Racial disparities in VA service connection for posttraumatic stress disorder disability

Med Care. 2003 Apr;41(4):536-49. doi: 10.1097/01.MLR.0000053232.67079.A5.


Background: "Service connected" veterans are those with documented, compensative conditions related to or aggravated by military service, and they receive priority for enrollment into the Veterans Affairs (VA) health care system. For some veterans, service connection represents the difference between access to VA health care facilities and no access.

Objectives: To determine whether there are racial discrepancies in the granting of service connection for posttraumatic stress disorder (PTSD) by the Department of Veterans Affairs and, if so, to determine whether these discrepancies could be attributed to appropriate subject characteristics, such as differences in PTSD symptom severity or functional status.

Research design: Mailed survey linked to administrative data. Claims audits were conducted on 11% of the sample.

Setting and subjects: The study comprised 2700 men and 2700 women randomly selected from all veterans filing PTSD disability claims between January 1, 1994 and December 31, 1998.

Results: A total of 3337 veterans returned usable surveys, of which 17% were black. Only 16% of respondents carried private health insurance, and 44% reported incomes of 20,000 US dollars or less. After adjusting for respondents' sociodemographic characteristics, symptom severity, functional status, and trauma histories, black persons' rate of service connection for PTSD was 43% compared with 56% for other respondents (P = 0.003).

Conclusion: Black persons' rates of service connection for PTSD were substantially lower than other veterans even after adjusting for differences in PTSD severity and functional status.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Combat Disorders / epidemiology
  • Combat Disorders / ethnology
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Logistic Models
  • Male
  • Medical Audit
  • Middle Aged
  • Minority Groups / statistics & numerical data*
  • Poverty
  • Prejudice
  • Random Allocation
  • Rape / psychology
  • Rape / statistics & numerical data
  • Socioeconomic Factors
  • Stress Disorders, Post-Traumatic / economics*
  • Stress Disorders, Post-Traumatic / ethnology*
  • United States / epidemiology
  • United States Department of Veterans Affairs / statistics & numerical data*
  • Utilization Review
  • Veterans / classification
  • Veterans Disability Claims / statistics & numerical data*