Veterans benefits for post-traumatic stress disorder in the United States explained

The United States has compensated military veterans for service-related injuries since the Revolutionary War, with the current indemnity model established near the end of World War I. The Department of Veterans Affairs (VA) began to provide disability benefits for post-traumatic stress disorder (PTSD) in the 1980s after the diagnosis became part of official psychiatric nosology.

Post-traumatic stress disorder (PTSD) is a serious, potentially debilitating psychiatric disorder that can develop after experiencing one or more terrifying or horrific events. It is characterized by (1) re-experiencing the trauma(s) in the form of vivid intrusive memories, dissociative flashback episodes, or nightmares; (2) avoidance of trauma-related thoughts and memories; and (3) frequently feeling under threat manifested as, for example, hypervigilance and intense startle reactions.[1] [2]

Some research suggests that VA disability benefits achieve their goal of helping veterans who have PTSD. The Veterans Benefits Administration (VBA), a component of the Department of Veterans Affairs, processes disability claims and administers all aspects of the VA disability program. Since 1988 VA disability claim decisions have been subject to federal court review.

Disability ratings theoretically represent a veteran's "average impairment in earnings capacity", on a scale from 0 to 100. Veterans who file a disability claim due to PTSD almost always receive a compensation and pension examination (C&P exam) by VA-employed or VA-contracted psychologists or psychiatrists. Social scientists and others have expressed concern about the consistency and accuracy of PTSD C&P exam findings, although the VA generally rejects such concerns as unfounded or exaggerated.

Recent efforts to change VA disability benefits for PTSD include urging the VA to place more emphasis on vocational rehabilitation and treatment versus cash payments; revising the General Rating Formula for Mental Disorders to better reflect problems experienced by veterans with PTSD, and considering a veteran's quality of life when determining the disability rating.

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) may develop following exposure to an extremely threatening or horrific event. It is characterized by several of the following signs or symptoms: unwanted re-experiencing of the traumatic event—such as vivid, intense, and emotion-laden intrusive memories—dissociative flashback episodes, or nightmares; active avoidance of thoughts, memories, or reminders of the event; hyperarousal symptoms such as always being on guard for danger, enhanced (exaggerated) startle response, insomnia, trouble concentrating, or chronic irritability; anhedonia, social detachment, excessively negative thoughts about oneself or the world, marked guilt or shame, or a persistent depressed or anxious mood.[3] [4] PTSD is the third-most compensated disability after hearing loss and tinnitus.[5]

Traumatic stressor

Matthew J. Friedman of the National Center for PTSD notes that PTSD is unique among mental health problems because of the great importance placed upon the cause, the traumatic stressor.[6]

A traumatic stressor is an event that meets Criterion A of the DSM-5 diagnostic criteria for PTSD, which requires, in part, that an individual "... was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence ...."[7] [8]

Veterans filing a disability claim for PTSD complete a form describing the traumatic stressors they endured during their military service.[9] VA has separate forms for PTSD generally and PTSD "secondary to personal assault".[10]

Diagnosis

Prior to 2014, VA C&P examiners determined if a veteran had PTSD based on DSM-IV diagnostic criteria for the disorder. VA updated most of its relevant regulations in August 2014 to reflect the publication of DSM-5.[11]

VA disability benefits for PTSD

The United States provides a range of benefits for veterans with post-traumatic stress disorder (PTSD), which was incurred in, or aggravated by their military service. The United States Department of Veterans Affairs (VA) provides benefits[12] to veterans whom the VA has determined have PTSD that developed during, or as a result of, their military service. These benefits not only include tax-free cash payments[13] but can also include free or low-cost mental health treatment and other healthcare, vocational rehabilitation services, employment assistance, independent living support, and more.[14]

History

Since the founding of the country, the United States has compensated the men and women who have served in its armed forces and uniformed services.[15] [16] [17] Near the end of World War I, the U.S. Congress passed legislation establishing an indemnity model for veterans' disability benefits.[18] Since that year, compensation has been provided to veterans who have physical or mental disabilities that were incurred during, or aggravated by, military service, and which have adversely impacted their ability to work. The amount of compensation provided—both cash payments and VA-sponsored services—is based on the veteran's "average impairment in earnings capacity".[19]

Service-connection

Service-connected means that a veteran has a disease or injury that is connected to his or her military service; that is, the disease or injury was incurred in, or aggravated by, their military service.[20]

Effectiveness

Whether disability benefits adequately compensate veterans with PTSD for loss in average earning capacity has been debated. A 2007 study found that older veterans (age 65 and up) rated at 50% disabled or higher for PTSD, including individual unemployability (IU) benefits, receive more in compensation (plus any earned income and retirement benefits such as Social Security or pensions) than non-disabled veterans earn in the workforce or receive in Social Security and other retirement benefits.[21] However, younger veterans (age 55 and below) generally receive less in compensation benefits (plus any earned income) than their non-disabled counterparts earn via employment. For example, the "parity ratio" for a 25-year-old veteran rated 100% disabled by PTSD is 0.75, and for a 35-year-old veteran rated 100% disabled by PTSD the ratio is 0.69. The parity ratio for a 75-year-old veteran receiving IU benefits is 6.81.

Research based on data collected in the 1990s indicates that veterans receiving disability benefits for PTSD experience a reduction in PTSD symptom severity and have lower rates of poverty and homelessness.[22] A 2017 study found that "denied" veterans (those who applied for—but did not receive—disability compensation) exhibit significantly worse overall health, functional limitations, poverty, and social isolation when compared to veterans who were awarded VA disability benefits.[23]

In addition to lost income, a Congressionally mandated commission,[24] argued that the VA disability benefits program should compensate veterans for non-economic losses, such as a decline in the veteran's quality of life. The U.S. Government Accountability Office (GAO) analyzed this recommendation and suggested that it be considered as one of three major changes to modernize the VA disability benefits program.[25]

Some scholars argue that the VA disability benefits program is counter-therapeutic because it provides no incentives to overcome symptoms and problems caused by the disorder, and, in fact, rewards veterans for staying sick.[26] [27] In a similar vein, a military scholar suggests that current VA disability benefits policy inculcates in veterans a lack of self-efficacy and fosters dependency.[28] [29] However, some VA researchers take issue with this assertion.[30]

Claims process

Eligibility

In order to be eligible for VA benefits, a veteran must have been discharged under "other than dishonorable conditions".[31] Stated differently if a veteran received a "Bad Conduct" discharge or a "Dishonorable" discharge they will, under most circumstances, not be eligible for VA benefits.[32]

Types of military service

Federal regulations describe three categories of military service, "active duty", "active duty for training", and "inactive duty training".[33] Eligibility for VA disability compensation requires that the veteran's service falls under one of these three categories. The definition of "active duty" military service includes "service at any time as a cadet at the United States Military, Air Force, or Coast Guard Academy, or as a midshipman at the United States Naval Academy".[34]

In line of duty and exceptions

There are exceptions to the general rule that injuries or diseases incurred in, or aggravated by, military service are eligible for VA disability compensation benefits. For example, such injuries or diseases must meet the "in line of duty" criteria. "In line of duty" means an injury or disease incurred or aggravated during a period of active military, naval, or air service unless such injury or disease was the result of the veteran's own willful misconduct or ..."was a result of his or her abuse of alcohol or drugs".[35]

Evidence

In order for a veteran to receive disability benefits for PTSD, the Veterans Benefits Administration (VBA), an organizational element of the VA, based on their review of medical and psychological evidence, must conclude that the veteran indeed has PTSD that developed as a result of military service. Reaching such a determination usually requires that the veteran receive a Compensation and Pension examination (C&P exam),[36] conducted by a psychologist or psychiatrist at a local VA medical facility or by a psychologist or psychiatrist in independent practice who conducts evaluations for a VA-contracted private vendor.[37]

Benefits claim procedures

VA provides a detailed description of the benefits claims process on its website.[38] Briefly, a Veterans Service Representative (VSR),[39] a VBA employee, reviews the information submitted by a veteran to determine if the VBA needs any additional evidence (e.g., medical records) to adjudicate the claim.[40]

VA has a legal obligation to help veterans obtain any evidence that will support their claim.[41] For example, the VSR might request a veteran's military personnel records, Social Security disability records, or private medical records.[42] The VSR will almost always request a Compensation and Pension examination (C&P exam),[43] also referred to as a "VA claim exam".

