To give you an idea of the content and focus of my recent Wʜɪᴛᴇ Pᴀᴘᴇʀ, Psych C&P Exams are Unfair to Veterans (PDF), here are the key points–similar to an “executive summary” of the paper:
unfair adj. – 1. unmerited, wrong; 2. biased, discriminatory; 3. unethical, dishonorable.
Psych C&P exams are unfair to veterans because:
* Many veterans receive unmerited disability compensation due to false positive C&P exam conclusions.
* Similarly, many veterans do not receive disability compensation, which they merit, due to false negative (wrong) C&P exam conclusions.
* Research indicates that a number of C&P examiners (psychologists and psychiatrists) harbor implicit discriminatory bias against African-American veterans (and perhaps other veterans of color) leading to significantly higher rates of false negative exam results for those vets, and significantly higher false positive rates for White veterans.
* In addition to failing to examine themselves for possible racial biases, many C&P examiners engage in possibly unethical behavior by failing to conduct comprehensive, evidence-based psychological assessments for PTSD and other mental disorders consistent with well-established professional guidelines and standards.
* These long-ignored problems have created a VA disability benefits program that dishonors veterans by awarding compensation to veterans who do not merit the benefits, and by denying compensation to veterans who qualify for the assistance they need and have earned.
VA is Responsible
Although I present extensive evidence supporting my argument that Psych C&P exams suffer from a high inaccuracy rate, keep in mind that the Department of Veterans Affairs bears the responsibility to demonstrate that their disability compensation program produces accurate disability determinations. In other words, the burden of proof is on VA.
STAR Does NOT Measure C&P Exam Quality
The VBA Systematic Technical Accuracy Review (STAR) program measures the reliability of VBA rating decisions only. It does not measure the reliability of Psych C&P exams.
C&P Exam Reliability Affects VBA Adjudication Reliability
The reliability of Psych C&P exams places an upper limit on the reliability of VBA adjudicative decisions. Stated differently, VBA adjudication reliability can only be as high as Psych C&P exam reliability.
Adjudicative decisions are the product of C&P exam conclusions and VBA disability ratings. Of course, VBA considers other evidence when making disability determinations, in addition to the C&P exam report. However, C&P exam results carry substantial weight with VBA rating staff., In addition, VBA almost always requests a C&P exam for psychological claims.,
VHA Has Never Evaluated C&P Exam Reliability or Validity
VHA (Veterans Health Administration) has never conducted program evaluation research to measure Psych C&P exam reliability or validity.
VHA Has Never Implemented a Meaningful Quality Assurance Program for C&P Exams
VHA has never developed a meaningful Quality Assurance (QA) program for Psych C&P exams. In fact, VHA seems to have relied on STAR program results as a cover for th
Multiple Sources of Evidence Indicate Significant Numbers of False Negative & False Positive Psych C&P Exam Conclusions
Evidence from the multiple sources listed below all point to unacceptably high rates of both false negative and false positive Psych C&P exam conclusions:
- empirical research;
- articles by C&P psychologists in peer-reviewed scholarly journals and blogs;
- Institute of Medicine reports;
- investigative journalism articles in major newspapers; and
- reports from individual veterans.
Other Mental Disorders Constitute 41% of Psych Disability Claims
While the majority of psychological disability claims are for PTSD, it is important to keep in mind that 41% of psychological disability claims are for other mental disorders, e.g., major depressive disorder secondary to service-connected Parkinson’s disease.
Claims for an Increased Disability Rating & TDIU Also Suffer from High Inaccuracy Rates
Requests (claims) for an increased disability rating, which often include a related claim for total disability due to individual unemployability (TDIU), constitute a significant portion of a C&P psychologist’s caseload.
Click here to download the complete Wʜɪᴛᴇ Pᴀᴘᴇʀ.
 See the Definition of Terms section (p. 7) for words and phrases with light green highlighting.
 See, e.g., 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.”); cf. 38 U.S.C. § 5103A(d) (“Medical Examinations for Compensation Claims.—(1) In the case of a claim for disability compensation, the assistance provided by the Secretary under subsection (a) shall include providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on the claim.”)
