Consideration of substance use in compensation and pension examinations of veterans filing PTSD claims.
Adult
Compensation and Redress
/ legislation & jurisprudence
Disability Evaluation
Female
Filing
/ standards
Humans
Male
Pensions
Stress Disorders, Post-Traumatic
/ diagnosis
Substance-Related Disorders
/ diagnosis
United States
United States Department of Veterans Affairs
/ economics
Veterans
/ legislation & jurisprudence
Veterans Disability Claims
/ economics
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
30
11
2017
accepted:
04
01
2019
entrez:
7
2
2019
pubmed:
7
2
2019
medline:
14
11
2019
Statut:
epublish
Résumé
Veterans filing claims that service-induced PTSD impairs them worry that claims examiners may attribute their difficulties to conditions other than PTSD, such as substance use. Substance use commonly co-occurs with PTSD and complicates establishing a PTSD diagnosis because symptoms may be explained by PTSD alone, PTSD-induced substance use, or by a substance use condition independent of PTSD. These alternative explanations of symptoms lead to different conclusions about whether a PTSD diagnosis can be made. How substance use impacts an examiner's diagnosis of PTSD in a Veteran's service-connection claim has not been previously studied. In this study, we tested the hypothesis that mention of risky substance use in the Compensation & Pension (C&P) examination would result in a lower likelihood of service-connection award, presumably because substance use reflected an alternative explanation for symptoms. Data were analyzed from 208 Veterans' C&P examinations, medical records, and confidentially-collected research assessments. In this sample, 165/208 (79%) Veterans' claims were approved for a mental health condition; 70/83 (84%) with risky substance use mentioned and 95/125 (76%) without risky use mentioned (p = .02). Contrary to the a priori hypothesis, Veterans with risky substance use were more likely to get a service-connection award, even after controlling for baseline PTSD severity and other potential confounds. They had almost twice the odds of receiving any mental health award and 2.4 times greater odds of receiving an award for PTSD specifically. These data contradict assertions of bias against Veterans with risky substance use when their claims are reviewed. The data are more consistent with substance use often being judged as a symptom of PTSD. The more liberal granting of awards is consistent with literature concerning comorbid PTSD and substance use, and with claims procedures that make it more likely that substance use will be attributed to trauma exposure than to other causes.
Identifiants
pubmed: 30726261
doi: 10.1371/journal.pone.0210938
pii: PONE-D-17-42219
pmc: PMC6364894
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0210938Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
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