After the VBA obtains all relevant documentation (evidence), the "rating activity" renders a decision regarding the veteran's claim. The VBA's M21-1 Adjudication Procedures Manual defines the "rating activity" as "... a group of specially qualified employees vested with the authority to make formal decisions, called 'rating decisions,' and take other actions on claims that require a rating decision".[44]

Obtaining assistance

Veterans may receive assistance with filing a VA disability compensation claim from a Veterans Service Officer. As the VA states, "[veterans] ... can work with a trained professional ... to get help filing a claim for disability compensation".[45] VA publishes an annual directory of accredited veterans' service organizations and state departments of veterans affairs[46] and VA has a "VSO search" feature on their eBenefits site.[47] Veterans service organizations and state agencies employ veterans service officers who provide assistance to veterans without charge. Some veterans' advocates recommend that veterans learn how to file claims on their own so that they retain full control over the process.[48]

Federal court review

If a claimant questions the decision made by the VBA, they can ask for the case to reviewed by the Board of Veterans Appeals.[49] That decision can be reviewed by the Court of Appeals for Veterans Claims, an Article I federal tribunal, which was established by The Veterans Judicial Review Act of 1988.[50]

Post-adjudication representation

Veterans may appeal the VBA's decision regarding their compensation claim, and they may ask to be represented by an accredited Veterans Service Officer, attorney, or claims agent in the appeals process. The VA does not require a veteran to be represented on appeal.[51]

VA prohibits attorneys or claims agents from charging a veteran for professional services prior to the adjudication of the veteran's claim.[52]

Unless they agree to work on a pro bono basis, attorneys and claims agents who represent veterans before the Veterans Benefits Administration, Board of Veterans Appeals, and Court of Appeals for Veterans Claims require payment for their services. At the federal court level, most attorneys work for Equal Access to Justice Act fees. These are attorney fees ordered by the court to be paid by the federal government when the government's position in litigation was not substantially justified.[52]

Disability rating

General rating formula for mental disorders

If the VBA determines that a veteran has service-connected PTSD, then they assign a disability rating, expressed as a percentage. This disability rating determines the amount of compensation[53] and other disability benefits the VA provides the veteran. The disability rating indicates the extent to which PTSD has deprived the veteran of their average earnings capacity.[54]

The VA assigns disability ratings based on criteria set forth in the Code of Federal Regulations, Title 38, Part 4—Schedule for Rating Disabilities,[55] often referred to as the "VA Schedule for Rating Disabilities" or VASRD.[56] The rating schedule for mental disorders is called the "General Rating Formula for Mental Disorders" (38 C.F.R. § 4.130),[57] which specifies criteria for disability ratings of 0%, 10%, 30%, 50%, 70%, or 100%.

Some argue that by relying on the current Rating Formula, "VA uses decades-old regulations developed for mental disorders that do not resemble PTSD", and consequently, "[i]rrelevant criteria ... may outweigh ... more relevant factors, leading VA to undercompensate veterans with valid diagnoses of PTSD."[58] Similarly, veterans service organizations have argued, for example, that a "... veteran service connected for schizophrenia and another veteran service connected for another psychiatric disorder should not be evaluated using the same general formula" and have supported efforts to revise the Rating Formula.[59]

Concern has been expressed by some RSVRs[60] (VBA "raters" who adjudicate claims) that automated software discourages their use of independent judgment to evaluate the claim as a whole, a charge senior VA officials reject.[61]

In 2012 the General Accountability Office reported that "VA's modifications of the medical information in the disability criteria have been slow and have not fully incorporated advances in technology and medicine. Moreover, the rating schedule has not been adjusted since its creation in 1945 to reflect ongoing changes in the labor market."[62]

On February 15, 2022 the Department of Veterans Affairs (VA) proposed to substantially change their disability rating schedule regarding mental disorders, including revising the General Rating Formula for Mental Disorders.[63] This "proposed rule", part of the executive branch's rulemaking process, will not become law until after VA reviews public comments, makes revisions, and publishes a "final rule".[64]

Claims for an increased disability rating

A veteran currently receiving compensation for service-connected PTSD may file a claim for an increase in his or her disability rating if PTSD symptom severity and related functional impairment has worsened.[65]

Individual unemployability

Under certain conditions,[66] veterans receiving service-connected disability compensation for PTSD may file a claim for individual unemployability.[67] If the VBA concludes that PTSD, either alone or in combination with other service-connected disabilities, would make it "... impossible for the average person to follow a substantially gainful occupation...",[68] the veteran will receive disability compensation at the 100% rate, even though their schedular rating is less than 100%.[69] [70]

PTSD C&P exam

As noted above, the VBA almost always requires a compensation and pension examination (C&P exam), also known as a "VA claim exam",[71] for veterans claiming service-connected PTSD. C&P exams are forensic mental health evaluations.[72] [73] There are two types of PTSD C&P exams: Initial and Review. The Initial PTSD exam must be conducted by a VA psychologist or psychiatrist certified by the VHA Office of Disability and Medical Assessment (DMA)[74] to evaluate veterans for this purpose.[75]

The Review PTSD exam may be completed by VA or non-VA psychologists and psychiatrists. Clinical or counseling psychology interns, psychiatric residents, licensed clinical social workers, nurse practitioners, physician assistants, and clinical nurse specialists may also conduct review PTSD exams, although they must be "closely supervised" by a psychologist or psychiatrist.[76]

Medical Disability Examination (MDE) contracts

The definition of "VA psychologist or psychiatrist" includes psychologists and psychiatrists in the private sector who conduct C&P exams for a Medical Disability Examination (MDE) company under contract with the VA.[77] the VA-contracted MDE companies are Optum Serve (formerly LHI),[78] [79] Veterans Evaluation Services (VES),[80] Loyal Source,[81] and Leidos QTC Health Services[82] (QTC) (Magellan Health manages the QTC network of providers).[83] MDE companies conduct about 90% of C&P exams (for all conditions, i.e., not just PTSD and other mental disorders).[84]

Presumption of competence

In most federal legal proceedings a psychologist or psychiatrist must demonstrate that they are competent to testify as an expert witness by satisfying standards specified in the Federal Rules of Evidence, particularly Rule 702, "Testimony by Expert Witnesses" (FRE 702).[85] However, VA medical examiners are presumed competent to provide expert witness testimony[86] [87] without having to meet FRE 702 standards.[88] [89] [90]

Concerns about reliability

Researchers, current and former VA psychologists, investigative journalists, and individual veterans have expressed concerns about the inter-rater reliability and validity of C&P exams for PTSD.[91] [92] For example:

Four possible outcomes of a psychological evaluation, including false positive and false negative conclusions.
Evaluation conclusionActual (true) condition
Evaluee has the claimed mental disorderEvaluee does not have the claimed mental disorder
Evaluee has the claimed mental disorderTrue positiveFalse positive
Evaluee does not have the claimed mental disorderFalse negativeTrue negative

Disability Benefits Questionnaire

Mental health professionals document the results of Initial and Review PTSD C&P exams on a Disability Benefits Questionnaire (DBQ).[123] VA developed Disability Benefit Questionnaires (DBQs) to streamline the VBA ratings process and thereby complete the claims process faster. In addition, veterans may ask their treating clinicians to complete a DBQ and possibly bypass the need for a C&P exam.[124] However, it is important to note that the VA discourages their mental health clinicians from completing DBQs for their patients.[125]

Some authors have expressed concern that the DBQ symptom list (for example, Section VII on the Review PTSD DBQ)[126] contains a series of signs, symptoms, and descriptions of functional impairment without any guidance regarding when these items should be endorsed.[127]

