Gender and Race Differences in Rates of PTSD Service Connection: Results From a Nationally Representative Panel of OEF/OIF/OND Veterans.

Background: Department of Veterans Affairs disability benefits for post-traumatic stress disorder (PTSD), also known as "service connection," have been shown to reduce homelessness and poverty, increase mental health engagement, and improve clinical outcomes. However, gender and race disparities in PTSD service connection have been described in Vietnam and post-Vietnam era Veterans.

Methods: Post-traumatic stress disorder service connection outcomes were assessed in a nationally representative, randomly selected, gender-stratified, prospective panel of 960 Veterans who served during Operations Enduring Freedom, Iraqi Freedom, and New Dawn. Using weighted logistic regression, we assessed the effects of male versus female gender and Black versus non-Black race on odds of PTSD service connection after controlling for other known predictors using Veterans Affairs administrative data. A secondary analysis supplemented administrative data with self-reported data in a subset of 410 Veterans.

Results: A total of 56.3% of men and 45.2% of women (P = .001) received PTSD service connection. In all, 51.1% of Black men versus 57.5% of non-Black men received PTSD service connection (P = .26), while 35.4% of Black women and 50.8% of non-Black women received PTSD service connection (P = .001). The mean total service connection rating, which determines base monthly compensation, was 69.4% ± 28.1 for men receiving PTSD service connection and 49.1% ±31.5 for men denied PTSD service connection (P <.001). The mean total service connection rating for women receiving PTSD service connection was 70.8% ±20.7 compared to 49.7% ± 27.4 for women denied PTSD service connection (P <.001). Disproportionate combat exposures explained the gender difference in PTSD service connection (effect size modification = 15.4%), but we could not identify a mediating confounder for the inverse association between Black race and PTSD service connection in women.

Conclusion: Women were less likely to receive PTSD service connection compared to men; this difference was nearly completely mediated by gender differences in combat exposure. Black women were less likely than non-Black women to receive PTSD service connection, but we could not identify a plausible mechanism to explain this finding. On net, the base compensation package was lower for Veterans denied PTSD service connection than for those receiving PTSD service connection.