Simmons Molly M, Farmer Carrie M, Cherney Samantha, Krull Heather
Rand Health Q. 2022 Jun 30;9(3):16. eCollection 2022 Jun.
For almost two decades, the United States has been engaged in continuous combat operations in Iraq, Afghanistan, and other theaters. Some service members have sustained injuries or developed medical conditions as a consequence of military service that affect their ability to perform their military duties. The process by which the U.S. Department of Defense (DoD) evaluates service members and determines whether they should be medically discharged has changed considerably since 2001. In particular, beginning in 2007, major changes to the Disability Evaluation System (DES) were implemented in response to concern about inefficiencies and confusion resulting from the practice of having DoD and the U.S. Department of Veterans Affairs (VA) conduct separate evaluations according to different criteria, thus producing different disability determinations. In 2008, DoD launched a pilot program to streamline the disability evaluation process, with VA conducting medical exams to be used by both DoD and VA. This system, the Integrated Disability Evaluation System (IDES), was formally adopted military-wide in 2011. Changes to DES also reflected changes in understanding of traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD), the signature injuries of the Iraq and Afghanistan wars. The authors review changes to disability evaluation policy and changes in the diagnosis and treatment of PTSD and TBI since 2001.
近二十年来，美国一直在伊拉克、阿富汗及其他战区持续开展作战行动。一些服役人员因军事任务而受伤或出现健康问题，影响了他们履行军事职责的能力。自2001年以来，美国国防部（DoD）评估服役人员并确定是否应让其医疗退役的程序发生了很大变化。特别是从2007年开始，对伤残评估系统（DES）进行了重大改革，以回应人们对国防部和美国退伍军人事务部（VA）按照不同标准进行单独评估所导致的效率低下和混乱局面的担忧，这种局面导致了不同的伤残判定结果。2008年，国防部启动了一个试点项目，以简化伤残评估程序，由退伍军人事务部进行医疗检查，供国防部和退伍军人事务部共同使用。这个系统，即综合伤残评估系统（IDES），于2011年在全军正式采用。伤残评估系统的变化也反映了对创伤性脑损伤（TBI）和创伤后应激障碍（PTSD）理解的变化，这两种伤病是伊拉克和阿富汗战争的典型伤病。作者回顾了自2001年以来伤残评估政策的变化以及创伤后应激障碍和创伤性脑损伤诊断与治疗方面的变化。
