The Mortality Rate of 100% Service-Connected U.S. Veterans (2024)

Abstract

Previously, it was unknown if 100% service-connected U.S. veterans have a diminished mortality. However, it is widely documented that this patient population experiences worse health due to their military service, so it is logical that their mortality will be diminished due to their worse health. This research study helped address an apparent gap in the literature regarding the mortality of 100% service-connected U.S. veterans. The objective of this research study was to answer the question, what is the average age at death of 100% service-connected U.S. veterans? This research study is a pilot study designed to help answer this initial question. This is important because it will help determine if the mortality of this U.S. veteran population is reduced due to their military service.

This is a quantitative research study with a descriptive design to establish the average age at death of 100% service-connected U.S. veterans. Only pre-existing de-identified categorical data was collected. All research activities were performed at the Oklahoma City VA Health Care System (OKCVAHCS) by OKCVAHCS research personnel. Data for this research study was collected from the Veterans Health Administration (VHA) Corporate Data Warehouse (CDW) through the VHA Informatics and Computing Infrastructure (VINCI). All male and female deceased 100% service-connected veterans in the VHA’s CDW at least 18 years of age were included in this research study. Descriptive statistics were utilized for all analyses to examine this patient population and determine their average age at death. Subanalyses by gender, race, and service-connected conditions were also performed. In this study, there were 309,977 deceased 100% service-connected U.S. veterans included. The study found the overall average age at death for all 100% service-connected U.S. veterans is 67 years of age. When separated by gender, the average age at death for all female 100% service-connected U.S. veterans is 63 years of age and the average age at death for all male 100% service-connected U.S. veterans is 68 years of age. The study results demonstrate female 100% service-connected veterans have a 22% diminished life expectancy when compared to the World Bank Data average human (civilian) life expectancy in the United States for females (81 years of age) and male 100% service-connected veterans have a 11% diminished life expectancy when compared to the World Bank Data average human (civilian) life expectancy in the United States for males (76 years of age).

INTRODUCTION

Currently, 2.87 million men and women serve in the United States Military, to include the National Guard and Reserve Forces (“Our Story,” 2019). Once these men and women’s service in the U.S. Military is over, they become veterans. According to the United States Census Bureau, as of November 11, 2015, there are almost 21.4 million veterans in the United States (“Veterans Statistics - Veterans Day 2015,” 2018, p. 1). This population is projected to decrease in Fiscal Year 2020 to 19,209,704 veterans, of which, 1,920,965 (10%) are female and 47.1% are sixty-five years old or older (, p. 1).

Veterans of the United States Military who incur injury(ies) and/or illness(es) as part of their military service can be awarded service-connected disability for those injury(ies) and/or illness(es) and can apply for disability compensation through the Department of Veterans Affairs (VA) (“Benefits Description,” 2018, p. 1). Service-connected disability is rated from 0% to 100%. Each injury and/or illness is awarded a value of disabling. “For veterans with more than one disabling condition, VA combines the individual ratings into a single combined rating and rounds it to the nearest 10%” (, p. 2). Once a veteran reaches 94% service-connection for their disabilities, the veteran is determined to be 100% disabled. As of September 30, 2019, it is reported that 4.94 million veterans are being compensated for service-related disabilities through the Disability Compensation (DC) program, of which, 778,173 are rated 100% service-connected (, p. 1).

The problem is that there is limited data available on the age at death for 100% service-connected U.S. veterans. Knowing this information will help establish if this veteran population has a diminished life due to their military service. Current data demonstrates that the veteran population experiences worse health due to their military service (; ; ; ). Also, current data demonstrates that there are 4.94 million veterans being compensated for service-related disabilities, of which, 16% are 100% service connected (, p. 1). As veterans experience numerous health conditions due to their military service, it is unknown if this population is dying prematurely due to these multiple health conditions caused by their military service. This may be an increasing issue, as the other 84% of veterans who are being compensated for service-related disabilities (about 4.2 million veterans), experience worsening health, and the projected veteran population for Fiscal Year 2020 who do not currently receive disability compensation (about 14.3 million veterans) experience worsening health.