The Veterans Benefits Administration (VBA) discontinued publicly available DBQs in April 2020, explaining that the lengthy approval process for publicly available government forms often meant DBQs contained outdated information. In addition, VBA indicated that in recent years "... a growing industry of individuals and companies marketing the service of completing DBQs for Veterans ... [were] engaged in questionable, even fraudulent, practices ...."[128] VBA's decision to remove publicly available DBQs came in the wake of a VA Office of Inspector General report that recommended the action.[129] However, the U.S. Congress negated VA's decision, passing a law in December 2020 requiring the agency to post the DBQs on the VA website.[130]

External links

Notes and References

  1. World Health Organization, "6B40 Post traumatic stress disorder," International Classification of Diseases, 11th Revision, 2018, rev. April 2019.
  2. van der Kolk, Bessel A. "The History of Trauma in Psychiatry." In Handbook of PTSD Science and Practice, edited by Matthew J. Friedman, Terence M. Keane, and Patricia A. Resick, 19–36. New York: Guilford, 2007.
  3. World Health Organization, Post traumatic stress disorder (6B40), International Classification of Diseases, 11th rev., ICD-11 for Mortality and Morbidity Statistics (April 2019).
  4. Shalev, Arieh Y. and Charles R. Marmar. "Conceptual History of Post-Traumatic Stress Disorder." In Post-Traumatic Stress Disorder, edited by Charles B. Nemeroff and Charles Marmar, 3–30. New York: Oxford University Press, 2018.
  5. Web site: Veterans Benefits Administration, VBA Annual Benefits Report Fiscal Year 2018, Compensation, p. 5 . benefits.va.gov . live . https://web.archive.org/web/20190826205815/https://www.benefits.va.gov/REPORTS/abr/docs/2018-compensation.pdf . August 26, 2019 . January 23, 2020.
  6. Web site: Friedman. Matthew J.. PTSD History and Overview. National Center for PTSD. October 3, 2019. https://web.archive.org/web/20191003080840/https://www.ptsd.va.gov/professional/treat/essentials/history_ptsd.asp. October 3, 2019. live.
  7. https://www.ecfr.gov/cgi-bin/text-idx?SID=a66f4d4f413ba1276a8d78fb9cd7dc34&mc=true&node=se38.1.3_1304&rgn=div8 Posttraumatic stress disorder
  8. https://www.ecfr.gov/cgi-bin/text-idx?SID=a66f4d4f413ba1276a8d78fb9cd7dc34&mc=true&node=se38.1.4_1125&rgn=div8 Diagnosis of mental disorders
  9. Web site: VA disability compensation for PTSD. 2019-09-27. U.S. Department of Veterans Affairs. en. October 3, 2019. When you file a disability claim, you'll also need to fill out one of these additional forms: A Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (VA Form 21-0781) or A Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder Secondary to Personal Assault (VA Form 21-0781a). https://web.archive.org/web/20190830063836/https://www.va.gov/disability/eligibility/ptsd/. 2019-08-30. live.
  10. Dep't Veterans Aff., Veterans Benefits Admin., Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD) Secondary to Personal Assault (VA Form 21-0781a, rev. July 2017)
  11. Schedule for Rating Disabilities—Mental Disorders and Definition of Psychosis for Certain VA Purposes, Section 4.125: DSM Reference and DSM–5 Nomenclature Change, 79 Fed. Reg. 45093, 45094 (August 4, 2014) (codified at 38 C.F.R. §4.125(a))
  12. Web site: Federal Benefits for Veterans, Dependents and Survivors, 2017 Edition. Department of Veterans Affairs. June 24, 2018. https://web.archive.org/web/20180606045117/https://www.va.gov/opa/publications/benefits_book.asp. June 6, 2018. live.
  13. Web site: VA Compensation Rate Table. Department of Veterans Affairs. November 24, 2018. mdy-all. https://web.archive.org/web/20181201110613/https://www.benefits.va.gov/COMPENSATION/resources_comp01.asp. December 1, 2018. live.
  14. Web site: Benefits A-Z . Veterans Benefits Administration, Department of Veterans Affairs . May 7, 2020.
  15. Ridgway. J.. The splendid isolation revisited: Lessons from the history of veterans benefits before judicial review. Veterans Law Review. 2011. 3. 135–219.
  16. Duty periods, 38 C.F.R. § 3.6(b)(2) ("... Full-time duty (other than for training purposes) as a commissioned officer of the Regular or Reserve Corps of the Public Health Service ...").
  17. Duty periods, 38 C.F.R. § 3.6(b)(3) ("Full-time duty as a commissioned officer of the Coast and Geodetic Survey or of its successor agencies, the Environmental Science Services Administration and the National Oceanic and Atmospheric Administration ...").
  18. Book: Economic Systems Inc. VA Disability Compensation Program: Legislative History. 2004. VA Office of Policy, Planning and, Preparedness. Washington, DC.
  19. An Act To amend and modify the War Risk Insurance Act, ch. 16, 41 Stat. 371, 373 (1919) ("A schedule of ratings of reductions in earning capacity from specific injuries or combinations of injuries of a permanent nature shall be adopted and applied by the bureau. Ratings may be as high as 100 per annum. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations and not upon the impairment in earning capacity in each individual case ...").
  20. Web site: 38 CFR § 3.303 - Principles relating to service connection.. Legal Information Institute at Cornell Law School. Service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein.. en. October 2, 2019. https://web.archive.org/web/20191002033311/https://www.law.cornell.edu/cfr/text/38/3.303. October 2, 2019. live.
  21. Book: Christensen. Eric. McMahon. Joyce. Schaefer. Elizabeth. Jaditz. Ted. Harris. Dan. Final Report for the Veterans' Disability Benefits Commission: Compensation, Survey Results, and Selected Topics. August 2007. The CNA Corporation. 4. August 23, 2014. https://web.archive.org/web/20171016174314/https://www.cna.org/CNA_files/PDF/D0016570.A4.pdf. October 16, 2017. live.
  22. Murdoch. Maureen. Long-term outcomes of disability benefits in US veterans with posttraumatic stress disorder. Archives of General Psychiatry. October 1, 2011. 68. 10. 1072–80. 10.1001/archgenpsychiatry.2011.105. 21969464. 9088710 . Regardless of claim outcome, veterans who apply for PTSD disability benefits are highly impaired. However, receiving PTSD benefits was associated with clinically meaningful reductions in PTSD symptoms and less poverty and homelessness.. free.
  23. Fried, Dennis Adrian, Marian Passannante, Drew Helmer, Bart K. Holland, and William E. Halperin. "The Health and Social Isolation of American Veterans Denied Veterans Affairs Disability Compensation". Health & Social Work 42, no. 1 (2017). https://doi.org/10.1093/hsw/hlw051
  24. Web site: Scott (USA, Ret.). LTG James Terry. Findings Of The Veterans' Disability Benefits Commission. U.S. Government Printing Office. June 20, 2015. Testimony before the Committee on Veterans' Affairs, U.S. House of Representatives. October 10, 2007. We believe that the level of compensation should be based on the severity of the disability and should make up for the average impairments of earnings capacity and the impact of the disability on functionality and quality of life. ... Current compensation payments do not provide a payment above that required to offset earnings loss. Therefore, there is no current compensation for the impact of disability on the quality of life for most veterans. While the permanent quality of life measures are developed, studied, and implemented, we recommend that compensation payments be increased up to 25 percent with priority to the more seriously disabled.. https://web.archive.org/web/20150924052558/http://www.gpo.gov/fdsys/pkg/CHRG-110hhrg39461/html/CHRG-110hhrg39461.htm. September 24, 2015. live.
  25. Web site: VA disability compensation: Actions needed to address hurdles facing program modernization (GAO-12-846). U.S. Government Accountability Office. January 8, 2020. September 10, 2012. Three key approaches for modernizing VA's disability programs recommended by disability commissions and others—providing quality of life payments, providing integrated vocational services with transitional cash assistance, and systematically factoring the effects of assistive technology and medical interventions into rating decisions—hold opportunity and challenges. Experts and veteran groups GAO interviewed believe each approach holds at least some opportunity for serving veterans more fairly, equitably, and effectively.. https://web.archive.org/web/20191013110709/https://www.gao.gov/products/GAO-12-846. October 13, 2019. live.
