The VA has been using unqualified medical personnel to perform Compensation and Pension (C&P) examinations and deny benefits for traumatic brain injuries (TBI) at many VA facilities across the country. This means that thousands of veterans were not afforded a fair shot to get a competent medical opinion about their condition. Instead of being examined by a specialist, there are many cases in which veterans were denied TBI benefits based on an examination by a nurse practitioner. This is a violation of VA policy.
TBI has been defined as “an alteration in brain function, or other evidence of brain pathology, caused by an external force.” occurs when a sudden trauma, such as a blow or jolt to the head, causes damage to the brain. Such injuries can result in impaired physical, cognitive, emotional, and behavorial functions. Veterans who sustain mild TBI (concussion), which accounts for the majority of injuries, may walk away from the event, seemingly unharmed, and may go unnoticed and untreated. Veterans who sustain moderate to severe TBI require immediate treatment, which begins at the site of the event and continues at a military treatment facility.
According to the VA, it is policy that each mental health professional who conducts a C&P exam for a mental disorder, for which TBI is classified, be appropriately qualified, and each facility Director, or designee, is responsible for ensuring that:
- The examiner must be clinically privileged, as governed by applicable law and the policies established at individual VA facilities, to perform or supervise the performance of the following activities as required for all C&P examinations for mental disorders.
- The mental health professional must be able to diagnose mental disorders, including personality disorders, using the body or system of names in the most current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
- They must provide an evaluation of each veteran using a multi-axial system as set forth in DSM with an explanation of the Axis V determination.
- They must determine when clinician-administered psychometric testing is necessary and integrate the results of this testing in the examination reports.
- The must document the veteran’s past and current mental health treatment and the veteran’s subjective response to these treatments in order to assess response to treatment and their potential for further improvement.
- Provide a prognosis with respect to each mental disorder or condition.
- When necessary, comment on the significance of the Veteran’s prior mental health assessments with respect to symptoms, occupational history, social history, and global assessment of functioning.
- Identify veterans presenting with complex diagnostic questions or other issues that are beyond the examiner’s expertise, and refer those veterans to a board-certified, or board-eligible, psychiatrist or a licensed doctoral-level psychologist who has the expertise necessary to complete the C&P mental disorder exam.
- Ensure that veterans who present with a history of a mental health diagnosis, or with any of the suicide warning signs or risk factors, have a further suicide risk assessment which can be completed by either the examiner or by referral, secondary to the C&P exam process. The veterans, regardless of risk, must be given the Veterans Crisis Line number: 1-800-273-TALK (8255).
All too often, those of us who advocate for veterans hear of their concerns as it relates to the qualifications of the examiner who performed their C&P exam, particularly when it comes to mental health exams. Many veterans we talk to lament on the qualifications of the examiner, particularly after they’ve read the exam report and see who it is signed off by. We listen and empathize with their frustration at the lack of professionalism on the part of the VA. It is almost as though the VA wants to minimize the residuals of TBI to avoid payment of benefits. By attributing symptoms to PTSD instead of TBI, it inhibits a veteran from receiving a rating of 100% permanent and total disability.
If a veteran takes anything away from this writing, it is this: be vigilent. If a veteran feels the C&P examiner and the exam itself is too speculative, he/she can challenge this in their NOD (Notice of Disagreement). While there are qualifications that should be met to be a C&P examiner, there isn’t a rule or policy that they must be a specialist in the field of the disability for which the C&P exam is for. The exception to this is PTSD, TBI, and other mental health disabilities.