Background: Critics fear that some Veterans use Department of Veterans Affairs (VA) mental health services solely to establish eligibility for posttraumatic stress disorder (PTSD) disability benefits, then drop out of treatment once their claim is approved. Objective: To examine the long-term effects of receiving VA disability benefits for PTSD on health care in the VA system. Methods: Using VA administrative data, we examined the health care utilization of a nationally representative cohort of former PTSD disability claimants. Veterans filed PTSD disability claims between 1994 and 1998. They returned mailed surveys between 1998 and 2000 (Time 1) and between 2004 and 2006 (Time 2). We examined their health care utilization for the 6 months before and after they received their surveys, comparing the health care use of successful claimants (SC+) to unsuccessful claimants (SC-). Results: Of the 3,337 Veterans in the cohort, 3,090 had at least one episode of care at a VA facility during the study period. Except for rehabilitative services, successful claimants were statistically significantly more likely to have used any outpatient VA service in the year centered on their Time 1 survey than were SC- Veterans (ps < 0.001). At Time 2, SC+ Veterans were more likely than SC- Veterans to have used any outpatient mental health (p < 0.001), primary care (p < 0.01) or surgical care (p < 0.05) services. Among those using any outpatient services at Time 2, the intensity of services used by SC+ and SC- Veterans was comparable (ps >0.08). Hospitalizations were similar in the two groups during both time periods (ps >0.11). From Time 1 to Time 2 (a period of 6 to 8 years), SC+ Veterans reduced the average number of mental health stops they made by 4.6 visits per year, whereas SC- Veterans reduced by 2.9 visits per year (p = 0.81). Conclusion: On net, more SC+ Veterans used outpatient mental health and other services than did SC- Veterans, and this effect persisted for up to 12 years after Veterans initially filed their claims. These data suggest that PTSD disability benefits facilitate access to and use of mental health and other care in the VA system.
Veterans’ Health Care Utilization in Department of Veterans Affairs Facilities Two to Twelve Years after Applying for PTSD Service Connection: Findings from a Nationally Representative Cohort
