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

• 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

Disability in the United States10%

10%

80%

with a disability, not severewith a severe disabilitywith no disability

The Framework of Disability

Normal State

Pathology

Impairment

Functional Interaction

Disability

International Classification of Impairments, Disabilities, and Handicaps

Normal State

Disease

Impairment

Disability Handicap

Model of Functioning and Disability

Health Condition

ActivitiesBody Functions

Environmental Factors

Personal Factors

Participation

Disability in the Armed Forces

Permanent disability

Temporary disability

Discharge from activeduty with or without

compensation

- Not fit for active duty

- To be re-evaluatedover time

Discharge return to duty

Sources of Disability Data

• Disability Agencies

• Physical Evaluation Boards

• Medical Evaluation Boards

• Line-of-Duty Reports

• Individual research reports

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

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

Incidence of Disability in the Armed Forces

0

10

20

30

40

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

Rat

e p

er 1

000

per

son

nel

/yea

r

Army Navy Air Force

Disposition of disability cases,1994

Army

8,413

Navy

10,786

Air Force

3,687

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

Medical conditions associated with disability

Total Number

Army

6,382

Navy

7,682

Air Force

3,687

Orthopedic/musculoskeletal 53.1 % 63.0 % 22 %

Mental disorders 14.2 9.7 21Neurologic/convulsive 12.1 9.3 13Systemic/respiratory 7.4 6.4 14Blood/skin/endocrine 3.3 3.5 12Cardiovascular system 3.4 2.7 6Digestive system 2.9 2.5 5Visual/auditory conditions 1.7 1.7 2

Top 10 diagnoses of musculoskeletal and connective tissue disorders, US Naval

MEB reports%Joint disorders 23.1

Back disorders 16.6Internal derangement of knee 11.8Other derangement of joint 7.7Intervertebral disc disorders 7.4Muscle/ligament disorders 4.8Other bone/cartilage disorders 4.5Osterarthrosis 4.3Peripheral enthesopathies 3.8Other disorders of soft tissue 3.4

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 %

Top 10 Reasons for MEB review in an Army Infantry Division, 1994

0 2 4 6 8 10 12

Diabetes

Disc Disorder

Psychiatric

Knee Disorder

Low Back Pain

Rate per 1000 personnel Percent

Knee Pain

Asthma

Flat Feet

Arm/Hand Fracture

Vascular Disease

200400

60080010001200

140016001800

80 81 82 83 84 85 86 87 88 89 90

(mil

lion

s of

dol

lars

)

Severance PayTemporary Disability

Permanent DisabilityTotal

Disability compensation costs paid by the military departments fiscal year 1980-1990.

Discussion

• 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

The information reviewed suggests that:

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