Return-to-duty rates among US military combat-related amputees in the global war on terror: Job description matters

BACKGROUND: The purpose of this study was to identify the differences seen between military occupation services (MOS) in terms of amputation patterns, subsequent disabling conditions, and their ability to return to duty. METHODS: A retrospective study of major extremity amputations sustained by US service members between October 1, 2001, and July 30, 2011, was performed. Data obtained from the amputation database, Joint Trauma Theater Database, and the Physical Evaluation Board Liaison Office included demographics, amputation location(s), Injury Severity Scores (ISSs), disabling conditions, disability ratings, and disposition status. RESULTS: There were 1,221 major extremity amputees identified during the specified time frame, of which 899 had data regarding disabling conditions, ratings, and disposition. All service branches were represented. Personnel from the US Army (USA) Infantry were significantly (p < 0.0001) more likely to sustain an amputation than other MOS. The USA Infantry, the US Marine Corps Infantry and the USA Armor represented the top three specialties and accounted for more than 57% of all amputees. Approximately 89% of all service members did not return to duty, and the mean combined for all amputees was 76. USA Special Forces (USA SF) operators were significantly more likely to return to duty (p = 0.0022) and be found fit for duty (p = 0.0015) than all other MOS despite having a mean ISS (20) that was no different from those of other service members. No USA SF personnel were found to have posttraumatic stress disorder as a disabling condition. CONCLUSION: All amputees, regardless of MOS, are not likely to return to active duty and especially unlikely to be found fit for duty, except for members of the USA SF. The reason(s) for the increased return to duty for USA SF personnel remains unknown but a lack of posttraumatic stress disorder may be a contributing factor. LEVEL OF EVIDENCE: Epidemiologic study, level IV.