation: Armed Forces Soc. 1986;13(1):57-79
references.pmid: 11616630
references.citation: Global Health. 2008 Jan 17;4:2
references.pmid: 18201375
references.citation: Tob Control. 2004 Mar;13 Suppl 1:i41-7
references.pmid: 14985616
references.citation: Med Care. 2000 Jun;38(6 Suppl 1):I7-16
references.pmid: 10843266
references.citation: BMJ. 2000 Aug 5;321(7257):371-4
references.pmid: 10926602
references.citation: Nicotine Tob Res. 2008 May;10(5):775-90
references.pmid: 18569751
references.citation: Addiction. 2007 Jul;102(7):1092-101
references.pmid: 17567397
references.citation: Eur J Public Health. 2007 Apr;17(2):162-70
references.pmid: 16837518
references.citation: Am J Public Health. 2000 Dec;90(12):1926-30
references.pmid: 11111269
references.citation: Tob Control. 2005 Feb;14(1):55-9
references.pmid: 15735301
references.citation: Tob Control. 2000 Sep;9(3):334-8
references.pmid: 10982579
references.citation: Public Health Rep. 1997 May-Jun;112(3):212-7; discussion 218
references.pmid: 9160055
references.citation: Mil Med. 2008 Oct;173(10):985-91
references.pmid: 19160617
references.citation: Tob Control. 2006 Dec;15 Suppl 4:iv37-43
references.pmid: 17130622