Abstract

Objective: To evaluate the relative distribution of service connection disability ratings among veterans with a diagnosis of Posttraumatic Stress Disorder (PTSD) and/or Traumatic Brain Injury (TBI) from all branches of service who went to war before and after a historic attack on US by a terrorist group on September 11, 2001 (9/11); and to determine the associated cost to the nation.
Methods: The Veterans Health Administration (VHA) provides care to veterans at over 1,400 medical establishments across the United States. We used clinical data from these establishments, provided by researching the Veterans Administrations Informatics and Computing Infrastructure (VINCI). First, we identified all veterans with the ICD-9 code diagnosis of PTSD and/or TBI who received services within the VA between years 1998 to 2014. We excluded those who had no listed service connection disability rating. The remaining cohort was divided into four groups based on their period of service: Pre-9/11 Group – those who entered and left service before September 11, 2001; Post–9/11 Group– those who first entered the service after September 11, 2001; Overlap-9/11 Group – those who entered service before 2001 and left service after September 11, 2001; Reentered Post-9/11 Group – those who entered and then left service before September 11, 2001 and then reentered after September 11, 2001. Both annual and projected 50-year compensation costs were calculated for these groups.
Results: We identified 1,067,691 veterans with PTSD and/or TBI diagnosis who were service connected during the period under study. The relative distribution was highest in Pre-9/11 Group (N=797,285; 74.7%), followed by Post-9/11 Group (N=174,134; 16.3%), Overlap-9/11 Group (N=82,450; 7.7%) and Reentered Post-9/11 Group (N=13,822; 1.3%). Majority of veterans in all groups were male. Veterans in Pre-9/11 Group were oldest (66.3 ± 11.3), those in the Post-9/11 Group were the youngest (36.1 ± 8.7), with the Overlap-9/11 Group (41.2 ± 8.4) and the Reentered Post-9/11 Group (46.7 ± 8.9) showing intermediate average ages. The projected service connection disability compensation cost will be at least $20.28 billion/year and total $515 billion in coming 50 years. Based on the 2014 numbers, we project inpatient and outpatient costs to be $3.63 billion and $1.48 billion annually, and this represents $106.4 billion and 40.4 billion in over the next 50 years, respectively.
Conclusions: PTSD/TBI continues to be a devastating problem for veterans, their families, and our society. Rising costs and limited success with currently mandated therapies calls for a new therapeutic approach to help manage this unsustainable cost to the nation.

Keywords: Posttraumatic stress disorder (PTSD); Traumatic brain injury (TBI); Combat; Veterans; Service connection disability