Six C&P Exams Per Day

VA Compensation and Pension examinations (C&P exams) for PTSD and other mental disorders lack adequate reliability and validity for several reasons, as I have discussed in previous posts.

Not providing C&P psychologists and psychiatrists enough time to conduct a thorough, evidence-based assessment of PTSD or other mental disorders is one of those reasons.

In FY2013 58% of new recipients of VA disability benefits for a mental disorder had PTSD.1 The VA C&P Examiner Clinician’s Guide (2002) recommends four hours for an Initial PTSD C&P exam, and the VA Best Practice Manual for Posttraumatic Stress Disorder (PTSD) Compensation and Pension Examinations (2002) recommends three to four hours.

But consider the following job announcement2 on USAJobs.gov for a C&P Psychologist:

The Compensation and Pension (C&P) Psychologist functions as the full-time mental health examiner for compensation and pension examinations. As such, the incumbent will perform all the duties necessary for high quality, timely completion of the mental health examinations assigned for initial, review, or increase C&P evaluations. It is expected that up to six examinations (i.e. face-to-face appointments with the patient) will be completed in a day, with the psychologist expected to review the Claims file, medical record, and associated background materials, perform the examination of the patient as requested by Newark Regional Office of Veterans Benefits Administration (VBA), and complete documentation of the examination by dictation or by typing within 24 hours.

Six exams in one eight-hour day, presuming the psychologist has other duties and is allowed to take a couple of bathroom breaks, means about one hour per exam.

How can these C&P psychologists conduct a reliable and valid PTSD C&P exam in one-third to one-fourth of the time recommended in VA’s own guidance?

Of course, they cannot do so. C&P psychologists and psychiatrists need adequate time to conduct quality PTSD evaluations, as a VA-requested study by the National Institute of Medicine pointed out eight years ago.3

Shall we work together to stop sacrificing quality to achieve greater productivity with C&P exams for posttraumatic stress disorder and other mental disorders? Do we not owe as much to Veterans and the American public?

Footnotes
1. VBA Annual Benefits Report Fiscal Year 2013

2. Job Announcement Number: BH-15-JL-1320141-BU; Vacancy Identification Number (VIN): 1320141; East Orange, NJ – Open Period: 05 FEB 2015 to 27 FEB 2015. Also: Job Announcement Number: KT-15-IJS-1400279-R19; Control Number: 403030500; Vacancy Identification Number (VIN) 1400279; Fayetteville, AR – Open Period: 05 MAY 2015 to 28 MAY 2015.

3. Institute of Medicine and National Research Council (2007). PTSD compensation and military service. Washington, DC: National Academies Press. | http://bit.ly/IOM-PTSD-Compensation