Returning from the War on Terrorism: What Every Iraq, Afghanistan, and Deployed Veteran Needs to Kno

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A few studies have examined the effect of deployment on businesses. Their findings suggest that for small employers the most important costs are caused by lost productivity rather than by requirements imposed by the Uniformed Services Employment and Reemployment Rights Act. Thus, employers must bear the costs of temporarily replacing their reservist employees; however, there do not appear to be data on those costs.

On the basis of published civilian age-group and firm-size data, Doyle et al. In additional, employers of reservists ordered to active duty for a month or less must continue health-insurance contributions for them. Small businesses might be disproportionately affected by the loss of reservists ordered to active duty, because the loss of an employee at a small firm constitutes a greater share of output than at a large firm.

Doyle and colleagues interviewed a small number of recipients of Small Business Administration Military Reservist Economic Injury Disaster Loans, which are given to companies that are unable to meet their operating expenses after an essential employee has been called to active duty.

The findings indicate that the most common effect of activation is lost business and that losses are experienced even after the reservists return from active duty. Furthermore, replacing a reservist, even if it is feasible, does not necessarily offset lost business; in some cases, the long-term effect of activation may result in permanent harm to the business Doyle et al. The Congressional Budget Office CBO, a interviewed 19 employers of 28 reservists and found that small businesses that lose essential employees, businesses that employ highly skilled workers, and self-employed reservists were the most severely affected as a result of activation and federal job protections.

The sections above have focused on many issues related to families, spouses, children, women, and racial and ethnic minorities identified in studies of previous conflicts rather than studies of OEF and OIF active-duty personnel, veterans, and family members. The committee believes that many of the studies provide information that is relevant to the current conflict, but active-duty service members, reservists, and veterans face hardships because of service in Iraq and Afghanistan that not only extend beyond physical and mental health problems but might be peculiar to these wars.

They also face numerous readjustment issues that influence their ability to adjust to life outside theater and that can affect their families. Research on the OEF and OIF deployed population is needed not only to understand the extent of the readjustment but to understand how to provide assistance.

The committee recommends that the Department of Defense, the Department of Veterans Affairs, and other federal agencies fund research on the social and economic effects of deployment and multiple deployments on families. For example, research should examine the effects of multiple deployments on domestic violence and maltreatment of children, as well as on financial well-being. The previous section described the stresses and potential health and social consequences that all service members and their family members face because of service in Iraq and Afghanistan.

Select subpopulations in the military face unique stressors and may have other needs that require additional attention. In this section, the committee reviews and summarizes needs specific to women and racial minorities. Although women are technically barred from serving in combat specialties, such as armor or infantry, a growing and unprecedented number of female soldiers are deployed to combat areas where their lives are at risk Burrelli, ; this is a relatively new phenomenon.

They serve in a range of support positions such as pilots, intelligence, transportation, and mechanics that involve travel outside military bases, coming under direct fire, and working alongside combat soldiers. All service members are exposed to exceptionally high levels of workplace stress, but women in the military face some unique stressors and trauma exposure that may affect their mental health and emotional well-being. Female veterans have a higher burden of medical illness, worse quality-of-life outcomes, and earlier psychologic morbidity than do men who are exposed to the same levels of trauma Nayback, Both the military and family life require commitment and loyalty, and servicewomen who have families may experience intense conflict between the demands of their military and family roles, given the centrality of the maternal role for most women.

Some of the issues specific to women are military-related sexual harassment and assault and the resulting mental health outcomes, histories of premilitary trauma, unique health-care needs, pregnancy and the postpartum period, and the configuration of family roles such as mother, spouse, and caregiver for aging parents. Women serving in the military face the risk of sexual harassment and sexual assault, both of which are associated with the development of mental health problems.

The study also found an association between sexual harassment and harmful alcohol use in women but not in men Gradus et al. Both sources of stress were found to contribute significantly to the development of PTSD. A study of a nationally representative sample of women in VA ambulatory care found that nearly one-fourth reported having experienced sexual assault while in the military Hankin et al.

The study also found that the prevalence of current depressive symptoms was three times higher and the prevalence of current alcohol-abuse symptoms two times higher in women who reported experiencing sexual assault during military service than in women who did not. That was a topic that the committee members often heard at their town hall meetings, particularly at the meeting in Killeen, Texas, outside Fort Hood see Appendix B.

