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A Practical Guide to Conducting VA Compensation and Pension Exams for PTSD and Other Mental Disorders

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Abstract

Despite being one of the most common forensic mental health evaluations, no article has ever appeared in a peer-reviewed journal describing how to conduct US Department of Veterans Affairs (VA) mental health compensation and pension examinations. This article rectifies that paucity of information. We outline the legal framework, ethical considerations, and administrative challenges inherent in these evaluations. We provide separate guidelines for private practice clinicians and VA staff or contractors. We pay special attention to the multiple sources of collateral information available for these exams and how to access relevant records. The article alerts examiners to the possibility that they might face resistance from VA officials if they screen for and assess symptom exaggeration or feigning and that they could encounter VA-imposed restrictions on time allotted for exams. Specific suggestions are made for different types of exams: Initial Post-traumatic Stress Disorder (PTSD), PTSD Review, Initial Mental Disorder, and Mental Disorder Review.

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Notes

  1. The Mental Disorders DBQ form states: “In order to conduct an initial examination for mental disorders, the examiner must meet one of the following criteria: a board-certified or board-eligible psychiatrist; a licensed doctorate-level psychologist; a doctorate-level mental health provider under the close supervision of a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist; a psychiatry resident under close supervision of a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist; or a clinical or counseling psychologist completing a one-year internship or residency (for purposes of a doctorate-level degree) under close supervision of a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist. In order to conduct a review examination for mental disorders, the examiner must meet one of the criteria from above, OR be a licensed clinical social worker (LCSW), a nurse practitioner, a clinical nurse specialist, or a physician assistant, under close supervision of a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist.” (emphasis added). See: http://www.vba.va.gov/disabilityexams.

  2. American Psychological Association Ethical Standard 2.01 (f) reads, “When assuming forensic roles, psychologists are or become reasonably familiar with the judicial or administrative rules governing their roles.” (American Psychological Association, 2002).

  3. http://benefits.va.gov/TRANSFORMATION/disabilityexams/

  4. But note that the Court also wrote: “This is not to say that particular medical information contained in a claims file might not have significance to the process of formulating a medically valid and well-reasoned opinion. As with any expert opinion, the factual premises of a medical opinion are certainly subject to examination. Many times those facts can be found in the information contained in the claims file. Critical pieces of information from a claimant’s medical history can lend credence to the opinion of the medical expert who considers them and detract from the medical opinions of experts who do not.” (Nieves-Rodriguez v. Peake, 22 Vet. App. 295 at 306, 2008).

  5. http://benefits.va.gov/TRANSFORMATION/disabilityexams/fax_numbers.asp

  6. VHA Directive 2010-045 states, “For mental health-related DBQs that are made available for providers not functioning as C&P examiners and to maintain the integrity of the patient–provider relationship, it is recommended that a Veteran’s treating provider not complete the DBQ.” (italics in original). Available at: http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2298.

  7. Federal Register: July 13, 2010 (Volume 75, Number 133) [Rules and Regulations] [Page 39843–39852] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr13jy10-13]

  8. You can order cards at http://www.suicidepreventionlifeline.org/Materials/Default.aspx or, if you are affiliated with a VA Medical Center, from that Center’s Suicide Prevention Coordinator.

  9. However, one should note that recent research indicates that in general, VA compensation recipients with PTSD experience “clinically meaningful reductions in PTSD symptoms and less poverty and homelessness” (Murdoch et al., 2011, p. 1072).

  10. Note that “false attribution” is different from “false imputation.” The latter term refers to attributing current mental disorder symptoms to an alleged stressor when the individual knows that such a causal connection does not exist (Resnick, 1997).

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Acknowledgments

The authors thank Francis Gilbert, Sofia Marsano, and Chad Hagans for their superb feedback and suggestions.

Author information

Authors and Affiliations

  1. Compensation & Pension Program, Charles George VA Medical Center, Department of Veterans Affairs, 1100 Tunnel Road, Asheville, NC, 28805-2576, USA

    Mark D. Worthen

  2. Compensation & Pension Office, James A. Haley Veteran’s Hospital, Department of Veterans Affairs, Tampa, FL, USA

    Robert G. Moering

Authors
  1. Mark D. Worthen
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  2. Robert G. Moering
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Correspondence to Mark D. Worthen.

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Notice

This article and the recommendations or opinions stated herein should in no way be construed to reflect the opinions or beliefs of the US Department of Veterans Affairs or the US government. The opinions expressed in this article are the authors’ alone.

