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• Between 2002 and 2017, the military health dystem diagnosed more than 200,000 active-duty service members with PTSD and nearly 300,000 with TBI.
• Over time, the share of service members with a PTSD diagnosis who were medically discharged increased significantly—from 16 percent in 2002 to 34 percent in 2015. Rates of medical discharge for service members with a TBI diagnosis increased from 7 to 18 percent during the same period.
• Disability ratings for service members who were medically discharged for PTSD increased over time: In 2008, 57 percent of service members with a disability rating for PTSD had a total rating of 0 to 40 percent; in 2009, almost all had a total rating of 50 percent or higher. Service members with diability ratings 30 percent or higher receive lifetime financial and health care benefits.
• A better understanding of disability evaluation trends and outcomes can help DoD set goals for diagnosing, treating, and evaluating disabilities among wounded, injured, and ill service members in future conflicts.

Since 2001, more than 3 million service members have deployed in support of multiple combat operations in Afghanistan, Iraq, and other theaters. Many have been diagnosed with the "signature wounds" of these conflicts: posttraumatic stress disorder (PTSD) and/or traumatic brain injury (TBI). During the intervening years, the process by which service members are evaluated for disability has evolved significantly, including a complete overhaul of the Disability Evaluation System (DES) beginning in 2007. Meanwhile, the Department of Defense (DoD) and the services made policy changes and initiated other efforts to improve screening for PTSD and TBI, encourage service members to seek treatment, improve quality of care, and reduce the stigma associated with treatment for these conditions.

To explore these changes, as well as their potential effects on the numbers and characteristics of service members who are evaluated through DES, the authors identify and assess trends in DES outcomes for PTSD and TBI between 2002 and 2017.

• Chapter One

  Introduction

• Chapter Two

  Methods and Data

• Chapter Three

  Trends in Disability Evaluations and Medical Discharges Among Cohorts of Service Members with a Posttraumatic Stress Disorder or Traumatic Brain Injury Diagnosis

• Chapter Four

  Trends in the Timing of Disability Disposition After Diagnosis

• Chapter Five

  Trends Among Cohorts of Service Members with a Posttraumatic Stress Disorder or Traumatic Brain Injury Disability Rating

• Chapter Six

  Conclusions

• Appendix A

  Creating the Analysis File

• Appendix B

  Key Definitions

• Appendix C

  Characteristics of the Diagnosis Cohorts

• Appendix D

  Additional Department of Defense–Wide Results

• Appendix E

  Air Force Results

• Appendix F

  Army Results

• Appendix G

  Marine Corps Results

• Appendix H

  Navy Results