Disability Status,Employment,and Access to Vocational Rehabilitation Services Among Rural Veterans with Physical and Mental Health Conditions

Abstract

Background

Veterans living in rural settings, especially those with chronic conditions, face unique challenges in accessing employment opportunities.

Objective

This study investigates whether receipt of vocational rehabilitation (VR) services is associated with improved employment outcomes among rural veterans with chronic conditions, even after controlling for demographic variables and service-connected disability status.

Methods

Data were collected from 400 veterans residing in rural areas in the U.S. Hierarchical logistic regression analysis was conducted to examine the association between VR service status and employment, controlling demographic variables and disability status.

Results

Logistic regression analysis indicated that VR service status was significantly associated with employment outcomes (p < 0.01), even after controlling for demographic variables and disability status. Specifically, veterans with disabilities residing in rural areas were 74% less likely to be employed compared to their counterparts without disabilities. Additionally, rural veterans who received VR services had a 71% higher likelihood of employment than those who did not receive VR services.

Conclusions

The findings suggest that VR services play a crucial role in supporting rural Veterans with disabilities in achieving employment outcomes. Interventions aimed at enhancing access to VR services may contribute to improving vocational rehabilitation and overall well-being among this population. Collaborative efforts between policymakers, healthcare providers, and community organizations are essential for addressing the employment needs of Veterans in rural areas and promoting their successful integration into the workforce.

Veterans residing in rural areas face distinct challenges that can significantly impact their ability to secure and maintain employment, particularly those with service-connected disabilities (Umucu, 2023; Umucu, Granger, Weichelt, et al., 2025). In 2021, nearly 4.6 million Veterans Health Administration (VHA) patients with service-connected disabilities lived in rural areas (National Center for Veterans Analysis and Statistics, 2023). These veterans often experience barriers such as limited access to healthcare services, fewer employment opportunities, and reduced availability of vocational rehabilitation (VR) services. These challenges can exacerbate the difficulties associated with the physical and mental health conditions prevalent among this population (Bailey et al., 2014; Green, 2017; Umucu, Granger, et al., 2024; Umucu, Lee et al., 2024; Ysasi & McDaniels, 2018). Understanding the factors that influence employment outcomes for veterans, particularly rural veterans, is crucial to developing effective interventions that address these barriers and support their vocational rehabilitation needs (Umucu & Lee, 2024).

Existing research consistently highlights the obstacles rural veterans encounter in accessing healthcare and employment services (Weeks et al., 2008). Geographic isolation and a shortage of healthcare providers in rural areas often lead to delayed and/or inadequate health and rehabilitation care, worsening both physical and mental health conditions. These health challenges can, in turn, hinder veterans’ ability to participate in the workforce (Buzza et al., 2011; U.S. Department of Veterans Affairs [VA], 2023). Furthermore, employment opportunities in rural areas are typically limited, particularly in industries that can accommodate the specific needs of veterans with disabilities. Compounding these difficulties is the fact that rural veterans frequently have less access to VR services than their urban counterparts, making it even more difficult to obtain the necessary support for successful employment outcomes (Ysasi & McDaniels, 2018).

The critical role of VR services in improving employment outcomes among veterans with disabilities is well documented. VR services provide personalized support, including job training, career counseling, and job placement assistance, which are essential in helping veterans navigate the labor market and overcome employment barriers (Boutin, 2011). Yet, the effectiveness of VR services in enhancing employment outcomes for rural veterans remains underexplored, especially in relation to the unique challenges posed by geographic isolation and the high prevalence of psychiatric disabilities within this group. Addressing this gap in the literature, even retrospectively, is essential for informing the development of targeted interventions to improve employment opportunities for rural veterans with disabilities.

Accordingly, this study aims to explore the relationship between employment status, disability status, and access to VR services among rural veterans with physical and mental health conditions in the United States. By analyzing data from a large sample of rural veterans, the we aimed to identify the factors influencing employment outcomes and evaluate the role of VR services in addressing their VR needs. Specifically, the study investigates whether receipt of VR services is associated with improved employment outcomes, even after controlling for demographic variables and service-connected disability status.

The findings of this study have the potential to significantly influence both policy and practice in the field of VA and VR. This research contributes to the growing body of literature addressing the employment needs of veterans and provides valuable insights for future initiatives aimed at supporting this important yet underserved population. The results could have meaningful implications for policymakers, healthcare providers, and community organizations working to enhance employment outcomes for veterans in rural areas.

