Research Article: Consideration of substance use in compensation and pension examinations of veterans filing PTSD claims

Date Published: February 6, 2019

Publisher: Public Library of Science

Author(s): Rebecca L. Jankowski, Anne C. Black, Christina M. Lazar, Bradley R. Brummett, Marc I. Rosen, Scott McDonald.


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.

Partial Text

In Fiscal Year (FY) 2016, the Veterans Benefits Administration (VBA) branch of the Department of Veterans Affairs (VA) approved nearly 100,000 new claims for mental health conditions caused or worsened by military service. Over half of these (53,983) were new claims for Posttraumatic Stress Disorder (PTSD). As of FY 16, there were a total of 887,899 Veterans compensated for service-connected PTSD, the most commonly compensated mental health condition and the third most compensated condition overall (behind only tinnitus and hearing loss).[1] Having a documented service-connected disability has several important benefits, one of which is eligibility to receive monthly disability compensation, which varies by the degree of disability (rated between 0–100%). The modal degree of compensation for service-connected mental health conditions (PTSD and other mental disorders) in FY 16 was 70%, whereas the other 15 most prevalent compensated disorders were each most often compensated at or below 20%.[1]




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