title: Anticipating the traumatic brain injury-related health care needs of women veterans after the Department of Defense change in combat assignment policy.
abstract: BACKGROUND
  Female service members' presence in combat zones during Operation Enduring Freedom and Operation Iraqi Freedom is unprecedented both in terms of the number of women deployed and the nature of their involvement. In light of changing Department of Defense policy governing the deployment of women in combat zones, this article intends to set the groundwork for estimating future combat-related injuries and subsequent Veterans Health Administration (VHA) utilization while focusing on traumatic brain injury (TBI).
  
  
  METHODS
  The article summarizes and presents the results of a study that examines veterans who present to VHA for TBI evaluation. For a national sample of veterans, a dataset including information on post-screening utilization, diagnoses, and location of care was constructed. The dataset included self-reported health symptoms and other information obtained from a standardized national VHA post-screening clinical evaluation, the comprehensive TBI evaluation (CTBIE).
  
  
  RESULTS
  Both women and men utilize high levels of VHA health care after a CTBIE. However, there are gender differences in the volume and types of services used, with women utilizing different services than their male counterparts and incurring higher costs, including higher overall and outpatient costs.
  
  
  CONCLUSIONS
  As women veterans seek more of their health care from the VHA, there will be a need for more coordinated care to identify and manage deployment-related TBI and common comorbidities such as posttraumatic stress disorder, depression, and chronic pain. Deployment-connected injuries are likely to rise because of the rescinding of the ban on women in combat. This in turn has critical implications for VHA strategic planning and budgeting.
authors.affiliation: DRMI, Naval Postgraduate School, Monterey, California. Electronic address: jhamara@nps.edu.
authors.forename: Jomana
authors.initials: J
authors.lastname: Amara
authors.affiliation: National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Iverson
authors.affiliation: VA Boston Healthcare System, Boston, Massachusetts; Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Maxine
authors.initials: M
authors.lastname: Krengel
authors.affiliation: Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts; Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts.
authors.forename: Terri K
authors.initials: TK
authors.lastname: Pogoda
authors.affiliation: Health Care Financing and Economics, VA Boston Healthcare System, Boston, Massachusetts.
authors.forename: Ann
authors.initials: A
authors.lastname: Hendricks
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001930:Brain Injuries / Q000175:diagnosis* / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D016134:Organizational Policy; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D059030:United States Department of Defense; D014493:United States Department of Veterans Affairs / Q000458:organization & administration / Q000706:statistics & numerical data*; D014728:Veterans / Q000523:psychology*; D058014:Veterans Health; D055815:Young Adult