Pogoda Terri K, Dismuke-Greer Clara E, Eppich Kaleb G, Nguyen Huong, Pugh Mary Jo, Walton Samuel R, Cifu David X, Walker William C
Author Affiliations: Center for Health Optimization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts (Dr Pogoda); Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts (Dr Pogoda); Health Economics Resource Center (HERC), VA Palo Alto Health Care System, Palo Alto, California (Dr Dismuke-Greer); Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah (Mr Eppich, Drs Nguyen, and Pugh); Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation (IDEAS) Center, VA Salt Lake City, Salt Lake City, Utah (Drs Nguyen and Pugh); Department of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University (VCU), Richmond, Virginia (Drs Walton, Cifu, and Walker); Institute of Women's Health, Virginia Commonwealth University (VCU), Richmond, Virginia (Dr Walton); and Richmond Veterans Affairs (VA) Medical Center, Central Virginia VA Health Care System, Richmond, VA (Drs Walton, Cifu, and Walker).
J Head Trauma Rehabil. 2025 Aug 27. doi: 10.1097/HTR.0000000000001105.
Those who served on active duty after September 11, 2001 (Post-9/11) are screened for deployment-related mild traumatic brain injury (mTBI) when initiating Veterans Health Administration (VHA) clinical services. Positive screeners are offered a referral to a Comprehensive TBI Evaluation (CTBIE) by a TBI specialist to further determine deployment-related mTBI history and access interdisciplinary care if indicated. This study examined whether Post-9/11 veterans who screened positive and also participated in a prospective longitudinal study (PLS) differed in characteristics and outcomes depending on their clinical VHA CTBIE completion status and mTBI positive (+) or negative (-) determinations (CTBIE = mTBI+, CTBIE = mTBI-, No CTBIE).
Veterans Health Administration (VHA) clinical and research settings.
658 Post-9/11 veterans.
Secondary analysis of the PLS using a retrospective cohort design.
Primary outcomes were associations of VHA CTBIE completion/determination with competitive employment and service-connected disability ratings obtained at time of PLS completion. Secondary outcomes included a range of PLS demographic, military, potential concussive event, health, functional, and quality-of-life measures.
Based on their PLS research data, relative to the No CTBIE group, the CTBIE = mTBI+ group had lower adjusted odds ratios (aOR) of competitive employment (aOR = .51, 95% confidence interval [CI] = 0.31-0.83, P = .008) and higher odds of having a ≥50% service-connected disability rating (aOR = 2.02, 95% CI = 0.31-0.83, P = .01). The CTBIE = mTBI+ group also reported higher neurobehavioral and posttraumatic stress disorder symptom severity, and poorer outcomes on quality-of-life measures than the No CTBIE group. Generally, few differences were detected between the CTBIE = mTBI- and either of the CTBIE = mTBI+ and No CTBIE groups.
This study leveraged the unique ability to combine VHA clinical and comprehensive research data to examine outcomes not routinely collected as part of standard VHA clinical care. These research data can inform VHA TBI leadership about long-term health and functional status of veterans who screen positive for TBI.