 U.S. Gᴏᴠ’ᴛ Aᴄᴄᴏᴜɴᴛᴀʙɪʟɪᴛʏ Oғғ., Mɪʟɪᴛᴀʀʏ Sᴇxᴜᴀʟ Tʀᴀᴜᴍᴀ: Iᴍᴘʀᴏᴠᴇᴍᴇɴᴛs Mᴀᴅᴇ, ʙᴜᴛ VA Cᴀɴ Dᴏ Mᴏʀᴇ ᴛᴏ Tʀᴀᴄᴋ ᴀɴᴅ Iᴍᴘʀᴏᴠᴇ ᴛʜᴇ Cᴏɴsɪsᴛᴇɴᴄʏ ᴏғ Dɪsᴀʙɪʟɪᴛʏ Cʟᴀɪᴍ Dᴇᴄɪsɪᴏɴs 18 (2014) (GAO-14-447) (“VBA adjudicators generally rely on examiners’ assessments when deciding whether to approve a claim…”).
 U.S. Dᴇᴘ’ᴛ Vᴇᴛᴇʀᴀɴs Aғғ., Oғғ. Iɴsᴘᴇᴄᴛᴏʀ Gᴇɴ., Rᴇᴠɪᴇᴡ ᴏғ Cᴏᴍᴘᴇɴsᴀᴛɪᴏɴ ᴀɴᴅ Pᴇɴsɪᴏɴ Mᴇᴅɪᴄᴀʟ Exᴀᴍɪɴᴀᴛɪᴏɴ Sᴇʀᴠɪᴄᴇs, Rᴇᴘ. Nᴏ. 7R1-A02-114 (1997) (“Disability benefit payments are based, in part, on interpretations of medical evidence by the Veterans Benefits Administration (VBA) disability rating specialists. That evidence is developed by physicians employed or supervised by the Veterans Health Administration (VHA), in the form of compensation and pension (C&P) examinations. … VBA cannot complete payment action on veterans’ disability claims until examination results are received.”) [emphasis added]
 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.”) [emphasis added] [PDF]
 Aᴍᴇʀɪᴄᴀɴ Hᴇʀɪᴛᴀɢᴇ Dɪᴄᴛɪᴏɴᴀʀʏ ᴏғ ᴛʜᴇ Eɴɢʟɪsʜ Lᴀɴɢᴜᴀɢᴇ (5th ed., 2016), (obscurantism n. 2. – “a policy of withholding information from the public”); also see Rᴀɴᴅᴏᴍ Hᴏᴜsᴇ Kᴇʀɴᴇʀᴍᴀɴ Wᴇʙsᴛᴇʀ’s Cᴏʟʟᴇɢᴇ Dɪᴄᴛɪᴏɴᴀʀʏ (2010) (obscurantism n. – 2. “deliberate obscurity or evasion of clarity”); and Pʀɪɴᴄᴇᴛᴏɴ U. & Fᴀʀʟᴇx Iɴᴄ., WᴏʀᴅNᴇᴛ 3.0, (2012) (2. obscurantism n. – “a deliberate act intended to make something obscure; syn. dissimulation, deception, dissembling, deceit – the act of deceiving”).
 Filip Buekens & Maarten Boudry, The Dark Side of the Loon: Explaining the Temptations of Obscurantism, 81 Tʜᴇᴏʀɪᴀ 126, 126 (2014) (“The charge of obscurantism suggests a deliberate move on behalf of the speaker, who is accused of setting up a game of verbal smoke and mirrors to suggest depth and insight where none exists. The suspicion is, furthermore, that the obscurantist does not have anything meaningful to say and does not grasp the real intricacies of his subject matter, but nevertheless wants to keep up appearances, hoping that his reader will mistake it for profundity.”)
 False positive disability determinations include requests (claims) for an increased disability rating that are granted in error, and false negative disability determinations include requests (claims) for an increased disability rating that are denied in error.
 Vᴇᴛᴇʀᴀɴs Bᴇɴᴇғɪᴛs Aᴅᴍɪɴ., Dᴇᴘ’ᴛ Vᴇᴛᴇʀᴀɴs Aғғᴀɪʀs, Compensation, in Fɪsᴄᴀʟ Yᴇᴀʀ 2016 Aɴɴᴜᴀʟ Bᴇɴᴇғɪᴛs Rᴇᴘᴏʀᴛ 35 (2017) [Note that each section of the report, e.g., Compensation, restarts pagination.] https://www.benefits.va.gov/REPORTS/annual_benefits_report.asp
 VA refers to such exams as Review C&P exams (as opposed to Initial exams conducted in response to an original claim for service-connected disability compensation). I do not know if VA has data regarding the percent of Psych C&P exams that are Initial exams vs. Review exams. I did not see any such statistics when I worked for VA (2010-2016), and I could not find anything in this regard on the VA website. My guesstimate would be 45% Review exams, and 55% Initial exams (Psych claims).
Click here to download the complete Wʜɪᴛᴇ Pᴀᴘᴇʀ.
[This post was edited on 27 Dec 2017.]