Disability Compensation Research Articles

Veteran Affairs disability compensation: Likely the U.S.’s largest disability program, but what do we know about its impacts on service‐disabled veterans?

AbstractThe last few decades have seen rapid growth in the size of the Veterans Affairs Disability Compensation (VADC) program, which provides tax‐free cash benefits to veterans with disabilities connected to military service. Given this recent growth, VADC is on pace to eclipse Social Security Disability Insurance (SSDI) to become the largest U.S. disability program by expenditures. Although there are decades of causal research on the design and impacts of SSDI, there is no comparable body of evidence for VADC. In this Policy Insight, we discuss how causal evidence was produced for Social Security‐administered disability programs and why there is a lack of this evidence for VADC. Chief among the explanations is a lack of VADC data access available to the broader researcher community, access that Social Security facilitates for the programs it administers. However, even with this access, the proliferation of benefits and services targeted to service‐disabled veterans implies that existing earnings loss studies and causal estimates of the impact of VADC benefit receipt on any given outcome of interest likely are mismeasurements of true effects. We conclude with recommendations for restructuring approaches to research design to accurately estimate impacts of VADC benefits as well as the wide array of other programs supporting service‐disabled veterans.

An Approach to Reduce the Incidence of Submarine Medical Evacuations by Identifying Individual Risk Characteristics: Preliminary Findings.

Military medical evacuations (MEDEVACs) are resource intensive and can disrupt operations and decrease readiness. Medical evacuations are a concern for the submarine force because of the limited medical resources onboard, the impact of manpower loss on smaller crews, and the compromise of operational stealth. Although some medical emergencies cannot be avoided, some MEDEVACs may be preventable. However, there is limited knowledge of the underlying causes and risk factors associated with submarine MEDEVACs. This work describes an approach to identify individual characteristics associated with submarine MEDEVACs by presenting preliminary results and next steps. Identifying those most at risk for a MEDEVAC will foster prevention strategies that lead to fewer MEDEVACs, military operation disruptions, missed work and limited duty days, unplanned losses, early separations, and disability compensation claims among navy submariners. This retrospective study examines MEDEVACs from U.S. Navy submarines from January 1, 2012 to December 31, 2020. Medical evacuation causes were classified by 3 major diagnostic categories: Injury, psychiatric, and medical (i.e., all other non-injury medical events, including dental issues). Diagnostic subcategories were grouped by body region (for injuries) and body system (for non-injuries). Identifiable information from MEDEVAC records were linked to personnel files to capture demographic and occupational variables. Trends across the years were examined, and frequencies and percentages of MEDEVAC cases by both major and sub-diagnostic categories were presented. For cases where both the major diagnostic categories and characteristics were both available, we assessed associations between major diagnostic categories and demographic and occupational characteristics, using Pearson's χ2 test for proportions and Fisher Freeman-Halton exact tests. Pairwise z-tests for proportions were used to determine which proportions differed significantly. A total of 1,283 MEDEVACs were confirmed from 2012 to 2020, with an annual average of 143. Across the years, 24.3% were caused by psychiatric issues (e.g., suicidal ideation), 18.4% were caused by injuries (e.g., blunt trauma), and the remaining 57.3% were caused by other medical emergencies (e.g., gastrointestinal issues). Among the cases linked to personnel files, the major diagnostic category was associated with age, rank, department, and submarine qualification status (group size varied). By age (n = 973), large differences in MEDEVAC causes were seen among submariners 21 to 25 years old who represented 52.4% of psychiatric versus 37.5% of medical MEDEVACs. In contrast, those 35 and older represented 17.0% medical versus 2.7% psychiatric MEDEVACs. Medical, non-injury cases were the most common cause for a MEDEVAC. There were proportionately more psychiatric than medical cases among younger, less experienced submariners. Conversely, there were proportionately more medical than psychiatric cases among older submariners. A centralized approach to collecting MEDEVAC data is needed. This is the most comprehensive study examining risk factors associated with submarine MEDEVACs. Follow-on work will include adding prior medical waiver requests, health indicators, and confirmed diagnoses to the dataset to conduct a risk analysis. Considering submarines have smaller crews than most surface ships, limited medical assets, and often operate in austere environments, examination of submarine MEDEVACs should be distinct from other navy and military MEDEVACs.

Work-Related Musculoskeletal Disorders: A Systematic Review and Meta-Analysis.