Another important barrier to seeking mental health care is the persistence of stigma surrounding mental illness and treatment Department of Defense Task Force on Mental Health, ; Hoge et al. A small but growing body of research investigates the relationship between sexual harassment and sexual trauma and the development of PTSD in women.

Among these 2, women veterans, deployment-based sexual harassment and assault were statistically significantly associated with the development of PTSD OR 5. Furthermore, the analyses identified a dose—response relationship between PTSD status and self-reported degree of sexual trauma no trauma, sexual harassment only, sexual assault only, and both harassment and assault. Among men and women in the military, rates of premilitary trauma such as childhood sexual or physical abuse are significant and higher than those in the general population Caulfield et al.

For example, a recent study Caulfield et al. Women entering military service are particularly likely to report prior trauma. In an analysis of the effect of premilitary interpersonal trauma on attrition, Caulfield et al. The investigators found that women who had histories of trauma were 1. Women are also more likely to have experienced chronic trauma before deployment, such as repeated childhood sexual assault or recurring intimate-partner violence, which confers increased risk for the subsequent development of PTSD Tolin and Foa, Wartime conditions impose unique challenges for female soldiers who need routine or specialized gynecologic health services, particularly as deployments become longer over 1 year and more frequent.

Furthermore, a substantial gap persists in predeployment gynecologic screenings and in-theater care Nielsen et al. Most women in the military are of childbearing age Reeves, When pregnancy is confirmed in female soldiers, they are classified as nondeployable but have the option of remaining on active duty to complete their service obligation; however, they are restricted from participating in most unit training activities such as aircraft flying, marksmanship, and field exercises.

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Typically, their duties are confined to indoor office work Bucher, A report from the Defense Women's Health Research Program suggests that those conditions may create an especially stressful environment for pregnant servicewomen Evans et al. The postpartum period can be particularly stressful for female service members, particularly when they are taking care of other children at the same time.

A recent analysis Weina, of the amount of time that postpartum female soldiers need to return to their prepregnancy fitness level and to perform the Army Physical Fitness Test 12 concluded that the current assessment 6 months after delivery does not allow women enough time to recover and that 12 months would be a more suitable time to determine whether female soldiers had returned to their prepregnancy fitness level.

The study also found that most women struggled to cope with the combination of roles required of them: In managing their lives, most servicewomen reported experiencing exhaustion to a degree that impeded their ability to exercise and return to their prepregnancy fitness levels by 6 months after delivery. Women in the military may be particularly stressed by the enormous strain that deployment places on their multiple roles of mother, spouse, and, increasingly, the caretaker for aging parents.

Although men might also assume the caretaker role, in general women continue to perform more housework than men and to be primary caregivers to their children regardless of their employment status Coltrane, Service members are expected to be on call for unexpected problems and emergencies, to maintain a state of readiness for deployment, and to regard the military mission as their top priority; meeting these expectations may be particularly stressful for military women who are raising children.

Deployment involves being separated from children and families for months at a time and leaving children behind with spouses or alternative caregivers. Single mothers confront special challenges. They report greater disruption to family functioning and more concerns about separation from their children Kelley, than do married mothers, probably because of the greater discontinuity in care that deployment imposes on their households.

Deployment appears to affect the marital stability of male and female soldiers differently. Angrist and Johnson found that deployment led to a large, statistically significant increase in divorce rates in women in the military, but not men. The literature shows that civilian women have higher rates of depression and anxiety disorders, including PTSD, than civilian men Kessler et al. Women who have PTSD experience a longer time to remission of symptoms than men, and their symptom remission rate is half that in men Breslau et al. Studies of military populations that are posted at permanent bases have yielded findings similar to those in civilian populations Hoge et al.

However, findings of studies that addressed sex differences in deployed military populations have been inconsistent Hoge et al. The current knowledge of PTSD in women is sparse and has several important gaps related to the development and course of combat-related PTSD and treatment needs. The US military is a multicultural and racially integrated institution Lundquist, , with increasing ethnic and racial diversity.

Even though the military is considered one of the most desegregated institutions, there is some evidence that minority-group members may experience discrimination that can have an adverse effect on their physical and mental health. A recent study Sohn and Harada, examined the association between perceptions of discrimination and self-reported mental and physical health for Asian and Pacific Islander, black, and Hispanic veterans.