The purpose of this research study is to answer the question, What is the average age at death of 100% service-connected U.S. veterans? This research study is a pilot study designed to help answer this initial question. This question is important because it will help determine if the mortality of 100% service-connected U.S. veterans is reduced due to their military service. For example, if this research study finds the average age at death of 100% service-connected U.S. veterans is 60 years of age for males and 65 years of age for females, and it is known that the average age of U.S. veterans not 100% service-connected is 67 years for males and 73 years for females (Maynard, el al., 2018, p. e373), then this would demonstrate that the 100% service-connected veteran population is experiencing death prematurely. If this is the case, identifying the issue may raise awareness so that medical facilities could make available a variety of health services and administrative support to help balance the veterans’ diminished lives. Also, once the average age at death for this population is known, it may be researched further by comparing this information to that of U.S. veterans who are not 100% service-connected and investigate medical diagnosis which may be the cause of this population’s diminished life.

LITERATURE REVIEW

There is an apparent gap in the literature regarding the average age at death of 100% service-connected U.S. veterans. Information currently known is the average human (civilian) life expectancy for males and females in the United States. According to World Bank Data, retrieved on January 20, 2020, the average human life expectancy in the United States is 76 years for males and 81 years for females, as of 2017 (“Life expectancy at birth, total (years),” 2020, p. 1). However, how does this information differ in the veteran population, specifically, in the 100% service-connected U.S. veteran population? As stated previously, it is already known the veteran population experience worse health due to their military service (Maynard, et al., 2018; Maynard, et al., 2018; Rogers, et al., 2004; Vaughan-Sarrazin, et al., 2007). A literature search for “100% service-connected U.S. veterans” in the Oklahoma University Library database yielded 1,210 related articles. However, none of these articles established the average age at death for this specific veteran population.

In 2004, the VA conducted a study to understand if the veteran population is sicker than the civilian population (Rogers, et al., 2004). This pilot study compared the health status of male veterans in the Boston area who participated in a previous research study in 1993-1995 to male civilian patients in the Boston area who participated in a previous research study in 1986. “This study showed that by any standard of comparison, the Veterans Health Study (VHS) veterans had worse health than did the Medical Outcomes Study (MOS) population” (Rogers et al., 2004, p. 256). According to Vaughan-Sarrazin, et al., (2007), “a number of studies over the past two decades have compared outcomes in Department of Veterans Affairs and private sector hospitals” (p. 1803). These studies produced conflicting results but were more aimed at comparing total VA care to the care received in civilian hospitals. However, neither of these research studies investigated the average age at death of 100% service-connected U.S. veterans.”

In 2018, another research study conducted by the VA and Clinical System Development and Evaluation researchers “compared military service and disability characteristics, including overall disability rating, and cause of death by year of birth” (Maynard, et al., 2018, p. 371). Among the numerous variables collected, this study collected veteran’s disability rating (0% to 100%) and veteran’s age at death for 605,344 deceased veterans who died between the years of 2004 and 2014. A review of this study’s data (Table I) yields a total of 232,049 veterans (38.3%) who died were 100% service-connected at time of their death (Maynard et al., 2018, p. e373). However, this study did not establish the average age of death for 100% service-connected U.S. veterans.

In 2018, another study by Maynard et al., (2018) was conducted to determine “the relationships among characteristics, disability ratings, and 1-year mortality risks of veterans receiving compensation for service-connected health conditions (ie., conditions related to illnesses or injuries incurred or aggravated during military service)” (p. 692). This research study compared veteran characteristics with 1-year mortality rates among veterans rated 10% to 40% service-connected (low), 50% to 90% service-connected (medium), and 100% service-connected (high). They noted veterans rated 100% service-connected were 2.5 times more likely to die than those rated in the low group. The researchers concluded, “veterans with a 100% disability rating comprise a highly select group with increased short-term risk of death due at least in part to their military service” (Maynard et al., 2018, p. 692). Also of note, the study found the highest risk for premature death due to military service of the 100% service-connected group was among enlisted personnel. “This finding suggests that rank may also predict premature death and is consistent with evidence showing that enlisted personnel have lower socioeconomic status and relatively less privilege than officers” (Maynard et al., 2018, p. 695). In conclusion, the authors recommend future studies should examine other variables related to age at death or premature death in this population.

RESEARCH DESIGN AND METHODS

This is a quantitative research study with a descriptive design to establish the average age at death of 100% service-connected U.S. veterans. Only pre-existing categorical data will be collected. All research activities will only be performed at the OKCVAHCS by OKCVAHCS personnel.

