Disability Compensation Research Articles

Disability benefits as an incentive for hysterectomy: Uterine fibroid patients in Taiwan

ABSTRACTWorker compensation insurance in Taiwan ensures that a woman under the age of 45 years who has her uterus removed can receive disability compensation benefits. The present study investigated whether such a compensation policy was related to a woman’s inclination to have a hysterectomy. We extracted the records of 16,030 women diagnosed with uterine fibroids (UF) between 2000 and 2010 from the Longitudinal Taiwan Health Insurance Database. Each younger and older age group had a significantly lower hysterectomy rate compared to that of the 44-year-old age group. Moreover, significantly more patients with lower monthly wages had had hysterectomies than those with higher monthly wages. Policy makers should be aware that worker compensation regulations in Taiwan might encourage women with economic need to undergo hysterectomy surgery when approaching the age of 45 years.

Son of Sam, Service-Connected Entitlements, and Disabled Veteran Prisoners

American veterans have been over-represented in the United States carceral system since at least the Vietnam War era. Prior to 1980, veterans who were wounded in the line of duty were entitled to hard-earned, service-connected disability benefits regardless of post-service involvement in the civilian criminal justice system. In 1979, the American media began running sensationalized stories detailing alleged abuse of the Social Security Disability Insurance (SSDI) program by notorious prisoners, including New York “Son of Sam” mass murderer, David Berkowitz. In response to the outcry over these well-publicized accounts of prisoner SSDI abuse, Congress enacted a law, 38 U.S.C. § 5313, that stripped certain veteran prisoners of their service-connected disability benefits. This Article argues that the federal law that strips disabled, justice-involved veterans of their service-connected benefits as the result of non-service-connected misconduct should be repealed. Section 5313 is unjust, unwarranted, and unproductive, for at least five reasons. First, Congress enacted the statute to realize federal cost savings at the expense of a politically and socially vulnerable population: disabled, justice-involved veterans. Second, the statute is grounded in faulty logic and a fundamental misunderstanding of the nature and purpose of the Department of Veterans Affairs (VA) disability compensation program. Third, Congress stripped disabled, justice-involved veterans of their service-connected disability benefits largely as a result of its erroneous conflation of VA disability compensation and SSDI benefits. Fourth, Section 5313 fails to take into account the evidence-based nexus between military service trauma and post-service mental health issues and related criminal behavior. Finally, revoking service-connected disability benefits impedes justice-involved veteran rehabilitation, reentry, and readjustment.

Tinnitus Disability Compensation: Focusing on Tinnitus Disorder Caused by Military Noise in Veterans

이명은 외부의 음원으로부터의 자극 없이 소리를 느끼는 상 태, 혹은 신체 내부에서 들리는 원하지 않는 청각적 자극이다. 이명은 실제 소리가 나지 않음에도 불구하고 소리가 들리는 것 을 호소하는 일종의 증상이다. 이명은 난청, 현기증과 더불어 중요한 청각 증상의 하나이다. 산업의 발달로 인한 소음 증가, 노령화 추세, 복잡한 생활과 약물남용 등 이명의 유발인자는 증 가하는 추세에 있다. 이명은 생명에 위협적이거나 다른 질병을 유발하는 위험한 장애는 아니지만, 이명으로 인해 나타나는 집 중력 장애, 수면장애, 불안 및 우울증 등과 같은 복잡한 현상들 이 이명 환자의 삶의 질에 부정적인 영향을 가져온다(Erlandsson et al., 1991; Tyler & Baker, 1983). 이명은 개인의 청력장애 를 포함한 신체적 장애와 더불어 감정, 삶의 형태 등과 같은 일 상생활 전반에 걸쳐 장애를 초래하는 다면적인 현상으로, 이명 자의 0.5~1%는 일상생활을 하는 데에 심각한 지장을 받는다 (Erlandsson & Hallberg, 2000).