Racial and ethnic discrimination during military service was significantly associated with poorer physical health but not mental health Sohn and Harada, Data on whether there is a differential effect of race and ethnicity on military personnel ever deployed seem to be inconsistent. A study of racial equity assessed according to examination of the racial distribution of US casualties in Iraq for the first 12 months of the conflict of military service by Gifford found that blacks do not disproportionately bear the burden of US military operations, nor do other racial or ethnic minorities.

Whites make up the majority of combat casualties given their majority status in active duty and their high representation in the US Army and Marine Corps combat specialties Gifford, Nonetheless, there is some evidence that minorities can have the worst outcomes of exposure to war. The authors were unable to explain those differences when adjusting for exposure to stressors or acculturation. Some reports have addressed the question of whether there are ethnic or racial differences in the receipt of military benefits. Other findings are inconclusive regarding whether there are ethnic or racial differences in service delivery or outcomes of military personnel.

Results of a study by Westermeyer et al. However, the study did not include a comparison group. In a prospective study of black and white veterans who had PTSD, no consistent or sustained differences in improvement were observed between racial groups, whether it was measured as psychometric change or by clinicians' improvement ratings Rosenheck and Fontana, Results of research on the role of race and ethnicity as risk factors for stress-related illness are mixed, but in general they support the conclusion that blacks and Hispanics are at greater risk for psychiatric disorders, particularly PTSD, as a result of deployment.

In the Vietnam Experience Study, nonwhite veterans had a poorer psychologic status 15—20 years after the war than did white veterans CDC, Those proportions held even when racial differences in combat exposure were controlled for inasmuch as minority groups experienced more war-zone exposures. Furthermore, they found that Hispanic male veterans were more likely to have current PTSD than men in other ethnic groups Schnurr et al.

In a study of 1, American Legionnaires who had served in Vietnam and were followed for 14 years, minority race contributed to a more chronic course of PTSD; however, the minority sample was too small for further investigation Koenen et al. It has been suggested that the racial gap in prevalence or course of PTSD in Vietnam veterans might stem from racism in the military, identification with a nonwhite enemy, exacerbation of existing stress by institutional racism, or lower financial or emotional resources after the war Marsella et al.

Some differences in ascertained rates may also be influenced by cultural differences, such as stigma, that can affect accuracy of reporting. A growing body of research documents racial and ethnic differences in beliefs, perceptions of stigma, and preferences related to mental health counseling and use of psychotropic drugs Cooper et al. Attitudinal barriers to seeking mental health care among racial and ethnic minority servicemen and servicewomen may be greater, particularly in the context of a military culture that continues to stigmatize mental health care.

In a study by Kang et al. After adjusting for age, sex, race, rank, branch, and military status, Black et al. The rates of hospitalization per 1, person-years were 9. Substance-abuse problems have been explored in a study of black and Hispanic veterans who were being treated in specialized intensive VA programs for people who had war-related PTSD Rosenheck and Fontana, The results showed that at the time of program admission, black patients had more severe alcohol and drug problems but less severe PTSD symptoms than white or Hispanic patients.

However, Latino veterans were not more likely to use VA outpatient care. Using the National Survey of Veterans, they found that Latino and American Indian veterans were more likely than non-Latino white veterans to report an inability to get needed care Washington et al. Those findings on access suggest a need for targeted outreach measures.

The increasing proportion of minorities in the military highlights the need to improve understanding of the potential role of perceived discrimination on health status. Sohn and Harada used the VIPS to assess the association between perceptions of discrimination and self-reported mental and physical health in Latino, Asian and Pacific Islander, black, and white veterans.

They found that racial and ethnic discrimination during military service was significantly associated with poorer physical health but not mental health. Those findings underscore the importance of developing policies that address racial and ethnic discrimination during military service while providing health care services for veterans.

The committee recommends that the Department of Defense, the Department of Veterans Affairs, and other federal agencies fund research on culturally sensitive treatment approaches targeted toward minorities. Research is also needed on utilization patterns of currently available services by minority populations and the efficacy of such services to improve health outcomes. To identify gaps in services and to plan for needed services, there is a requirement for useful information about the economic impact of service in OEF and OIF on individual veterans and their families; however, there is little information on the magnitude of that impact, especially with regard to how it changes over time.