  26. Mossman. D.. At the VA, it pays to be sick. The Public Interest. 1994. 114. 35–47. Sadly, a program with good intentions has yielded a series of perverse incentives that reward illness, encourage patients to view themselves as incapacitated, and poison the relationships between patients and their caregivers.. August 13, 2014. https://web.archive.org/web/20140813174211/http://www.nationalaffairs.com/public_interest/detail/at-the-va-it-pays-to-be-sick. August 13, 2014. live.
  27. Web site: Satel. S.. PTSD's diagnostic trap. American Enterprise Institute. August 13, 2014. Told he is disabled, the veteran and his family may assume—often incorrectly—that he is no longer able to work. At home on disability, he risks adopting a "sick role" that ends up depriving him of the estimable therapeutic value of work.. February 2011. https://web.archive.org/web/20140813154035/http://www.aei.org/article/society-and-culture/ptsds-diagnostic-trap/. August 13, 2014. live.
  28. Gade. Daniel. A Better Way to Help Veterans. National Affairs. 16. Summer, 2013. 53–69. August 13, 2014. ... VA benefit policies ... distort incentives and encourage veterans to live off of government support instead of working to their full capability..
  29. Book: Gade. Daniel M.. Daniel Gade. Huang. Daniel. Wounding warriors : how bad policy is making veterans sicker and poorer. 2021. 978-1-955026-99-4. Washington, DC.
  30. Marx. Brian P.. Miller. Mark W.. Sloan. Denise M.. Litz. Brett T.. Kaloupek. Danny G.. Keane. Terence M.. Military-related PTSD, current disability policies, and malingering. American Journal of Public Health. May 2008. 98. 5. 773–74. 10.2105/AJPH.2007.133223. 2374833. Frueh et al. present an incomplete picture of the literature and neglect substantial evidence that contradicts their thesis. 18381982.
  31. Web site: Disability Compensation: Eligibility. Department of Veterans Affairs. November 30, 2012. https://web.archive.org/web/20121203054819/http://www.benefits.va.gov/COMPENSATION/types-disability.asp. December 3, 2012. live.
  32. Moering. Robert. Military service records: Searching for the truth. Psychological Injury and Law. 4. 3–4. 217–34. 10.1007/s12207-011-9114-3. 2011. 73163419 . May 19, 2013. https://web.archive.org/web/20131019104735/http://www.cavcbar.net/confpdf/Military%20Service%20Records%20Searching%20for%20the%20Truth%20VA%20Psychiatric%20Exams%20Dr%20Moering.pdf. October 19, 2013. live.
  33. https://www.ecfr.gov/cgi-bin/text-idx?SID=daea93a960e44a753119f95f701eb7d4&mc=true&node=se38.1.3_16&rgn=div8 Duty periods
  34. https://www.ecfr.gov/cgi-bin/text-idx?SID=daea93a960e44a753119f95f701eb7d4&mc=true&node=se38.1.3_16&rgn=div8 Duty periods
  35. https://www.ecfr.gov/cgi-bin/text-idx?SID=a2fa09bdf4061c69c6d11602246467b2&mc=true&node=se38.1.3_16&rgn=div8 38 C.F.R. § 3.6
  36. Book: The PTSD Compensation and Pension Examination. Institute of Medicine. 2007 . National Academies Press. 10.17226/11870 . 978-0-309-10552-1 . October 20, 2012. https://web.archive.org/web/20131110081422/http://www.nap.edu/openbook.php?record_id=11870&page=85. November 10, 2013. live.
  37. Dep't Veterans Affairs, Off. Inspector Gen., Inadequate Oversight of Contracted Disability Exam Cancellations, Rpt. No. 18-04266-115 at 2 ("VBA has contracted billions of dollars to schedule, conduct, and document exams for veterans to obtain a medical diagnosis and to determine the severity of a claimed disability.") and at 19 (Table A.1. Medical Disability Examination (MDE) Background Timeline) (June 10, 2019).
  38. Web site: Claims Process – Compensation. Department of Veterans Affairs. September 21, 2013. https://web.archive.org/web/20130921083918/http://benefits.va.gov/compensation/process.asp. September 21, 2013. live.
  39. Web site: Veterans Service Representative. MyCareer@VA. Department of Veterans Affairs. September 21, 2013. https://web.archive.org/web/20130926083946/http://mycareeratva.va.gov/Careerpath/Pages/Job.aspx?job=05_099605. September 26, 2013. live.
  40. Web site: The VA claim process after you file your claim. April 30, 2020. Department of Veterans Affairs, Veterans Benefits Administration. en. May 10, 2020.
  41. Web site: Veterans Claims Assistance Act of 2000. Public Law 106-475. Nov. 9, 2000. Government Printing Office. September 22, 2013. https://web.archive.org/web/20130926090025/http://www.gpo.gov/fdsys/pkg/PLAW-106publ475/pdf/PLAW-106publ475.pdf. September 26, 2013. live.
  42. Dep't Veterans Aff., Veterans Benefits Admin., M21-1 Adjudication Procedures Manual, pt. 1, chap. 1, sec. C - Duty to Assist with Obtaining Records and a Medical Examination or Opinion (February 19, 2019).
  43. The VA Medical Examination And Disability Rating Process: Hearing before the Subcomm. Disability Assistance & Memorial Aff. of the H. Comm. Veterans Aff., 110th Congress 63-65 (2008) (statement of Michael McGeary, Senior Program Officer & Study Dir., Comm. Med. Evaluation Veterans Disability Benefits, Bd. Mil. & Veterans Health, Inst. of Med., Nat'l Acad.) ("Applicants for disability compensation are asked to provide their medical records and, under the duty-to-assist law, VBA helps them obtain those records, especially their service medical records. In nearly every case, VBA has applicants undergo a compensation and pension, or C&P, examination performed by a Veterans Health Administration (VHA) or contractor clinician.")
  44. Dep't Veterans Aff., Veterans Benefits Admin., M21-1 Adjudicative Procedures Manual, pt. III, subpt. iv, chap. 1, sec. a. Definition: Rating Activity (September 28, 2018).
  45. Web site: Get help filing your claim or appeal. July 4, 2022. U.S. Department of Veterans Affairs. en. July 4, 2022. https://web.archive.org/web/20191001091120/https://www.va.gov/disability/how-to-file-claim/. October 1, 2019. live.
  46. Office of the Secretary, Dep't Veterans Aff., Veterans and Military Service Organizations and State Directors of Veterans Affairs: 2019 Directory
  47. Web site: VSO Search - VA/DoD eBenefits . 2022-07-05 . www.ebenefits.va.gov.
  48. Asknod, Veterans Administration Claims: What You Need to Know to Be Successful, (Xlibris, 2012), 30–31.
  49. Ridgway. James D.. March 1, 2012. Erratum to: Mind Reading and the Art of Drafting Medical Opinions in Veterans Benefits Claims. Psychological Injury and Law. en. 5. 1. 74. 10.1007/s12207-012-9119-6. 1938-9728. free.
  50. https://www.govinfo.gov/content/pkg/STATUTE-102/pdf/STATUTE-102-Pg4105.pdf Veterans' Judicial Review Act
  51. Web site: Frequently Asked Questions - Board of Veterans' Appeals. Board of Veterans Appeals (va.gov). en. May 10, 2020. Although it is not required, you may decide to be represented by an accredited Veterans Service Organization (VSO), attorney, or claims agent..
  52. Web site: 38 C.F.R. 14.636 – Payment of fees for representation by agents and attorneys in proceedings before Agencies of Original Jurisdiction and before the Board of Veterans' Appeals.. Code of Federal Regulations. United States Government Printing Office (GPO). April 30, 2013. https://web.archive.org/web/20171222105456/https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=d8a5ee044a562fb453141b3c21dea77d&h=L&n=38y1.0.1.1.16&r=PART&ty=HTML#38:1.0.1.1.16.0.163.37. December 22, 2017. live.
  53. Web site: Veterans Compensation Benefits Rate Tables. Veterans Benefits Administration. Department of Veterans Affairs. December 28, 2013. https://web.archive.org/web/20131228032408/http://www.benefits.va.gov/COMPENSATION/resources_comp01.asp. December 28, 2013. live.
  54. Web site: Current VA disability compensation rates . April 30, 2020 . Veterans Affairs . en . May 12, 2020.
  55. Web site: 38 CFR Part 4 - SCHEDULE FOR RATING DISABILITIES. Legal Information Institute, Cornell Law School. en. May 11, 2020.
  56. Web site: VA Schedule for Rating Disabilities (VASRD). National Resource Directory (nrd.gov). en. May 11, 2020.