Background: Musculoskeletal disorders (MSDs) involve muscles, nerves, tendons, joints, cartilage, and spinal discs. These conditions can be triggered by both the work environment and the type of work performed, factors that, in some cases, can also exacerbate pre-existing conditions. This systematic review aims to provide an overview of the impact that different work-related activities have on the musculoskeletal system. Methods: A global search of publications was conducted using the following international bibliographic web databases: PubMed and Web of Science. The search strategies combined terms for musculoskeletal disorders and workers. In addition, a meta-analysis was conducted to estimate the prevalence of MSDs within the healthcare sector. Results: A total of 10,805 non-duplicated articles were identified, and finally, 32 studies were reviewed in this article. Once the literature search was completed, occupational figures were categorized into healthcare, farming, industrial, and computer sectors. In the healthcare sector, the prevalence estimate for degenerative diseases of the lumbar spine was 21% (497 out of 2547 physicians and dentists) (95% CI, 17-26%), while for osteoarthritis of the hand, it was 37% (382 out of 1013 dentists) (95% CI, 23-51%). Conclusions: Musculoskeletal disorders significantly impair workers' quality of life, especially in healthcare sector. These conditions are also associated with high costs for employers, such as absenteeism, lost productivity, and increased costs for healthcare, disability, and workers' compensation.

Військові виплати: поняття та адміністративна проблематика воєнного часу

This article examines the system of military benefits in Ukraine, focusing on their structure, scope, and impact on military personnel and their families. In particular, the different types of military payments, such as salaries, allowances for special conditions of service, disability compensation and pensions, are examined. Changes in legislation on military benefits and their compliance with international standards are also analyzed. It emphasizes the importance of adequate financial support for the military to maintain their combat readiness and morale. A detailed analysis reveals what factors influence the level of military payments, including budgetary constraints, the economic situation in the country, and the army’s need for modern weapons and equipment. The article also examines the effectiveness of the system of payments in providing social protection to military personnel and their families, as well as the possibility of ensuring an adequate standard of living after retirement. Finally, the article concludes with a discussion of what improvements can be made to the military pay system to make military careers more attractive and ensure stability in the military. The article also analyzes the role of military payments in maintaining military discipline and motivation of personnel. In particular, the article discusses the timeliness and regularity of payments, their correspondence to the actual living expenses of the military, as well as the possibility of receiving additional incentives for length of service, military ranks or special tasks. Finally, the article highlights the prospects for further development of the military pay system in Ukraine and the importance of improving this system in order to ensure national security and defense capability. The article also addresses the urgent problem of social security for military personnel in the context of armed conflict. The author analyzes the current state of payments to military personnel, including salaries, additional remuneration and compensation. The main focus is on legislative changes that have taken place in recent years and their impact on the welfare of the military. Particular attention is paid to the analysis of recent legislative initiatives aimed at improving the social protection of military personnel. The provisions of the new laws and regulations governing payments, as well as their effectiveness and impact on the motivation of the military are examined in detail. The article also analyzes the problems of implementing these laws in practice, including bureaucratic obstacles and insufficient funding. The article concludes that the military pay system needs to be further improved, emphasizing the importance of timely and fair financial support for military personnel as one of the key factors in maintaining the army’s combat capability and morale. The author offers recommendations on possible areas for reforming the payment system, including the introduction of new mechanisms for controlling and ensuring transparency of financial flows. The article is important for researchers in the field of social policy, military experts, and those involved in the process of formulating and implementing state policy in the field of defense. It contributes to a deeper understanding of the problems and prospects for the development of the social security system for military personnel in Ukraine, which is an important aspect of ensuring national security and stability of the state.

Implications of Race Adjustment in Lung-Function Equations.

