Among SAA-deployed Veterans with available PFTs, 51.1% met criteria for VA pulmonary disability compensation, with increasing severity correlating with higher odds of functional limitations.
Cohort (n=9,191)
Yes
Over half of SAA-deployed Veterans with available PFTs met criteria for VA disability compensation, which correlated with greater functional and symptom burden.
Abstract Rationale For Veterans undergoing evaluation for service-connected disability due to non-infectious, non-malignant lung disease, the Department of Veterans Affairs (VA) determines eligibility for compensation and VA health care using pulmonary function test (PFT)-based rating criteria reflecting the severity of disability (10%, 30%, 60%, or 100%). Veterans deployed to Southwest Asia and Afghanistan (SAA) may be at elevated risk for lung disease due to airborne hazards exposure, potentially leading to a substantial pulmonary disability burden. Prior studies have demonstrated increased respiratory symptoms among SAA Veterans, though associations with objective lung diagnoses remain variable. Objective We aim to determine the proportion of SAA Veterans in the VA Airborne Hazards and Open Burn Pits Registry (“Registry”) who meet PFT-based disability criteria and evaluate how these classifications relate to functional and symptom outcomes. Methods We identified Registry participants enrolled in the Veterans Health Administration with at least one PFT performed after their initial deployment (1990-2021). Predicted values of lung function parameters were calculated using Global Lung Function Initiative (GLI 2022) equations. Disability ratings were computed for FEV1, FVC, FEV1/FVC, and DLCO according to VA criteria, with an overall rating categorized by the highest across parameters. Diagnoses were not evaluated. We examined the distributions of overall and parameter-specific disability categories and assessed associations between disability category and Registry questionnaire measures of functional limitation and respiratory symptoms using mixed-effects logistic regression, adjusting for age, sex, height, intervals between last deployment, PFT, and questionnaire, with VA site as a random effect. Results A total of 9,191 Veterans (39.3±9.9 years-old; 87% male) had qualifying PFTs in the VA Informatics and Computing Infrastructure database. Overall, 51.1% met a threshold for PFT-based disability: 34.9% (10%), 12.0% (30%), 3.3% (60%), and 0.9% (100%). Among the parameters, FEV1/FVC most frequently determined the 10% and 30% categories (73.2% and 57.1%), whereas FVC predominated at 60% and 100% categories (48.0% and 55.3%). Increasing disability severity correlated with higher odds of functional limitations and respiratory symptoms (Figure). Conclusions Over half of SAA-deployed Veterans with available PFTs met PFT-based criteria for VA disability compensation. Higher impairment levels correlated with greater functional and symptom burden. Although applying VA disability criteria solely to PFT values without accounting for diagnoses may over- or underestimate impairment, the observed prevalence and parameters capturing different severity ranges underscore the clinical and policy relevance of these objective measures and the need to integrate physiologic testing with patient-reported outcomes for disability evaluation. This abstract is funded by: The U.S. Department of Veterans Affairs Airborne Hazards and Burn Pits Center of Excellence
Zeng et al. (Fri,) conducted a cohort in Pulmonary disability (n=9,191). Deployment to Southwest Asia and Afghanistan (Airborne hazards exposure) was evaluated on Proportion meeting PFT-based disability criteria. Among SAA-deployed Veterans with available PFTs, 51.1% met criteria for VA pulmonary disability compensation, with increasing severity correlating with higher odds of functional limitations.
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