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Racial Disparities in VA Service Connection for Posttraumatic Stress Disorder Disability

Murdoch, Maureen MD, MPH*†; Hodges, James PhD; Cowper, Diane MA¶∥; Fortier, Larry MA*; van Ryn, Michelle PhD, MPH

doi: 10.1097/01.MLR.0000053232.67079.A5
Original Articles

Background.  “Service connected” veterans are those with documented, compensative conditions related to or aggravated by military service, and they receive priority for enrollment into the Veterans Affairs (VA) health care system. For some veterans, service connection represents the difference between access to VA health care facilities and no access.

Objectives.  To determine whether there are racial discrepancies in the granting of service connection for posttraumatic stress disorder (PTSD) by the Department of Veterans Affairs and, if so, to determine whether these discrepancies could be attributed to appropriate subject characteristics, such as differences in PTSD symptom severity or functional status.

Research Design.  Mailed survey linked to administrative data. Claims audits were conducted on 11% of the sample.

Setting and Subjects.  The study comprised 2700 men and 2700 women randomly selected from all veterans filing PTSD disability claims between January 1, 1994 and December 31, 1998.

Results.  A total of 3337 veterans returned useable surveys, of which 17% were black. Only 16% of respondents carried private health insurance, and 44% reported incomes of $20,000 or less. After adjusting for respondents’ sociodemographic characteristics, symptom severity, functional status, and trauma histories, black persons’ rate of service connection for PTSD was 43% compared with 56% for other respondents (P = 0.003).

Conclusion.  Black persons’ rates of service connection for PTSD were substantially lower than other veterans even after adjusting for differences in PTSD severity and functional status.

*From the Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, Minnesota.

From the †Department of Internal Medicine,

‡Division of Biostatistics,

and the §Department of Epidemiology, School of Public Health, University of Minnesota School of Medicine, Minneapolis, Minnesota.

¶From the Rehabilitation Research Outcomes Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida.

∥From the VA Information Resource Center, Hines, Illinois.

Supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (#GEN97–002).

Portions of this research were presented at the HSR&D 19th Annual Meeting, February 15, 2001 in Washington, DC and at the Academy for Health Service Research and Health Policy 2001 Annual Meeting, June 2001 in Atlanta, GA. The findings and conclusions presented here are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or VA Health Services Research and Development Service.

Address correspondence and reprint requests to: Maureen Murdoch, MD, MPH, Minneapolis VAMC/Center for Chronic Disease Outcomes Research, One Veterans Drive (111-0), Minneapolis, MN 55417. E-mail:

Received May 20, 2002; initial review July 17, 2002; accepted October 21, 2002.

© 2003 Lippincott Williams & Wilkins, Inc.