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To examine Department of Veterans Affairs (VA) provider and Veteran perceptions of how return to work (RTW) may impact disability compensation benefits for Veterans with traumatic brain injury (TBI) and/or posttraumatic stress disorder (PTSD).
Interview data collected between 2014-2021 on vocational rehabilitation services for Veterans with TBI or PTSD from 4 separate cross-sectional studies were aggregated. We created a secondary dataset that focused on references to RTW and disability compensation and conducted a thematic analysis.
VA medical centers (VAMCs).
23 Veterans with TBI with or without comorbid PTSD at 2 VAMCs and 66 providers across 32 VAMCs participated. Provider categories included psychiatrists, psychologists, social workers, and vocational rehabilitation specialists.
Main Outcome Measures
Interview responses regarding perceptions on RTW and disability compensation.
Both VA providers and Veterans perceived that many Veterans with TBI and/or PTSD want to RTW, but that the potential for reduction of disability compensation among those who do is a barrier. VA providers were concerned that RTW would be associated with a decrease in disability compensation and that symptom management difficulties would lead to job loss. Options that Veterans considered when deciding to RTW included: finding a job where wages/benefits are sufficient to replace any lost disability compensation, working part-time to remain under the income threshold that triggers benefits reduction, or not pursuing employment.
Disability compensation can replace income lost due to difficulty sustaining gainful employment, but perceptions held by Veterans or VA providers may disincentivize RTW. RTW can improve health and functioning among Veterans with TBI and/or PTSD. Systems-level efforts to coordinate disability compensation protections for an extended period after RTW may offer Veterans the psychological safety to pursue employment.