Marlene E. Gubata

Trends in the epidemiology of disability related to traumatic brain injury in the US Army and Marine Corps: 2005 to 2010

Background:Traumatic brain injury (TBI) has been recognized as a major public health issue for several decades. Despite technological advancements in protective equipment and medical care available during recent military conflicts, TBI is the most common neurological condition among Soldiers and Marines evaluated for discharge from service. This study describes the demographic, service-related, and disability characteristics of Soldiers and Marines referred for combat-related TBI disability evaluation. Methods:Cross-sectional analysis of Soldiers and Marines evaluated for combat-related disability between October 1, 2004 and September 30, 2010 was performed. Traumatic brain injury cases were identified using the Veterans Affairs Schedule for Rating Disabilities code for TBI and compared with other combat-related disabilities. Results:Combat-related TBI disability rates have significantly increased in both the Army and the Marine Corps since 2005. Significantly more unfitting conditions are present on average in combat-related TBI cases than in other combat-related disability cases. Combat-related TBI disability cases are more likely to be medically retired than other types of combat-related disability. Conclusions:Because veterans with combat-related TBI disabilities are likely to require chronic care for TBI-associated medical conditions, disability evaluation policy and programs must ensure that combat-related TBI disabilities are accurately identified and compensated, and the potential long-term care needs are addressed.

Temporal Trends in the Epidemiology of Disabilities Related to Posttraumatic Stress Disorder in the U.S. Army and Marine Corps From 2005–2010

Since the start of Operation Iraqi Freedom and Operation Enduring Freedom, over 2 million U.S. military members were deployed to Iraq and Afghanistan. The estimated prevalence of posttraumatic stress disorder (PTSD) among soldiers and Marines returning from combat zones varies from 5%-20%; little is known about those individuals whose PTSD renders them unfit for duty. This report describes the rates and correlates of PTSD in soldiers and Marines evaluated for disability. Data for service members who underwent disability evaluation between fiscal years 2005-2010 were analyzed for trends in disability rates, ratings, retirement, and comorbid disability. PTSD rates varied by age, sex, race, rank, branch of service, and component. Most cases were deployed and were considered combat-related. Over the study period, the rate and severity of disability from PTSD increased substantially. Significant increases in disability from PTSD incidence, rating, and retirement were observed in both services. Other medical conditions, largely musculoskeletal and neurological, were present in the majority of cases indicating many cases also experienced disabling physical injuries. Further research is needed to target interventions accurately for redeploying service members to minimize comorbidity associated with disability from PTSD and facilitate continuation in military service or successful transition to civilian life.

A prospective study of physical fitness, obesity, and the subsequent risk of mental disorders among healthy young adults in army training

OBJECTIVE Mental health disorders contribute substantially to medical and occupational morbidity. The role of fitness and physical activity in the prevention of mental health disorders is not well established, but epidemiologic data suggest that physical activity can protect against anxiety and depression. METHOD The analyses presented in this report, from a prospective cohort study, evaluate the association between fitness (as measured by a 5-minute step test), and being overweight (defined as exceeding weight and body fat allowances) at military entrance, with subsequent onset of mental disorder diagnosis in the first year of service. The association between risk factors and mental disorder diagnosis was analyzed using multivariate Poisson regression with the adjusted incidence rate ratio (aIRR) as the measure of association. RESULTS Among weight-qualified participants, factors associated with increased incidence of mental disorder included failing the physical fitness test (aIRR: 1.36, p<0.0001), female sex (aIRR: 2.17, p<0.0001), and smoking (aIRR: 1.49, p<0.0001). Among fit participants, being overweight was not significantly associated with mental disorder (aIRR: 1.11, p=0.1540). CONCLUSIONS This test has potential military utility as an adjunct part of the medical examination process. Additional research is needed among civilians to determine if similar associations exist. If so, intervention studies should be conducted to determine if improving physical fitness reduces subsequent psychiatric disorder risk, particularly among young adults entering into stressful situations.

Military occupation and deployment: descriptive epidemiology of active duty U.S. Army men evaluated for a disability discharge

OBJECTIVE Physically demanding jobs and history of deployment put Soldiers at increased risk for injury, hospitalizations, and disability. Characterizing differences in disability outcomes by occupation and deployment history may identify specific military populations for targeted prevention and intervention programs as well as potential areas of future research. METHODS A cross-sectional analysis was conducted on U.S. Army enlisted men evaluated in the Department of Defenses Disability Evaluation System (DES) between fiscal years 2005 and 2011, comparing those assigned a Combat Arms military occupational specialty (MOS) to individuals with any other MOS (Other). RESULTS Among deployed Soldiers, those with Combat Arms MOS were substantially and significantly more likely to receive medical disability retirement than Other MOS and were more likely to be evaluated for conditions compatible with combat exposures, including post-traumatic stress disorder, residuals of traumatic brain injury, and paralysis. Among nondeployed Soldiers, Combat Arms MOS were only slightly more likely to receive medical disability than Other MOS, and no substantial differences in medical conditions were noted between the two MOS groups. CONCLUSIONS Combat Arms MOS is a significant risk factor for disability retirement primarily among deployed men. Further research is needed to identify specific military occupations most at risk for disability retirement.

