Musculoskeletal Injury Risk and Military Separation Following Serious Injury and Recovery in the Warrior Care and Transition Program

Introduction Military service members are at increased risk of musculoskeletal injury (MSKI), which is associated with service member non-ready status and military separation. The Warrior Care and Transition Program (WCTP) was created to help seriously injured soldiers recover and return to the active force or transition to civilian life. The risk of MSKI following reintegration is unknown, as is the role MSKI plays in military separation after return to force. Materials and Methods The Medical Operations Data-System Warrior Transition and Military Health System Data Repository datasets were used to identify participants in WCTP from 2007 to 2018 who returned to the active force. Warrior Care and Transition Program participants were matched 1:3 with non-WCTP active duty controls. Inpatient and outpatient MSKI care was identified with ICD codes; logistic and Poisson regression compared MKSI care among WCTP participants with mental, physical, and both injury types vs controls. Cox Proportional Hazards models calculated the risk of military separation by MSKI status. Results Warrior Care and Transition Program participants with physical only injuries were 184% and 269% more likely to have inpatient and outpatient care, respectively, than controls; similarly, those with mental injuries had 371% and 139% higher likelihood; those with both injuries had 380% and 363% higher likelihood. The hazard ratio for military separation after WCTP exit was increased (190%) for those with MSKI, specifically as time from exit progressed. Those with a mental health component to injury had a higher risk of separation than those without; however, hazard decreased with time. Conclusion The odds and rates of MSKI care for WCTP participants were increased 2-4 times. Risk was greater for soldiers who had a mental health component to their injury, suggesting a need for ongoing physical and mental health support for WCTP participants even following full recovery and return to the active force.