Identifying obstacles to return to duty in severely injured combat-related servicemembers with amputation

Abstract

Abstract-The capacity of servicemembers with amputation to return to duty after combat-related amputation and the associated disabilities remains largely unknown. The purpose of this study was to examine the disabling conditions and return to duty rates of servicemembers with amputation across all service branches following major limb amputations from September 2001 through July 2011. Pertinent medical information, military occupation status, return to duty designation, disabling conditions, and disability ratings for each servicemember were obtained from the Physical Evaluation Board Liaison Office (PEBLO). Across all service branches, 16 (2%) servicemembers were found fit for duty (Fit) and allowed to continue with their preinjury occupation. Another 103 (11%) were allowed to continue on Active Duty (COAD) in a less physically demanding role. More than half (554, 56%) were determined fully disabled (PEBLO rating > 75); the average disability rating was 73. COAD and Fit Army servicemembers had lower Injury Severity Scores than other servicemembers (17.4, p = 0.009 and 11.2, p < 0.001, respectively). Despite improvements in their care and rehabilitation, only 13% of all servicemembers with amputation are able to return to Active Duty and many have multiple disabling conditions that contribute to a very high level of disability.

Factors Influencing Functional Outcomes and Return-to-Work After Amputation: A Review of the Literature

“…Most studies were open to all persons with an amputation, regardless of amputation etiology or level of amputation [27, 36–38, 43–47]. However, some studies did target specific cohorts, such as individuals who experienced a traumatic amputation related to combat operations [25, 26, 28–30, 33, 35, 41] or individuals with upper extremity amputation [9, 31, 34, 40], because of the potential impact of the characteristic on outcomes of interest. Overall, the majority of studies involved samples that were almost exclusively all male and under the age of 40 years.…”

“…Civilian employment rates following an amputation vary significantly within these studies from a low of 48%[30] to a high of 89%[26] post amputation. Among service members, amputation resulted in only 11–13% continuing on activity duty[29, 33], though a study reported 63% of the 52 British soldiers injured in Afghanistan and Iraq remained in military service 2 years post injury[28]. Various factors were assessed for their relationship with RTW after amputation, including demographic characteristics, physical functioning, and pre-injury vocational history.…”

Social relationships in rehabilitation and their impact on positive outcomes among amputees with lower limb loss at Walter Reed National Military Medical Center

“…In that study, factors external to the rehabilitation programme, such as issues of broken trust associated with the injury or afterwards, were seen as having a greater influence over the extent to which patients adhered to their rehabilitation programme and adopted their prosthetics into their everyday lives. Other studies have examined rates of return to duty (21,22) the experience of female veterans with limb-loss (23), ongoing work on life after injury as former patients navigate community living (24,25), and, as mentioned above, the significance and meaning of assistive devices in the lives of individuals with lower-extremity amputations (8).…”

Rehabilitation and multiple limb amputations: A clinical report of patients injured in combat

“…Two patients had reenlistment records prior to eventual dis charge. Previous research found that overall only 11 percent of people with major limb amputations remained on Active Duty and 2 percent continued in the same military occupational specialty after amputation [19][20]. A full discussion of issues related to future employment and community reintegration are beyond the scope of this study.…”