Murdoch Maureen, Clothier Barbara Ann, Noorbaloochi Siamak, Webermann Aliya Rachel
Section of General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, MN 55417, USA.
Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN 55417, USA.
Mil Med. 2025 Jun 30;190(7-8):e1646-e1654. doi: 10.1093/milmed/usaf007.
Department of Veterans Affairs disability benefits for post-traumatic stress disorder (PTSD), also known as "service connection," have been shown to reduce homelessness and poverty, increase mental health engagement, and improve clinical outcomes. However, gender and race disparities in PTSD service connection have been described in Vietnam and post-Vietnam era Veterans.
Post-traumatic stress disorder service connection outcomes were assessed in a nationally representative, randomly selected, gender-stratified, prospective panel of 960 Veterans who served during Operations Enduring Freedom, Iraqi Freedom, and New Dawn. Using weighted logistic regression, we assessed the effects of male versus female gender and Black versus non-Black race on odds of PTSD service connection after controlling for other known predictors using Veterans Affairs administrative data. A secondary analysis supplemented administrative data with self-reported data in a subset of 410 Veterans.
A total of 56.3% of men and 45.2% of women (P = .001) received PTSD service connection. In all, 51.1% of Black men versus 57.5% of non-Black men received PTSD service connection (P = .26), while 35.4% of Black women and 50.8% of non-Black women received PTSD service connection (P = .001). The mean total service connection rating, which determines base monthly compensation, was 69.4% ± 28.1 for men receiving PTSD service connection and 49.1% ±31.5 for men denied PTSD service connection (P <.001). The mean total service connection rating for women receiving PTSD service connection was 70.8% ±20.7 compared to 49.7% ± 27.4 for women denied PTSD service connection (P <.001). Disproportionate combat exposures explained the gender difference in PTSD service connection (effect size modification = 15.4%), but we could not identify a mediating confounder for the inverse association between Black race and PTSD service connection in women.
Women were less likely to receive PTSD service connection compared to men; this difference was nearly completely mediated by gender differences in combat exposure. Black women were less likely than non-Black women to receive PTSD service connection, but we could not identify a plausible mechanism to explain this finding. On net, the base compensation package was lower for Veterans denied PTSD service connection than for those receiving PTSD service connection.
美国退伍军人事务部针对创伤后应激障碍（PTSD）发放的残疾福利，也被称为“服役关联福利”，已被证明能减少无家可归和贫困现象，提高心理健康参与度，并改善临床治疗效果。然而，在越南战争及战后时期的退伍军人中，PTSD服役关联福利存在性别和种族差异。
在一个具有全国代表性、随机选取、按性别分层的前瞻性样本中，对960名在持久自由行动、伊拉克自由行动和新黎明行动期间服役的退伍军人进行了PTSD服役关联福利结果评估。利用加权逻辑回归，在使用退伍军人事务部行政数据控制其他已知预测因素后，我们评估了男性与女性、黑人与非黑人种族对PTSD服役关联几率的影响。一项次要分析在410名退伍军人的子集中用自我报告数据补充了行政数据。
共有56.3%的男性和45.2%的女性（P = 0.001）获得了PTSD服役关联福利。总体而言，51.1%的黑人男性与57.5%的非黑人男性获得了PTSD服役关联福利（P = 0.26），而35.4%的黑人女性和50.8%的非黑人女性获得了PTSD服役关联福利（P = 0.001）。决定每月基本补偿的平均总服役关联评级，对于获得PTSD服役关联福利的男性为69.4%±28.1，对于未获得PTSD服役关联福利的男性为49.1%±31.5（P < 0.001）。获得PTSD服役关联福利的女性的平均总服役关联评级为70.8%±20.7，而未获得PTSD服役关联福利的女性为49.7%±27.4（P < 0.001）。不成比例的战斗经历解释了PTSD服役关联福利中的性别差异（效应大小修正 = 15.4%），但我们无法确定黑人种族与女性PTSD服役关联福利之间负相关关系的中介混杂因素。
与男性相比，女性获得PTSD服役关联福利的可能性较小；这种差异几乎完全由战斗经历中的性别差异所介导。黑人女性获得PTSD服役关联福利的可能性低于非黑人女性，但我们无法确定一个合理的机制来解释这一发现。总体而言，未获得PTSD服役关联福利的退伍军人的基本补偿套餐低于获得该福利的退伍军人。