The committee will examine the topic more fully in phase 2 of its study, but this section provides a preliminary look at the long-term economic impact of deployment on troops, families, and the larger community. To clarify what the committee means by economic impact, it is useful to briefly review the way in which economists define the various costs of war. The total social costs of war comprise public costs or budgetary costs , which comprise benefits paid to veterans directly by governments and taxpayers; social economic costs , which comprise the burdens felt and paid for by individual veterans and their households; macroeconomic costs , which are spread over entire economies; and interest costs , namely the extra spending in the future required to put off the payment of costs that come due today.

The committee is charged with estimating the economic impact of deployment on those who have served in OEF or OIF and their families.

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Budgetary costs indicate the extent to which the federal government compensates veterans for negative economic outcomes resulting from their service, while social economic costs indicate the magnitude of additional economic burdens placed on veterans and their families for which the government does not compensate i. The committee will not, at least in this phase 1 report, discuss macroeconomic or interest costs.

The human burdens of war extend far beyond the period of active conflict, and these burdens carry real economic impacts for veterans and their families. To best plan for alleviating or compensating for these impacts, government projections of readjustment needs should take a long-term view. Combat injuries are the clearest example of persistent outcomes, but research has shown that combat deployment results in other, more subtle long-reaching effects. It is critical for VA and DOD to provide for the acute needs of returning veterans and their families, but it is equally important to plan for the long-term consequences and ensure that there will be adequate resources and infrastructure to continue to provide care, services, and compensation to OEF and OIF veterans and their families over many decades.

In the short run, a variety of factors will keep the public costs associated with deployment-related needs deceptively low: However, the human costs of coping with the lingering physical, mental, and social deployment-related outcomes will certainly continue to accrue after the conclusion of the Iraq and Afghanistan wars, as can be seen by examining trends in use of health care and benefits in veteran populations from past conflicts.

For example, use by the largest and best documented cohort, World War II veterans, peaked around , 33 years after the end of hostilities. The figures also show that the needs of World War I veterans appear to have peaked around , 47 years after armistice. The pattern among veterans of the Korean War is less clear: The number of Vietnam veterans receiving disability and pensions and total real spending on their benefits are still rising, as are the number of veterans of the Persian Gulf War who receive disability and pensions.

Number of veterans on disability and pension payrolls by period of service. Data include both living veterans and deceased veterans whose dependents received survivor benefits. Total real spending on disability compensation and pensions for veterans by period of service. Each point represents real spending in inflation-adjusted dollars on members of the veteran cohort, constructed as the product of inflated nominal more On the basis of data from past wars, Figures 4. However, the majority of claims have yet to be submitted.

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Bilmes projects that a total of , veterans from the conflicts in Iraq and Afghanistan will seek disability benefits. It should be noted, however, that the numbers are not perfectly indicative of the total burden of readjustment and coping needs of veterans and their families. Government spending on disability benefits and pensions approximates the magnitude of more latent sources of need—namely, the physical and psychologic effects of military service on veterans—but represents, in combination with direct medical costs paid by the government through VA or TRICARE, only the publicly compensated portion of the burden borne by veterans and their families.

Missing from this accounting method are the unknown social and financial burdens felt and paid by individual veterans and their households, as noted above—what economists refer to as social economic costs. The magnitude of such burdens is poorly understood. Finally, the historical data do not account for the education, retraining, vocational, and other social needs of returning service members and veterans.

Educational benefits, most notably the GI Bill, are a major means of helping veterans to reintegrate into civilian life. Researchers view the GI Bill as having vastly expanded the educational attainment of birth cohorts with high rates of military service in World War II and Korea Bound and Turner, ; Stanley, Spending on education benefits is substantial when compared to spending on medical and disability benefits. As noted in Chapter 3 of this report, while lessons learned from past conflicts can be informative, many unique aspects of OEF and OIF might result in significant deviations from historical trends.

For example, advances in battlefield medicine have resulted in saving the lives of many severely wounded service members who in past conflicts likely would have died from their wounds. These survivors of very severe injuries need more intensive care than the most severely wounded service members from prior wars, implying that extrapolating from past conflicts might result in an underestimation of the overall burden of need for persons impacted by OEF and OIF.

