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Disabilities due to Injury in the U.S. Armed Forces

Disabilities due to Injury in the U.S. Armed Forces. Thomas Songer Ronald LaPorte. Learning and Performance Objectives. Understand the spectrum of disability and the factors influencing it

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Disabilities due to Injury in the U.S. Armed Forces

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  1. Disabilities due to Injury in the U.S. Armed Forces Thomas Songer Ronald LaPorte

  2. Learning and Performance Objectives • Understand the spectrum of disability and the factors influencing it • Identify the data sources for disability information in the U.S. Armed Forces and understand their strengths and limitations • Identify the potential burden of injury-related disability

  3. 10% 10% 80% Disability in the United States with a disability, not severe with a severe disability with no disability

  4. The Framework of Disability Normal State Pathology Impairment Functional Interaction Disability

  5. International Classification of Impairments, Disabilities, and Handicaps Normal State Disease Impairment Handicap Disability

  6. Model of Functioning and Disability Health Condition Body Functions Activities Participation Environmental Factors Personal Factors

  7. Disability in the Armed Forces Discharge from active duty with or without compensation Permanent disability Temporary disability - Not fit for active duty - To be re-evaluated over time Discharge return to duty

  8. Sources of Disability Data • Disability Agencies • Physical Evaluation Boards • Medical Evaluation Boards • Line-of-Duty Reports • Individual research reports

  9. Identifying Injury-Related Disability • VASRD codes - diagnostic codes for a wide spectrum of diseases and physical impairments covering all major body systems • ICD-9-CM codes - diagnostic codes used to describe the nature of the medical condition and cause of an injury

  10. Categories of Disability • Permanent disability – a permanent disability resulting in discharge with full compensation. • Separation with severance pay – disability resulting in discharge with separation pay. • Separation without benefits – disability resulting in discharge without pay • Temporary disability – a medical disability that could change over time; not fit for active duty • Fit for duty – return for active duty

  11. Incidence of Disability in the Armed Forces Army Navy Air Force 40 30 Rate per 1000 personnel/year 20 10 0 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995

  12. Disposition of disability cases,1994 Army Navy Air Force Permanent disability 16% 4% 15% Separation with pay 41% 61% 19% Separation - no benefits 4% — 2% Temporary disability 15% 22% 23% Fit for duty 24% 5% 41% Other — 8% — Total Number 8,413 10,786 3,687

  13. Medical conditions associated with disability Army Navy Air Force Orthopedic/ musculoskeletal 53.1 % 63.0 % 22 % Mental disorders 14.2 9.7 21 Neurologic/convulsive 12.1 9.3 13 Systemic/respiratory 7.4 6.4 14 Blood/skin/endocrine 3.3 3.5 12 Cardiovascular system 3.4 2.7 6 Digestive system 2.9 2.5 5 Visual/auditory conditions 1.7 1.7 2 Total Number 6,382 7,682 3,687

  14. Top 10 diagnoses of musculoskeletal and connective tissue disorders, US Naval MEB reports % Joint disorders 23.1 Back disorders 16.6 Internal derangement of knee 11.8 Other derangement of joint 7.7 Intervertebral disc disorders 7.4 Muscle/ligament disorders 4.8 Other bone/cartilage disorders 4.5 Osterarthrosis 4.3 Peripheral enthesopathies 3.8 Other disorders of soft tissue 3.4

  15. Top 10 injury diagnoses, Naval MEB reports Dislocation of knee 13.8 % Sprains/strains of knee/leg 9.3 % Ankle fracture 6.7 % Fracture of tibia and fibula 5.1 % Fracture of tarsal/metatarsal 4.3 % Fracture of vertebral column 3.8 % Sprains/strains of ankle and foot 3.7 % Fracture of radius and ulna 3.5 % Shoulder dislocation 2.9 % Fracture of carpal bones 2.8 %

  16. Top 10 Reasons for MEB review in an Army Infantry Division, 1994 Rate per 1000 personnel Percent Knee Pain Low Back Pain Asthma Knee Disorder Flat Feet Psychiatric Arm/Hand Fracture Disc Disorder Vascular Disease Diabetes 0 2 4 6 8 10 12

  17. Disability compensation costs paid by the military departments fiscal year 1980-1990. Severance Pay Permanent Disability Temporary Disability Total 1800 1600 1400 1200 (millions of dollars) 1000 800 600 400 200 82 80 81 83 84 85 86 87 88 89 90

  18. Discussion The information reviewed suggests that: • Physical disability rates in the Armed Forces are at higher levels this decade than seen in the previous decade • 30% to 50% of disability cases could be due to injury • Most disability cases under review result in discharge from active service

  19. Discussion [2] • Compensation for injury-related disability costs hundreds of millions of dollars • It is difficult to identify accurately the frequency and burden of injury-related disability in the Armed Forces from existing data sources

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