The authors analyze trends in disability outcomes by identifying cohorts of service members who were diagnosed with posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) and look prospectively at medical discharge and other career outcomes. They also look retrospectively at service members who were medically discharged with a disability rating for PTSD or TBI and examine trends in diagnoses, treatments, and other service outcomes.

Cover: Trends in Department of Defense Disability Evaluation System Ratings and Awards for Posttraumatic Stress Disorder and Traumatic Brain Injury, 2002–2017
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Trends in Department of Defense Disability Evaluation System Ratings and Awards for Posttraumatic Stress Disorder and Traumatic Brain Injury, 2002–2017

by Heather Krull, Carrie M. Farmer, Stephanie Rennane, Evan Goldstein, Philip Armour, Teague Ruder

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Research Questions

  1. What trends in diagnosis, treatment, and disability evaluation for PTSD and TBI can be identified?
  2. What policy changes associated with identifying and treating PTSD and TBI have been made to DES since 2001?
  3. What factors are associated with changes in the numbers and percentages of service members being rated and treated for PTSD and/or TBI from 2002 to 2017?

Since 2001, more than 3 million service members have deployed in support of multiple combat operations in Afghanistan, Iraq, and other theaters. Many have been diagnosed with the "signature wounds" of these conflicts: posttraumatic stress disorder (PTSD) and/or traumatic brain injury (TBI). During the intervening years, the process by which service members are evaluated for disability has evolved significantly, including a complete overhaul of the Disability Evaluation System (DES) beginning in 2007. Meanwhile, the Department of Defense (DoD) and the services made policy changes and initiated other efforts to improve screening for PTSD and TBI, encourage service members to seek treatment, improve quality of care, and reduce the stigma associated with treatment for these conditions.

To explore these changes, as well as their potential effects on the numbers and characteristics of service members who are evaluated through DES, the authors identify and assess trends in DES outcomes for PTSD and TBI between 2002 and 2017.

Key Findings

  • Between 2002 and 2017, the military health dystem diagnosed more than 200,000 active-duty service members with PTSD and nearly 300,000 with TBI.
  • Over time, the share of service members with a PTSD diagnosis who were medically discharged increased significantly—from 16 percent in 2002 to 34 percent in 2015. Rates of medical discharge for service members with a TBI diagnosis increased from 7 to 18 percent during the same period.
  • Disability ratings for service members who were medically discharged for PTSD increased over time: In 2008, 57 percent of service members with a disability rating for PTSD had a total rating of 0 to 40 percent; in 2009, almost all had a total rating of 50 percent or higher. Service members with diability ratings 30 percent or higher receive lifetime financial and health care benefits.
  • A better understanding of disability evaluation trends and outcomes can help DoD set goals for diagnosing, treating, and evaluating disabilities among wounded, injured, and ill service members in future conflicts.

Recommendations

  • As DoD and the services continue to evolve policies and practices to improve system performance and service member health, the effects of those changes should be evaluated as they are implemented.
  • DoD should conduct analyses to understand the impacts of increases in disability ratings.
  • Studies that assess the well-being of service members after medical discharge, to include veterans benefits, should be conducted. New data collection efforts will be needed to fully understand how service experiences and such processes as disability evaluation are correlated with longer-term health outcomes.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methods and Data

  • Chapter Three

    Trends in Disability Evaluations and Medical Discharges Among Cohorts of Service Members with a Posttraumatic Stress Disorder or Traumatic Brain Injury Diagnosis

  • Chapter Four

    Trends in the Timing of Disability Disposition After Diagnosis

  • Chapter Five

    Trends Among Cohorts of Service Members with a Posttraumatic Stress Disorder or Traumatic Brain Injury Disability Rating

  • Chapter Six

    Conclusions

  • Appendix A

    Creating the Analysis File

  • Appendix B

    Key Definitions

  • Appendix C

    Characteristics of the Diagnosis Cohorts

  • Appendix D

    Additional Department of Defense–Wide Results

  • Appendix E

    Air Force Results

  • Appendix F

    Army Results

  • Appendix G

    Marine Corps Results

  • Appendix H

    Navy Results

Research conducted by

This research was sponsored by the Psychological Health Center of Excellence and conducted within the Forces and Resources Policy Center of the RAND National Security Research Division (NSRD).

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