  57. Web site: Schedule of ratings – mental disorders. Code of Federal Regulations, Title 38: Pensions, Bonuses, and Veterans' Relief, Part 4 – Schedule for Rating Disabilities, Subpart B – Disability Ratings, Mental Disorders. Government Printing Office, Electronic Code of Federal Regulations (e-CFR). December 28, 2013. Note: Scroll down about one page to find the General Rating Formula for Mental Disorders – it appears immediately under 9440 Chronic adjustment disorder. This placement is misleading because it appears as if the Rating Formula applies to Chronic Adjustment Disorder only, which is not the case. The Rating Formula applies to all mental disorders.. https://web.archive.org/web/20150923232924/http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=128a291288f3267f643ad3455298d7ac&n=38y1.0.1.1.5.2&r=SUBPART#se38.1.4_1130. September 23, 2015. live.
  58. Simonson. Scott. Back from war – A battle for benefits: Reforming VA's disability ratings system for veterans with post-traumatic stress disorder. Arizona Law Review. 2008. 50. 1177–1204. June 10, 2014. https://web.archive.org/web/20160304000554/http://www.arizonalawreview.org/pdf/50-4/50arizlrev1177.pdf. March 4, 2016. live.
  59. Web site: Wilson. John. Statement of John L. Wilson, Assistant National Legislative Director, Disabled American Veterans at the Hearing of the Subcommittee on Disability Assistance and Memorial Affairs, House Veterans Affairs Committee, on the Implementation and Status Update on the Veterans' Benefits Improvement Act, P.L. 110-389, on February 3, 2010. archives.democrats.veterans.house.gov. U.S. House of Representatives. June 10, 2014. https://web.archive.org/web/20140919000058/http://archives.democrats.veterans.house.gov/hearings/Testimony.aspx?TID=67155&Newsid=524&Name=%20John%20L.%20Wilson. September 19, 2014. live.
  60. Web site: Ratings Veterans Service Representative. MyCareer@VA. Department of Veterans Affairs. September 21, 2013. https://web.archive.org/web/20130926084141/http://mycareeratva.va.gov/Careerpath/Pages/Job.aspx?job=05_099604. September 26, 2013. live.
  61. News: Huang. Daniel. Automated System Often Unjustly Boosts Veterans' Disability Benefits: Reduction of VA staff input allows more patients to exaggerate symptoms. May 13, 2015. May 12, 2015 [print edition]. Wall Street Journal. May 11, 2015. A6. An effort by the Department of Veterans Affairs that aimed to speed the processing of disability-benefits applications also loosened controls that prevent veterans from exaggerating symptoms to receive more money, say current and former VA employees. A software system introduced in 2012 that automates veterans' disability levels for compensation relies almost solely on a patient's self-reported ailments, the employees say, even in the face of contradictory information. While the new system reduced paperwork and increased output, it limited the information that the VA's employees who determine compensation eligibility and dollar amounts—called raters—can consider, according to these employees. The result, raters contend: a more inaccurate process that approves higher levels of disability than veterans' military records, medical histories and other evidence might show—in some cases increasing payments to veterans by thousands of dollars a month. The process, they maintain, also ignores stated VA rules in which claims must be evaluated 'in light of the [veteran's] whole recorded history'. Senior VA officials counter that the software system still relies on raters' expertise to determine the accuracy of claims. They say it is designed to facilitate, but not replace, that process. Raters 'have every right to change [the symptoms] if there is other evidence in the file', one official said..
  62. U.S. Gov't Accountability Off., GAO-12-846, VA Disability Compensation: Actions Needed to Address Hurdles Facing Program Modernization 5 (2012).
  63. Schedule for Rating Disabilities: Mental Disorders, 87 Fed. Reg. 8498 (proposed Feb. 15, 2022) (to be codified at 38 C.F.R. § 4.126 and § 4.130).
  64. Office of the Federal Register, A Guide to the Rulemaking Process (2011).
  65. See Definitions, Initial claim, claim for increase, 38 C.F.R. § 3.1(p)(1)(ii). See also Veterans Benefits Admin., Adjudication Proc. Manual, Identification of Claims for Increase, M21-1, pt. III, subpt. ii, chap. 2, sec. E, subsec. 1.
  66. Total disability ratings for compensation based on unemployability of the individual, 38 CFR § 4.16 (2018),Web site: 38 CFR § 3.1 - Definitions. . law.cornell.edu . live . https://web.archive.org/web/20190819011816/https://www.law.cornell.edu/cfr/text/38/3.1 . August 19, 2019 . January 24, 2019.
  67. Web site: Individual Unemployability. Veterans Benefits Administration – Compensation. Department of Veterans Affairs. August 15, 2019. https://web.archive.org/web/20190807143523/https://www.benefits.va.gov/compensation/claims-special-individual_unemployability.asp. August 7, 2019. live.
  68. Total and permanent total ratings and unemployability, 38 C.F.R. § 3.340 (2018), https://www.law.cornell.edu/cfr/text/38/3.340
  69. Web site: VA Individual Unemployability if you can't work. April 30, 2020. Department of Veterans Affairs. en. May 11, 2020.
  70. Veterans Benefits Admin., Adjudication Proc. Manual, Compensation Based on Individual Unemployability (IU), M21-1, pt. IV, subpt. ii, chap. 2, sec. F (July 8, 2019), accessed on August 18, 2019.
  71. Web site: Your VA Claim Exam: Know What's Next (Claim Exam Fact Sheet). Veterans Benefits Administration (VBA). December 2016. www.VA.gov. October 11, 2017. The VA claim exam, also called a C&P exam, is different from a regular medical appointment because the examiner won't prescribe any medicine or treat you for your disability. This exam occurs only if you file a compensation or pension claim.. https://web.archive.org/web/20170622173331/http://www.benefits.va.gov/COMPENSATION/docs/claimexam-factsheet.pdf. June 22, 2017. live.
  72. https://www.gpo.gov/fdsys/pkg/FR-2010-07-13/pdf/2010-16885.pdf Stressor Determinations for Posttraumatic Stress Disorder
  73. Worthen . Mark D. . Moering . Robert G. . 2011 . A Practical Guide to Conducting VA Compensation and Pension Exams for PTSD and Other Mental Disorders . Psychological Injury and Law . en . 4 . 3–4 . 194 . 10.1007/s12207-011-9115-2 . 18074279 . https://perma.cc/C9QK-MR23 . August 17, 2019 . 1938-971X . The term 'forensic' does not mean 'crime-related' or 'what you see on CSI.' ... [Merriam-Webster's definition is:] 'relating to or dealing with the application of scientific knowledge to legal problems'..
  74. Book: Functional Organizational Manual. Department of Veterans Affairs. 2016. 3.1. Washington, DC. 238–240. The Office of Disability and Medical Assessment (DMA) (10NC8) provides executive leadership to VHA's disability programs worldwide, including both the traditional Compensation and Pension (C&P) and the Integrated Disability Evaluation System (IDES) programs.. December 21, 2017. https://web.archive.org/web/20170210134049/https://www.va.gov/ofcadmin/docs/VA_Functional_Organization_Manual_Version_3-1.pdf. February 10, 2017. live.
  75. Web site: Certification of Clinicians Performing VA Disability Evalutions [''sic''] (VHA Directive 1603)]. VHA Publications. Department of Veterans Affairs, Veterans Health Administration. August 23, 2014. PDF. April 22, 2013. https://web.archive.org/web/20140826114714/http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1643. August 26, 2014. live.
  76. Web site: Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire (VA Form 21-0960P-3). Veterans Health Administration. August 24, 2014. October 2012. The following health care providers can perform REVIEW examinations for PTSD: 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; 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; or 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.. https://web.archive.org/web/20141021021158/http://www.vba.va.gov/pubs/forms/VBA-21-0960P-3-ARE.pdf. October 21, 2014. live.
  77. Web site: Claim Exam Information - Compensation . January 4, 2023 . December 24, 2023 . www.benefits.va.gov.
