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Gender Differences in Service Connection for PTSD

Murdoch, Maureen MD, MPH*; Hodges, James PhD; Hunt, Carolyn; Cowper, Diane MA§; Kressin, Nancy PhD; O'Brien, Nancy MSW#

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Background. Mentally ill female veterans obtain a smaller proportion of their care from Department of Veterans Affairs (VA) facilities than mentally ill male veterans do, possibly because women are less likely than men to be service connected for psychiatric disabilities. “Service connected” veterans have documented, compensative conditions related to or aggravated by military service, and they receive priority for enrollment into the VA healthcare system.

Objectives. To see if there are gender discrepancies in rates of service connection for posttraumatic stress disorder (PTSD) and, if so, to see if these discrepancies could be attributed to appropriate subject characteristics (eg, differences in symptom severity or impairment).

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

Subjects. Randomly selected veterans seeking VA disability benefits for PTSD. Women were oversampled to achieve a gender ratio of 1:1.

Results. A total of 3337 veterans returned usable surveys (effective response rate, 68%). Men's unadjusted rate of service connection for PTSD was 71%; women's, 52% ( P < 0.0001). Adjustment for veterans' PTSD symptom severity or functional impairment did not appreciably reduce this discrepancy, but adjustment for dissimilar rates of combat exposure did. Estimated rates of service connection were 53% for men and 56% for women after adjusting for combat exposure. This combat preference could not be explained by more severe PTSD symptoms or greater functional impairment.

Conclusions. Instead of a gender bias in awards for PTSD service connection, we found evidence of a combat advantage that disproportionately favored men. The appropriateness of this apparent advantage is unclear and needs further investigation.

*From the Center for Chronic Disease Outcomes Research (a VA HSR&D National Center of Excellence) and Section of General Internal Medicine, Minneapolis VA Medical Center, Minneapolis Minnesota, and Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota.

From the Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, Minnesota.

From the Compensation and Pension Service, Veterans Benefits Administration, Washington, DC.

§From the Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida; formerly of VA Information Resource Center (VIReC), Midwest Center for Health Services and Policy Research (a VA HSR&D National Center of Excellence), Edward J. Hines, Jr. VA Hospital, Hines Illinois, and Institute for Health Services Research and Policy Studies, Northwestern University, Evanston, Illinois.

From the Center for Health Quality, Outcomes and Economic Research (a VA HSR&D National Center of Excellence), Bedford VA Medical Center. Bedford, Massachusetts, and Health Service Department, Boston University School of Public Health, Boston, Massachusetts.

#From the Social Work Service, Minneapolis VA Medical Center, Minneapolis, Minnesota, and the Mental and Behavioral Health Product Service Line, Veterans Integrated Service Network 24, Minneapolis, Minnesota.

This research was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (#GEN97–002). Dr. Kressin is a Research Career Scientist, Department of Veterans Affairs, Health Services Research and Development Service (HSR&D). Ms. Hunt is Deputy Director, Compensation and Pension Service, Veterans Benefits Administration.

The findings and conclusions presented in this report are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the Veterans Benefits Administration, or VA HSR&D.

Portions of this research were presented at the VA HSR&D 19th Annual Meeting, February 2001 in Washington, DC; the Academy for Health Service Research and Health Policy 2001 Annual Meeting, June 2001 in Atlanta, GA; and the Health Issues of Military and Veteran Women: A Research Symposium, June 2002 in Washington, DC.

Address correspondence and reprint request to: Maureen Murdoch, MD, MPH, Section Gen Intern Med and CCDOR (111–0), Minneapolis VA Medical Center, One Veterans Drive, Minneapolis, MN 55417. E-mail: murdo002@tc.umn.edu

© 2003 Lippincott Williams & Wilkins, Inc.