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Validity of Posttraumatic Stress Disorder Service Connection Status in Veterans Affairs Electronic Records of Iraq and Afghanistan Veterans

J Clin Psychiatry 2016;77(4):517–522

Objective: This study examined the extent to which veterans’ posttraumatic stress disorder (PTSD) service connection (SC) status corresponded to their PTSD diagnostic status, as determined by a semistructured diagnostic interview.

Method: Participants were 834 veterans in the Veterans After-Discharge Longitudinal Registry (Project VALOR), an observational registry of veterans with and without PTSD who are enrolled in the Veterans Affairs (VA) health care system. PTSD diagnostic status was confirmed using the Structured Clinical Interview for DSM-IV (SCID).

Results: Concordance between PTSD SC status and current and lifetime PTSD diagnosis was 70.2% and 77.2%, respectively. Individuals with PTSD SC were twice as likely as those without PTSD SC to have a current SCID PTSD diagnosis (OR = 2.11 [95% CI, 1.47–3.04]; P < .001) and almost 3 times as likely to have a lifetime SCID PTSD diagnosis (OR = 2.72 [95% CI, 1.67–4.41]; P < .001). For current PTSD, results showed a slightly higher proportion of false positives—individuals who did not meet SCID criteria but who did have SC for PTSD—than false negatives—individuals who met SCID criteria but did not have SC for PTSD. For lifetime PTSD, the proportion of false negatives was approximately twice the proportion of false positives.

Conclusions: PTSD diagnostic and SC status are discordant for a significant minority of veterans. Findings revealed that both the number of veterans who are service connected without meeting criteria for PTSD and the number of veterans who meet PTSD criteria but have not been granted SC status are concerning.