  78. Web site: Military Medical Disability Examinations. 2023-12-24 . www.optum.com.
  79. Web site: Provider Portal . 2023-12-24 . providers.optumserve.com. LHI is now Optum Serve..
  80. Web site: Veterans Evaluation Services. August 23, 2014. https://web.archive.org/web/20141009004458/http://www.vesservices.com/. October 9, 2014. live.
  81. Web site: 2023-01-16 . Loyal Source Government Services Announces the Opening of 21 Medical Disability Examination Clinics Across the Western U.S. . 2023-12-24 . Yahoo Finance . en-US.
  82. Web site: 2024-01-30 . Leidos QTC Health Services . 2024-06-05 . en-US.
  83. Web site: QTC. www.magellanprovider.com. en. January 4, 2018. https://web.archive.org/web/20180105011350/http://www.magellanprovider.com/provider-network/join-the-network/qtc.aspx. January 5, 2018. live.
  84. U.S. Gov't Accountability Off., GAO-21-444T, Better Planning Needed as Use of Contracted Examiners Continues to Grow at 8.
  85. https://www.law.cornell.edu/rules/fre/rule_702
  86. Ridgway. James D.. 2012. Erratum to: Mind Reading and the Art of Drafting Medical Opinions in Veterans Benefits Claims. Psychological Injury and Law. en. 5. 1. 72–87. 10.1007/s12207-012-9119-6. 59476790 . 1938-971X. The key to understanding the role of medical evidence in the current adjudication process is realizing that medical opinions in veterans' cases are essentially substitutes for live expert testimony in a trial-like setting.. free.
  87. [Nieves-Rodriguez v. Peake]
  88. Veterans Benefits Admin., Dep't Veterans Aff., M21-1 Adjudication Procedures Manual, Definition: Rules of Evidence, pt. V, subpt. ii, chap. 1, sec. A, no. 1, subsec. b ("the codified Federal rules of evidence used in Federal court proceedings do not apply in VA proceedings.").
  89. Veterans Benefits Admin., Dep't Veterans Aff., M21-1 Adjudication Procedures Manual, Questions About Competency and/or Validity of Examinations, pt. IV, subpt. i, chap. 3, sec. A, no. 1, subsec. o ("there is a presumption that a selected medical examiner is competent").
  90. Angela K. Drake, Yelena Duterte, and Stacey-Rae Simcox, Review of Recent Veterans Law Decisions of the Federal Circuit 2020 Edition, 70 1381, 1401–1414 (2021) (history and analysis of the presumption of competence for VA medical examiners).
  91. Yelena Duterte, Duty to Impair: Failure to Adopt the Federal Rules of Evidence Allows the VA to Rely on Incompetent Examiners and Inadequate Medical Examinations, 90 UMKC L. Rev. 511 (2022) ("Although the VA has a duty to assist veterans in this process, the VA impairs veterans by providing and relying on incompetent examiners and inadequate medical opinions.")
  92. Meisler . Andrew W. . Gianoli . Mayumi O. . 2022 . The Department of Veterans Affairs disability examination program for PTSD: Critical analysis and strategies for remediation. . Psychology, Public Policy, and Law . 28 . 4 . 479–490 . en . 10.1037/law0000359 . 1939-1528. The Department of Veterans Affairs disability program for posttraumatic stress disorder … has, for decades, received criticism on several grounds, including granting of unjustified or inflated awards and providing a system that serves as a disincentive to recovery..
  93. Book: Institute of Medicine and National Research Council. PTSD Compensation and Military service. May 8, 2007. National Academies Press. 204–05. November 16, 2014. https://web.archive.org/web/20110814080316/http://www.iom.edu/Reports/2007/PTSD-Compensation-and-Military-Service.aspx. August 14, 2011. live.
  94. Sparr. L. F.. White. R.. Friedman. M. J.. Wiles. D. B.. 1994. Veterans' psychiatric benefits: enter courts and attorneys. The Bulletin of the American Academy of Psychiatry and the Law. 22. 2. 205–222. 0091-634X. 7949410. Among regional offices, there has been considerable variability in adjudicating claims. For example from 1986 to 1990, the PTSD claim approval rate in 58 VA regional offices varied from 36.2 percent to 73.5 percent..
  95. Murdoch. Maureen. Hodges. James. Cowper. Diane. Sayer. Nina. February 2005. Regional variation and other correlates of Department of Veterans Affairs Disability Awards for patients with posttraumatic stress disorder. Medical Care. 43. 2. 112–121. 0025-7079. 15655424. ... rates of PTSD service connection varied almost twofold across regions between 1994 and 1998. Consistent with earlier research, this variation could not be explained by regional dissimilarities in veterans' sociodemographic or military characteristics, rates of major medical comorbidity, or combat-injury status. We extend these findings to show that the regional variation in PTSD disability awards likewise could not be attributed to regional differences in veterans' current PTSD symptom severity or level of disability.. 10.1097/00005650-200502000-00004. 22099834 .
  96. Web site: Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). PTSD: For Professionals. National Center for PTSD. November 16, 2014. The CAPS is the gold standard in PTSD assessment.. https://web.archive.org/web/20141109114009/http://www.ptsd.va.gov/professional/assessment/adult-int/caps.asp. November 9, 2014. live.
  97. Jackson, J. C.. Variation in practices and attitudes of clinicians assessing PTSD-related disability among veterans. Journal of Traumatic Stress. October 2011. 24. 5. 610. 10.1002/jts.20688. 21913226. etal. Standardized interviews were seldom employed, with 85% and 90% reporting that they 'never' or 'rarely' use the Clinician Administered PTSD Scale (CAPS) and the Structured Clinical Interview for the DSM-IV Axis I Disorders (SCID), respectively ... (citations omitted)..
  98. Book: Watson. P.. McFall. M.. McBrine. C.. Schnurr. P. P.. Friedman. M. J.. Keane. T.. Hamblen. J. L.. Best Practice Manual for Posttraumatic Stress Disorder (PTSD) Compensation and Pension Examinations. 2002. 20. Department of Veterans Affairs. May 13, 2015. [t]he Clinician Administered PTSD Scale (CAPS) is recommended as the interview method of choice, for conducting compensation and pension examinations for PTSD. The CAPS is a structured clinical interview designed to assess symptoms of PTSD corresponding to DSM-IV criteria. The CAPS has a number of advantages over other diagnostic interview methods for PTSD ... (citation omitted).. https://web.archive.org/web/20150423064101/http://www.avapl.org/pub/PTSD%20Manual%20final%206.pdf. April 23, 2015. live.
  99. Speroff, T.. Impact of evidence-based standardized assessment on the disability clinical interview for diagnosis of service-connected PTSD: A cluster-randomized trial. Journal of Traumatic Stress. December 2012. 25. 6. 607–15. 10.1002/jts.21759. 23225029. etal. The findings of this study show that administering a standardized disability assessment resulted in more complete coverage of functional impairment and PTSD symptoms. Standardized assessment elicited an increase in relevant information and nearly eliminated variation between examiners and medical centers. Furthermore, this study found that standardized assessment substantially diminished the uncertainty in diagnosis, and increased concordance of diagnosis ....
  100. Marx. Brian P.. Engel-Rebitzer. Eden. Bovin. Michelle J.. Parker-Guilbert. Kelly S.. Moshier. Samantha. Barretto. Kenneth. Szafranski. Derek. Gallagher. Matthew W.. Holowka. Darren W.. The influence of veteran race and psychometric testing on veterans affairs posttraumatic stress disorder (PTSD) disability exam outcomes.. Psychological Assessment. en. 29. 6. 710–719. 10.1037/pas0000378. 28594214. ... among veterans diagnosed with PTSD by an independent evaluator, Black veterans were significantly less likely than White veterans to receive both a C&P PTSD diagnosis and to be given PTSD service connection status. Further, among veterans not meeting diagnostic criteria for SCID PTSD, Black veterans tended to be more likely than White veterans to be denied both C&P PTSD status and PTSD service connection status.. 2017. free.
