Objective: To describe the prevalence and impact of vestibular dysfunction and nonspecific dizziness diagnoses and explore their associations with traumatic brain injury (TBI) severity, mechanism, and postconcussive comorbidities among post-9/11 veterans. Setting: Administrative medical record data from the US Departments of Defense and Veterans Affairs (VA). Participants: Post-9/11 veterans with at least 3 years of VA care. Design: Cross-sectional, retrospective, observational study. Main Measures: International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for TBI, vestibular dysfunction, dizziness, and other commonly associated postconcussive conditions; Neurobehavioral Symptom Inventory. Results: Of the 570 248 post-9/11 veterans in this sample, 0.45% had a diagnosis of vestibular dysfunction and 2.57% had nonspecific dizziness. Those with either condition were more likely to have evidence of TBI (57.11% vs 28.51%) and reported more disruption from neurobehavioral symptoms. Blast and nonblast injuries were associated with greater symptom disruption, particularly in combination. Conclusions: There was a consistent, significant association between TBI and vestibular dysfunction or nonspecific dizziness, after controlling for sociodemographic factors, injury mechanism, and comorbid conditions. Given that most deployed post-9/11 veterans report blast and/or nonblast injuries, the need for prompt identification and management of these conditions and symptoms is clear.

Beginning May of 2013 and ending in September, I worked with Grace After Fire (Grace), a virtual nonprofit organization that focuses on issues related to female veterans. Grace’s mission is to provide female veterans with the means to gain knowledge, insight and self-renewal. Grace’s mission is accomplished through peer support and resource referral. The aim of my thesis project was to conduct an analysis of Grace’s peer support system, Table Talk: Color Me Camo (Table Talk). Because Table Talk is a fairly new program for Grace, just over a year old, the outreach coordinators were eager to learn: 1) if they were indeed meeting their mission of empowering female veterans, and 2) the point-of-view of the peer facilitators who conduct Table Talk. To help Grace gain perspective, I interviewed women who had previously attended Table Talk, as well as peer facilitators responsible for coordinating the peer support system-all of whom are female veterans. The following is their story.

The Non-Veteran Administration Care (NVC) is a program in which the Veterans Health Administration purchases health care when it cannot provide the health services needed for eligible Veterans. The rising cost of this program led to audits by the Office of the Inspector General and other entities. The scholarly problem for this DNP Project was the lack of oversight, accountability, and management, found throughout the audits of NVC, as well as a lack of evaluation of NVC. The purpose of this project was to ascertain if there was a relationship between the Non-VA Care Coordination program (NVCC) and utilization of care. The NVCC was implemented to eliminate the deficiencies cited by audits. Sleep study and chiropractic consults for FY 2013 (pre-NVCC) and FY 2014 (post-NVCC) were examined. Sleep apnea service was available at the local Veteran Administration Medical Center and chiropractic service was not. Utilization of care was determined by emergency room (ER) visits and admissions related to the consult. A logic model was used to conceptualize the project and the longer-term implementation and evaluation of NVCC, and descriptive statistics were used to analyze trends in the chiropractic data (sleep study consults were excluded from the analysis due to the minute number). There were a total of 859 chiropractic consults and 2,184 approved visits analyzed. The results revealed that Veterans who utilized the consults had no ER visits or admissions related to referrals for chiropractic consults. Completed chiropractic consults remained proportionality the same both years. NVCC had no association with the utilization of care. This scholarly project contributes to social change by empowering consumers and providing transparency in the government through audits that facilitate quality improvement and evaluation of the NVCC program.