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Methods

We conducted a cross-sectional study of health-related quality-of-life scores using the 1999 Large Health Survey of Veteran Enrollees (6). That survey used a modification of the Medical Outcomes Study 36-item Short Form Health Survey (7) called the Veterans SF-36. The Veterans SF-36 includes a multi-item scale that assesses health limitations in eight domains: physical activities because of health problems; social activities because of physical or emotional problems; usual role activities because of physical health problems; bodily pain; general mental health—psychological distress and well-being; limitations in usual role activities because of emotional problems; vitality—energy and fatigue; and general health perceptions (8). The Veterans SF-36 has been widely used, disseminated, and documented as reliable and valid in the VHA (9).