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

January 29, 2023

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 suffering from 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

Main article: 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][a]

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.[12] The United States Department of Veterans Affairs (VA) provides benefits[13] 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[14] but can also include free or low-cost mental health treatment and other healthcare, vocational rehabilitation services, employment assistance, independent living support, and more.[15]

History

 
Revolutionary War soldiers

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 generally.[16][17][18] Near the end of World War I, the U.S. Congress passed legislation establishing an indemnity model for veterans' disability benefits.[19] Since that year, compensation has been provided to veterans suffering from 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".[20]

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.[21]

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,[22] 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.[23] 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"[b] 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.[23]

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.[25] 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.[26]

In addition to lost income, a Congressionally mandated commission,[27] 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.[28]

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.[29][30] 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.[31][32] However, some VA researchers take issue with this assertion.[33]

Claims process

Eligibility

In order to be eligible for VA benefits, a veteran must have been discharged under "other than dishonorable conditions".[34] 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.[35]

Types of military service

Federal regulations describe three categories of military service, "active duty", "active duty for training", and "inactive duty training".[36] 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".[37]

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".[38]

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),[39] 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.[40]

Benefits claim procedures

VA provides a detailed description of the benefits claims process on its website.[41] Briefly, a Veterans Service Representative (VSR),[42] 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.[43]

VA has a legal obligation to help veterans obtain any evidence that will support their claim.[44] For example, the VSR might request a veteran's military personnel records, Social Security disability records, or private medical records.[45] The VSR will almost always request a Compensation and Pension examination (C&P exam),[46] also referred to as a "VA claim exam".[47]

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".[48]

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".[49] VA publishes an annual directory of accredited veterans' service organizations and state departments of veterans affairs[50] and VA has a "VSO search" feature[c] on their eBenefits site.[51] 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.[52]

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.[53] 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.[54]

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.[55]

VA prohibits attorneys or claims agents from charging a veteran for professional services prior to the adjudication of the veteran's claim.[56]

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.[56]

Disability rating

General rating formula for mental disorders

 
Code of Federal Regulations, Title 38 – Pensions, Bonuses, and Veterans' Relief

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[57] 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.[57][58]

The VA assigns disability ratings based on criteria set forth in the Code of Federal Regulations, Title 38, Part 4—Schedule for Rating Disabilities,[59] often referred to as the "VA Schedule for Rating Disabilities" or VASRD.[60] The rating schedule for mental disorders is called the "General Rating Formula for Mental Disorders" (38 C.F.R. § 4.130),[61] which specifies criteria for disability ratings of 0%, 10%, 30%, 50%, 70%, or 100%.[d]

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."[62] 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.[63]

Concern has been expressed by some RSVRs[64] (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.[65]

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."[66]

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.[67] 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".[68]

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.[69]

Individual unemployability

Under certain conditions,[70] veterans receiving service-connected disability compensation for PTSD may file a claim for individual unemployability.[22] 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...",[71] the veteran will receive disability compensation at the 100% rate, even though their schedular rating is less than 100%.[72][73]

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",[47] for veterans claiming service-connected PTSD. C&P exams are forensic mental health evaluations.[74][75] 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)[76] to evaluate veterans for this purpose.[77]

The definition of "VA psychologist or psychiatrist" includes psychologists and psychiatrists in the private sector who conduct C&P exams for a Medical Disability Evaluation (MDE) company under contract with the VBA.[78] The companies with current VBA contracts[79][80] are Logistics Health, Inc. (LHI);[81] Veterans Evaluation Services (VES);[82] Vet Fed;[83] and QTC[84] (QTC in turn contracts with Magellan Health to manage their network of providers).[85]

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.[86]

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).[87] However, VA medical examiners are presumed competent to provide expert witness testimony[88][89] without having to meet FRE 702 standards.[90][91][92]

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.[93][94] For example:

