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The goal of this study was to investigate predictors of employment status in male and female post- 9/11 Veterans evaluated for traumatic brain injury (TBI) in the Veterans Health Administration. Prior research suggests there are gender differences in psychosocial characteristics among this cohort. Methods: This was a crosssectional analysis of post-9/11 Veterans who completed a TBI evaluation between July 2009 and September 2013. Results: Women had lower prevalence of deployment-related TBI (65.5%) compared with men (75.3%), but the percentages of those unemployed across the TBI diagnostic categories were similar for men (38%) and women (39%). Adjusted log-binomial regression found that unemployment was significantly associated with age, education, marital status, moderate/severe TBI, suspected posttraumatic stress disorder, depression, and drug abuse/dependence, and neurobehavioral symptom severity for men, whereas for women only more severe affective and cognitive symptoms were associated with unemployment. Conclusions: Although the unemployment rate was similar across gender, there was a clearer pattern of demographic and health factors, including TBI severity, that was significantly associated with employment status in men. There may be other factors contributing to the female Veteran unemployment rate, underscoring the need to investigate unique contributors to unemployment, as well as how treatment and employment services can be expanded and tailored for post-9/11 Veterans.

Objective: To determine the demographic and service characteristics that differentially impact utilization and cost of Veterans Health Administration (VHA) services for Operation Enduring Freedom and Operation Iraq Freedom (OEF/OIF) Veterans screened or evaluated for traumatic brain injury (TBI). Setting: We examined Department of Defense (DoD) and VHA administrative records of OEF/OIF Veterans who were screened or evaluated for TBI. Participants: Our study population was OEF/OIF Veterans who separated from DoD in Fiscal Years 2003–2009 and who were screened or evaluated in VHA for TBI between October 2008 and July 2009. Design: We describe the demographics and service characteristics of separated Veterans and those who accessed the VHA. We report the cost of VHA utilization and estimate a probit regression model to assess determinants of VHA utilization and costs by OEF/OIF Veterans screened and evaluated for TBI by VHA. Results: Females and Veterans older than 37 years utilize VHA services more intensely. Across all services, the Reserve Components utilize health services more than the Active Components placing more demand on VHA for services. Conclusion: VHA utilization and costs is impacted by the demographic and service characteristics of Veterans. The variation in Veteran groups incurring higher costs and utilization indicates different usage patterns of VHA services by each group with implications for patient load as the DoD deploys higher numbers of females and the Reserve Components.

Female service members' presence in combat zones during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) is unprecedented both in terms of the number of women deployed and the nature of their involvement during deployment (Street, Vogt, & Dutra, 2009). Currently, women represent a larger proportion of U.S. military forces than ever before, comprising 10% to 20% of forces deployed in support of OEF/OIF, equaling nearly 300,000 deployed female troops from 2003 to 2013 (Burrelli, 2013; National Center for Veterans Analysis and Statistics, 2010). In future U.S. military operations, female involvement in combat zones is likely to increase following the January 2013 Department of Defense (DOD) decision lifting the official ban on women in combat and combat units (Bumiller & Shanker, 2013).

The concordance of Department of Veterans Affairs (VA) clinician judgment of mild traumatic brain injury (mTBI) history with American Congress of Rehabilitation Medicine (ACRM)-based criteria was examined for Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) Veterans. In order to understand inconsistencies in agreement, we also examined the associations between evaluation outcomes and conceptually relevant patient characteristics, deployment-related events, current self-reported health symptoms, and suspected psychiatric conditions. The Veteran sample comprised 14,026 OIF/OEF VA patients with deployment-related mTBI history (n = 9,858) or no history of mTBI (n = 4,168) as defined by ACRM-based criteria. In the majority of cases (76.0%), clinician judgment was in agreement with the ACRM-based criteria. The most common inconsistency was between clinician judgment (no) and ACRM-based criteria (yes) for 21.3% of the patients. Injury etiology, current self-reported health symptoms, and suspected psychiatric conditions were additional factors associated with clinician diagnosis and ACRM-based criteria disagreement. Adherence to established diagnostic guidelines is essential for accurate determination of mTBI history and for understanding the extent to which mTBI symptoms resolve or persist over time in OIF/OEF Veterans.

Background: Female service members’ presence in combat zones during Operation Enduring Freedom and Operation Iraqi Freedom is unprecedented both in terms of the number of women deployed and the nature of their involvement. In light of changing Department of Defense policy governing the deployment of women in combat zones, this article intends to set the groundwork for estimating future combat-related injuries and subsequent Veterans Health Administration (VHA) utilization while focusing on traumatic brain injury (TBI). Methods: The article summarizes and presents the results of a study that examines veterans who present to VHA for TBI evaluation. For a national sample of veterans, a dataset including information on post-screening utilization, diagnoses, and location of care was constructed. The dataset included self-reported health symptoms and other information obtained from a standardized national VHA post-screening clinical evaluation, the comprehensive TBI evaluation (CTBIE). Findings: Both women and men utilize high levels of VHA health care after a CTBIE. However, there are gender differences in the volume and types of services used, with women utilizing different services than their male counterparts and incurring higher costs, including higher overall and outpatient costs. Conclusion: As women veterans seek more of their health care from the VHA, there will be a need for more coordinated care to identify and manage deployment-related TBI and common comorbidities such as posttraumatic stress disorder, depression, and chronic pain. Deployment-connected injuries are likely to rise because of the rescinding of the ban on women in combat. This in turn has critical implications for VHA strategic planning and budgeting.

The Veterans Health Administration screens for traumatic brain injury (TBI) among all its patients who were deployed to Afghanistan or Iraq. This paper reports patient-level results of the screening program in 2008 and 2009 including rates of referrals and utilization. METHODS We based rates of positive screens on all screened patients from October 2007 through March 2009 as captured in VHA electronic records of screenings. We derived rates of TBI confirmed by comprehensive evaluations only from October 2008 through July 2009 as captured in VHA electronic evaluations records. We obtained patient characteristics from Department of Defense and VHA data.

Background: Many service members deployed to the Afghanistan and Iraq theatre of operations are returning with multiple injuries, including traumatic brain injury (TBI) and sensory impairment. Studies of sensory impairment among patients with TBI have focused either on the auditory or visual modality. However, their co-prevalence, termed dual sensory impairment (DSI), is not well-documented. We examined self-reported rates of auditory and visual impairment in Afghanistan and Iraq war Veterans receiving TBI evaluations.