Adjustment for race is discouraged in lung-function testing, but the implications of adopting race-neutral equations have not been comprehensively quantified. We obtained longitudinal data from 369,077 participants in the National Health and Nutrition Examination Survey, U.K. Biobank, the Multi-Ethnic Study of Atherosclerosis, and the Organ Procurement and Transplantation Network. Using these data, we compared the race-based 2012 Global Lung Function Initiative (GLI-2012) equations with race-neutral equations introduced in 2022 (GLI-Global). Evaluated outcomes included national projections of clinical, occupational, and financial reclassifications; individual lung-allocation scores for transplantation priority; and concordance statistics (C statistics) for clinical prediction tasks. Among the 249 million persons in the United States between 6 and 79 years of age who are able to produce high-quality spirometric results, the use of GLI-Global equations may reclassify ventilatory impairment for 12.5 million persons, medical impairment ratings for 8.16 million, occupational eligibility for 2.28 million, grading of chronic obstructive pulmonary disease for 2.05 million, and military disability compensation for 413,000. These potential changes differed according to race; for example, classifications of nonobstructive ventilatory impairment may change dramatically, increasing 141% (95% confidence interval [CI], 113 to 169) among Black persons and decreasing 69% (95% CI, 63 to 74) among White persons. Annual disability payments may increase by more than $1 billion among Black veterans and decrease by $0.5 billion among White veterans. GLI-2012 and GLI-Global equations had similar discriminative accuracy with regard to respiratory symptoms, health care utilization, new-onset disease, death from any cause, death related to respiratory disease, and death among persons on a transplant waiting list, with differences in C statistics ranging from -0.008 to 0.011. The use of race-based and race-neutral equations generated similarly accurate predictions of respiratory outcomes but assigned different disease classifications, occupational eligibility, and disability compensation for millions of persons, with effects diverging according to race. (Funded by the National Heart Lung and Blood Institute and the National Institute of Environmental Health Sciences.).

Identifying factors associated with physical therapy use versus non-use among injured workers with back pain in Washington State.

There is little information about predictors of physical therapy (PT) use among injured workers with back pain. The primary objective of this study is to investigate the associations between PT use and baseline factors not routinely captured in workers' compensation (WC) data. We conducted a secondary analysis using the Washington State Workers' Compensation Disability Risk Identification Study Cohort, which combines self-reported surveys with claims data from the Washington State Department of Labor and Industries State Fund. Workers with an accepted or provisional WC claim for back injury between June 2002 and April 2004 were eligible. Baseline factors for PT use were selected from six domains (socio-demographic, pain and function, psychosocial, clinical, health behaviors, and employment-related). The outcome was a binary measure for PT use within 1 year of injury. Bivariate and multivariable logistic regression models were conducted to evaluate the associations between PT use and baseline factors. Among the 1370 eligible study participants, we identified 673 (49%) who received at least one PT service. Baseline factors from five of the six domains (all but health behaviors) were associated with PT use, including gender, income, pain and function measures, injury severity rating, catastrophizing, recovery expectations, fear avoidance, mental health score, body mass index, first provider seen for injury, previous injury, and several work-related factors. We identify baseline factors that are associated with PT use, which may be useful in addressing disparities in access to care for injured workers with back pain in a WC system.

Increased [18F]Fluorodeoxyglucose Uptake in the Left Pallidum in Military Veterans with Blast-Related Mild Traumatic Brain Injury: Potential as an Imaging Biomarker and Mediation with Executive Dysfunction and Cognitive Impairment.