  • Some current or former VA psychologists assert that VA medical centers do not allocate enough time for C&P psychologists and psychiatrists to conduct a thorough, evidence-based assessment, with less time presumably reducing the reliability and validity of the results.[95]
  • Research has demonstrated marked regional variance with regard to the proportion of veteran claimants who receive VA disability compensation for PTSD.[96][97]
  • A survey of C&P examiners (psychologists) revealed that 85% "never" or "rarely" used the Clinician-Administered PTSD Scale (CAPS),[98][99] for PTSD compensation and pension exams,[98] even though a VA Best Practice Manual recommends its use during C&P exams,[100] and research has shown that using the CAPS improves PTSD C&P exam reliability and validity.[101]
Four possible outcomes of a psychological evaluation, including false positive and false negative conclusions.
Evaluation conclusion Actual (true) condition
Evaluee has the claimed mental disorder Evaluee does not have the claimed mental disorder
Evaluee has the claimed mental disorder True positive False positive
Evaluee does not have the claimed mental disorder False negative True negative
  • An empirical study published in 2017[102] suggested C&P examiner racial bias might have led to an increased rate of false negative[103] conclusions (regarding PTSD diagnosis and service connection) for Black veterans, and a high rate of false positive[104] conclusions for White veterans. This finding corresponds with past research,[105][106] subsequent research,[107] and legal scholarship[108] discussing the potential for implicit racial biases on the part of mental health clinicians in general, and C&P psychologists and psychiatrists in particular.
  • Some VA facilities prohibit examiners from using symptom validity tests to screen or assess for malingering and other forms of dissimulation.[109][110]
  • Several researchers have published empirical studies in peer-reviewed scholarly journals pointing to significant rates of both false positive and false negative PTSD C&P exam conclusions.[111][112][113]
  • Social scientists conducted independent PTSD assessments of veterans who had filed disability benefits claims for PTSD, some of whom had been awarded service-connected compensation for PTSD and some had not. The study found significant rates of both false positive and false negative VBA adjudicative decisions.[114] Although VBA adjudicators rely on other sources of evidence, in addition to C&P exam results, VBA almost always requests a C&P exam for PTSD claims,[115] and C&P exam results significantly influence VBA determinations.[116][117]
  • Individual combat veterans,[118][119] newspaper articles[120][121] and editorials,[122][123] assert that a sizable percentage of veterans filing PTSD disability claims exaggerate or feign PTSD symptoms.

Disability Benefits Questionnaire

Mental health professionals document the results of Initial and Review PTSD C&P exams on a Disability Benefits Questionnaire (DBQ).[124] 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.[125] However, it is important to note that the VA discourages their mental health clinicians from completing DBQs for their patients.[126]

Some authors have expressed concern that the DBQ symptom list (for example, Section VII on the Review PTSD DBQ)[127] contains a series of signs, symptoms, and descriptions of functional impairment without any guidance regarding when these items should be endorsed.[128]

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 ...."[129] VBA's decision to remove publicly available DBQs came in the wake of a VA Office of Inspector General report that recommended the action.[130] 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.[131]

Notes

  1. ^ Claims that were appealed before August 4, 2014 would still use DSM-IV PTSD diagnostic criteria. See 79 Fed. Reg. 45093 at 45094 ("The Secretary does not intend for the provisions of this interim final rule to apply to claims that have been certified for appeal to the Board of Veterans' Appeals or are pending before the Board of Veterans' Appeals, the United States Court of Appeals for Veterans Claims, or the United States Court of Appeals for the Federal Circuit.")
  2. ^ The CNA report cited herein describes the "parity ratio" as: "A ratio of exactly 1 would be perfect parity, indicating that the earnings of disabled veterans, plus their VA compensation, gives them the same lifetime earnings as their peers. A ratio of less than one would mean that the service-disabled veterans receive less than their peers on average, while a ratio of greater than one would mean that they receive more than their peers."[24]
  3. ^ The abbreviation "VSO" stands for Veterans Service Organization or Veterans Service Officer.
  4. ^ Note that the General Rating Formula for Mental Disorders, and its associated percentages, are unrelated to the concept of "parity ratio" mentioned earlier in the article. The term "parity ratio" is used by economists generally and in the economic study of veterans receiving compensation for PTSD discussed in the Effectiveness section of this article.[23] While important for policy-makers to consider, the Rating Formula is not based on parity ratio as determined in that research.