Methods

Procedure

This project is part of the Improving Rural Enrollment, ACcess, and Halthcare in Rural Veterans (I-REACH Rural Veterans) Program developed by the PI (EU) and funded by the Federal Office of Rural Health Policy (FORHP) Rural Veterans Health Access Program of the U.S. Department of Health and Human Services (see the following link for more information: https://www.ruralhealthinfo.org/project-examples/1127). The data for this study was collected from Veterans living in rural settings upon ethics committee approval from the Institutional Review Board. Participants were eligible for our study if they meet all of the following criteria: (a) a Veteran who is 18 years old or older and (b) living in a rural area in the U.S. The survey was distributed by using media materials, including social media materials. Data quality was checked utilizing attention check items (e.g., “Select correct responses: five plus 2 = seven.”; “Select the color option below: Car.”). Those who failed attention checks were removed from the dataset. We only extracted participants who did not have any self-reported physical or mental health condition, resulting in a total of 400 veterans with physical and mental health conditions living in rural settings.

Participants

The mean age of participants was 36.05 (SD = 11.43). The majority of participants were male (N = 316; 79%). Most participants were non-Hispanic White (N = 275; 68.8%), followed by Black (N = 70; 17.5%), American Indian or Alaska Native (N = 25; 6.3%), Native Hawaiian or Pacific Islander (N = 14; 3.5%), Asian (N = 10; 2.5%), and others (N = 6; 1.6%). A total of 84 participants were identified as Hispanic (21%), and most participants had at least a high school degree (96.3%).

Materials

We used a demographic questionnaire to gather data about participants’ age, gender, race, and education. Participants’ employment status was measured utilizing a single item (i.e., “What is your employment status?”). Based on participants’ responses, we coded this item as a dichotomous item (employed vs unemployed). Participants’ clinical status was measured using a single item (i.e., “Do you have any of the following conditions (Check all that apply)”). Participants were given multiple conditions such as depression, anxiety, hearing loss, and others. Participants were asked a single item (i.e., “Do you receive Vocational rehabilitation services?”) to assess whether they received any vocational rehabilitation services. Based on participants’ responses, we coded this item as a dichotomous item.

Data Analysis

A descriptive statistic was conducted to report participants’ demographic and health characteristics. To respond to our research question, we conducted a hierarchical logistic regression to examine whether receiving VR services were associated with employment status (1 = employed) after controlling demographic variables and service-connected disability status. In step 1, we entered demographic covariates (i.e., age, gender [1 = female], minority status [1 = minority]); in step 2, we entered service-connected disability status (1 = yes); and in step 3, we entered VR service status (1 = yes). All statistics were conducted with SPSS 28.0.

Results

Descriptive Statistics

About 46% of participants reported having a service-connected disability. Regarding mental health conditions, participants reported depression (45%), anxiety (51%), PTSD (26.3%), bipolar disorder (19.3%), substance use disorders (8%), personality disorder (7%), and schizophrenia (5%). Regarding physical health conditions, participants reported migraines (25.5%), tinnitus (20.3%), paralysis (18.3%), hearing loss (17.5%), musculoskeletal disease (14%), Alzheimer's disease (2.5%), and others (4.8%).

Logistic Regression Analysis

We entered demographic variables (i.e., age, gender, minority status) in the first block, followed by service-connected disability status in the second block, with VR service status in the third block. The first block with demographic variables only was not significantly associated with employment (χ² = 6.36, df = 3, p = 0.10) with the Nagelkerke R² = 0.03. The second block with demographic variables and service-connected disability status was significantly associated with employment (χ² = 31.74, df = 4, p < 0.001) with the Nagelkerke R² = 0.12. By examining specific variables in the second block, service-connected disability presence was significantly and negatively associated with employment status (B = −1.37, AOR = .26, CI 95% [.15–.45], p < 0.001). This indicates that rural veterans with disabilities were 74% less likely to be employed than those without disabilities. The third block with demographic variables, service-connected disability status, and VR service status was associated with employment (χ² = 35.77, df = 5, p < 0.001) with the Nagelkerke R² = 0.14. By examining specific variables in the third block, we found that receiving VR services were significantly and positively associated with employment (B = .54, AOR = 1.71, CI 95% [1.01–2.90], p < 0.01), indicating that rural veterans who received VR services were 71% more likely to be employed than those who did not receive VR services. Overall, the entire model, containing all predictor variables in three blocks, explained 14% (Nagelkerke R²) of the variance in employment status, indicating that the model was able to distinguish between employed veterans living in rural areas and those who were not.