Appendix: Recommended Resources

Appendix: Recommended Resources

Mental Disability Evaluations in Particular

American Academy of Psychiatry and the Law (2008). AAPL practice guideline for the forensic evaluation of psychiatric disability. Journal of the American Academy of Psychiatry and the Law, 36(4), S3–S50. Available at: http://www.jaapl.org/content/36/Supplement_4/S3.full.pdf

Association of VA Psychologist Leaders (AVAPL) electronic email list for VA mental health compensation and pension examiners and other interested parties. To subscribe write to webmaster1@avapl.org

Department of Veterans Affairs (2002). Best practice manual for posttraumatic stress disorder (PTSD) compensation and pension examinations. Washington, D.C.: Author.

Foote, W. E. (2008). Evaluations of individuals for disability in insurance and Social Security contexts. In R. Jackson (Ed.), Learning forensic assessment (international perspectives on forensic mental health) (pp. 449–479). New York: Taylor & Francis Group.

Gold, L. H., & Shuman, D. W. (2009). Evaluating mental health disability in the workplace: Model, process, and analysis. New York: Springer.

Forensic Mental Health Evaluations in General

American Academy of Psychiatry and the Law (2005). Ethics guidelines for the practice of forensic psychiatry. Bloomfield, CT: Author.

Committee on Ethical Guidelines for Forensic Psychologists (1991). Specialty guidelines for forensic psychologists. Behavioral Sciences and the Law, 15(6), 655–665. [Note: A new version of the Guidelines will be published very soon in American Psychologist.]

Goldstein, A. M. (Ed.) (2006). Forensic psychology: Emerging topics and expanding roles. New York: Wiley.

Goldstein, A. M., & Weiner, I. B. (Eds.) (2003). Handbook of psychology, forensic psychology (Volume 11). New York: Wiley.

Grisso, T. (2002). Evaluating competencies: Forensic assessments and instruments (Perspectives in law & psychology) (2nd ed.). New York: Springer.

Heilbrun, K. (2001). Principles of forensic mental health assessment (Perspectives in law & psychology). New York: Springer.

Heilbrun, K., Grisso, T., Goldstein, A. M. (2008). Foundations of forensic mental health assessment (Best practices in forensic mental health assessment). New York: Oxford University Press.

Melton, G. B., Petrila, J., Poythress, N. G.; Slobogin, C., Lyons, P. M., Jr., Otto, R. K. (2007). Psychological evaluations for the courts: A handbook for mental health professionals and lawyers (3rd ed.). New York: Guilford Press.

Rogers, R. (Ed.). Clinical assessment of malingering and deception (3rd ed.). New York: Guilford Press.

Rosner, R. (Ed.) (2003). Principles and practice of forensic psychiatry. London, England: Hodder Arnold.

Simon, R. I., & Gold, L. H. (Eds.). The American Psychiatric publishing textbook of forensic psychiatry (2nd ed.). Arlington, VA: American Psychiatric.

The Veteran’s Experience

Burkett, B.G., & Whitley, G. (1998). Stolen valor: How the Vietnam generation was robbed of its heroes and its history. Dallas, TX: Verity Press.

Cantrell, B.C., & Dean, C. (2005). Down range: To Iraq and back. Bellingham, WA: Hearts Toward Home International.

Herr, M. (1977/2009). Dispatches. New York: Everyman’s Library.

Junger, S., & Hetherington, T. (2010). Restrepo [Documentary film]. USA: Outpost Films.

Junger, S. (2010). War. New York: Twelve.

Moore, H., & Galloway, J. (1993). We were soldiers once… and young. New York: Harper Perennial.

National Center for PTSD (2004). Iraq war clinician guide (2nd ed.). Available online only at: http://www.ptsd.va.gov/professional/manuals/iraq-war-clinician-guide.asp

Schroder, W., & Dawe, R. (2007). Soldier’s heart: Close-up today with PTSD in Vietnam veterans. Portsmouth, NH: Praeger.

Shaw, M. E., & Hector, M. A. (2010). Listening to military members returning from Iraq and/or Afghanistan: A phenomenological investigation. Professional Psychology: Research and Practice, 41(2), 128–134. doi:10.1037/a0018178

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Worthen, M.D., Moering, R.G. A Practical Guide to Conducting VA Compensation and Pension Exams for PTSD and Other Mental Disorders. Psychol. Inj. and Law 4, 187–216 (2011). https://doi.org/10.1007/s12207-011-9115-2

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