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. ISBN 9781609181741
  3. ^ World Health Organization, Post traumatic stress disorder (6B40) Archived August 1, 2018, at archive.today, 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. ISBN 978-0-19-025944-0
  5. ^ "Veterans Benefits Administration, VBA Annual Benefits Report Fiscal Year 2018, Compensation, p. 5" (PDF). benefits.va.gov. (PDF) from the original on August 26, 2019. Retrieved January 23, 2020.
  6. ^ Friedman, Matthew J. "PTSD History and Overview". National Center for PTSD. from the original on October 3, 2019. Retrieved October 3, 2019.
  7. ^ Posttraumatic stress disorder, 38 C.F.R. § 3.304(f), ("Service connection for posttraumatic stress disorder requires medical evidence diagnosing the condition in accordance with §4.125(a) of this chapter; a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred.")
  8. ^ Diagnosis of mental disorders, 38 C.F.R. § 4.125(a), ("Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association (2013), is incorporated by reference into this section ....")
  9. ^ "VA disability compensation for PTSD". U.S. Department of Veterans Affairs. September 27, 2019. from the original on August 30, 2019. Retrieved 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)
  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 October 3, 2019, at the Wayback Machine (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 October 2, 2019, at the Wayback Machine, 79 Fed. Reg. 45093, 45094 (August 4, 2014) (codified at 38 C.F.R. §4.125(a))
  12. ^ Direct service connection; wartime and peacetime—Posttraumatic stress disorder, 38 C.F.R. §3.304(f), eCFR—Code of Federal Regulations, from the original on July 10, 2017, retrieved October 2, 2019
  13. ^ "Federal Benefits for Veterans, Dependents and Survivors, 2017 Edition". Department of Veterans Affairs. from the original on June 6, 2018. Retrieved June 24, 2018.
  14. ^ "VA Compensation Rate Table". Department of Veterans Affairs. from the original on December 1, 2018. Retrieved November 24, 2018.
  15. ^ "Benefits A-Z". Veterans Benefits Administration, Department of Veterans Affairs. Retrieved May 7, 2020.
  16. ^ Ridgway, J. (2011). "The splendid isolation revisited: Lessons from the history of veterans benefits before judicial review" (PDF). Veterans Law Review. 3: 135–219.
  17. ^ 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 ...").
  18. ^ 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 ...").
  19. ^ Economic Systems Inc (2004). VA Disability Compensation Program: Legislative History. Washington, DC: VA Office of Policy, Planning and, Preparedness.
  20. ^ 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 ...").
  21. ^ "38 CFR § 3.303 - Principles relating to service connection". Legal Information Institute at Cornell Law School. from the original on October 2, 2019. Retrieved October 2, 2019. 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.
  22. ^ a b "Individual Unemployability". Veterans Benefits Administration – Compensation. Department of Veterans Affairs. from the original on August 7, 2019. Retrieved August 15, 2019.
  23. ^ a b c Christensen, Eric; McMahon, Joyce; Schaefer, Elizabeth; Jaditz, Ted; Harris, Dan (August 2007). Final Report for the Veterans' Disability Benefits Commission: Compensation, Survey Results, and Selected Topics (PDF). The CNA Corporation. p. 4. (PDF) from the original on October 16, 2017. Retrieved August 23, 2014.
  24. ^ Christensen, Eric; McMahon, Joyce; Schaefer, Elizabeth; Jaditz, Ted; Harris, Dan (August 2007). Final Report for the Veterans' Disability Benefits Commission: Compensation, Survey Results, and Selected Topics (PDF). The CNA Corporation. p. 3. (PDF) from the original on October 16, 2017. Retrieved August 23, 2014.
  25. ^ Murdoch, Maureen (October 1, 2011). "Long-term outcomes of disability benefits in US veterans with posttraumatic stress disorder". Archives of General Psychiatry. 68 (10): 1072–80. doi:10.1001/archgenpsychiatry.2011.105. PMC 9088710. PMID 21969464. 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.
  26. ^ 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
  27. ^ Scott (USA, Ret.), LTG James Terry (October 10, 2007). "Findings Of The Veterans' Disability Benefits Commission". Testimony before the Committee on Veterans' Affairs, U.S. House of Representatives: U.S. Government Printing Office. from the original on September 24, 2015. Retrieved June 20, 2015. 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 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.
  28. ^ "VA disability compensation: Actions needed to address hurdles facing program modernization (GAO-12-846)". U.S. Government Accountability Office. September 10, 2012. from the original on October 13, 2019. Retrieved January 8, 2020. 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.
  29. ^ Mossman, D. (1994). "At the VA, it pays to be sick". The Public Interest. 114: 35–47. from the original on August 13, 2014. Retrieved August 13, 2014. 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.