Impacts of the 2010 VA PTSD Rule Change on Veterans’ Disability Compensation and Reported Cognitive Disability

In July 2010, the Department of Veterans Affairs (VA) simplified the process of obtaining veterans’ disability compensation (DC) for veterans with posttraumatic stress disorder (PTSD) who served in...

A Comparative Analysis of VHA, Non-VHA, and Overall Outpatient Treatment Use Intensity Among Older U.S. Veterans Denied or Awarded VA Service-Connected Disability Compensation

Poorer health is often associated with greater healthcare use among the general population. In contrast, while many veterans denied VA disability compensation ("denied applicants") are as impaired as those awarded VA disability compensation ("awarded applicants"), studies suggest that these veterans may nevertheless utilize less VHA healthcare. Whether they concurrently utilize less non-VHA, and overall healthcare, however, remains a critical, unresolved issue. The 2001 National Survey of Veterans was used to examine VHA, non-VHA, and overall outpatient healthcare treatment use intensity during the previous 12 months among veterans denied or awarded VA disability compensation. Results: Denied applicants were significantly more likely than those awarded to have not used any VHA outpatient healthcare during the previous 12 months (OR=2.45, 95% CI: 1.24, 4.81). Moreover, while not statistically significant, point estimates consistently suggested that denied may have concurrently used more non-VHA, and overall outpatient healthcare than awarded. It appears veterans denied VA disability compensation are forgoing VHA outpatient healthcare services, perhaps in favor of non-VHA outpatient healthcare services. While this result may be consistent with the intent of VA service-connected disability policy, further analysis is necessary to confirm adequate access to healthcare for denied veterans.

Deserving Veterans' Disability Compensation: A Qualitative Study of Veterans' Perceptions.

Veterans recently returned from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) experience many health and mental health problems after deployment. These OEF/OIF veterans are applying and appealing for veterans' disability compensation (VDC) at rapidly increasing rates, often for "invisible conditions" such as posttraumatic stress disorder. Little is known about how veterans experience the process of applying and receiving VDC. In-depth qualitative interviews were conducted with OEF/OIF veterans ages 35 and younger (N=18). This article addresses how veterans perceive themselves, and other veterans, of being deserving and undeserving of VDC. Veterans' rationales can be categorized into four primary areas: (1) risking and suffering, (2) the cause of the condition, (3) intentions to become self-sufficient, and (4) putting VDC to "good use."

Interminable Parade Rest: The Impossibility of Establishing Service Connection in Veterans Disability Compensation Claims when Records Are Lost, Destroyed, or Otherwise Unavailable

Problems with the Department of Veterans Affairs (VA) have been widely reported in the news and have perhaps contributed to the growth of law school veterans clinics and veterans law scholarship. By statute, veterans are eligible for disability compensation benefits for illness or injury connected to the veteran’s service in the armed forces. The process of seeking benefits is intended to be non-adversarial requiring VA to assist veterans in developing their claims. Unfortunately, VA’s nagging problems including poor management and a lack of accountability produce well-documented and devastatingly negative effects on veterans. These effects are not limited to veterans receiving disability benefits, but extends to veterans who never make it past the claim stage because their claims are denied. Typically, service medical records are used to establish service-connection. When those records are unobtainable, there are alternative sources of medical or lay evidence that can be used to establish service-connection. However, when service medical records are lost or destroyed and there is no other contemporaneous medical evidence, the veteran likely suffers an absolute bar to receiving a favorable decision about service-connection. Any decision made without service medical records is necessarily based on a lack of evidence rather than an evaluation of the evidence. My article responds to this problem by proposing administrative, statutory, and judicial remedies to give the veteran a presumption of service-connection. This presumption would require the veteran to provide two forms of alternative evidence, including the veteran’s own statements, to support service-connection. The government would then have the opportunity to rebut the presumption by proving impossibility of the existence of the event, injury, or disease.

