Purpose <p>Occupational diseases (ODs) often disrupt careers and threaten long-term employment. Vocational rehabilitation (VR) is intended to restore work ability, yet evidence on its effectiveness for OD patients is scarce. This study uses nationwide registry data to evaluate the impact of VR on sustained work participation.</p> Methods <p>We analyzed linked data from multiple Finnish registers, including all individuals aged 18–55 who received VR through workers’ compensation insurance for an OD recognized between 2005 and 2018.&#xa0;Rehabilitees were propensity score–matched to OD patients without VR. Subgroup analyses distinguished rehabilitees who received formal education during VR from those who did not. Follow-up time averaged 5.1 years and extended up to 8 years post-VR.</p> Results <p>A total of 1377 matched pairs were formed. Work participation at one year post-VR was lower among rehabilitees than controls (74.1% vs 84.0%), reflecting severe baseline impairment. However, the gap narrowed over time, with near parity at four years (79.1% vs 81.6%). Neither group regained pre-OD levels (&gt; 90%). Recovery was faster among those receiving education: Parity was achieved within two years (82.0% vs 82.7%), and the employment rate continued to improve throughout the 8-year follow-up (84.8% vs 84.4%).</p> Conclusions <p>As required by legislation, VR is implemented when other interventions are insufficient to ensure sustainable employability. The results show that VR recipients achieved a level of work participation comparable to that of the control group, although the two groups were not fully comparable due to statutory entitlement<i>.</i> This study suggests that VR effectively promotes labor market integration.</p>