  30. ^ Satel, S. (February 2011). "PTSD's diagnostic trap". American Enterprise Institute. from the original on August 13, 2014. Retrieved 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.
  31. ^ Gade, Daniel. "A Better Way to Help Veterans" (PDF). National Affairs. 16 (Summer, 2013): 53–69. Retrieved August 13, 2014. ... VA benefit policies ... distort incentives and encourage veterans to live off of government support instead of working to their full capability.
  32. ^ Gade, Daniel M.; Huang, Daniel (2021). Wounding warriors : how bad policy is making veterans sicker and poorer. Washington, DC. ISBN 978-1-955026-99-4.
  33. ^ Marx, Brian P.; Miller, Mark W.; Sloan, Denise M.; Litz, Brett T.; Kaloupek, Danny G.; Keane, Terence M. (May 2008). "Military-related PTSD, current disability policies, and malingering". American Journal of Public Health. 98 (5): 773–74. doi:10.2105/AJPH.2007.133223. PMC 2374833. PMID 18381982. Frueh et al. present an incomplete picture of the literature and neglect substantial evidence that contradicts their thesis
  34. ^ "Disability Compensation: Eligibility". Department of Veterans Affairs. from the original on December 3, 2012. Retrieved November 30, 2012.
  35. ^ Moering, Robert (2011). "Military service records: Searching for the truth" (PDF). Psychological Injury and Law. 4 (3–4): 217–34. doi:10.1007/s12207-011-9114-3. S2CID 73163419. (PDF) from the original on October 19, 2013. Retrieved May 19, 2013.
  36. ^ Duty periods, 38 C.F.R. § 3.6 (2019).
  37. ^ Duty periods, 38 C.F.R. § 3.6(4) (2019).
  38. ^ 38 C.F.R. § 3.6
  39. ^ The PTSD Compensation and Pension Examination. Institute of Medicine. National Academies Press. 2007. doi:10.17226/11870. ISBN 978-0-309-10552-1. from the original on November 10, 2013. Retrieved October 20, 2012.
  40. ^ 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).
  41. ^ "Claims Process – Compensation". Department of Veterans Affairs. from the original on September 21, 2013. Retrieved September 21, 2013.
  42. ^ "Veterans Service Representative". MyCareer@VA. Department of Veterans Affairs. from the original on September 26, 2013. Retrieved September 21, 2013.
  43. ^ "The VA claim process after you file your claim". Department of Veterans Affairs, Veterans Benefits Administration. April 30, 2020. Retrieved May 10, 2020.
  44. ^ "Veterans Claims Assistance Act of 2000" (PDF). Public Law 106-475. Nov. 9, 2000. Government Printing Office. (PDF) from the original on September 26, 2013. Retrieved September 22, 2013.
  45. ^ 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).
  46. ^ 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 February 23, 2017, at the Wayback Machine, 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.")
  47. ^ a b Veterans Benefits Administration (VBA) (December 2016). "Your VA Claim Exam: Know What's Next (Claim Exam Fact Sheet)" (PDF). www.VA.gov. (PDF) from the original on June 22, 2017. Retrieved 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.
  48. ^ 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).
  49. ^ "Get help filing your claim or appeal". U.S. Department of Veterans Affairs. July 4, 2022. from the original on October 1, 2019. Retrieved July 4, 2022.
  50. ^ Office of the Secretary, Dep't Veterans Aff., Veterans and Military Service Organizations and State Directors of Veterans Affairs: 2019 Directory October 3, 2019, at the Wayback Machine
  51. ^ "VSO Search - VA/DoD eBenefits". www.ebenefits.va.gov. Retrieved July 5, 2022.
  52. ^ Asknod, Veterans Administration Claims: What You Need to Know to Be Successful, (Xlibris, 2012), 30–31. ISBN 9781477139523
  53. ^ 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. 5 (1): 74. doi:10.1007/s12207-012-9119-6. ISSN 1938-9728.
  54. ^ Veterans' Judicial Review Act, P.L. 100–687, 102 Stat. 4105, 100th Cong. (Nov. 18, 1988) (codified as amended at 38 U.S.C. §§ 7251–7299).
  55. ^ "Frequently Asked Questions - Board of Veterans' Appeals". Board of Veterans Appeals (va.gov). Retrieved 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.
  56. ^ a b "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). from the original on December 22, 2017. Retrieved April 30, 2013.
  57. ^ a b "Veterans Compensation Benefits Rate Tables". Veterans Benefits Administration. Department of Veterans Affairs. from the original on December 28, 2013. Retrieved December 28, 2013.
  58. ^ "Current VA disability compensation rates". Veterans Affairs. April 30, 2020. Retrieved May 12, 2020.
  59. ^ "38 CFR Part 4 - SCHEDULE FOR RATING DISABILITIES". Legal Information Institute, Cornell Law School. Retrieved May 11, 2020.
  60. ^ "VA Schedule for Rating Disabilities (VASRD)". National Resource Directory (nrd.gov). Retrieved May 11, 2020.
  61. ^ "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). 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. from the original on September 23, 2015. Retrieved December 28, 2013.
