VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, United States of America.
VA Connecticut Healthcare System, West Haven, Connecticut, United States of America.
PLoS One. 2019 Feb 6;14(2):e0210938. doi: 10.1371/journal.pone.0210938. eCollection 2019.
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.
退役军人提出的因 PTSD 导致的服务障碍索赔，他们担心理赔审查员可能将他们的困难归因于 PTSD 以外的其他情况，例如物质使用障碍。物质使用障碍通常与 PTSD 共病，并使 PTSD 诊断变得复杂，因为症状可能仅由 PTSD、由 PTSD 引起的物质使用或与 PTSD 无关的物质使用状况来解释。这些对症状的替代解释导致对是否可以做出 PTSD 诊断的不同结论。在退役军人的服务关联索赔中，物质使用如何影响审查员对 PTSD 的诊断，以前尚未研究过。在这项研究中，我们检验了以下假设：在补偿和养老金（C&P）检查中提到危险物质使用，将降低服务关联奖的可能性，大概是因为物质使用反映了对症状的替代解释。我们分析了来自 208 名退役军人的 C&P 检查、医疗记录和机密收集的研究评估数据。在这个样本中，208 名退役军人的索赔中有 165/208（79%）获得了心理健康状况的批准；70/83（84%）提到有危险物质使用，95/125（76%）没有提到（p=0.02）。与先验假设相反，即使在控制了 PTSD 严重程度基线和其他潜在混杂因素后，有危险物质使用的退役军人更有可能获得服务关联奖。他们获得任何心理健康奖的可能性几乎是两倍，获得 PTSD 特定奖的可能性是 2.4 倍。这些数据与在审查他们的索赔时对有危险物质使用的退役军人的偏见断言相矛盾。这些数据更符合物质使用通常被判断为 PTSD 的症状的说法。更宽松的授予奖项的做法与关于 PTSD 和物质使用共病的文献一致，并且与使物质使用更有可能归因于创伤暴露而不是其他原因的索赔程序一致。