Blast-related mild traumatic brain injury (blast-mTBI) can result in a spectrum of persistent symptoms leading to substantial functional impairment and reduced quality of life. Clinical evaluation and discernment from other conditions common to military service can be challenging and subject to patient recall bias and the limitations of available assessment measures. The need for objective biomarkers to facilitate accurate diagnosis, not just for symptom management and rehabilitation but for prognostication and disability compensation purposes is clear. Toward this end, we compared regional brain [18F]fluorodeoxyglucose-positron emission tomography ([18F]FDG-PET) intensity-scaled uptake measurements and motor, neuropsychological, and behavioral assessments in 79 combat Veterans with retrospectively recalled blast-mTBI with 41 control participants having no lifetime history of TBI. Using an agnostic and unbiased approach, we found significantly increased left pallidum [18F]FDG-uptake in Veterans with blast-mTBI versus control participants, p < 0.0001; q = 3.29 × 10-9 [Cohen's d, 1.38, 95% confidence interval (0.96, 1.79)]. The degree of left pallidum [18F]FDG-uptake correlated with the number of self-reported blast-mTBIs, r2 = 0.22; p < 0.0001. Greater [18F]FDG-uptake in the left pallidum provided excellent discrimination between Veterans with blast-mTBI and controls, with a receiver operator characteristic area under the curve of 0.859 (p < 0.0001) and likelihood ratio of 21.19 (threshold:SUVR ≥ 0.895). Deficits in executive function assessed using the Behavior Rating Inventory of Executive Function-Adult Global Executive Composite T-score were identified in Veterans with blast-mTBI compared with controls, p < 0.0001. Regression-based mediation analyses determined that in Veterans with blast-mTBI, increased [18F]FDG-uptake in the left pallidum-mediated executive function impairments, adjusted causal mediation estimate p = 0.021; total effect estimate, p = 0.039. Measures of working and prospective memory (Auditory Consonant Trigrams test and Memory for Intentions Test, respectively) were negatively correlated with left pallidum [18F]FDG-uptake, p < 0.0001, with mTBI as a covariate. Increased left pallidum [18F]FDG-uptake in Veterans with blast-mTBI compared with controls did not covary with dominant handedness or with motor activity assessed using the Unified Parkinson's Disease Rating Scale. Localized increased [18F]FDG-uptake in the left pallidum may reflect a compensatory response to functional deficits following blast-mTBI. Limited imaging resolution does not allow us to distinguish subregions of the pallidum; however, the significant correlation of our data with behavioral but not motor outcomes suggests involvement of the ventral pallidum, which is known to regulate motivation, behavior, and emotions through basal ganglia-thalamo-cortical circuits. Increased [18F]FDG-uptake in the left pallidum in blast-mTBI versus control participants was consistently identified using two different PET scanners, supporting the generalizability of this finding. Although confirmation of our results by single-subject-to-cohort analyses will be required before clinical deployment, this study provides proof of concept that [18F]FDG-PET bears promise as a readily available noninvasive biomarker for blast-mTBI. Further, our findings support a causative relationship between executive dysfunction and increased [18F]FDG-uptake in the left pallidum.

The US Department of Veterans Affairs: Disparities in Disability Compensation Approval Rates for ethnic minority Veterans, what is the Way Forward?

Introduction and Background: The U.S. Department of Veteran Affairs (VA) provides social services to eligible military veterans, including education, rehabilitation, healthcare, and compensation payments. However, the VA has faced challenges in administration management claims, with significant disparities in initial claim approval rates between racial and ethnic groups. Minority veterans, including African Americans, Asian Americans/Pacific Islanders, Hispanics, Native Americans/Alaska Natives, and Native Hawaiians, may qualify for numerous benefits. Briefly describe the research problem or question, providing context for the study. Objectives or Research Questions: How disparities in disability compensation approval rates among ethnic minority veterans compared to white veterans within the US Department of Veterans Affairs and mitigate strategies?" The study's main objective is to address disability compensation approval rate disparities for ethnic minority veterans by identifying causes, assessing impact, recommending solutions, ensuring equity, and monitoring progress. Methodology: The study analyzed disability compensation approval rates for minority veterans within the Department of Veterans Affairs (VA) using a quantitative research design. Data was collected from VA administrative records and databases. A representative sample of 100 claim applications was selected. Descriptive statistical analysis revealed significant disparities in approval rates, controlling for age and disability severity. Results: The study found that minority veterans had the lowest approval rate for disability claims, at 61%, compared to 75% for white veterans. Conclusion: The Department of Veteran Affairs (VA) has been criticized for racial disparities in disability compensation claims, with white veterans receiving the highest approval rates and African American veterans receiving the lowest. The VA's leadership's negligence and failure to address these disparities have led to systematic benefit obstruction for minority veterans. The study recommends enhancing training programs, implementing an equity action plan, and developing standardized guidelines for all veterans.

Treatment Approaches for Altered Facial Expression: A Systematic Review in Facioscapulohumeral Muscular Dystrophy and Other Neurological Diseases.

Facial weakness is a key feature of facioscapulohumeral muscular dystrophy (FSHD) and may lead to altered facial expression and subsequent psychosocial impairment. There is no cure and supportive treatments focus on optimizing physical fitness and compensation of functional disabilities. We hypothesize that symptomatic treatment options and psychosocial interventions for other neurological diseases with altered facial expression could be applicable to FSHD. Therefore, the aim of this review is to collect symptomatic treatment approaches that target facial muscle function and psychosocial interventions in various neurological diseases with altered facial expression in order to discuss the applicability to FSHD. A systematic search was performed. Selected studies had to include FSHD, Bell's palsy, Moebius syndrome, myotonic dystrophy type 1, or Parkinson's disease and treatment options which target altered facial expression. Data was extracted for study and patients' characteristics, outcome assessment tools, treatment, outcome of facial expression and or psychosocial functioning. Forty studies met the inclusion criteria, of which only three studies included FSHD patients exclusively. Most, twenty-one, studies were performed in patients with Bell's palsy. Studies included twelve different therapy categories and results were assessed with different outcomes measures. Five therapy categories were considered applicable to FSHD: training of (non-verbal) communication compensation strategies, speech training, physical therapy, conference attendance, and smile restoration surgery. Further research is needed to establish the effect of these therapies in FSHD. We recommend to include outcome measures in these studies that cover at least cosmetic, functional, communication, and quality of life domains.