  62. ^ Simonson, Scott (2008). "Back from war – A battle for benefits: Reforming VA's disability ratings system for veterans with post-traumatic stress disorder" (PDF). Arizona Law Review. 50: 1177–1204. (PDF) from the original on March 4, 2016. Retrieved June 10, 2014.
  63. ^ 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. from the original on September 19, 2014. Retrieved June 10, 2014.
  64. ^ "Ratings Veterans Service Representative". MyCareer@VA. Department of Veterans Affairs. from the original on September 26, 2013. Retrieved September 21, 2013.
  65. ^ Huang, Daniel (May 11, 2015). "Automated System Often Unjustly Boosts Veterans' Disability Benefits: Reduction of VA staff input allows more patients to exaggerate symptoms". No. May 12, 2015 [print edition]. Wall Street Journal. p. A6. Retrieved May 13, 2015. 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.
  66. ^ U.S. Gov't Accountability Off., GAO-12-846, VA Disability Compensation: Actions Needed to Address Hurdles Facing Program Modernization 5 (2012).
  67. ^ 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).
  68. ^ Office of the Federal Register, A Guide to the Rulemaking Process (2011).
  69. ^ See Definitions, Initial claim, claim for increase August 19, 2019, at the Wayback Machine, 38 C.F.R. § 3.1(p)(1)(ii). See also Veterans Benefits Admin., Adjudication Proc. Manual, Identification of Claims for Increase August 19, 2019, at the Wayback Machine, M21-1, pt. III, subpt. ii, chap. 2, sec. E, subsec. 1.
  70. ^ Total disability ratings for compensation based on unemployability of the individual, 38 CFR § 4.16 (2018),"38 CFR § 3.1 - Definitions". law.cornell.edu. from the original on August 19, 2019. Retrieved January 24, 2019.
  71. ^ Total and permanent total ratings and unemployability, 38 C.F.R. § 3.340 (2018), https://www.law.cornell.edu/cfr/text/38/3.340 August 15, 2019, at the Wayback Machine
  72. ^ "VA Individual Unemployability if you can't work". Department of Veterans Affairs. April 30, 2020. Retrieved May 11, 2020.
  73. ^ Veterans Benefits Admin., Adjudication Proc. Manual, Compensation Based on Individual Unemployability (IU) August 15, 2019, at the Wayback Machine, M21-1, pt. IV, subpt. ii, chap. 2, sec. F (July 8, 2019), accessed on August 18, 2019.
  74. ^ Stressor Determinations for Posttraumatic Stress Disorder, 75 Fed. Reg. 39843, 39848 (July 13, 2010) ("... As explained above, a C&P examination is forensic evidence for purposes of determining whether a veteran is entitled to disability compensation for PTSD and, if so, how much.")
  75. ^ 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. 4 (3–4): 194. doi:10.1007/s12207-011-9115-2. ISSN 1938-971X. S2CID 18074279. Archived from the original on August 17, 2019. 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'.
  76. ^ Functional Organizational Manual (PDF). 3.1. Washington, DC: Department of Veterans Affairs. 2016. pp. 238–240. (PDF) from the original on February 10, 2017. Retrieved December 21, 2017. 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.
  77. ^ "Certification of Clinicians Performing VA Disability Evalutions [sic] (VHA Directive 1603)" (PDF). VHA Publications. Department of Veterans Affairs, Veterans Health Administration. April 22, 2013. from the original on August 26, 2014. Retrieved August 23, 2014.
  78. ^ Murphy, Thomas (June 25, 2014). "Witness Testimony of Mr. Thomas Murphy, Director, Compensation Service, Veterans Benefits Administration, U.S. Department of Veterans Affairs". VBA and VHA Interactions: Ordering and Conducting Medical Examinations: U.S. House of Representatives, Committee on Veterans Affairs. from the original on August 26, 2014. Retrieved August 23, 2014. VHA supplements these C&P clinics' capabilities, as necessary, using contracted disability examination services. These contractors support the performance of required disability examinations during surges in claims processing, for periods of staffing vacancies, or for times when specialists are required. VHA may also use these services for Veterans who do not live near a VHA medical facility. The use of these "on demand" services allows VHA to maintain examination timeliness and quality to support VA's goals for processing disability claims. VHA medical facilities can use locally contracted services through an individual facility or utilize the centralized, national VHA Disability Examination Management (DEM) contract. ... In addition to examinations completed by VHA, VBA contracts with three vendors to conduct C&P examinations.
  79. ^ Veterans Benefits Admin., Dep't Veterans Aff., Contract Examination Reports, M21-1 Adjudication Procedures Manual, pt. III, subpt. iv, chap. 3, sec. D, no. 1, subsec. b.
  80. ^ Advisory Committee on Disability Compensation, Department of Veterans Affairs, June 20–21 Meeting Minutes (p. 4) (2017). https://www.va.gov/ADVISORY/docs/Minutes-ACDCJun2017.pdf December 22, 2017, at the Wayback Machine
  81. ^ "LHI: Care for Mission Critical". logisticshealth.com. from the original on November 13, 2017. Retrieved January 4, 2018.
  82. ^ "Veterans Evaluation Services". from the original on October 9, 2014. Retrieved August 23, 2014.