Psychological, social, and mechanical work exposures and disability retirement: a prospective registry study

BackgroundRelations between several occupational psychological and social factors and disability retirement remain largely unexplored. Knowledge of which specific aspects of the work environment that affect risk of disability is a prerequisite for the success of organizational interventions aiming to prevent premature work force exit. The objective of the present study was to determine contributions to registered disability retirement by a broad range of psychological and social work exposures while taking into account effects of mechanical exposure.MethodsWritten consent was obtained from 13 012 employees (96 organizations) representing a wide range of occupations, to link their survey responses to data from the Norwegian national registry of disability compensation. Median follow-up time was 5.8 years. To determine effects of self-reported work exposures on risk of disability retirement hazard ratios (HR) and 99% confidence intervals (99% CI) were calculated with Cox regression analysis. Effects of sex, age group, skill level, sickness absence in the last three years, and work exposures estimated to be confounders were accounted for. Post hoc stratification by sex was conducted to explore if identified predictors affected risk of disability retirement differently in men compared to women.ResultsContributors to higher risk of disability retirement were “role conflict” (high level HR 1.55 99% CI 1.07 to 2.24) and “physical workload” (high level HR 1.93 99% CI 1.39 to 2.68). Contributors to lower risk of disability retirement were “positive challenge” (high level HR 0.56 99% CI 0.34 to 0.93), “fair leadership” (high level HR 0.56 99% CI 0.39 to 0.81), and “control over work intensity” (high level HR 0.62, 99% CI 0.47 to 0.82). Direction of effects was not dependent on sex in any of the five identified predictors.ConclusionsSeveral specific psychological and social work factors are independent contributors to risk of disability retirement. In order to prevent premature work force exit workplace interventions should consider targeting the predictors identified by the present study.

Comparability of health service use by veterans with multisymptom illness and those with chronic diseases.

To compare health service utilization and disability claims among military personnel with multisymptom illness (MSI) (but no chronic diseases), those with chronic disease(s) and those without MSI or chronic diseases. MSI is also known as Gulf War illness. Cohort study. Australia. In total, 1288 participants of a Gulf War veterans' study conducted in 2000-2003 (Wave-1) were followed up in 2011-2012 (Wave-2), aged on average 40 years. About 160 had MSI, 217 had chronic disease(s) and 911 had neither chronic disease(s) nor MSI. At Wave-2, the cohort was linked to the national Medicare and Department of Veterans' Affairs (DVA) databases to obtain health service utilization and disability claims data recorded between 2001 and 2012. The likelihood of visiting a general practitioner (GP) (risk ratio [RR] = 1.04, 95% confidence interval [CI] = 0.92, 1.19) or visiting a specialist medical doctor (RR= 0.83; 95% CI= 0.54, 1.28) or hospitalizations (RR = 0.89; 95% CI = 0.61, 1.29) or) in the 12 months preceding Wave-2 or successfully claiming for DVA disability compensation (RR = 1.13; 95% CI = 0.86, 1.47) was similar for personnel with MSI and those with chronic disease(s). However, GP consultations, hospitalizations, specialist doctor consultations and disability claims were significantly higher among those with MSI than those without MSI/chronic diseases. Health service use and disability claims by personnel with MSI were comparable to those with chronic disease(s), but were in excess of those without MSI/chronic diseases. Hence recognition of the high health service use by personnel with MSI is important to ensure adequate provision of health services.

The Health and Social Isolation of American Veterans Denied Veterans Affairs Disability Compensation.

Authors comparatively analyzed health and social isolation between U.S. military veterans denied Veterans Affairs (VA) disability compensation and veterans awarded VA disability compensation. The 2001 National Survey of Veterans was used to create a sample of 4,522 veterans denied or awarded VA disability compensation. Using the Andersen health services utilization model as a conceptual framework, multivariate logistic regression was applied to assess relationships between VA disability compensation award status, three separate domains of health, and correlates of social isolation. Results indicate that denied applicants were more likely than those awarded to have poor overall health (odds ratio [OR]=1.45, 95% confidence interval [CI]: 1.23, 1.70), and limitations in activities of daily living (OR=1.12, 95% CI: 1.03, 1.21). Denied applicants' physical functioning (40.3) and mental functioning (41.2) composite summary scores were not clinically different from those of awarded applicants (39.0 and 40.1, respectively), indicating that both were comparably impaired. Veterans denied VA disability compensation had poor health and functional impairments. They also experienced poverty and isolation, suggesting that they may be in need of additional supportive services. Connecting veterans to community resources could be a vital service to provide to all veterans applying for disability compensation.

