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. Disability in the United States 10% 80% 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 Disability Handicap

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

7. Disability in the Armed Forces Permanent disability Temporary disability Discharge from active duty with or without compensation - 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 0 10 20 30 40 19821983198419851986198719881989199019911992199319941995 Rate per 1000 personnel/year ArmyNavyAir Force

12. Disposition of disability cases,1994 Army 8,413 Navy 10,786 Air Force 3,687 Permanent disability16% 4%15% Separation with pay41%61%19% Separation - no benefits 4%— 2% Temporary disability15%22%23% Fit for duty24% 5%41% Other— 8%— Total Number

13. Medical conditions associated with disability Total Number Army 6,382 Navy 7,682 Air Force 3,687 Orthopedic/ musculoskeletal53.1 %63.0 %22 % Mental disorders14.2 9.721 Neurologic/convulsive12.1 9.313 Systemic/respiratory 7.4 6.414 Blood/skin/endocrine 3.3 3.512 Cardiovascular system 3.4 2.7 6 Digestive system 2.9 2.5 5 Visual/auditory conditions 1.7 2

14. Top 10 diagnoses of musculoskeletal and connective tissue disorders, US Naval MEB reports % Joint disorders23.1 Back disorders16.6 Internal derangement of knee11.8 Other derangement of joint7.7 Intervertebral disc disorders7.4 Muscle/ligament disorders4.8 Other bone/cartilage disorders4.5 Osterarthrosis4.3 Peripheral enthesopathies3.8 Other disorders of soft tissue3.4

15. Top 10 injury diagnoses, Naval MEB reports Dislocation of knee13.8 % Sprains/strains of knee/leg9.3 % Ankle fracture6.7 % Fracture of tibia and fibula5.1 % Fracture of tarsal/metatarsal4.3 % Fracture of vertebral column3.8 % Sprains/strains of ankle and foot3.7 % Fracture of radius and ulna3.5 % Shoulder dislocation2.9 % Fracture of carpal bones2.8 %

16. Top 10 Reasons for MEB review in an Army Infantry Division, 1994 024681012 Diabetes Disc Disorder Psychiatric Knee Disorder Low Back Pain Rate per 1000 personnelPercent Knee Pain Asthma Flat Feet Arm/Hand Fracture Vascular Disease

17. 200 400 600 800 1000 1200 1400 1600 1800 8081 82 8384858687888990 (millions of dollars) Severance Pay Temporary Disability Permanent Disability Total Disability compensation costs paid by the military departments fiscal year 1980-1990.

18. 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:

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