  83. ^ "VA—MDE|VetFed". www.vetfed.com. from the original on October 12, 2017. Retrieved July 2, 2020. In partnership with QTC, VetFed locates, subcontracts, and trains a wide range of General Medicine and Specialty medical professionals in performing medical disability examinations for Veterans and separating service members within the Western Region (San Diego and Los Angeles Regional Offices).
  84. ^ "QTC - Quality, Timeliness, Customer Service". QTCM.com. QTC, A Lockheed-Martin Company. from the original on November 29, 2012. Retrieved August 23, 2014.
  85. ^ "QTC". www.magellanprovider.com. from the original on January 5, 2018. Retrieved January 4, 2018. QTC has chosen Magellan to maintain a network of providers offering Compensation and Pension (C&P) examinations to veterans and service members.
  86. ^ "Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire (VA Form 21-0960P-3)" (PDF). Veterans Health Administration. October 2012. (PDF) from the original on October 21, 2014. Retrieved August 24, 2014. 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.
  87. ^ Fed. R. Evid. 702.
  88. ^ Ridgway, James D. (2012). "Erratum to: Mind Reading and the Art of Drafting Medical Opinions in Veterans Benefits Claims". Psychological Injury and Law. 5 (1): 72–87. doi:10.1007/s12207-012-9119-6. ISSN 1938-971X. S2CID 59476790. 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.
  89. ^ Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008), (“both VA medical examiners and private physicians offering medical opinions in veterans benefits cases are nothing more or less than expert witnesses.”).
  90. ^ 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.").
  91. ^ 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").
  92. ^ Angela K. Drake, Yelena Duterte, and Stacey-Rae Simcox, Review of Recent Veterans Law Decisions of the Federal Circuit 2020 Edition, 70 Am. U. L. Rev. 1381, 1401–1414 (2021) (history and analysis of the presumption of competence for VA medical examiners).
  93. ^ 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.")
  94. ^ 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. doi:10.1037/law0000359. ISSN 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.
  95. ^ Institute of Medicine and National Research Council (May 8, 2007). PTSD Compensation and Military service. National Academies Press. pp. 204–05. from the original on August 14, 2011. Retrieved November 16, 2014.
  96. ^ 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. ISSN 0091-634X. PMID 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.
  97. ^ 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. doi:10.1097/00005650-200502000-00004. ISSN 0025-7079. PMID 15655424. S2CID 22099834. ... 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.
  98. ^ a b Jackson, J. C.; et al. (October 2011). "Variation in practices and attitudes of clinicians assessing PTSD-related disability among veterans". Journal of Traumatic Stress. 24 (5): 610. doi:10.1002/jts.20688. PMID 21913226. 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).
  99. ^ "Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)". PTSD: For Professionals. National Center for PTSD. from the original on November 9, 2014. Retrieved November 16, 2014. The CAPS is the gold standard in PTSD assessment.
  100. ^ Watson, P.; McFall, M.; McBrine, C.; Schnurr, P. P.; Friedman, M. J.; Keane, T.; Hamblen, J. L. (2002). Best Practice Manual for Posttraumatic Stress Disorder (PTSD) Compensation and Pension Examinations (PDF). Department of Veterans Affairs. p. 20. (PDF) from the original on April 23, 2015. Retrieved 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).
  101. ^ Speroff, T.; et al. (December 2012). "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. 25 (6): 607–15. doi:10.1002/jts.21759. PMID 23225029. 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 ...
  102. ^ 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. (2017). "The influence of veteran race and psychometric testing on veterans affairs posttraumatic stress disorder (PTSD) disability exam outcomes". Psychological Assessment. 29 (6): 710–719. doi:10.1037/pas0000378. PMID 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.
  103. ^ O'Toole, Marie T., ed. (2013). Mosby's Medical Dictionary (Kindle edition) (9th ed.). St. Louis, MO: Elsevier Health Sciences. Kindle Locations 77966-77971. ISBN 978-0-323-08541-0. 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.
  104. ^ Colman, Andrew M. (2015). "False positive". A Dictionary of Psychology (4th ed.). Oxford University Press. doi:10.1093/acref/9780199657681.001.0001. ISBN 9780199657681. 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.
  105. ^ 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. doi:10.1097/01.MLR.0000053232.67079.A5. ISSN 0025-7079. PMID 12665717. S2CID 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).
  106. ^ 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. doi:10.1176/appi.ps.201100526. ISSN 1075-2730. PMC 3677046. PMID 23318842.