Psychotherapeutic and work-oriented interventions: employment outcomes among young adults with work disability due to a mental disorder

BackgroundWe examined the extent to which psychotherapeutic and work-oriented interventions were included in a medical treatment and rehabilitation plan and whether they predicted future employment among young adults with work disability due to a mental disorder.MethodsData were obtained from the treatment and rehabilitation plans of 1163 young adults aged 18‒34 years, who in 2008 were granted fixed-term work disability compensation due to a mental disorder and were followed for 5 years.ResultsForty-six percent had no proposal for psychotherapy or a work-oriented intervention in their treatment and rehabilitation plan, 22 % had a plan for only a psychotherapeutic intervention, 23 % had a plan for only a work-oriented intervention, and 10 % had both types of interventions planned. Having a planned psychotherapeutic intervention (HR = 1.35, 95 % CI 1.07–1.69) and of the work-oriented interventions, planned rehabilitative courses and training (HR = 1.34, 95 % CI 1.03–1.70) predicted quicker entry into competitive employment. Having a plan for both a psychotherapeutic and work-oriented intervention was associated with being employed at the end of the follow-up (OR = 1.77, 95 % CI 1.07–2.95).ConclusionsYoung adults with a long-term psychiatric work disability episode rarely have a recorded plan for rehabilitation in their treatment and rehabilitation plan although psychotherapeutic interventions and a combination of a psychotherapeutic and work-oriented intervention might help them gain employment.

The meaning of employment from theperspective of persons with spinal cordinjuries in six European countries.

People with spinal cord injuries (SCI) are underrepresented in the labour force. To examine the meaning of employment, as it is understood in the context of participation and integration in society, among persons with SCI in six European countries. We ask how SCI relates to employment, for the functions of employment, alternatives to employment, and its obstacles. Semi-structured interviews were conducted with 74 persons and qualitatively analysed using a grounded theory approach. Employment was ranked as very important independent of the participants current employment status. We identified three main functions of employment: 1) employment contributes to the creation of personal and collective identity and social recognition; 2) employment enables structuring of time and distracts from impairment and pain; 3) employment is as an important social arena that facilitates interaction with other people. Voluntary work and domestic work did not fully replace the social functions of employment, nor correspond to the design of the disability compensation systems. This study illustrates the high value of employment and a need to pay more attention to a broader range of productive work. It also reveals the interdependencies between employment status and income mediated by the disability compensation schemes.

The Labor Supply of Disabled Veterans: 1995-2014

Disabled veterans are less likely to work today than in the past; between 1995 and 2014, the percent of veterans who were working while receiving disability compensation from the Department of Veterans Affairs (VA) dropped from 62 percent to 49 percent. This drop has led the VA – which liberalized the list of health conditions that qualify veterans for benefits in the early 2000s – to face the same concern as the Social Security Administration: that the proportion of individuals receiving disability income who could work, but do not, has grown. Using the Current Population Survey’s Veterans Supplement, this paper finds that employment and labor force participation rates have fallen for disabled veterans only modestly more than for non-disabled veterans. Adjusting for the rapid aging of the disabled veteran population reduces the gap in labor market activity between disabled and non-disabled veterans by 40-70 percent. Although the share of veterans with disability ratings of 50 percent or greater (indicating severe disability) has increased, the most-disabled veterans have not reduced their labor market activity – if anything, their labor supply has actually increased. The results suggest that the decline in employment and labor force participation of disabled veterans is largely a function of age and the increased prevalence of severe disability and not a changing propensity for work. This finding should alleviate concerns that the Veteran’s Administration disability system is discouraging employment any differently than in the past.