Furthermore, accelerated and lengthened overseas deployment, reduced dwell times between deployments, and repeated reintegration into life outside theater for the returning OEF and OIF service members and their families may result in additional burdens that are poorly understood, including higher rates of divorce, juvenile delinquency, or disruptions in communities that lose workers called up to National Guard or reserve units.

Little is known about the incidence of those outcomes or their connection with wartime service, and even less is known about how the burden of need associated with those outcomes evolves over time and more research is vitally needed. The committee will more fully examine these potential and emerging burdens on veterans, their families, and communities in phase 2. The most consistently produced sets of formal projections are released by CBO, whose researchers sift through VA reports to the Office of Management and Budget to specify many of the key assumptions.

It appears that CBO does not have the personnel or funding to produce forecasts more frequently, and it is already charged by Congress with assessing a far wider array of government programs than those for veteran support. VA does not have the personnel, the funding, or the mandate from Congress to produce broad forecasts of service needs. Meanwhile, the burden borne by wounded service members and their families, and thus the public responsibility to treat or compensate them, is large and probably will persist for the rest of their lives.

Historically, as stated above, the peak demand for compensation has lagged the end of hostilities by 30 years or more, so the maximum stress on support systems for OEF and OIF veterans and their families might not be felt until or later. The committee recommends that Congress appropriate funds and direct the Department of Veterans Affairs to expand the role of its actuary to produce annual long-term forecasts of costs associated with all health and disability benefits consistent with the practices of Social Security and Medicare.

Brain injuries may be categorized as mild, moderate, or severe see Silver et al. Dependence is characterized by tolerance, withdrawal, need for increasing amounts, persistent desire, and unsuccessful efforts to reduce use of a substance. Abuse is characterized by recurrent use of a substance to the point where it causes domestic, occupational, interpersonal, or legal problems or use in physically hazardous situations.

The study defined binge drinking as consuming more than four drinks for men and more than three drinks for women during a single event.

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Binge drinking was defined as consuming six or more drinks on at least one occasion in at least one month of the preceding year. The term era veteran is being used to mean veterans who were not deployed to theater. The UCX program is the military counterpart of civilian unemployment insurance, and honorably discharged active-duty service members are eligible to receive UCX benefits. The National Comorbidity Survey Harvard School of Medicine, is a nationally representative community household survey of the prevalences and correlates of mental disorders in the United States.

Real quantities are derived by deflating and inflating nominal totals to levels by using the Consumer Price Index. Turn recording back on.

National Center for Biotechnology Information , U. The approaches considered should include Prospective clinical surveillance to allow early detection and intervention for health complications. Protocols for preventive interventions that target high-incidence or high- risk complications. Protocols for training in self-management aimed at improving health and well-being. Major Depression Major depression is the most common mood disorder reported in civilian populations; it is characterized by persistent feelings of sadness accompanied by several symptoms related to changes in appetite or sleeping patterns, loss of interest in activities, fatigue, inability to concentrate, and hopelessness or suicidal thoughts.

Suicide Suicidal behavior is one of the most serious consequences of mental disorders. Deployment and Military Families Many men and women who return from the war zone adjust to their lives out of theater successfully; others have difficulty in adjusting or transitioning to family life, to their jobs, and to living in their communities.

Deployment and Military Spouses The challenges of deployment are different for service members and their spouses and the readjustment needs of military spouses are not secondary to those of the returning service member. Deployment and Children Many parents, practitioners, and policy makers are concerned about the implications of deployment for children, but the research evidence remains sparse, and the research has used longitudinal or quasiexperimental designs relatively rarely. Deployment and Social Outcomes Education Many studies have evaluated whether veterans and service members achieve more education than civilians, but few have evaluated whether educational attainment is affected by deployment.

Income, Earnings, Wages, and Debt It has been noted that members of the reserve components earn more income when activated than before being activated Loughran et al. Incarceration In , over , veterans were in prison or jail in the United States—more than half for violent offenses. Communities A few studies have examined the effect of deployment on businesses. Military-Related Sexual Harassment and Assault and Mental Health Women serving in the military face the risk of sexual harassment and sexual assault, both of which are associated with the development of mental health problems.

Premilitary Trauma Among men and women in the military, rates of premilitary trauma such as childhood sexual or physical abuse are significant and higher than those in the general population Caulfield et al.

