Role of homelessness and incarceration in time-to-decision on veterans affairs disability benefits for a mental health condition.

Abstract

Homelessness and incarceration are major psychosocial concerns in the United States that may be mitigated by access to disability benefits. Data from the Veterans Benefits Administration (VBA) provides a unique opportunity to study how the process of obtaining disability benefits and time-to-decision might be affected by homelessness and/or incarceration among veterans in the Veterans Health Administration (VHA). The purpose of this study was to examine how homelessness and/or incarceration status among VHA-enrolled U.S. veterans might affect outcomes of VBA disability benefits claims for a mental health condition, including time-to-decision and rating outcomes. Using a retrospective cohort design, linked VHA/VBA data from 2022 to 2023 on 327,047 U.S. veterans (including 7,202 homeless veterans and 280 incarcerated veterans) were analyzed with multivariable Cox regressions. Overall, 85.7% of veterans received award of a Department of Veterans Affairs (VA) service-connected disability for a mental health condition. Although VA service-connected disability for a mental health condition was awarded less frequently for homeless and incarcerated veterans, the time-to-decision for homeless veterans-with or without incarceration-was twice as fast as nonhomeless and nonincarcerated veterans, after adjustment for demographic and clinical characteristics. In conclusion, although homeless and/or incarcerated veterans were less likely to receive VA service-connected disability for a mental health condition than other VA disability-seeking veterans, homeless veterans had faster decision times on VA disability applications. These findings inform ongoing efforts to ensure veterans with diverse backgrounds and needs receive the VBA benefits for which they qualify. (PsycInfo Database Record (c) 2025 APA, all rights reserved).