Iraq/Afghanistan-era Veterans with back pain: Characteristics and predictors of compensation and pension award

Abstract

Abstract-Approximately 440,000 U.S. Veterans receive compensation for back and/or neck conditions. Veterans Benefits Administration (VBA) criteria state that back compensation determinations are based on impaired back function and not comorbidity or lifestyle, but whether compensation is based solely on consideration of the lumbosacral region is unknown. In this study, we conducted a cross-sectional analysis of medical chart data from 178 post-9/11 Veterans applying for service connection for back pain in fiscal year 2012 at the Department of Veterans Affairs Connecticut Healthcare System. Altogether, 62% were noted to have impairment of back functioning and 74% were awarded compensation. Rates of comorbidities (obesity, depression, smoking, and illicit drug use) were high. In multivariate models predicting compensation awarded, only having an impaired back was associated with service-connected compensation. Pain was associated with extent of service connection, but this relationship was fully mediated by functional back impairment. No other measure (including work status) significantly predicted compensation. In summary, service connection was largely based on functional impairment, as called for in VBA criteria. Although pain and comorbidities undoubtedly affect day-to-day functioning, these factors were not independently related to service connection. Veterans present with many remediable conditions, and the service-connection evaluation may be an opportunity to engage them in treatment.

Brief Counseling for Veterans with Musculoskeletal Disorder, Risky Substance Use, and Service Connection Claims

“…For example, our studies' participating veterans' overall pain severity (mean pain over the past week of 5.1) was higher than average NRS ratings from the MSD Cohort Study veterans, whose mean pain NRS scores were 3.4 in 2011 [61]. We are only aware of one other published study describing veterans seeking service connection for MSD, which also found high rates of pain-related impairment, substance use, and psychiatric comorbidity [62].…”

Comparison of attitudes towards the service connection claims process among veterans filing for PTSD and veterans filing for musculoskeletal disorders

“…[ 15 ] Comorbid conditions are common; in a previously-described cohort of post-9/11 veterans seeking an initial service connection evaluation for back pain, the mean service connection rating was 14% for musculoskeletal disorders but averaged an additional 45% for other conditions. [ 16 ]…”

“…[15] Comorbid conditions are common; in a previously-described cohort of post-9/11 veterans seeking an initial service connection evaluation for back pain, the mean service connection rating was 14% for musculoskeletal disorders but averaged an additional 45% for other conditions. [16] The purpose of this study was to compare attitudes and beliefs about the service connection process between veterans submitting service connection claims for PTSD and musculoskeletal disorders. Examining and understanding attitudes towards the C&P process is important, as it can impact clinical care and engagement in treatment.…”