Evaluation of psychiatric disability in PTSD of military origin

Background: Israeli veterans suffering from post-traumatic stress disorder (PTSD) filed claims for recognition of their mental disability and for compensation underwent thorough psychiatric evaluations conducted by an interdisciplinary team. Objective: To study the clinical features and functional impairment of PTSD veterans who filed claims for psychiatric disability. To evaluate possible relationships among severity of PTSD, psychiatric comorbidity and level of disability. Method: Subjects were 294 veterans with PTSD. Evaluation included a semi-structured psychiatric interview; self report questionnaires of PTSD, psychiatric symptoms and assessment of functional impairments (in self-care in daily living, interpersonal - familial and social, and occupational functioning). Upon completion of the various assessments the psychiatrist determined a global disability score. Results: 156/294 (53%) of the PTSD subjects had psychiatric comorbidity, mainly depression (31 %) and anxiety (15%). PTSD casualties suffered significant functional impairments, more in occupational functioning than interpersonal and activities of daily living, respectively. A number of PTSD symptoms were positively correlated with functional impairments in the occupational and interpersonal areas and with the global disability score, while psychiatric comorbidity was not. Conclusion: PTSD veterans who file for psychiatric disability report severe mental distress and functional impairment, and probably constitute the more severe PTSD casualties. Systematic assessment of functional impairment in addition to clinical examination is needed for valid evaluation of disability and for determining disability score.