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Caretakers Women in the military may be particularly stressed by the enormous strain that deployment places on their multiple roles of mother, spouse, and, increasingly, the caretaker for aging parents. Women and Posttraumatic Stress Disorder The literature shows that civilian women have higher rates of depression and anxiety disorders, including PTSD, than civilian men Kessler et al. Ethnicity, Race, and Culture The US military is a multicultural and racially integrated institution Lundquist, , with increasing ethnic and racial diversity.

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PRELIMINARY FINDINGS - Returning Home from Iraq and Afghanistan - NCBI Bookshelf

Interpersonal hostility and violence in Vietnam combat veterans with chronic posttraumatic stress disorder: A review of theoretical models and empirical evidence. Aggression and Violent Behavior 5 5: Utility of mechanism-of-injury-based assessment and treatment: Blast Injury Program case illustration. Journal of Rehabilitation Research and Development 42 4: Incarceration and veterans of the first Gulf War.

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Research and Practice 39 4: Visual impairment and dysfunction in combat-injured servicemembers with traumatic brain injury. Optometry and Vision Science 86 7: Course of illness and substance abuse. American Journal of Psychiatry 3: The epidemiology of posttraumatic stress disorder: What is the extent of the problem?

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Journal of Traumatic Stress 15 3: Hazardous alcohol use and receipt of risk-reduction counseling among US veterans of the wars in Iraq and Afghanistan.

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Pain Medicine 10 7: The Veteran's Money Book: Health Care Benefits Overview , Vol. Department of Veterans Affairs. Overcoming Anxiety for Dummies. Restoring the Soul after War. Military Mental Health Care: A Resource and Recovery Guide. The Long Road Home: One Step at a Time.

A Stranger in my Bed: When the War Never Ends: A Memoir of Life after War. Better Serving Those Who Serve: After the War Zone: Back from the Front: Combat Trauma, Love, and the Family. Courage after Fire for Parents of Service Members: New Harbinger Publications, Inc. Veteran's Guide to Adjustment. North Charleston, South Carolina: CreateSpace Independent Publishing Platform. Life after the Military: A Handbook for Transitioning Veterans.

Living and Surviving in Harm's Way: A Story of War and the Life that Follows. Once a Warrior, Always a Warrior: From Warrior to Civilian. Thank You for Your Service. Inside the Hearts, Minds, and Souls of our Soldiers. Adjusting to Life after Deployment. The Wounded Warrior Handbook: A Resource Guide for Returning Veterans. The Sacrifices of our Veterans and their Families. Those who have borne the battle: Six American Veterans after Iraq.

To Iraq and Back. My Story of Survival, Strength, and Spirit. The Heart and the Fist: In recent years, more than 1. When not on active duty, more than 20 percent of these vets do not have health care coverage, and many more are unaware of the hundreds of benefits to which they have access. As a result, many are suffering financial strain during and after deployment.

This is a discouraging statistic because the federal and state governments, as well as private foundations, have scholarships and military discounts available only to veterans. There are billions of dollars in aid available, waiting to be claimed, but the problem is finding and properly applying for these programs. This groundbreaking new book will provide help to those heroic Americans who have answered our government s call to duty. You will find all contact information and Web sites included, making it easy to apply for the benefits you are entitled to, while meeting the requirements of the Department of Veterans Affairs and other organizations and private institutions.

Here is a small sampling of what you will learn about: If you are in the military now, a veteran, or a military family member, you will find this resource invaluable. Atlantic Publishing is a small, independent publishing company based in Ocala, Florida. Today, over titles are in print covering subjects such as small business, healthy living, management, finance, careers, and real estate. Atlantic Publishing prides itself on producing award winning, high-quality manuals that give readers up-to-date, pertinent information, real-world examples, and case studies with expert advice.

Every book has resources, contact information, and web sites of the products or companies discussed. This Atlantic Publishing eBook was professionally written, edited, fact checked, proofed and designed. The print version of this book is pages and you receive exactly the same content. Over the years our books have won dozens of book awards for content, cover design and interior design including the prestigious Benjamin Franklin award for excellence in publishing. We are proud of the high quality of our books and hope you will enjoy this eBook version.

Veterans Benefits For Dummies. For Service to Your Country. Social Security, Medicare and Government Pensions. Financial Management of Health Care Organizations. Financial and Managerial Accounting for School Administrators. The Handbook of Employee Benefits: Concepts of Disability Income Insurance.

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