Data for this research study will be collected from the Veterans Health Administration (VHA) Corporate Data Warehouse (CDW) through the VA Informatics and Computing Infrastructure (VINCI). The VHA’s CDW is a central data repository designed to provide a high performance business intelligence infrastructure through the VA. It is a national repository of data from VISTA and several other VHA clinical and administrative systems. It provides for better visibility of the VA’s veteran population and a greater availability of data across VA Administrations.

The VHA CDW is composed of national data from the Veterans Health Administration (VHA), the Veterans Benefit Administration (VBA), the Department of Defense (DoD), and the Centers for Medicare and Medicaid Services (CMS). VINCI is an initiative to improve VA researchers’ access to VA data and to assist with the analysis of that data while ensuring data security and veterans’ privacy. To complete this initiative, VINCI has partnered with the VA CDW to provide data to the VA’s research community.

A data request will be submitted to VINCI utilizing the Data Access Request Tracker (DART). The DART will request data for the total number of deceased 100% service-connected veterans in the CDW at the time of the request (selected time-period). The DART will request their 1) age at death; gender; 3) race; 4) service-connected medical conditions; and 5) branch of service (Army, Navy, Marine Corp, Air Force, and Coast Guard). This data will be requested from the VHA Vital Status Master File. It is the most complete source of veterans’ information for vital status and date of death. It combines death information from the Beneficiary Identification Records Locator Subsystem (BIRLS), a VBA database, Medical SAS Inpatient Datasets, the Social Security Administration (SSA) Death Master File (DMF), and the Medicare Vital Status File. The VINCI requested data will be placed in a VINCI workspace for review and analysis. This information will remain in the VINCI environment for data analysis. Descriptive analysis will be used to examine this patient population data and determine the mortality of 100% service-connected veterans.

STATISTICAL ANALYSIS

Descriptive statistics will be used for all analyses to examine this patient population and determine the average age at death of 100% service-connected veterans.

To determine mortality of 100% service-connected U.S. veterans, this research study will average the age at death of all deceased 100% service-connected U.S. veterans in the CDW at the time of the request. Then, this research study will divide this dataset by male and female and average the age at death to establish the mortality of male and female 100% service-connected U.S. veterans to investigate if there is a difference by gender. Then, this research study will divide this dataset by race and average the age at death to investigate if there is a difference by race. Next, this research study will divide this dataset by branch of service (Army, Navy, Marine Corp, Air Force, and Coast Guard) and average the age at death to investigate if there is a difference by branch of service. Finally, the medical conditions of these veterans will be trended to determine the ten most common service-connected medical conditions for this population.

INCLUSION AND EXCLUSION CRITERIA

This research study will request existing de-identified historical patient data of all deceased 100% service-connected veterans in the VA CDW at the moment in time the data is requested.

HUMAN PARTICIPANTS

It is estimated 700,000 participants’ information may be included in this research study through collection of existing data. All deceased males and females ages 18 to 120 with a 100% VA service-connected rating at the time the data is collected from the CDW will be included. The research study will seek Exempt criteria four (Secondary Research) in accordance with the 2018 Revised Common Rule since IRB approval will be sought after January 21, 2019. The research study will also request a Waiver of Consent and complete HIPAA Privacy Waiver from the IRB. IRB approval will be sought from the Oklahoma University Health Sciences Center (OUHSC) IRB because it is an IRB of record for the OKCVAHCS, and from the OKCVAHCS’s Research and Development Committee (R&DC) as required. Risk to human participants is less than minimal. Possible risks to study participation include disclosure of protected health information (PHI). However, provisions have been made to protect the privacy interest of all research participants and protect their research data. All study data will be kept in strict confidence and maintained in the VINCI workspace.

Results from this research study has the potential to help establish if 100% service-connected veterans’ life expectancy is reduced due to their military service. If so, medical facilities could provide a variety of health services and administrative support to these veterans to balance their life expectancy. This may benefit the veterans participating in this research study indirectly.

Privacy, Confidentiality, and Information Security Provisions have been made to protect the privacy interest of all research participants and to protect their research data. All participants’ data will be de-identified and kept in the VINCI workspace to maintain confidentiality and security. All information/data collected is considered VA research data/records. No VA sensitive information will be removed from or stored outside of the VA protected environment. Access to research records will only be granted to key study personnel (KSP), and access will be removed once KSP are no longer part of the research team. No VA data/records will be maintained on any hard drive or mobile devices.

