Title: Demographic profile and service-connection trends of posttraumatic stress disorder and traumatic brain injury in US veterans pre- and post-9/11

Abstract

Introduction: Changes in the nature of warfare hasaltered the health consequences among veterans. We planned to understand the demographic changes in the active-duty service member profile prior to and following September 11, 2001 (9/11).We analyzed the diagnosis of posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) as recorded in service-connection ratings (percent disability). Methods: A retrospective cohort-study of military veterans who received care at Veterans Health Administration medical centers between December 1998 and May 2014 using clinical data from the Corporate Data Warehouse. Results: A cohort of 1,339,937 veterans who received an inpatient/outpatient diagnosis of PTSD and/or TBIwas divided into 4 service period groups and 3 diagnosis categories. The service periods included pre-9/11 (n = 1,030,806; 77%), post-9/11 (n = 204,083; 15%), overlap-9/11 (n = 89,953; 7%), and re-entered post-9/11 (n = 15,095; 1%). The diagnosis categories included PTSD alone (n = 1,132,356; 85%), TBI alone (n = 100,789; 7%) and PTSD+TBI (n = 106,792; 8%). Results of the post-9/11 group revealed significant changes, including (1) increase of veterans with PTSD+TBI; (2) increase of female veterans with PTSD+TBI; and (3) increasedlevel of severity of diagnosed PTSD/ TBI evidenced by higher service-connected disability pensions at younger age in the post-9/11 group and; (4) unequal distribution of veterans with PTSD+TBI across geographic areas. Conclusions: The veteran of the post-9/11 period does not mirror the pre-9/11 period. Findings are valuable for policy making, allocating resources, and reconsidering the paradigm for treating veterans with these injuries recognising: (a) increasing number of veterans with PTSD, TBI and associated multisystem issues, (b) increasing number of female veterans, (c) increasing number of younger veterans with higher disability pensions (d) geographical areas with disproportionate numbers of veterans. Conflict of interest statement: The authors report no actual or potential conflicts of interest with regard to this article.

Biography

• Retired from VA after 32 years and 21 years of service in Army Reserve and 6 deployments. • Former Clinical Director of PTSD Program and Assistant Clinical Professorat VAMC. Former Medial Director of Restorative Brain Clinic. Passionate working with war veterans, service members with PTSD, TBI and deployment related behavioural health issues and teach people how to overcome adversities. • Dedicated life to mind body medicine and teach people preventive lifestyle changes to live long healthy lives. • Author of three books with latest book, “Innovative Holistic Approaches to PTSD and Life stress” based upon studies of hundreds of people who were resilient despite going through numerous traumatic events. • Recipient of “Legion of Merit,” award and “Order of Military Medical Merit”. • Iraq, Afghanistan War Veteran, worked in Germany, Japan and Guatemala as Army physician.