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

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

Urologists have a duty to think about occupational urinary cancers

More than 11% of employees are exposed to carcinogens in the usual course of their work. The benefits of recognition as an occupational disease (OD) allow victims of work firstly to benefit from a disability compensation. But there are collective challenges. It is important to understand that accidents at work and recognised OD are not financially covered by health insurance, which is financed by everyone, but by a specific branch, known as “professional risks/occupational risks”, financed by employers alone. Being recognised as having an OD modifies the benefits: 100% coverage of all the costs inherent to the OD, including transport costs, increase of daily allowances, payment of a pension (or of a lump sum if the Permanent Incapacity rate is<10%). A survivor's pension may be paid to the beneficiaries in the event of the patient's death. OD “is presumed to be of occupational origin: any disease designated in a table of OD and contracted under the conditions set out in this table”. Although the declaration of OD must be made by the victim (or his dependents) to the national health insurance fund, it can only exist on condition that a doctor has drawn up a descriptive Initial Medical Certificate (IMC), taking care to use the exact terms of the tables (15 ter and 16 bis) and the professional/occupational origin.

Malingering assessment after severe traumatic brain injury in forensic psychology with a potential embedded symptom validity indicator of Symptom Checklist 90.

Malingering of neuropsychological damage is common among traumatic brain injury patients pursuing disability compensation in forensic contexts. There is an urgent need to explore differences in neuropsychological assessment outcomes with different levels of cooperation. A total of 420 participants with severe traumatic brain injury were classified into malingering group, partial cooperation group, and complete cooperation group according to the Binomial forced-choice digit memory test. The Wechsler Adult Intelligence Scale, event-related potential component, and Symptom Checklist 90 were applied subsequently to assess the psychological status of participants. Participants in the malingering group presented lower scores in the binomial forced-choice digit memory test and the Wechsler Adult Intelligence Scale, lower P3 amplitude, and simultaneously higher scores in the Symptom Checklist 90 than the other two groups. The actual intelligence quotient of participants with malingering tendencies ranged mostly between normal and marginal damage, and they often reported elevated whole scale scores in the Symptom Checklist 90. The Cooperation Index (defined as the ratio of positive symptom distress index to global severity index, CI) was proposed and validated to function as an embedded validity indicator of the Symptom Checklist 90, and the area under the receiver operating characteristic (ROC) curve was 0.938. When valued at 1.28, CI has the highest classification ability in differentiating malingering from non-malingering. Combined with the CI and P3 amplitude, the area under the ROC curve for malingering diagnosis further reached 0.952. Any non-optimal effort in a forensic context will lead to unexpected deviation in psychology evaluation results. CI is a potential candidate to act as an embedded validity indicator of the Symptom Checklist 90. The combination of CI and P3 amplitude can help to identify malingering in participants after severe traumatic brain injury.

Abstract WP249: Risk for Ischemic and Hemorrhagic Stroke is Increased in Veterans Exposed to Agent Orange and Those With Myeloproliferative Neoplasms

