Association of Clinical TBI Severity and Military Factors With Veteran TBI Service-Connected Disability Ratings and Total Compensation: A Long-Term Impact of Military Brain Injury Consortium (LIMBIC) Study.

OBJECTIVE

To understand how traumatic brain injury (TBI) clinical severity and military factors were associated with the likelihood of receiving a TBI service-connected disability (SCD) determination and monthly total SCD compensation among Veterans.

SETTING

Veterans Health Administration (VHA) and Veterans Benefits Administration (VBA).

PARTICIPANTS

1 319 590 veterans with a VBA SCD rating who entered the VHA between October 1, 2000, and September 24, 2019.

DESIGN

This retrospective study analyzed the association of TBI severity and military factors with a TBI SCD determination, TBI SCD rating percentage, and monthly total SCD compensation. Administrative VHA and VBA records were utilized.

MAIN MEASURES: Any TBI SCD determination, TBI SCD rating percentage, and monthly SCD compensation.

RESULTS

93 911 (7.1%) Veterans had an SCD rating for TBI. TBI SCD increased monthly total compensation by $362 (95% CI 353, 370) in bivariate and $45 (95% CI 38, 52) in adjusted models. Females had lower TBI SCD percentage (-3.03; 95% CI -3.92, -2.14) but higher monthly compensation ($37; 95% CI 33, 42). TBI severity was associated with increasing TBI SCD percentage and monthly SCD compensation. In adjusted models, deployment (-2.36; 95% CI -3.02, -1.69) was associated with lower TBI SCD percentage but not monthly compensation, while combat exposure was not associated with TBI SCD percentage but was associated with higher compensation ($46; 95% CI 40, 53).

CONCLUSION

TBI severity was significantly associated with TBI SCD determination and TBI SCD rating percentage, in addition to overall SCD compensation. Although deployment was significantly associated with TBI SCD determination, non-deployment was associated with higher TBI SCD percent ratings. These results may be explained by TBI occurring in non-deployment military settings, such as training. This highlights the need to study risk for TBI in the general military environment to ensure that all military-related TBI exposures are recognized and that any related disability is appropriately compensated.