Epidemiology of asthma-related disability in the U.S. Armed Forces: 2007-2012.

OBJECTIVE: To characterize the demographic, disability and deployment characteristics of U.S. Armed Forces personnel with an asthma-related disability discharge, which includes separation (without benefits) and retirement (with disability benefits). METHODS: Incidence rates for personnel evaluated for disability discharge and/or disability retired due to asthma and due to all other causes of disability discharge were calculated per 100,000 active duty enlisted service members by year. Multivariate logistical regression was used to examine the associations between disability retirement and several demographic and disability characteristics of service members evaluated for asthma-related disability discharge versus those evaluated for any other non-respiratory condition for each branch of military service. RESULTS: Service members evaluated for disability discharge related to asthma most often do not have comorbidity and are disability retired rather than separated, with rates of disability retirement increasing over time. Groups with a significantly higher incidence of evaluation for asthma-related disability include females, individuals who entered the military prior to the age of 20, non-Whites, and those with a history of deployment to Iraq or Afghanistan. The characteristic most associated with the odds of disability retirement was a history of deployment. CONCLUSIONS: New-onset asthma occurring after military entry often causes occupational impairment in service members, especially in those that have been deployed to Iraq or Afghanistan.

Risk factors for disability discharge in enlisted active duty Army soldiers.

BACKGROUND: The rate of permanent disability retirement in U.S. Army soldiers and the prevalence of combat-related disabilities have significantly increased over time. Prior research on risk factors associated with disability retirement included soldiers retired prior to conflicts in Iraq and Afghanistan. OBJECTIVE: To identify risk factors for disability discharge among soldiers enlisted in the U.S. Army during military operations in Iraq and Afghanistan. METHODS: In this case-control study, cases included active duty soldiers evaluated for disability discharge. Controls, randomly selected from soldiers with no history of disability evaluation, were matched to cases based on enlistment year and sex. Conditional logistic regression models calculated odds of disability discharge. Attributable fractions estimated burden of disability for specific pre-existing condition categories. Poisson regression models compared risk of disability discharge related to common disability types by deployment and combat status. RESULTS: Characteristics at military enlistment with increased odds of disability discharge included a pre-existing condition, increased age or body mass index, white race, and being divorced. Musculoskeletal conditions and overweight contributed the largest proportion of disabilities. Deployment was protective against disability discharge or receiving a musculoskeletal-related disability, but significantly increased the risk of disability related to a psychiatric or neurological condition. CONCLUSIONS: Soldiers with a pre-existing condition at enlistment, particularly a musculoskeletal condition, had increased odds of disability discharge. Risk of disability was dependent on condition category when stratified by deployment and combat status. Additional research examining conditions during pre-disability hospitalizations could provide insight on specific conditions that commonly lead to disability discharge.

Epidemiology of psychiatric disability without posttraumatic stress disorder among U.S. Army and Marine Corps personnel evaluated for disability discharge.

Psychiatric disorders are a common reason for disability discharge from the U.S. military. Research on psychiatric disorders in military personnel evaluated for disability discharge has historically focused on posttraumatic stress disorder (PTSD), yet 40% of service members evaluated for a psychiatric-related disability do not have PTSD. This study's objective was to describe characteristics and correlates of disability in Army and Marine Corps personnel diagnosed with psychiatric disorders other than PTSD. In this cross-sectional study, the chi-square and Wilcoxon-Mann-Whitney tests compared the distribution of demographic, disability and deployment characteristics between those evaluated for non-PTSD psychiatric disability (N = 9125) versus those evaluated for any other non-psychiatric condition (N = 78,072). Multivariate logistic regression examined associations between disability retirement and demographic and disability characteristics. Results show a significantly higher prevalence of disability retirement, deployment, and comorbidity among Army and Marine Corps personnel evaluated for disability discharge related to a non-PTSD psychiatric disorder. Mood disorders, anxiety disorders and dementia were the most commonly evaluated psychiatric disorders. Characteristics associated with increased odds of non-PTSD psychiatric-related disability retirement includes being in the Marine Corps (OR = 1.24), being black (OR = 1.29) or other race (OR = 1.33), having a combat-related condition (OR = 2.50), and older age. Service members evaluated for a non-PTSD psychiatric disability have similar rates of disability retirement as those evaluated for PTSD, suggesting non-PTSD psychiatric disorders cause a severe and highly compensated disability. Additional research is needed describing the epidemiology of specific non-PTSD psychiatric disorders, such as depression, in service members evaluated for disability discharge.

Risk factors for back-related disability in the US Army and Marine Corps.