The Impact of Disability Benefits on Labor Supply: Evidence from the VA's Disability Compensation Program

Combining administrative data from the US Army, Department of Veterans Affairs, and Social Security Administration, we analyze the effect of the VA's Disability Compensation (DC) program on veterans' labor force participation and earnings. We study the 2001 Agent Orange decision, a unique policy change that expanded DC eligibility for Vietnam veterans who served in theater but did not expand eligibility to other veterans of this era, to assess the causal effects of DC enrollment. We estimate that benefits receipt reduced veterans' labor force participation by 18 percentage points, though measured income net of transfer income rose on average. (JEL H51, I12, I18, J14, J22, J28, J31)

US Veterans' Use Of VA Mental Health Services And Disability Compensation Increased From 2001 To 2010.

There has been concern about the capacity of the Department of Veterans Affairs (VA) health care system to provide care for veterans returning from war zones in the Middle East and Afghanistan. We used two nationally representative surveys of US veterans in 2001 and 2010 to examine changes in the veteran population and veterans' use of health care services after a decade of war. The population was older and more diverse in 2010 than in 2001. In both years, veterans who served in the World War II era or earlier were more likely to have been exposed to combat-related trauma than veterans of more recent service eras. In 2010 veterans who served in the Persian Gulf War era (1990 through the wars in Iraq and Afghanistan) were more likely to have used VA mental health services and to have received VA disability compensation than veterans of previous service eras. Compared to veterans in 2001, those in 2010 were two times more likely to have used any VA health services and were more likely to have received VA disability compensation. These findings highlight changes in the veteran population over time that are important to consider in planning for future VA services.

Combating Veteran Poverty: Providing Veterans with the Means to Avoid Living in Poverty

The number of veterans living in poverty is growing each year. In fact, veterans are overrepresented in the homeless population. Also, veterans with disabilities are at greater risk than veterans without disabilities of living in poverty. This article examines the VA claims process and the role of the Department of Veterans Affairs in compensating these men and women for their service. The VA claims process is slow and overwhelmed and can lead to veterans waiting an extremely long time to receive their benefits even though the process is supposed to be pro-claimant. Additionally, veterans, during the claims process, have the burden of proving that their injury or disability is service-connected. However, the VA claims process does provide certain presumptive periods for some physical and psychological disabilities, which relieves veterans of the burden to prove that their injury is actually service-connected. This article also examines other programs which help compensate veterans for their service to have the means to live above the poverty line. Such programs provide veterans with compensation for injuries and disabilities which occurred during service and funding for higher education. Perhaps the most important tool that the VA uses to combat veteran poverty is legislation that provides tuition for veterans, and, in some cases, allows veterans to attend college for free. Education is perhaps the most important tool because it provides veterans the skills to get a civilian job and make a living to provide for themselves and their families after service. In order to reduce the number of veterans living in poverty, the VA compensation process must be streamlined, and funds issued to veterans to pay for higher education should be increased, not reduced.

Disability in Fibromyalgia Associates with Symptom Severity and Occupation Characteristics

It is intuitive that disability caused by illness should be reflected in illness severity. Because disability rates for fibromyalgia (FM) are high in the developed world, we have examined disease and work characteristics for patients with FM who were working, unemployed, or receiving disability payments for disability as a result of FM. Of the 248 participants in a tertiary care cohort study of patients with FM, 90 were employed, 81 were not employed and not receiving disability payments, and 77 were not working and currently receiving disability payments awarded for disability caused by FM. Demographic, occupation, and disease characteristics were compared among the groups. The prevalence of disability caused by FM was 30.8%. There were no demographic differences among the working, unemployed, or disabled patients. With the exception of measures for anxiety and depression, all measurements for disease severity differed significantly among the groups, with greater severity reported for the disabled group, which used more medications and participated less in physical activity. Disabled patients were more likely previously employed in manual professions or the service industry, whereas employed patients were more commonly working in non-manual jobs that included clerical, managerial, or professional occupations (p = 0.005). The one-third rate of disability for this Canadian cohort of patients with FM is in line with other reports from the western world. Associations of disability compensation were observed for subjective report of symptom severity, increased use of medications, and previous employment in more physically demanding jobs.