  107. ^ 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. 185 (Supplement_1): 296–302. doi:10.1093/milmed/usz208. ISSN 0026-4075. PMID 32074380. Despite being diagnosed with PTSD at similar rates to their referent categories, females and Black veterans are less likely to receive PTSD disability awards.
  108. ^ 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.
  109. ^ Russo, Arthur (March 5, 2014). "Assessing veteran symptom validity" (PDF). Psychological Injury and Law. 7 (2): 178–90. doi:10.1007/s12207-014-9190-2. S2CID 54869033. (PDF) from the original on November 29, 2014. Retrieved November 16, 2014.
  110. ^ Poyner, G. (May 27, 2010). "Psychological evaluations of veterans claiming PTSD disability with the Department of Veterans Affairs: A clinician's viewpoint". Psychological Injury and Law. 3 (2): 130–32. doi:10.1007/s12207-010-9076-x.
  111. ^ Arbisi, P. A.; Murdoch, M.; Fortier, L.; McNulty, J. (2004). "MMPI-2 validity and award of service connection for PTSD during the VA compensation and pension evaluation". Psychological Services. 1 (1): 56–67. doi:10.1037/1541-1559.1.1.56.
  112. ^ Freeman, T.; Powell, M.; Kimbrell, T. (April 15, 2008). "Measuring symptom exaggeration in veterans with chronic posttraumatic stress disorder". Psychiatry Research. 158 (3): 374–80. doi:10.1016/j.psychres.2007.04.002. PMID 18294699. S2CID 9304082.
  113. ^ Wisdom, N. M.; et al. (2014). "PTSD and cognitive functioning: Importance of including performance validity testing". The Clinical Neuropsychologist. 28 (1): 128–45. doi:10.1080/13854046.2013.863977. PMID 24354897. S2CID 205810338.
  114. ^ 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. 77 (4): 517–522. doi:10.4088/jcp.14m09666. ISSN 0160-6689. PMID 26797388. 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.
  115. ^ 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 February 23, 2017, at the Wayback Machine) ("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.")
  116. ^ 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.")
  117. ^ 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 June 18, 2017, at the Wayback Machine) ("VBA adjudicators generally rely on examiners' assessments when deciding whether to approve a claim ...").
  118. ^ Hernandez, Christopher (February 26, 2014). "PTSD, Reading Comprehension and the Great American Love of Victimhood". Breach Bang Clear. from the original on October 13, 2017. Retrieved October 13, 2017. 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.
  119. ^ 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.")
  120. ^ Zarembo, Alan (August 3, 2014). "As disability awards grow, so do concerns with veracity of PTSD claims". Los Angeles Times. from the original on November 11, 2014. Retrieved November 19, 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.
  121. ^ Huang, Daniel (October 27, 2014). "VA Disability Claims Soar: Some See Higher Fraud Risk as More Vets Seek Compensation, Overloading Doctors". The Wall Street Journal. Dow Jones & Company. Retrieved November 19, 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.
  122. ^ McVay, Mark (June 21, 2014). "When PTSD benefits are abused". Denver Post. from the original on June 20, 2015. Retrieved June 20, 2015. 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.'
  123. ^ Harbaugh, Ken (June 1, 2015). "The Risk of Over-Thanking Our Veterans". The New York Times. from the original on June 7, 2015. Retrieved June 20, 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.
  124. ^ "Disability Benefits Questionnaire". Veterans Health Administration. from the original on August 24, 2014. Retrieved August 24, 2014.
  125. ^ "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)" (PDF). U.S. Senate Committee on Veterans Affairs. March 13, 2013. p. 12. (PDF) from the original on August 26, 2014. Retrieved August 24, 2014. 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.
  126. ^ "Documentation of Medical Evidence for Disability Evaluation Purposes (VHA Directive 2013-002)" (PDF). 4(e)(1)(c): Veterans Health Administration. January 14, 2013. p. 4. from the original on October 19, 2013. Retrieved August 24, 2014. 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.{{cite web}}: CS1 maint: location (link)
  127. ^ "Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire (VA Form 21-0960P-3, OCT 2012)" (PDF). VBA Forms. Department of Veterans Affairs. (PDF) from the original on February 26, 2015. Retrieved May 13, 2015.
  128. ^ Worthen, M. D.; Moering, R. G. (December 2011). "A Practical Guide to Conducting VA Compensation and Pension Exams for PTSD and Other Mental Disorders". Psychological Injury and Law. 4 (3–4): 192. doi:10.1007/s12207-011-9115-2. S2CID 18074279. (PDF) from the original on October 21, 2014. Retrieved June 10, 2014. 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.
  129. ^ "Discontinuance of Publicly Available Disability Benefits Questionnaires (DBQs)". Veterans Benefits Administration. April 2, 2020. Retrieved April 3, 2020.
  130. ^ 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
  131. ^ 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).

