Document Type
Article
Abstract
Objective
To identify factors associated with transitioning from Military Health System (MHS) to Veterans Health Administration (VHA) care in post-9/11 veterans.
Study Setting and Design
Retrospective cohort study from the Long-Term Impact of Military-Relevant Brain Injury Consortium Phenotype Study.
Data Sources and Analytic Sample
Population-level data were analyzed from MHS and VHA electronic health data (FY2000-2020). Participants received ≥ 3 years of MHS care and separated from the military before October 1, 2016. The primary outcome was transition from MHS to VHA care after military separation. Covariates included demographic, military, and deployment characteristics at military separation; physical, mental, and substance use disorder (SUD) diagnoses, behavioral risk factors, and multimorbidity 2 years before military separation.
Principal Findings
Among 1,594,869 post-9/11 veterans, 81.9% were male, 54.2% active-duty, and 48.8% were ages 25–34. Of the 78% that transitioned to VHA care, 70% had combat deployments, 17.5% were women, and 38.5% were Asian/Pacific Islander, Black, Hispanic, or Native American. Pain (55.8%) and smoking history (40.8%) were most prevalent 2 years before military separation. Post-9/11 veterans diagnosed with schizophrenia [average marginal effect (AME): 0.096, 95% CI: 0.0084–0.108] had a higher probability of transitioning to VHA care. Multimorbidity of TBI, PTSD, SUD, depression, or pain was associated with increased probability of transitioning to VHA care (AME: 0.043, 95% CI: 0.042–0.044). National Guard (AME: 0.089, 95% CI: 0.087–0.091) members transitioned more often than active duty members. Biracial/multiracial/multiethnic members (AME: −0.389, 95% CI: −0.395 to −0.383) had a lower probability of transitioning to VHA care.
Conclusions
Post-9/11 veterans with multimorbidity and significant disease burden experienced more MHS-VHA care transitions. Biracial/multiracial/multiethnic members may benefit from enhanced care coordination between the MHS and VHA to reduce disparities and improve population health in post-9/11 veterans. Future research should examine MHS-VHA care transitions in service members treated for suicidality.
Digital Object Identifier (DOI)
Publication Info
Published in Health Services Research, Volume 61, Issue 2, 2026, pages e70087-.
© 2026 The Author(s). Health Services Research published by Wiley Periodicals LLC. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
APA Citation
Wooten, N. R., Amaun, M. E., Myers, M., Addo, P. N. O., Bowers, J., Carey, F. R., Rull, R. P., Boyko, E. J., Bell, N., DeFede‐Lopéz, A., & Pugh, M. J. V. (2026). Physical and Behavioral Health Diagnoses and Comorbidities Associated With Transition From Military Health System to Veterans Health Care Among Post‐9/11 Veterans. Health Services Research, 61(2). https://doi.org/10.1111/1475-6773.70087