Trends in disability and program participation among U.S. veterans

BackgroundDisability is increasingly part of the lives of veterans and more research is needed to understand its impact on veterans' participation in disability benefit programs. Objective/hypothesisWe examine how recent trends in receipt of service-connected disability compensation from the Department of Veterans Affairs (VA) compare to trends in self-reported disability and participation in Social Security Disability Insurance (DI) and Supplemental Security Income (SSI) among veterans. MethodsWe use 2002–2013 data from the Current Population Survey to describe trends in receipt of VA disability compensation and to compare between trends in self-reported disability and DI/SSI participation for veterans versus nonveterans. ResultsThe percentage of veterans reporting they receive VA disability compensation increased substantially from 2002 to 2013 and was especially notable among younger (ages 18–39) and older (ages 50–64) veterans. From 2009 to 2013, self-reported disability increased among the younger and older veterans but not among middle-age veterans and nonveterans, and self-reported cognitive disability increased substantially among young veterans. DI/SSI participation among older veterans increased more than for nonveterans over the period examined. ConclusionsEffective policies are needed to incentivize work among young veterans and to help them obtain both the skills they need to succeed in the labor force and the supports (such as psychiatric health services) they need to do so. Older veterans are facing increasing challenges in the labor market, and further research is needed to determine whether these challenges are primarily related to health, a growing skills gap, or poorly-aligned incentives.

Subjective perceptions as prognostic factors of time to fitness for work during a 4-year period after inpatient rehabilitation for orthopaedic trauma

Time to fitness for work (TFW) was measured as the number of days that were paid as compensation for work disability during the 4 years after discharge from the rehabilitation clinic in a population of patients hospitalised for rehabilitation after orthopaedic trauma. The aim of this study was to test whether some psychological variables can be used as potential early prognostic factors of TFW. A Cox proportional hazards model was used to estimate the associations between predictive variables and TFW. Predictors were global health, pain at hospitalisation and pain decrease during the stay (all continuous and standardised by subtracting the mean and dividing by two standard deviations), perceived severity of the trauma and expectation of a positive evolution (both binary variables). Full data were available for 807 inpatients (660 men, 147 women). TFW was positively associated with better perceived health (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.13-1.19), pain decrease (HR 1.46, 95% CI 1.30-1.64) and expectation of a positive evolution (HR 1.50, 95% CI 1.32-1.70) and negatively associated with pain at hospitalisation (HR 0.67, 95% CI 0.59-0.76) and high perceived severity (HR 0.72, 95% CI 0.61-0.85). The present results provide some evidence that work disability during a four-year period after rehabilitation may be predicted by prerehabilitation perceptions of general health, pain, injury severity, as well as positive expectation of evolution.

Health and Health Care Service Utilization Among U.S. Veterans Denied VA Service-Connected Disability Compensation: A Review of the Literature.

The general consensus in studies of individuals seeking federal disability compensation is that individuals "denied" disability compensation are healthier than those "awarded." In contrast, studies of military veterans seeking U.S. Department of Veterans Affairs (VA) disability compensation suggest that those "denied" ("denied applicants") may be as impaired as those "awarded" ("awarded applicants"), and likely have critical, albeit unmet health care needs. Moreover, although social isolation among U.S. Veterans has received some attention, its broad influence on health and health care consumption among veterans "denied" VA disability compensation is not well understood. To provide a more thorough understanding of "denied" applicants' health, health care utilization, and social conditions. We reviewed published reports of health, health care utilization, and social isolation "relevant" to U.S. Veterans "denied" VA disability compensation. Among 122 research items initially reviewed, a total of 47 met our inclusion criteria and are summarized herein. Compared to veterans "awarded" VA disability compensation, those "denied" have poorer health, use less VA health care, and may experience social isolation. Veterans "denied" VA disability compensation may comprise a vulnerable subgroup of veterans in need of supportive services. Such needs may be addressed through evidence-based targeted outreach programs.