Racial/Ethnic and Geographic Determinants of TBI Service-Connected Disability and Total SCD Compensation in U.S. Veterans

Research Objectives To examine the association of race/ethnicity and geography with service-connected disability (SCD) for traumatic brain injury (TBI) and how such determinants affect monthly total SCD compensation by TBI SCD status. Design Retrospective observational cohort study. Setting Veterans Health Administration (VHA) /Veterans Benefits Administration (VBA). Participants Veterans from LIMBIC-CENC Phenotype study with ≥1 SCD rating from the VBA. Interventions N/A. Main Outcome Measures SCD designation for TBI based on VA Schedule for Rating Disabilities (VASRD) diagnostic codes (8045 [residuals of TBI] and 9304 [neurocognitive disorder due to TBI]) and monthly VBA compensation per veteran during 2022. Results Results 1,225,679 Veterans without and 93,911 with TBI SCD were included. Veterans living in highly rural areas (OR 1.44, 95% CI 0.06,0.05) and on Tribal Lands (OR 1.28, 95% CI 0.25,0.31) had the highest odds of receiving a TBI SCD award in unadjusted models. In adjusted models for all factors except TBI severity, Native Americans (AOR 1.12, 95% CI 1.06,1.18) and Asian American Pacific Islanders (AOR 1.19, 95% CI 1.16, 1.22), had the highest odds of a TBI SCD award relative to non-Hispanic Whites. In the unadjusted model examining monthly overall SCD compensation, a TBI award was associated with an additional $362 (95% CI 353,370) in compensation. Veterans on Tribal Lands (OR $-80 95% CI -157,-4) had significantly lower compensation relative to urban areas. Native Americans (OR $169 95% CI 153, 185) had the lowest additional SCD compensation relative to Non-Hispanic Whites, and other Non-Hispanic White race/ethnicities. Conclusions Native American Veterans and those living on Tribal Lands were disproportionately affected by observed disparities in TBI SCD award status and monthly compensation. Author(s) Disclosures We wish to acknowledge the inspiration and mentoring of Ralph G. DePalma, MD, FACS, In Memoria. Work supported by U.S. Army Medical Research Acquisition Activity LIMBIC Award/W81XWH-18-PH/TBIRP-LIMBIC. Dr. Pugh supported by VA HSR&D Research Career Scientist Award (IK6HX003762). The views expressed do not represent the official policy or position of the Department of Defense, or Department of Veterans Affairs.