All VA research records will be maintained and destroyed in accordance with VHA’s Record Control Schedule (RCS). Any incidents regarding VA privacy and/or information security will be reported to the OKCVAHCS Information Security Officer (ISO) and/or the OKCVAHCS Privacy Officer (PO) within one hour of becoming aware of the incident in accordance with VA policy. This report will detail the problem and unanticipated risk. The incident will also be immediately reported to the IRB, OKCVAHCS Associate Chief of Staff for Research and Development (ACOS/R&D), and the OKCVAHCS Research Compliance Officer (RCO) or Compliance and Business Integrity Officer (CBIO). Any presentations or publications from this research will not identify any participants by name.

RESULTS

This study utilized information from the VHA’s Vital Status File, which includes data from the National Death Index (NDI) and the VA Suicide Data Repository. The cohort for this research study was requested from the VHA CDW, through VINCI, utilizing the criterion: all deceased males and females older than 18 years of age with a 100% service-connected disability rating at the time of the request. On April 7, 2020, the VINCI provided the study cohort matching this criterion. The study utilized the scrambled social security number to link the age at death, gender, race, and service-connected conditions with each 100% service-connected veteran included in this research study. Once access was granted to the VHA CDW, this study utilized the query in figure 2 to collect age at death and gender.

In this study, there were 309,980 deceased 100% service-connected U.S. veterans matching the study’s inclusion criteria. Their age at death ranges from 19 years of age (n=8) to 123 years of age (n=3). It is believed that the three veterans who died at 123 years old is an error. This is because all three dates of birth were 1/1/1871, all three died on 7/23/1994, and they were listed as World War II veterans. Because these are believed to be an error, these three participants were omitted from the study cohort leaving 309,977 included in this research study. Of these included, .08% were ages 19 to 24 at death (n=242), 15% were 25 to 54 at death (n=46,879), 24% were 55 to 64 at death (n=74,327), 61% were 65 to 99 at death (n=188,244), and .09% were 100 to 108 years old at death (n=286). Regarding gender, 2.7% are female (n=8,324), 97% are male (n=301,643), and the gender of .03% are unknown (n=10). The overall average age at death for all 100% service-connected U.S. veterans is 67 years. When separated by gender, the average age at death for all female 100% service-connected U.S. veterans is 63 years of age and the average age at death for all male 100% service-connected U.S. veterans is 68 years of age.

Further subanalysis of age at death by gender and race noted the average age at death for white males is 70 years of age (n=110,219) and for white females is 64 years of age (n=3,391). For both White males and females, post-traumatic stress (n=21,626 for males and n=516 for females) is the most common service-connected condition. The average age at death for black or African American males is 66 years of age (n=21,322) and black or African American females is 58 years of age (n=906).

For both black or African American males and females psychosis, schizophrenia paranoid (n=4,285 for males and n=151 for females) is the most common service-connected condition. The average age at death for American Indian or Alaskan Native males is 68 years of age (n=1,477) and American Indian or Alaskan Native females is 62 years of age (n=26). For American Indian or Alaskan Native males, the most common service-connected condition is post-traumatic stress (n=467) and for American Indian or Alaskan Native females is lupus (n=17). The average age at death for Asian males is 72 years of age (n=445) and Asian females is 43 years of age (n=12). For Asian males, there are three common service-connected conditions. These conditions are post-traumatic stress (n=60), psychosis, schizophrenia paranoid (n=60), and arteriosclerotic heart disease (n=60). For Asian females, the most common service-connected condition is major depressive disorder (n=7). The average age at death for Native Hawaiian or Other Pacific Islander males is 71 years of age (n=1,670) and Native Hawaiian or Other Pacific Islander females is 59 years of age (n=24). For Native Hawaiian or Other Pacific Islander males, the most common service-connected condition is post-traumatic stress (n=301) and for Native Hawaiian or Other Pacific Islander females is diaphragm paralysis or paresis (n=7).

Regarding race, the study utilized the scrambled social security number to link the race to the age at death and gender for each 100% service-connected veteran included in this research study. This study utilized the query in figure 3 to collect race and ethnicity. According to race, .1% are Hispanic or Latino (n=361), .2% are Asian (n=457), .5% are American Indian or Alaskan Native (n=1567) or Native Hawaiian or Other Pacific Islander (n=1694), 4% responded that they did not know their race (n=13,470), 7% are black or African American (n=22,228), 37% are white (n=113,610), and 51% did not provide a response for race (n=156,590).