Agent Orange (AO) is a dioxin containing defoliant and carcinogen used in the Korean and Vietnam War. There is limited evidence of the association between AO exposure among Veterans and stroke. Stroke is not yet part of the list of presumptive conditions according to the Promise to Address Comprehensive Toxics (PACT) Act which provides Veterans and their survivors disability compensation for conditions arising from exposure to AO. Myeloproliferative Neoplasms (MPN) are uncommon etiologies of stroke but whether AO exposure increases incidence of stroke in MPN has not been described. Utilizing the Veterans Affairs Informatics and Computing Infrastructure (VINCI) database, a case-control study was performed from 1/1/2006 – 1/26/2023 on the Veterans from Illinois, the state most representative of the US population. ICD-9 and -10 codes identified Veterans with stroke and MPN. AO exposure was verified on the Veterans’ service duration and location. Qualitative data were compared by chi-square tests. Among 586,555 Veterans from Illinois, there were 15,455 ischemic stroke (IS), 1,593 hemorrhagic stroke (HS), 2,752 MPN, and 59,393 with AO exposure. Among MPNs, there were 237 IS (41 with AO) and 26 HS (3 with AO). IS and HS were associated with AO exposure, OR 1.34 95% CI 1.28-1.41, p&lt;0.0001, and OR 1.20 95% CI 1.03-1.39, p=0.02, respectively. MPN is associated with IS and HS, OR 3.52, 95% CI 3.08-4.03, and OR 3.54, 95% CI 2.4-5.23, both p&lt;0.0001, respectively. There is no significant association with AO exposure among Veterans with MPN with stroke. Among non-MPN Veterans with AO exposure, there was an earlier median age of IS and HS, 67 vs. 70 and 67 vs. 71, both p&lt;0.0001. There was no difference in median age of stroke among MPN Veterans with or without AO exposure. There were no differences with rates of hypertension, hyperlipidemia, diabetes, smoking, heart failure, and pulmonary hypertension among MPN Veterans with stroke with and without AO exposure. In conclusion, there is an association of AO exposure with IS and HS with an earlier onset among those exposed. There is a strong association between MPN and stroke independent of AO exposure. The biologic plausibility of endothelial dysfunction and accelerated atherosclerosis from AO exposure warrants further investigation.

New assessment recommendations for disability in private accident insurance, part4 : An interdisciplinary consensus approach-Disability outside the compensation scheme

The following article is an element of a4-part series on the presentation and discussion of new design recommendations for disability compensation in the private accident insurance. The introduction to the topic and the associated basics as well as the concept of the new draft of the design recommendations for the upper and lower extremities have already been published in Die Unfallchirurgie (formerly Der Unfallchirurg) on 17 February, 18 July and 18 November 2022 [2-4]. The topic of the fourth and final part published here is the assessment recommendations for disability outside the compensation scheme.

The human-elephant conflict in Sri Lanka: history and present status

AbstractHuman-elephant conflict (HEC) is a severe conservation, socio-economic and environmental issue of forests and ecosystems in elephant inhabiting countries, including Sri Lanka. Due to the rapid growth of human and elephant populations, both struggles to share limited land resources. The major causes and contexts of HEC in Sri Lanka include land use change, habitat loss due to human population growth, crop raiding behavior, problem elephants, and changes in agriculture practices. Since 2019, 125 people and 370 elephants have killed annually on average due to the conflict. Also, Sri Lanka has recorded the highest annual elephant deaths and second-highest human deaths due to HEC. The human death rate has increased by approximately 42% over previous three decades. The Sri Lankan government provides compensation for death and disability of the human caused by elephants and for elephant-damaged houses or properties. The Sri Lankan elephant (Elephas maximus maximus) is an endangered subspecies. It’s home range is restricted to 50–150 km2and depends on the availability of food, water, and shelter of the habitat in which they live. Various management strategies have been developed by the government and villagers to prevent and mitigate HEC. Today, Sri Lankan elephants are protected under Sri Lankan law, with punishment by fines and jail terms. This article reviews the history, present status, and traditional conflict management of HEC in Sri Lanka. We suggest a satellite data fusion approach with GIS modeling to identify risk zones of HEC to develop further protective measures for humans and elephants.

The optimization of zakat funds distribution in Aceh in improving the welfare of the disable

Objectives – The purpose of this study was to determine the optimal level and implementation of the zakat fund distribution program for the Disabled within the perspective of improving the well-being of mustahik.&#x0D; Method – The descriptive qualitative research design is used in this study. In this study, there were five informants, two of whom were key figures. The primary and secondary data sources used in this study were observation, interviews, and documentation.&#x0D; Findings – The study's findings indicate that the distribution of zakat funds for disability has not been carried out optimally, and the funds are channeled through two program criteria, namely moderate disability and severe disability, and have not had a significant impact on improving the welfare of mustahik. Mustahik wishes for more programs, such as those that provide business capital to people with disabilities.&#x0D; Limitation– study only focused on Zakat Fund Compensation Program for the Disabled provided by Baitul Mal Aceh Tamiang regency.&#x0D; Practical Implication– This study demonstrates the need for additional disability compensation programs in Baitul Mal, Aceh Tamiang Regency, such as providing business capital to disabled people so that they can feel prosperous.&#x0D;