STUDY DESIGN: Matched case-control epidemiological study. OBJECTIVE: To identify pre-enlistment, demographic, and service-related risk factors for back-related disability in enlisted US soldiers and Marines comparing those who were deployed with those who did not deploy during the service term. SUMMARY OF BACKGROUND DATA: Back conditions are a major cause of morbidity and lost work days in both the US working population and military. Back-related conditions are among the most prevalent causes of military disability discharge but little research has been conducted to identify risk factors for back-related disabilities in this population. METHODS: Cases included enlisted Army and Marine Corps service members evaluated for back-related disability. Controls, frequency matched by year of military entrance and service, were selected from the enlisted service member population. Pre-enlistment demographic and medical characteristics, deployment, and ambulatory care data collected from existing military databases were used. Crude and adjusted odds of back-related disability were modeled using conditional logistic regression. RESULTS: In adjusted models, service members who were overweight (odds ratio [OR]: 1.17; 95% confidence interval [95% CI]: 1.12-1.23) and obese (OR: 1.35; 95% CI: 1.26-1.44), between ages 25 and 29 years (OR: 1.23; 95% CI: 1.16-1.31), or 30 years or older (OR: 1.43; 95% CI: 1.34-1.52) at military entrance were at increased odds of a back-related disability. History of a back diagnosis at the pre-enlistment medical examination (OR: 1.94; 95% CI: 1.50-2.50) and deploying once (OR: 1.09; 95% CI: 1.05-1.14) were also associated with increased odds of a back-related disability. CONCLUSION: Enlisted soldiers and marines with back-related disabilities were more likely to be older, have a higher body mass index, have a history of pre-enlistment back conditions, and were deployed once, compared with controls without a back-related disability. Additional research is necessary to further examine the complex relationship between deployment to combat zones, onset of musculoskeletal symptoms, and back-related disability in soldiers and marines. LEVEL OF EVIDENCE: 4.

Trends in the epidemiology of disability related to traumatic brain injury in the US Army and Marine Corps: 2005 to 2010.

BACKGROUND: Traumatic brain injury (TBI) has been recognized as a major public health issue for several decades. Despite technological advancements in protective equipment and medical care available during recent military conflicts, TBI is the most common neurological condition among Soldiers and Marines evaluated for discharge from service. This study describes the demographic, service-related, and disability characteristics of Soldiers and Marines referred for combat-related TBI disability evaluation. METHODS: Cross-sectional analysis of Soldiers and Marines evaluated for combat-related disability between October 1, 2004 and September 30, 2010 was performed. Traumatic brain injury cases were identified using the Veterans Affairs Schedule for Rating Disabilities code for TBI and compared with other combat-related disabilities. RESULTS: Combat-related TBI disability rates have significantly increased in both the Army and the Marine Corps since 2005. Significantly more unfitting conditions are present on average in combat-related TBI cases than in other combat-related disability cases. Combat-related TBI disability cases are more likely to be medically retired than other types of combat-related disability. CONCLUSIONS: Because veterans with combat-related TBI disabilities are likely to require chronic care for TBI-associated medical conditions, disability evaluation policy and programs must ensure that combat-related TBI disabilities are accurately identified and compensated, and the potential long-term care needs are addressed.

Military occupation and deployment: descriptive epidemiology of active duty U.S. Army men evaluated for a disability discharge.

OBJECTIVE: Physically demanding jobs and history of deployment put Soldiers at increased risk for injury, hospitalizations, and disability. Characterizing differences in disability outcomes by occupation and deployment history may identify specific military populations for targeted prevention and intervention programs as well as potential areas of future research. METHODS: A cross-sectional analysis was conducted on U.S. Army enlisted men evaluated in the Department of Defense's Disability Evaluation System (DES) between fiscal years 2005 and 2011, comparing those assigned a Combat Arms military occupational specialty (MOS) to individuals with any other MOS (Other). RESULTS: Among deployed Soldiers, those with Combat Arms MOS were substantially and significantly more likely to receive medical disability retirement than Other MOS and were more likely to be evaluated for conditions compatible with combat exposures, including post-traumatic stress disorder, residuals of traumatic brain injury, and paralysis. Among nondeployed Soldiers, Combat Arms MOS were only slightly more likely to receive medical disability than Other MOS, and no substantial differences in medical conditions were noted between the two MOS groups. CONCLUSIONS: Combat Arms MOS is a significant risk factor for disability retirement primarily among deployed men. Further research is needed to identify specific military occupations most at risk for disability retirement.

Temporary disability retirement cases: variations in time to final disposition and disability rating by service and medical condition.

OBJECTIVE: Service members undergoing disability evaluation are placed on the temporary disability retirement list (TDRL) when their disabling medical condition(s) may change in severity over time. Information is sparse on the epidemiology of the TDRL population and factors influencing time spent on the TDRL or changes in compensation ratings before final disability outcome. METHODS: A cross-sectional study was conducted on U.S. Army, Navy, and Marine Corps personnel placed on the TDRL between fiscal years 2005 to 2009. RESULTS: Approximately 85% of cases were finalized at first re-evaluation and more than 75% were permanently retired. Overall, about 50% of cases retained the same disability rating throughout the process. Cases with medical conditions within two or more body systems were more likely to be permanently retired and receive a change in disability rating than those with medical condition(s) within a single body system. CONCLUSIONS: Most cases retained the same disability rating and were permanently retired by the first re-evaluation. Important areas of future research include cost-benefit analyses to determine if length of time currently allowable on the TDRL can be shortened or if repeated evaluations are necessary and exploration of specific medical conditions likely to change in severity over time.