Gender Differences in Compensation and Pension Claims Approval for PTSD
Maureen Murdoch MD MPH
VA Medical Center
Minneapolis, MN
Funding Period: October 1997 - September 2000

BACKGROUND/RATIONALE:
Quality assurance reviews commissioned by the Veterans Benefits Administration (VBA) suggested that approval rates for disability claims related to personal assault and Post Traumatic Stress Disorder (PTSD), claims filed almost wholly by women, might have been too low. To address this concern, VBA developed an educational intervention designed to improve the development and success rate of PTSD claims filed on behalf of women.

OBJECTIVE(S):
(1) Compare success rates of veterans seeking disability benefits for combat-related PTSD to that of veterans seeking benefits for PTSD attributed to personal assault. (2) Determine if gender differences exist in the granting of disability benefits for PTSD and, if so, identify likely sources of variance. (3) Determine the efficacy of the VBA-sponsored educational intervention on claims approval rates.

METHODS:
We are conducting a quasi-experimental study in which applicants for PTSD-related disability benefits will be compared before and after the VBA educational effort. Differences in claims’ success rates for men and women will be compared after adjusting for stressor-type, PTSD symptomatology, work and role functioning, physical functioning, and social adaptability. In a separate analysis, women's claims’ success rates before and after the intervention will be compared. Hierarchical modeling will be used to control for regional differences in claims approval rates. Endogenous data will be collected by survey and linked to administrative data. A random selection of 2,700 men and women, respectively, who applied for PTSD disability benefits between December, 1994 and December, 1998. The sample provides 85 per cent power to detect a 10 per cent change (pre- v. post-) in claims' approvals.

FINDINGS/RESULTS:
The project establishes a model of mutually beneficial VHA and VBA collaboration while simultaneously exploring questions of interest to both. Our findings should help establish what factors are important in predicting the success of disability claims and should assess the effectiveness of educational teleconferences in improving claims development.

IMPACT:
This will be one of the largest studies ever conducted in individuals with PTSD, and it offers a wealth of clinical information about participants' functional status and health care utilization. Important epidemiological information pertaining to in-service stressors and post-military stressors will also be available. In addition, to our knowledge, this is the first time anyone has studied predictors of disability claims success in the VA system, and it will be important to see how various demographic variables influence the outcome. In this regard, we will be able to describe across-VISN differences in PTSD claims approval rates (if any) and try to identify likely sources of variance. We will also be able to estimate the effectiveness (if any) of the VBA's educational intervention. A positive study would support funding additional educational interventions, whereas a negative finding would suggest more efficacious methods need to be devised to improve claims development.

PUBLICATIONS:

Journal Articles

1. Murdoch M, Polusny MA, Hodges J, Cowper D. The association between in-service sexual harassment and post-traumatic stress disorder among Department of Veterans Affairs disability applicants. Military Medicine. 2006; 171(2): 166-73.
2. Murdoch M, Hodges J, Cowper D, Sayer N. Regional variation and other correlates of Department of Veterans Affairs Disability Awards for patients with posttraumatic stress disorder. Medical Care. 2005; 43(2): 112-21.
3. Murdoch M, van Ryn M, Hodges J, Cowper D. Mitigating effect of Department of Veterans Affairs disability benefits for post-traumatic stress disorder on low income. Military Medicine. 2005; 170(2): 137-40.
4. Halek K, Murdoch M, Fortier L. Spontaneous reports of emotional upset and health care utilization among veterans with posttraumatic stress disorder after receiving a potentially upsetting survey. The American Journal of Orthopsychiatry. 2005; 75(1): 142-51.
5. Murdoch M, Polusny MA, Hodges J, O'Brien N. Prevalence of in-service and post-service sexual assault among combat and noncombat veterans applying for Department of Veterans Affairs posttraumatic stress disorder disability benefits. Military Medicine. 2004; 169(5): 392-5.
6. Sayer N, Spoont M, Murdoch M. The Department of Veterans Affairs Disability Compensation Program: What providers should know. Federal Practitioner. 2004; 21(5): 15-20.
7. Arbisi PA, Murdoch M, Fortier L. MMPI-2 Validity and Award of Service Connection for PTSD During the VA Compensation and Pension Evaluation. Psychological services. 2004; 1(1): 56-67.
8. Murdoch M, Hodges J, Hunt C, Cowper D, Kressin N, O'Brien N. Service connection for PTSD is not a gender issue. Medical Care. 2003; 41(12): 1417-1418.
9. Murdoch M, Nelson DB, Fortier L. Time, gender, and regional trends in the application for service-related post-traumatic stress disorder disability benefits, 1980-1998. Military Medicine. 2003; 168(8): 662-70.
10. Murdoch M, Hodges J, Cowper D, Fortier L, van Ryn M. Racial disparities in VA service connection for posttraumatic stress disorder disability. Medical Care. 2003; 41(4): 536-49.

DRA: Health Services and Systems, Military and Environmental Exposures, Special (Underserved, High Risk) Populations
DRE: Resource Use and Cost
Keywords: PTSD, Women - or gender differences
MeSH Terms: Stress Disorders, Post-Traumatic, Women