Veteran Policy Insights

Labor Day has just passed: Summer vacations are over, school is back in session, and Congress is under pressure to pass appropriations bills before the fiscal year ends. As you settle into your fall routine, we encourage you to catch up on RAND work exploring a different way of comparing veteran and nonveteran suicide rates. We also have a new perspective that explains how proposed legislation could change benefit eligibility for some disabled veterans.

These two recent publications showcase our researchers’ ongoing efforts to break down the complicated but critical policy issues that matter to veterans and those who care about them. Visit veterans.rand.org to learn more about our published and ongoing work, as well as how to collaborate with us. Forward this newsletter to friends and colleagues and encourage them to subscribe here so they too can stay informed about developments in research, policy, and public discussions on veterans’ issues.

Warmly,

Carrie M. Farmer and Rajeev Ramchand

Codirectors, RAND Epstein Family Veterans Policy Research Institute

The U.S. Department of Veterans Affairs estimates that recent suicide rates among veterans were 1.57 to 1.66 times greater than those of nonveterans, adjusted for age and sex differences using direct standardization. RAND researchers used an alternative approach to adjusting for age and sex, comparing the veteran population (which is older and contains far more men) with an age- and sex-matched nonveteran population. This method shows a far lower—but still elevated—mortality ratio for veterans, who experience about 11 suicides for every 10 in the nonveteran comparison group. Veteran suicide risk also varies substantially within subgroups; specifically, younger veterans and veterans who are women are at the highest risk relative to their nonveteran peers. Given these significant variations, indirect standardization can provide a more precise view of suicide risk factors and inform targeted prevention strategies and interventions. Although both methods of adjusting for population differences are valid, the RAND researchers argue that their method provides a more intuitive comparison of veteran and nonveteran suicide rates—and one that treats each such death as equally important.

Comparison of Suicide Rates Among U.S. Veteran and Nonveteran Populations

Retired service members with a service-connected disability do not always receive their full retirement pay and disability benefits because of rules against “double-dipping” from federal funding sources. The Major Richard Star Act, which was introduced in the House and Senate earlier this year, would allow some veterans to concurrently receive full retirement pay and disability benefits. If the act is signed into law, what would change for disabled veterans, and how many would actually see an increase in their compensation?

Potential Changes to Veterans’ Benefits Under the Major Richard Star Act: Veterans’ Issues in Focus

September is a big month on Capitol Hill: Congress must address various provisions to fund the government, including VA and other federal agencies, before the fiscal year ends. Prior to the August recess, Congress began addressing these issues. Below, we highlight some of the veteran-related provisions in the current House and Senate versions of the FY 2024 National Defense Authorization Act and Military Construction, Veterans Affairs, and Related Agencies (MilCon-VA) appropriations bills.

House version H.R. 2670: Passed on July 14 (219–210) and sent to the Senate. This version and the Senate version will most likely go to a conference committee to resolve differences. The original House bill (prior to amendments) included the following requirements:

• A report on the “feasibility and advisability of implementing comprehensive mental health exams for transitioning servicemembers and whether it would have an impact on helping prevent suicide.”
• A pilot program to address the potential health effects of medical marijuana use, implemented by DoD in consultation with VA.

Senate version S. 2226: Passed on July 27 (86–11) with some recommendations related to veterans:

• Giving all separating or retiring service members the “right to opt out of sharing their contact information with community-based organizations and related entities.”
• Directing the U.S. Comptroller General to evaluate how discharge review boards handle requests for a discharge upgrade based on “covered mental health conditions.”
• Encouraging DoD “to facilitate pathways for separating servicemembers to secure quality employment prior to the day they exit service.”

Senate version S. 2127: Passed out of committee on June 22 with the following recommendations:

• Expand Veteran Employment Through Technology Education Courses (VET-TEC) to meet increased demand.
• Direct VA to submit reports and updates on the average number of days it takes to get an appointment through both VA and community care. (Read Carrie Farmer’s testimony on the challenges with available data on the timeliness and quality of VA community care.)
• Encourage VA to expand the use of alternative treatments for pain management.

House version H.R. 4366: Passed on July 27 (219–211) with 41 amendments. Several provisions could have significant implications for veterans’ health care:

• Congress would withhold 25% of the funds for VA’s electronic health record implementation until the VA Secretary provides specific reports to the House and Senate Veterans’ Affairs Committees, which he must do by July 1, 2024. (Read Shira Fischer’s commentary on the challenges VA has encountered in getting the new system up and running.)
• VA would be prohibited from implementing its interim final rule on abortions. (Read Kayla Williams’s September 2022 testimony on this topic.)
• VA would be prohibited from using appropriated funds to enforce any COVID-19 mask mandates.
• VA would be prohibited from providing surgical procedures or hormone therapies for gender-affirming care. (Read Kayla Williams’s opinion piece on the science behind this care.)
• VA would be required to “conduct large-scale studies into the efficacy of drugs with FDA breakthrough therapy status to treat PTSD through medication-assisted therapy trials.” The drugs to be included in the study are psilocybin, MDMA, and “others designated as breakthrough therapies by the FDA.” (RAND researchers recently explored the evolving legal and policy landscape of psychedelics and veterans’ mental health.)

• A prominent health care news outlet covered Andrew Morral, Terry Schell, and Rosanna Smart’s nuanced findings on veteran suicide.
• C-SPAN aired a virtual discussion about the report by Todd Helmus, Ryan Brown, and Rajeev Ramchand on the prevalence of veterans’ support for extremist groups and beliefs, which was also featured in a Military Times article on lethal domestic terrorism threats.
• Institute co-director Carrie Farmer briefed House Veterans Affairs Committee Democratic legislative analysts on VA community care.
• Kayla Williams was quoted in a Rolling Stone article about abortion access for veterans.
• Military.com quoted RAND researcher Jeff Wenger in an article about the low veteran unemployment rate in a robust jobs market.
• RAND research on military food insecurity and institute co-director Rajeev Ramchand’s work in support of the DoD Suicide Prevention and Response Independent Review Committee were featured in a recent War Horse story on military suicide prevention.

September 21, 4–5pm EDT / 1–2pm PDT

Join the RAND Epstein Family Veterans Policy Research Institute as experts discuss the research on veterans’ risk of becoming food insecure and which food-insecure veterans are least likely to access Supplemental Nutrition Assistance Program (SNAP) benefits compared with their nonveteran counterparts. The webinar will explore barriers that veterans encounter when they try to enroll in SNAP and current efforts to address food insecurity among veterans. This event will be open to the public, with advance registration required. Those who register will receive Zoom connection details via email. See event details and register.