Section of General Internal Medicine, Minneapolis VA Health Care System, One Veterans Drive (111-0), Minneapolis, MN, 55417, USA.
Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive (152), Minneapolis, MN, 55417, USA.
BMC Womens Health. 2021 Feb 16;21(1):70. doi: 10.1186/s12905-021-01214-7.
In 2011, the Department of Veterans Affairs (VA) strengthened its disability claims processes for military sexual trauma, hoping to reduce gender differences in initial posttraumatic stress disorder (PTSD) disability awards. These process improvements should also have helped women reverse previously denied claims and, potentially, diminished gender discrepancies in appealed claims' outcomes. Our objectives were to examine gender differences in reversals of denied PTSD claims' outcomes after 2011, determine whether disability awards (also known as "service connection") for other disorders offset any PTSD gender discrepancy, and identify mediating confounders that could explain any persisting discrepancy.
From a nationally representative cohort created in 1998, we examined service connection outcomes in 253 men and 663 women whose initial PTSD claims were denied. The primary outcome was PTSD service connection as of August 24, 2016. Secondary outcomes were service connection for any disorder and total disability rating. The total disability rating determines the generosity of Veterans' benefits.
51.4% of men and 31.3% of women were service connected for PTSD by study's end (p < 0.001). At inception, 54.2% of men and 63.2% of women had any service connection-i.e., service connection for disorders other than PTSD (p = 0.01) and similar total disability ratings (p = 0.50). However, by study's end, more men than women had any service connection (88.5% versus 83.5%, p = 0.05), and men's mean total disability rating was substantially greater than women's (77.1 ± 26.2 versus 66.8 ± 30.7, p < 0.001). History of military sexual assault had the largest effect modification on men's versus women's odds of PTSD service connection.
Even after 2011, cohort men were more likely than the women to reverse initially denied PTSD claims, and military sexual assault history accounted for much of this difference. Service connection for other disorders initially offset women's lower rate of PTSD service connection, but, ultimately, men's total disability ratings exceeded women's. Gender discrepancies in service connection should be monitored beyond the initial claims period.
2011 年，美国退伍军人事务部（VA）加强了对军事性创伤的残疾索赔处理程序，希望减少初始创伤后应激障碍（PTSD）残疾评定中的性别差异。这些程序的改进也应该有助于女性推翻以前被否决的索赔，并可能缩小上诉索赔结果中的性别差异。我们的目标是检查 2011 年后推翻最初被否决的 PTSD 索赔结果的性别差异，确定其他疾病的残疾评定（也称为“服务连接”）是否抵消了 PTSD 性别差异，以及确定可以解释任何持续差异的中介混杂因素。
我们从 1998 年创建的一个全国代表性队列中，检查了 253 名男性和 663 名最初 PTSD 索赔被拒绝的女性的服务连接结果。主要结果是截至 2016 年 8 月 24 日的 PTSD 服务连接。次要结果是任何疾病的服务连接和总残疾评定。总残疾评定决定了退伍军人福利的慷慨程度。
51.4%的男性和 31.3%的女性在研究结束时获得 PTSD 服务连接（p<0.001）。在开始时，54.2%的男性和 63.2%的女性有任何服务连接，即 PTSD 以外的疾病的服务连接（p=0.01）和相似的总残疾评定（p=0.50）。然而，到研究结束时，与女性相比，更多的男性有任何服务连接（88.5%对 83.5%，p=0.05），男性的平均总残疾评定显著高于女性（77.1±26.2 对 66.8±30.7，p<0.001）。军事性攻击史对男性与女性 PTSD 服务连接的可能性差异的影响最大。
即使在 2011 年之后，队列中的男性也比女性更有可能推翻最初被否决的 PTSD 索赔，而军事性攻击史解释了这种差异的大部分原因。最初，其他疾病的服务连接抵消了女性 PTSD 服务连接率较低的情况，但最终，男性的总残疾评定超过了女性。在最初的索赔期之外，应该监测服务连接中的性别差异。