Personality Assessment Questionnaire as a pre-accession screen for risk of mental disorders and early attrition in U. S. Army recruits.

Personality assessment tools have been studied as predictors of performance in civilian and military work settings. The Tailored Adaptive Personality Assessment System (TAPAS) was developed to improve selection of new military recruits by predicting motivational outcomes such as job effort, physical fitness, and drive to perform at high standards. The purpose of this study is to examine the utility of TAPAS as a predictor of psychiatric morbidity and early discharge in a sample of 15,082 Army, active duty, enlisted, nonprior service recruits. Associations between TAPAS personality dimension score quintiles and mental disorder diagnoses, attrition, and health care utilization in United States Army recruits who took TAPAS in the fiscal year 2010 were analyzed using multivariate logistic regression and log-linear modeling. TAPAS physical conditioning dimension scores were predictive of mental disorder diagnosis and attrition, with TAPAS scorers in the lowest quintile at increased odds of early discharge (odds ratio [OR]: 2.08, 95% CI 1.73, 2.51), mental disorder diagnosis (OR: 1.41, 95% CI 1.20, 1.66) and greater mental health care utilization (1.61, 95% CI 1.46, 1.78) compared with TAPAS scorers in the highest quintile. Results indicated that TAPAS may have an important use as a mental health fitness screening tool for those who wish to serve in the military by identifying a limited high risk group of applicants for mental health diagnostic evaluation. TAPAS may augment current cognitive and educational screens and potentially reduce the burden of mental disorders and premature attrition.

Pre‑enlistment hearing loss and hearing loss disability among US soldiers and marines

Hearing loss is a common condition among US adults, with some evidence of increasing prevalence in young adults. Noise-induced hearing loss attributable to employment is a significant source of preventable morbidity world-wide. The US military population is largely comprised of young adult males serving in a wide variety of occupations, many in high noise-level conditions, at least episodically. To identify accession and service-related risk factors for hearing-related disability, matched case-control study of US military personnel was conducted. Individuals evaluated for hearing loss disability in the US Army and Marine Corps were frequency matched to controls without history of disability evaluation on service and enlistment year. Conditional logistic regression was used to examine the association between accession and service-related factors and hearing-related disability evaluations between October 2002 and September 2010. Individuals with medically disqualifying audiograms or hearing loss diagnoses at application for military service were 8 and 4 times more likely, respectively, to have a disability evaluation related to hearing loss, after controlling for relevant accession, demographic, and service-related factors. Conservative hearing loss thresholds on pre-enlistment audiograms, stricter hearing loss medical waiver policies or qualified baseline audiograms pre-enlistment are needed in the U.S military. Industrial corporations or labor unions may also benefit from identifying individuals with moderate hearing loss at the time of employment to ensure use of personal protective equipment and engineer controls of noise.

Cost-Effectiveness Analysis of the U.S. Army Assessment of Recruit Motivation and Strength (ARMS) Program

The Assessment of Recruit Motivation and Strength (ARMS) Study was conducted at six Military Entrance Processing Sites during 2005-2006. The objectives were to compare morbidity and attrition of Army accessions who exceeded body fat (EBF) accession standards compared to weight for height or body fat qualified (WQ) and to compare among the WQ subset, those who were physically fit as measured by a 5-minute step test compared to unfit. We performed a cost-effectiveness analysis to address both objectives. Analysis was performed by gender with the primary outcomes of musculoskeletal injury and attrition. Results were expressed in terms of cost per year of military service. Sensitivity analysis was performed on probability cost estimates. We found WQ female recruits were

Risk factors for disability retirement among active duty Air Force personnel.

5,141 less expensive per year than EBF female recruits. WQ males were

Temporal trends in disability evaluation and retirement in the Army, Navy, and Marine Corps: 2005-2011.

2,785 less expensive per year of military service than EBF male recruits. Among WQ recruits, fit females were

Temporary Disability Retirement Cases: Variations in Time to Final Disposition and Disability Rating by Service and Medical Condition

3,638 and fit males were