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Brain Injury

Racial/Ethnic and Geographic Determinants of TBI Service-Connected Disability and Total SCD Compensation in U.S. Veterans

Tuesday, October 31, 2023
3:35 PM – 3:41 PM  
Location: Station 7

    Presenting Author(s)

  • Clara E. Dismuke-Greer, PhD (she/her/hers)

    Research Health Science Specialist
    Health Economics Resource Center (HERC), VA Palo Alto Health Care System
    Brunswick, Georgia, United States

    • Non-presenting Author(s)

  • Terri K. Pogoda, PhD

    Research Health Scientist
    VA Boston Healthcare System
    Boston, Massachusetts, United States

  • CG

    Carla Garcia

    Research Associate
    Health Economics Resource Center (HERC), VA Palo Alto Health Care System, United States

  • AD

    Ariana Del Negro

    Technical Writer III
    Palo Alto Veterans Institute for Research (PAVIR), United States

  • JB

    John Brown

    Administrative Officer, Research and Development Service
    VA Boston Healthcare System, United States

  • DL

    David Shane Lowry, PhD

    Assistant Professor
    University of Southern Maine, United States

  • Mary Jo Pugh, PhD, RN

    Professor/Research Career Scientist
    University of Utah/VA Salt Lake City
    Salt Lake City, Utah, United States

Research Objectives: To examine the association of race/ethnicity and geography with service-connected disability (SCD) for traumatic brain injury (TBI) and how such determinants affect monthly total SCD compensation by TBI SCD status.

Design: Retrospective observational cohort study

Setting: Veterans Health Administration (VHA) /Veterans Benefits Administration (VBA)

Participants: Veterans from LIMBIC-CENC Phenotype study with ≥1 SCD rating from the VBA

Interventions: N/A

Main Outcome Measures: SCD designation for TBI based on VA Schedule for Rating Disabilities (VASRD) diagnostic codes (8045 [residuals of TBI] and 9304 [neurocognitive disorder due to TBI]) and monthly VBA compensation per veteran during 2022.

Results: Results
1,225,679 Veterans without and 93,911 with TBI SCD were included. Veterans living in highly rural areas (OR 1.44, 95% CI 0.06,0.05) and on Tribal Lands (OR 1.28, 95% CI 0.25,0.31) had the highest odds of receiving a TBI SCD award in unadjusted models. In adjusted models for all factors except TBI severity, Native Americans (AOR 1.12, 95% CI 1.06,1.18) and Asian American Pacific Islanders (AOR 1.19, 95% CI 1.16, 1.22), had the highest odds of a TBI SCD award relative to non-Hispanic Whites.
In the unadjusted model examining monthly overall SCD compensation, a TBI award was associated with an additional $362 (95% CI 353,370) in compensation. Veterans on Tribal Lands (OR $-80 95% CI -157,-4) had significantly lower compensation relative to urban areas. Native Americans (OR $169 95% CI 153, 185) had the lowest additional SCD compensation relative to Non-Hispanic Whites, and other Non-Hispanic White race/ethnicities.

Conclusions: Native American Veterans and those living on Tribal Lands were disproportionately affected by observed disparities in TBI SCD award status and monthly compensation.

Author(s) Disclosures: We wish to acknowledge the inspiration and mentoring of Ralph G. DePalma, MD, FACS, In Memoria.
Work supported by U.S. Army Medical Research Acquisition Activity LIMBIC Award/W81XWH-18-PH/TBIRP-LIMBIC. Dr. Pugh supported by VA HSR&D Research Career Scientist Award (IK6HX003762). The views expressed do not represent the official policy or position of the Department of Defense, or Department of Veterans Affairs.