  101. Book: Mosby's Medical Dictionary. Elsevier Health Sciences. 2013. 978-0-323-08541-0. O'Toole. Marie T.. 9th. St. Louis, MO. Kindle Locations 77966-77971. Kindle edition. false negative - an incorrect result of a diagnostic test or procedure that falsely indicates the absence of a finding, condition, or disease. The rate of occurrence of false-negative results varies with the diagnostic accuracy and specificity of the test or procedure. As the accuracy and specificity of a test increase, the rate of false-negatives decreases. Certain tests are known to yield false negative results at a certain rate; in all tests a small number will occur by chance alone..
  102. Book: Colman, Andrew M.. http://www.oxfordreference.com/view/10.1093/acref/9780199657681.001.0001/acref-9780199657681-e-3045. A Dictionary of Psychology. Oxford University Press. 2015. 9780199657681. 4th. false positive, n. - An incorrect classification of an element as a member of a class to which it does not in fact belong, as when a decision procedure results in a person being wrongly diagnosed as having a disorder.. subscription. 10.1093/acref/9780199657681.001.0001. False positive.
  103. Murdoch. Maureen. Hodges. James. Cowper. Diane. Fortier. Larry. van Ryn. Michelle. April 2003. Racial disparities in VA service connection for posttraumatic stress disorder disability. Medical Care. 41. 4. 536–549. 10.1097/01.MLR.0000053232.67079.A5. 0025-7079. 12665717. 22491388 . After adjusting for respondents' sociodemographic characteristics, symptom severity, functional status, and trauma histories, black persons' rate of service connection for PTSD was 43% compared with 56% for other respondents (P = 0.003)..
  104. Rosen. Marc I.. Afshartous. David. Nwosu. Sam. Scott. Melanie C.. Jackson. James C.. Marx. Brian. Murdoch. Maureen. Sinnot. Patricia L.. Speroff. Theodore. April 1, 2013. Racial Differences in Veterans' Satisfaction With Examination of Disability From Posttraumatic Stress Disorder. Psychiatric Services. 64. 4. 354–359. 10.1176/appi.ps.201100526. 1075-2730. 3677046. 23318842.
  105. Redd. Andrew M. Gundlapalli. Adi V. Suo. Ying. Pettey. Warren B P. Brignone. Emily. Chin. David L. Walker. Lauren E. Poltavskiy. Eduard A. Janak. Jud C. Howard. Jeffrey T. Sosnov. Jonathan A. January 7, 2020. Exploring Disparities in Awarding VA Service-Connected Disability for Post-Traumatic Stress Disorder for Active Duty Military Service Members from Recent Conflicts in Iraq and Afghanistan. Military Medicine. en. 185. Supplement_1. 296–302. 10.1093/milmed/usz208. 32074380 . 0026-4075. Despite being diagnosed with PTSD at similar rates to their referent categories, females and Black veterans are less likely to receive PTSD disability awards.. free.
  106. Wandler. Hillary A.. Spring 2013. The Role of Culture in Advocating for Accurate Diagnosis and Rating of Veterans' Psychological Disabilities. Mental Health Law & Policy Journal. 2. 18. The real potential for injustice comes when patient's whose culture's heavily influence the way they communicate distress meet clinicians who use a universalist or one-size-fits-all approach to assessment and diagnosis. As a patient may report symptoms differently across cultures, a clinician may interpret what the patient reports differently depending on the clinician's approach to assessment and diagnosis. The effect is even more significant when the patient and the clinician are from different cultures..
  107. Russo. Arthur. Assessing veteran symptom validity. Psychological Injury and Law. March 5, 2014. 7. 2. 178–90. 10.1007/s12207-014-9190-2. 54869033 . November 16, 2014. https://web.archive.org/web/20141129020456/http://www.veteranslawlibrary.com/files/Veterans_Symptom_Validity_Russo.pdf. November 29, 2014. live.
  108. Poyner, G.. Psychological evaluations of veterans claiming PTSD disability with the Department of Veterans Affairs: A clinician's viewpoint. Psychological Injury and Law. May 27, 2010. 3. 2. 130–32. 10.1007/s12207-010-9076-x. free.
  109. Arbisi, P. A.. Murdoch, M.. Fortier, L.. McNulty, J.. MMPI-2 validity and award of service connection for PTSD during the VA compensation and pension evaluation. Psychological Services. 2004. 1. 1. 56–67. 10.1037/1541-1559.1.1.56.
  110. Freeman, T.. Powell, M.. Kimbrell, T.. Measuring symptom exaggeration in veterans with chronic posttraumatic stress disorder. Psychiatry Research. April 15, 2008. 158. 3. 374–80. 10.1016/j.psychres.2007.04.002. 18294699. 9304082 .
  111. Wisdom, N. M.. PTSD and cognitive functioning: Importance of including performance validity testing. The Clinical Neuropsychologist. 2014. 28. 1. 128–45. 10.1080/13854046.2013.863977. 24354897. 205810338 . etal.
  112. Marx. Brian P.. Bovin. Michelle J.. Szafranski. Derek D.. Engel-Rebitzer. Eden. Gallagher. Matthew W.. Holowka. Darren W.. Schnurr. Paula P.. Rosen. Raymond C.. Keane. Terence M.. January 19, 2016. Validity of Posttraumatic Stress Disorder Service Connection Status in Veterans Affairs Electronic Records of Iraq and Afghanistan Veterans. The Journal of Clinical Psychiatry. en. 77. 4. 517–522. 10.4088/jcp.14m09666. 26797388. 0160-6689. This study examined the extent to which veterans' posttraumatic stress disorder (PTSD) service connection (SC) status corresponded to their PTSD diagnostic status, as determined by a semi-structured diagnostic interview. ... For current PTSD, results showed a slightly higher proportion of false positives—individuals who did not meet SCID criteria but who did have SC for PTSD—than false negatives—individuals who met SCID criteria but did not have SC for PTSD. For lifetime PTSD, the proportion of false negatives was approximately twice the proportion of false positives. ...  PTSD diagnostic and SC status are discordant for a significant minority of veterans..
  113. The VA Medical Examination And Disability Rating Process: Hearing before the Subcomm. Disability Assistance & Memorial Aff. of the H. Comm. Veterans Aff., 110th Congress 63–65 (2008) (statement of Michael McGeary, Senior Program Officer & Study Dir., Comm. Med. Evaluation Veterans Disability Benefits, Bd. Mil. & Veterans Health, Inst. of Med., Nat'l Acad.)(GPO Serial No. 110–70) ("Applicants for disability compensation are asked to provide their medical records and, under the duty-to-assist law, VBA helps them obtain those records, especially their service medical records. In nearly every case, VBA has applicants undergo a compensation and pension, or C&P, examination performed by a Veterans Health Administration (VHA) or contractor clinician.")
  114. Washington v. Nicholson, 21 Vet. App. 191, 197 (2007) (Hagel, J., concurring) ("Because of the immense importance of medical evidence in the VA claims process," [medical examinations and opinions] "can bear significantly upon the outcome of the claim for VA benefits.")
  115. U.S. Government Accountability Office, Military sexual trauma: Improvements made, but VA can do more to track and improve the consistency of disability claim decisions (p. 18) (2014) (GAO-14-447) ("VBA adjudicators generally rely on examiners' assessments when deciding whether to approve a claim ...").
  116. News: PTSD, Reading Comprehension and the Great American Love of Victimhood. Hernandez. Christopher. February 26, 2014. Breach Bang Clear. October 13, 2017. en-US. I'm proud as hell of being a veteran. I'm proud of the men and women I served with. ¶ I didn't join the military so that my country could give me a free ride for the rest of my life, I joined to defend it from its worst enemies. I expected pain, fear and hardship from war. I believe our job as soldiers is to endure that pain, fear and hardship so our citizens don't have to. We are the barrier between our people and foreign threats. ¶ Being part of that barrier doesn't require heroism. But it does require integrity, courage and strength. The same integrity, courage and strength my great uncle Leo undoubtedly showed before he marched to his death on Bataan, and my great uncle Jesse showed when he jumped into Sicily, Normandy and Holland, and my great uncle Richard showed as he fought his way through Korea. And by generations of other American warriors on battlegrounds from Lexington to the Korengal Valley. ¶ Every time a veteran makes a false claim of PTSD, that barrier is weakened. Every time a veteran is exposed as a fraud, the barrier loses precious integrity. Every story that hints we're all damaged by PTSD, that we're all unstable, that we're all victims, gouges chunks from the barrier's foundation.. https://web.archive.org/web/20171013172858/http://www.breachbangclear.com/ptsd-jackassery-heroism-integrity-courage-strength/. October 13, 2017. live.