Concerning service-connected conditions, the study utilized the scrambled social security number to link the service-connected conditions to race, age at death, and gender. This study utilized the query in figure 4 to collect service-connected conditions.

There is a total of 260,581 service-connected conditions matched to 100% service-connected veterans in this study. This left about 16% whose service-connected conditions are unknown (n=49,397). The veterans with known service-connected conditions suffered from a plethora of medical conditions due to their military service. Examples of these medical conditions are burns, abscesses, diabetes mellitus, high blood pressure, cancers, hearing loss, tuberculosis, chronic back conditions, heart disease, blindness, sleep apnea, chronic inflammation, lupus, amyotrophic lateral sclerosis, various cancers, chronic obstructive pulmonary disorder, AIDs, colitis, irritable bowel syndrome, and numerous mental health conditions. The ten most common service-connected conditions among this population are: 1) 14% post-traumatic stress (n=42,635), 2) 11% psychosis, schizophrenia paranoid (n=35,499), 3) 7% psychosis, schizophrenia undifferentiated (n=22,157), 4) 5% arteriosclerotic heart disease (n=15,716), 5) 4% loss of a body part(s) (n=12,279), 6) 3% neurosis, general anxiety disorder (n=9,837), 7) 3% neoplasm, various types (n=8,593), 8) 2% psychosis schizophrenia residual and other (n=6,211), 9) 2% bipolar disorder (n=6,164), and 10) 2% brain syndrome (n=6,093). Surprisingly, 40% of these service-connected diagnoses is a type of mental health condition (n=122,503).

Regarding branch of service, the study was not able to link military branch of service to the study population, so this variable was not included.

CONCLUSION

This study noted the overall average age at death for all 100% service-connected U.S. veterans is 67 years. When separated by gender, the average age at death for female 100% service-connected U.S. veterans is 63 years of age and the average age at death for male 100% service-connected U.S. veterans is 68 years of age. This mortality rate, for both male and female 100% service-connected U.S. veterans, is less than the average human (civilian) life expectancy in the United States for males (76 years of age) and females (81 years of age) as reported by the World Bank Data retrieved on January 20, 2020 (“Life expectancy at birth, total (years),” 2020, p. 1). On average, there is about 9 years difference at age of death between each race/gender dyad except for the Asian males and females. In this pair, there is 29 years difference at death between genders. In each race/gender dyad, the males age at death is greater than the females except for the Hispanic or Latino genders. In this group, the females age at death is 12 years greater than males. Both are interesting outliers and should be researched further to investigate their cause.

A limitation of this study is associating the average human (civilian) life expectancy, as reported by the World Bank Data, to the average age at death of 100% service-connected U.S. veterans, as these are not comparable populations. Instead, this study is using this association as a starting point to demonstrate a diminished life expectancy for 100% service-connected U.S. veterans. It is recommended that future research be conducted to compare this study’s results to the average age at death of non 100% service-connected U.S. veterans, as these are more analogous populations.

In conclusion, this study added to the literature by establishing the average age at death of 100% service-connected U.S. veterans. The study results demonstrate female 100% service-connected veterans have a 22% diminished life expectancy when equated to the World Bank Data average human (civilian) life expectancy in the United States for females (81 years of age) and male 100% service-connected veterans have a 11% diminished life expectancy when equated to the World Bank Data average human (civilian) life expectancy in the United States for males (76 years of age). Given these results, 100% service-connected women U.S. veterans experience a two times greater diminished life expectancy than that of male 100% service-connected U.S. veterans. While the numbers in the female group are smaller, the findings of premature death and greater diminished life expectancy are very troubling. However, for both genders, the findings of premature death and diminished life expectancy further accentuate the importance of benefits and health care services needed to help balance their mortality.

ACKNOWLEDGEMENT OF VA RESEARCH SUPPORT AND EMPLOYEMENT

This material is the result of work supported with resources and the use of facilities at the Oklahoma City VA Health Care System (635) in Oklahoma City, Oklahoma. The author serves as the Research Compliance Officer at the Oklahoma City VA Health Care System (635) in Oklahoma City, Oklahoma.

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