Abstract Rationale The ATS’s recommendation for race-neutral spirometry flagged disability as a research priority. There is no prior published data from real-world disabled patients. The Promises to Address Comprehensive Toxics (PACT) Act recognizes sarcoidosis in Veterans as a presumptively service-connected disability. This offers an avenue to explore the impact of race-neutral interpretation on the adjudication of disability payments. Methods We conducted a population-based retrospective study using Veterans Health Administration (VHA) records. Study inclusion required Veterans to be enrolled in the VHA, have available spirometry data, and to have received care for diagnosis of sarcoidosis through the VHA or Medicare between 2002 and 2022. Age, sex, height, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio were extracted from spirometry nearest their time of diagnosis. We recorded whether every included participant had a current disability status connected to their sarcoidosis. We calculated each participant’s percent predicted values for FEV1 and FVC using both GLI-2012 and GLI-Global, then compared each approach’s resultant disability rating. We calculated VHA disability ratings using the chronic bronchitis option for pulmonary sarcoidosis as specified in the Code of Federal Regulations Title 38 Chapter 1 Part 4. Assuming a Veteran alone with no dependents, we extracted the monthly compensation from the 2025 current Veterans disability compensation rates table. We compared each participant’s disability ratings and payments under the two interpretative reference equations. Results Among a cohort of 26, 708 with sarcoidosis, 3, 551 participants met our study’s inclusion criteria. They were predominantly male (87%), with 51% falling in the age range of 51-70 years old. Most identified as either Black (48. 5%) or White (46. 5%). Their mean FEV1 was 2. 69L ±0. 82L. The mean FVC was 3. 61L±0. 97L. 14. 5% had a VA disability status currently connected to their sarcoidosis diagnosis. Overall, the use of GLI-Global increased the proportion and severity of veterans eligible for disability status relative to the use of GLI-2012. This effect was most marked among Black veterans. While this did not affect payments for 78. 2% of Black Veterans, 15% would see higher monthly payments under GLI-Global’s race-neutral interpretation (Figure 1). Consequently, the proportion of Black Veterans not qualifying for payments would almost halve, while the most severely affected 0. 75% participants would see payments increased by over 400 monthly. Conclusions Despite the PACT Act, earned disability from sarcoidosis is severely underutilized among Veterans. Adoption of a race-neutral interpretation could significantly enhance prospective payments overall. This abstract is funded by: Nina Ireland Program for Lung Health
Baugh et al. (Fri,) studied this question.