A Longitudinal Investigation of the Impact of COVID-19 on Patients With Chronic Pain

The COVID-19 pandemic prompted unexpected changes in the healthcare system. This current longitudinal study had 2 aims: 1) describe the trajectory of pandemic-associated stressors and patient-reported health outcomes among patients receiving treatment at a tertiary pain clinic over 2 years (May 2020 to June 2022); and 2) identify vulnerable subgroups. We assessed changes in pandemic-associated stressors and patient-reported health outcome measures. The study sample included 1270 adult patients who were predominantly female (74.6%), White (66.2%), non-Hispanic (80.6%), married (66.1%), not on disability (71.2%), college-educated (59.45%), and not currently working (57.9%). We conducted linear mixed effect modeling to examine the main effect of time with controlling for a random intercept. Findings revealed a significant main effect of time for all pandemic-associated stressors except financial impact. Over time, patients reported increased proximity to COVID-19, but decreased pandemic-associated stressors. A significant improvement was also observed in pain intensity, pain catastrophizing, and PROMIS-pain interference, sleep, anxiety, anger, and depression scores. Demographic-based subgroup analyses for pandemic-associated stressors revealed that younger adults, Hispanics, Asians, and patients receiving disability compensation were vulnerable groups either during the initial visit or follow-up visits. We observed additional differential pandemic effects between groups based on participant sex, education level, and working status. In conclusion, despite unanticipated changes in pain care services during the pandemic, patients receiving pain treatments adjusted to pandemic-related stressors and improved their health status over time. As the current study observed differential pandemic impacts on patient subgroups, future studies should investigate and address the unmet needs of vulnerable subgroups. PerspectiveOver a 2-year timeframe, the pandemic did not adversely influence physical and mental health among treatment-seeking patients with chronic pain. Patients reported small but significant improvements across indices of physical and psychosocial health. Differential impacts emerged among groups based on ethnicity, age, disability status, gender, education level, and working status.

Comparison of stratification techniques for optimal management of patients with chronic low back pain in spine clinics

Identifying optimal stratification techniques for subgrouping patients with low back pain (LBP) into treatment groups for the purpose of identifying optimal management and improving clinical outcomes is an important area for further research. Our study aimed to compare performance of the STarT Back Tool (SBT) and three stratification techniques involving PROMIS domain scores for use in patients presenting to a spine clinic for chronic LBP. Retrospective cohort study. Adult patients with chronic LBP seen in a spine center between 11/14/18-5/14/19 who completed patient-reported outcomes (PROs) as part of routine care, and were followed up with completed PROs 1-year later. Four stratification techniques, including SBT, and 3 PROMIS-based techniques: the NIH Task Force recommended Impact Stratification Score (ISS), symptom clusters based on latent class analysis (LCA), and SPADE symptom clusters. The four stratification techniques were compared according to criterion validity, construct validity, and prognostic utility. For criterion validity, overlap in characterization of mild, moderate, and severe subgroups were compared to SBT, which was considered the gold standard, using quadratic weighted kappa statistic. Construct validity compared techniques' ability to differentiate across disability groups defined by modified Oswestry LBP Disability Questionnaire (MDQ), median days in the past month unable to complete activities of daily living (ADLs), and worker's compensation using standardized mean differences (SMD). Prognostic utility was compared based on the techniques' ability to predict long-term improvement in outcomes, defined as improvement in global health and MDQ at 1-year. There were 2246 adult patients with chronic LBP included in our study (mean age 61.0 (SD 14.0), 55.0% female, 83.4% white). All stratification techniques resulted in roughly a third of patients grouped into mild, moderate, and severe categories, with ISS and LCA demonstrating substantial agreement with SBT, while SPADE had moderate agreement. Construct validity was met for all techniques, with large effects demonstrated between mild and severe categories for differentiating MDQ, ADLs, and worker's compensation disability groups (SMD range 0.57-2.48). All stratification techniques demonstrated ability to detect improvement by 1-year, with severe groups experiencing the greatest improvement in multivariable logistic regression models. All four stratification techniques demonstrated validity and prognostic utility for subgrouping patients with chronic LBP based on risk of long-term disability. ISS and LCA symptom clusters may be the optimal methods given the improved feasibility of including only a few relevant PROMIS domains. Future research should investigate multidisciplinary treatment approaches to target mild, moderate, and severe patients based on these techniques.