  117. Overcoming PTSD: Assessing VA's Efforts to Promote Wellness and Healing, H. Comm. Veterans Affairs, 115th Cong. 5 (2017) statement of Brendan O'Byrne, Veteran, United States Army ("[During group psychotherapy sessions] I heard stories that sounded a lot like a bad day rather than a traumatic moment. As weeks went by, I realized the sad truth about a portion of the veterans there, they were scammers, seeking a higher rating without a real trauma. This was proven when I overheard one vet say to another that he had to 'pay the bills' and how he 'was hoping this in-patient was enough for a 100% rating'. I vowed never to participate in group counseling through the VA again. ... The trend I have seen among the combat veterans, the most traumatized group, [is to] stay away from the VA, or at the very least, [stay away from] the group counseling settings. They have no patience for the fraudulent veterans scamming the system to get a pay check and they are definitely not going to open up about their worst days to those who know nothing about them.")
  118. News: Zarembo. Alan. As disability awards grow, so do concerns with veracity of PTSD claims. November 19, 2014. Los Angeles Times. August 3, 2014. Even some veterans whose diagnosis falls under deep suspicion have managed to keep their disability ratings. In one case that Moering reviewed in 2009, he searched military records and concluded that a Navy veteran on the disability rolls for PTSD had lied to VA clinicians about having served in the elite SEALs and concocted his combat history. The VA responded by reducing his PTSD rating from 50% to 30%, records show.. https://web.archive.org/web/20141111060343/http://www.latimes.com/local/la-me-ptsd-disability-20140804-story.html#page=1. November 11, 2014. live.
  119. News: Huang. Daniel. VA Disability Claims Soar: Some See Higher Fraud Risk as More Vets Seek Compensation, Overloading Doctors. November 19, 2014. The Wall Street Journal. Dow Jones & Company. October 27, 2014. Requests for disability pay by veterans have ballooned during the past five years, overloading many doctors who evaluate the claims and increasing the possibility of fraud, according to current and former VA staff and government watchdogs..
  120. News: McVay. Mark. When PTSD benefits are abused. June 20, 2015. Denver Post. June 21, 2014. I ran into John a few years back for the first time since the early 1970s when we both returned to Michigan from Vietnam. But John was clearly excited to see me. 'Hey man,' he said, 'have you applied for PTSD benefits yet? You can get a couple thousand a month. All you have to do is go to this counseling program for two weeks. Nothing to it. You ought to go.'. https://web.archive.org/web/20150620135011/http://www.denverpost.com/voices/ci_26002740/when-ptsd-benefits-are-abused. June 20, 2015. live.
  121. News: Harbaugh. Ken. The Risk of Over-Thanking Our Veterans. June 20, 2015. The New York Times. June 1, 2015. And while most vets who receive disability checks deserve them, one of the worst kept secrets among those seeking a disability rating is that the system can be beaten. Claim the right combination of symptoms, whether you are suffering or not, and there is a decent chance you can get a monthly disability check, tax free, for the rest of your life. There are even blogs out there to walk you through the process of claiming an injury that cannot be disproved.. https://web.archive.org/web/20150607032909/http://www.nytimes.com/2015/06/01/opinion/the-risk-of-over-thanking-our-veterans.html. June 7, 2015. live.
  122. Committee on the Review of the Department of Veterans Affairs Examinations for Traumatic Brain Injury, Nat'l Acad. Sci., Eng'g, & Med., Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans 103 (2019).
  123. Web site: Disability Benefits Questionnaire. Veterans Health Administration. August 24, 2014. https://web.archive.org/web/20140824095306/http://www.benefits.va.gov/compensation/dbq_disabilityexams.asp. August 24, 2014. live.
  124. Web site: VA Claims Process: Review of VA's Transformation Efforts: Hearing before the S. Comm. on Veterans' Affairs, 113th Cong. 12 (13 Mar 2013) (statement of Allison A. Hickey, Under Secretary for Benefits, Veterans Benefits Admin., U.S. Dep't Veterans Affairs). U.S. Senate Committee on Veterans Affairs. August 24, 2014. 12. March 13, 2013. DBQs replace traditional VA examination reports and are designed to capture all the needed medical information relevant to a specific condition at once and up front so that claims can be developed and processed in a more timely and accurate manner, with the end result being faster service for Veterans. DBQs change the way medical evidence is collected, giving Veterans the option of having their private physician complete a DBQ that provides the medical information needed to rate their claims—minimizing the need for a VA exam which adds additional time to the claim development process. Information in the DBQs maps to the VA Schedule for Rating Disabilities, and provides all of the necessary information to decide a disability claim.. https://web.archive.org/web/20140826115020/http://www.veterans.senate.gov/imo/media/doc/CHRG-113shrg80110.pdf. August 26, 2014. live.
  125. Web site: Documentation of Medical Evidence for Disability Evaluation Purposes (VHA Directive 2013-002). Veterans Health Administration. August 24, 2014. 4(e)(1)(c). 4. PDF. January 14, 2013. For mental health disability examination requests, it is recommended that the Veteran's treating provider not complete the disability examination to maintain the integrity of the patient-provider relationship.. https://web.archive.org/web/20131019101748/http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2856. October 19, 2013. live.
  126. Web site: Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire (VA Form 21-0960P-3, OCT 2012). VBA Forms. Department of Veterans Affairs. May 13, 2015. https://web.archive.org/web/20150226052504/http://www.vba.va.gov/pubs/forms/VBA-21-0960P-3-ARE.pdf. February 26, 2015. live.
  127. Worthen, M. D.. Moering, R. G.. A Practical Guide to Conducting VA Compensation and Pension Exams for PTSD and Other Mental Disorders. Psychological Injury and Law. December 2011. 4. 3–4. 192. 10.1007/s12207-011-9115-2. 18074279 . One section of every mental health-related DBQ is a symptom checklist where, for example, examiners are asked to check off a box if a veteran has 'depressed mood' or 'anxiety'. Unfortunately, the DBQ does not provide any guidance with regard to how one determines the level of symptom frequency, severity, or duration required to endorse a given symptom. Thus, for example, if a veteran reports that she feels 'a little depressed' once or twice a week, it is not clear if the examiner should check off the 'depressed mood' box or not.. June 10, 2014. https://web.archive.org/web/20141021045234/http://www.cavcbar.net/confpdf/A%20Practical%20Guide%20to%20Conducting%20CP%20Exams%20(Worthen%20Moering).pdf. October 21, 2014. live.
  128. Web site: Discontinuance of Publicly Available Disability Benefits Questionnaires (DBQs). April 2, 2020. Veterans Benefits Administration. en. April 3, 2020.
  129. Off. Inspector Gen., Dep't Veterans Aff., Rep. No. 19-07119-80, Telehealth Public-Use Questionnaires Were Used Improperly to Determine Disability Benefits 13 (Feb. 18, 2020) https://www.va.gov/oig/pubs/VAOIG-19-07119-80.pdf
  130. Publication and Acceptance of Disability Benefit Questionnaire Forms of Department of Veterans Affairs, Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020, Pub. L. No. 116-315, § 2006 (Jan. 5, 2021).

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Veterans benefits for post-traumatic stress disorder in the United States".

Except where otherwise indicated, Everything.Explained.Today is © Copyright 2009-2024, A B Cryer, All Rights Reserved. Cookie policy.