Discussion

Employment, as a public health intervention, plays a critical role in promoting health and well-being among both civilians and veterans with disabilities (Chan et al., 2017; Umucu & Lee, 2024; Umucu, Granger, Degeneffe, et al., 2025; Umucu et al., 2022). This is especially true for veterans, who are disproportionately affected by a range of health conditions, homelessness, and other health and rehabilitation disparities (Umucu, 2023; Umucu, Granger, Celik Zencir, et al., 2025; Umucu, Lee, et al., 2025). This study provides important insights into the relationship between employment, disability status, and access to vocational rehabilitation (VR) services among rural veterans with physical and mental health conditions. The findings indicate that VR services are significantly associated with improved employment outcomes, even after controlling for demographic variables and the presence of service-connected disabilities. This result is particularly meaningful given the distinct challenges faced by rural veterans, including geographic isolation, limited access to healthcare, and fewer employment opportunities compared to their urban counterparts (Umucu, Granger, Weichelt, et al., 2025).

One of the most compelling findings of this study is the statistically significant association between receiving VR services and higher employment rates among rural veterans. This suggests that VR services are instrumental in helping veterans overcome barriers to employment that are often exacerbated by rural living conditions. The hierarchical logistic regression analysis demonstrated that even after accounting for demographic factors such as age, gender, and minority status, as well as the presence of a service-connected disability, VR services independently contributed to the likelihood of employment. This underscores the effectiveness of VR services in addressing the employment needs of rural veterans, particularly those with disabilities, who are at a higher risk of unemployment (Kukla et al., 2016).

The study also highlights the substantial impact of service-connected disabilities on employment outcomes. Veterans with service-connected disabilities were significantly less likely to be employed compared to those without such disabilities. This finding aligns with existing literature that indicates the presence of a disability, especially a service-connected one, poses considerable challenges to obtaining and maintaining employment (Umucu, 2021, 2023). However, the mitigating effect of VR services on this negative association is a crucial aspect of this study, suggesting that VR programs can partially offset the disadvantages faced by veterans with service-connected disabilities.

The positive association between VR services and employment outcomes among rural veterans has significant implications for policy and practice. First, it highlights the need for increased investment in VR services, particularly in rural areas where access is often limited. Enhancing the availability and reach of these services could lead to better employment outcomes for veterans, which in turn could improve their overall quality of life and economic stability. Moreover, the findings suggest that policymakers should prioritize the development of targeted interventions that specifically address the unique challenges faced by rural veterans. This could include mobile VR services, tele-rehabilitation, or partnerships with local community organizations to ensure that veterans in remote areas have access to the support they need (Day et al., 2021; National Organization of State Offices of Rural Health, 2014). Given that the study found VR services to be a critical factor in improving employment outcomes, expanding these services in rural areas could be a key strategy in reducing the employment gap between rural and urban veterans.

While the study provides valuable insights, several limitations should be acknowledged. One primary limitation is the cross-sectional design, which restricts the ability to establish causal relationships between VR services and employment outcomes. Future research should employ longitudinal designs to understand better the temporal relationship between VR services and employment status. Another limitation is the reliance on self-reported data, which may be subject to response biases. Future studies could benefit from incorporating more objective measures of employment and disability status, such as administrative data or clinical assessments, to validate the self-reported information. Additionally, the study's sample was predominantly non-Hispanic White males, which limits the generalizability of the findings to other demographic groups, including women veterans and veterans from diverse racial and ethnic backgrounds.

Building on the findings of this study, future research should explore several areas to deepen our understanding of the relationship between VR services and employment outcomes among rural veterans. First, future research should focus on the long-term effects of VR services on rural veterans’ employment outcomes through longitudinal studies, assessing job stability, career growth, and income sustainability. Additionally, exploring the quality of employment obtained, considering job satisfaction, benefits, and career alignment, could provide a more comprehensive understanding of VR services’ impact on veterans’ well-being. Further investigation is needed to identify the most effective components of VR services, such as job training or career counseling, to optimize their impact. Research should also address barriers to accessing these services in rural areas, including transportation, awareness, and service availability, to develop strategies that enhance accessibility and effectiveness.

Conclusion

This study contributes to the growing body of literature on the employment challenges faced by rural veterans and the role of VR services in addressing these challenges. The findings underscore the importance of VR services in supporting the employment outcomes of rural veterans, particularly those with service-connected disabilities. By addressing the study's limitations and pursuing future research directions, we can further enhance our understanding of how to effectively support the vocational rehabilitation needs of this vulnerable population and improve their employment prospects in the long term.