Anticipating the Traumatic Brain Injury–Related Health Care Needs of Women Veterans After the Department of Defense Change in Combat Assignment Policy



      Female service members' presence in combat zones during Operation Enduring Freedom and Operation Iraqi Freedom is unprecedented both in terms of the number of women deployed and the nature of their involvement. In light of changing Department of Defense policy governing the deployment of women in combat zones, this article intends to set the groundwork for estimating future combat-related injuries and subsequent Veterans Health Administration (VHA) utilization while focusing on traumatic brain injury (TBI).


      The article summarizes and presents the results of a study that examines veterans who present to VHA for TBI evaluation. For a national sample of veterans, a dataset including information on post-screening utilization, diagnoses, and location of care was constructed. The dataset included self-reported health symptoms and other information obtained from a standardized national VHA post-screening clinical evaluation, the comprehensive TBI evaluation (CTBIE).


      Both women and men utilize high levels of VHA health care after a CTBIE. However, there are gender differences in the volume and types of services used, with women utilizing different services than their male counterparts and incurring higher costs, including higher overall and outpatient costs.


      As women veterans seek more of their health care from the VHA, there will be a need for more coordinated care to identify and manage deployment-related TBI and common comorbidities such as posttraumatic stress disorder, depression, and chronic pain. Deployment-connected injuries are likely to rise because of the rescinding of the ban on women in combat. This in turn has critical implications for VHA strategic planning and budgeting.
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      Jomana Amara, PhD, is Associate Professor of Economics at the Defense Resources Management Institute at the Naval Postgraduate School. Her research focuses on international economics, defense economics, health economics, and the economics of the public sector.


      Katherine M. Iverson, PhD, Clinical Psychologist at VA Boston Healthcare System's National Center for PTSD and Assistant Professor of Psychiatry at Boston University, focuses on detection and treatment of trauma-related mental health issues, with an emphasis on women Veterans.


      Maxine Krengel, PhD, is a Neuropsychologist affiliated with VA Boston Healthcare System and the Boston University School of Medicine, Department of Neurology. Her work focuses on TBI and Veteran health.


      Terri K. Pogoda, PhD, Investigator at VA Boston Healthcare System's Center for Healthcare Organization and Implementation Research, and Research Assistant Professor at Boston University School of Public Health, studies organizational and patient factors associated with outcomes for Veterans with TBI.


      Ann Hendricks, PhD, Economist and Director for VA Boston Healthcare System's Health Care Financing and Economics center at the time of manuscript preparation, is retired.