Racial, Ethnic, and Rural Disparities in U.S. Veteran COVID-19 Vaccine Rates

Race, ethnicity, and rurality-related disparities in coronavirus disease 2019 (COVID-19) vaccine uptake have been documented in the United States (US). We determined whether these disparities existed among patients at the Department of Veterans Affairs (VA), the largest healthcare system in the US. Using VA Corporate Data Warehouse data, we included 5,871,438 patients (9.4% women) with at least one primary care visit in 2019 in a retrospective cohort study. Each patient was assigned a single race/ethnicity, which were mutually exclusive, self-reported categories. Rurality was based on 2019 home address at the zip code level. Our primary outcome was time-to-first COVID-19 vaccination between December 15, 2020-June 15, 2021. Additional covariates included age (in years), sex, geographic region (North Atlantic, Midwest, Southeast, Pacific, Continental), smoking status (current, former, never), Charlson Comorbidity Index (based on ≥1 inpatient or two outpatient ICD codes), service connection (any/none, using standardized VA-cutoffs for disability compensation), and influenza vaccination in 2019-2020 (yes/no). Compared with unvaccinated patients, those vaccinated (n=3,238,532; 55.2%) were older (mean age in years vaccinated=66.3, (standard deviation=14.4) vs. unvaccinated=57.7, (18.0), p<.0001)). They were more likely to identify as Black (18.2% vs. 16.1%, p<.0001), Hispanic (7.0% vs. 6.6% p<.0001), or Asian American/Pacific Islander (AA/PI) (2.0% vs. 1.7%, P<.0001). In addition, they were more likely to reside in urban settings (68.0% vs. 62.8, p<.0001). Relative to non-Hispanic White urban Veterans, the reference group for race/ethnicity-urban/rural hazard ratios reported, all urban race/ethnicity groups were associated with increased likelihood for vaccination except American Indian/Alaskan Native (AI/AN) groups. Urban Black groups were 12% more likely (Hazard Ratio (HR)=1.12 [CI 1.12-1.13]) and rural Black groups were 6% more likely to receive a first vaccination (HR=1.06 [1.05-1.06]) relative to white urban groups. Urban Hispanic, AA/PI and Mixed groups were more likely to receive vaccination while rural members of these groups were less likely (Hispanic: Urban HR=1.17 [1.16-1.18], Rural HR=0.98 [0.97-0.99]; AA/PI: Urban HR=1.22 [1.21-1.23], Rural HR=0.86 [0.84-0.88]). Rural White Veterans were 21% less likely to receive an initial vaccine compared with urban White Veterans (HR=0.79 [0.78-0.79]). AI/AN groups were less likely to receive vaccination regardless of rurality: Urban HR=0.93 [0.91-0.95]; AI/AN-Rural HR=0.76 [0.74-0.78]. Urban Black, Hispanic, and AA/PI Veterans were more likely than their urban White counterparts to receive a first vaccination; all rural race/ethnicity groups except Black patients had lower likelihood for vaccination compared with urban White patients. A better understanding of disparities and rural outreach will inform equitable vaccine distribution.

A Sojourn to the Shores of Justice: Navigating the Labyrinth of DBA Investigations to Protect the Mysteries of Returnees from Low-Income Countries: A Case Study of Uganda

This documentary investigation exposes mistreatment and exploitation of Ugandan contractors injured while supporting U.S. military operations in Iraq and Afghanistan. Under the Defense Base Act (DBA), these workers were entitled to medical benefits and disability compensation if wounded overseas. However, complex bureaucracies and bias against foreign claimants led to systemic denial of their rights. Through legal document analysis, interviews with claimants and experts, and an immersive case study, consistent evidence emerges of local agents extorting funds, opaque processes delaying awards, discriminatory compensation compared to Western contractors, and lack of recourse. The Ugandan government failed to exercise oversight or advocate for citizens entangled in this biased system, allowing rampant abuse and theft by local agents. Thousands of Ugandan families were left devastated, sacrificed in service of American wars abroad without their own government's protection. This study gives voice to an invisible population robbed of dignity and justice after being injured in America's War on Terror. It compels radical reforms guided by empathy to uphold the moral promises owed to marginalized workers endangered in foreign battlefields. This documentary will raise awareness through poignant storytelling and irrefutable facts, engaging both hearts and minds to transform a broken system into one centered on human rights and redemption.