External links

  • Department of Veterans Affairs' website
  • National Center for PTSD, Department of Veterans Affairs

January 29, 2023
veterans, benefits, post, traumatic, stress, disorder, united, states, united, states, compensated, military, veterans, service, related, injuries, since, revolutionary, with, current, indemnity, model, established, near, world, department, veterans, affairs, . 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 United States Army medic 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 suffering from 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 amp 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 amp 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 Contents 1 Post traumatic stress disorder 1 1 Traumatic stressor 1 2 Diagnosis 2 VA disability benefits for PTSD 2 1 History 2 2 Service connection 2 3 Effectiveness 3 Claims process 3 1 Eligibility 3 1 1 Types of military service 3 1 2 In line of duty and exceptions 3 1 3 Evidence 3 2 Benefits claim procedures 3 2 1 Obtaining assistance 3 3 Federal court review 3 4 Post adjudication representation 4 Disability rating 4 1 General rating formula for mental disorders 4 2 Claims for an increased disability rating 4 3 Individual unemployability 5 PTSD C amp P exam 5 1 Presumption of competence 5 2 Concerns about reliability 5 3 Disability Benefits Questionnaire 6 Notes 7 References 8 External linksPost traumatic stress disorder EditMain article 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 Edit 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 Edit Prior to 2014 VA C amp 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 a VA disability benefits for PTSD EditThe 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 12 The United States Department of Veterans Affairs VA provides benefits 13 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 14 but can also include free or low cost mental health treatment and other healthcare vocational rehabilitation services employment assistance independent living support and more 15 History Edit Revolutionary War soldiers 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 generally 16 17 18 Near the end of World War I the U S Congress passed legislation establishing an indemnity model for veterans disability benefits 19 Since that year compensation has been provided to veterans suffering from 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 20 Service connection Edit 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 21 Effectiveness Edit 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 22 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 23 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 b 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 23 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 25 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 26 In addition to lost income a Congressionally mandated commission 27 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 28 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 29 30 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 31 32 However some VA researchers take issue with this assertion 33 Claims process EditEligibility Edit In order to be eligible for VA benefits a veteran must have been discharged under other than dishonorable conditions 34 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 35 Types of military service Edit United States Coast Guard Academy seal Federal regulations describe three categories of military service active duty active duty for training and inactive duty training 36 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 37 In line of duty and exceptions Edit 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 38 Evidence Edit 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 amp P exam 39 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 40 Benefits claim procedures Edit VA provides a detailed description of the benefits claims process on its website 41 Briefly a Veterans Service Representative VSR 42 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 43 VA has a legal obligation to help veterans obtain any evidence that will support their claim 44 For example the VSR might request a veteran s military personnel records Social Security disability records or private medical records 45 The VSR will almost always request a Compensation and Pension examination C amp P exam 46 also referred to as a VA claim exam 47 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 48 Obtaining assistance Edit 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 49 VA publishes an annual directory of accredited veterans service organizations and state departments of veterans affairs 50 and VA has a VSO search feature c on their eBenefits site 51 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 52 Federal court review Edit If a claimant questions the decision made by the VBA they can ask for the case to reviewed by the Board of Veterans Appeals 53 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 54 Post adjudication representation Edit Seal of the U S Court of Appeals for Veterans Claims 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 55 VA prohibits attorneys or claims agents from charging a veteran for professional services prior to the adjudication of the veteran s claim 56 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 56 Disability rating EditGeneral rating formula for mental disorders Edit Code of Federal Regulations Title 38 Pensions Bonuses and Veterans Relief 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 57 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 57 58 The VA assigns disability ratings based on criteria set forth in the Code of Federal Regulations Title 38 Part 4 Schedule for Rating Disabilities 59 often referred to as the VA Schedule for Rating Disabilities or VASRD 60 The rating schedule for mental disorders is called the General Rating Formula for Mental Disorders 38 C F R 4 130 61 which specifies criteria for disability ratings of 0 10 30 50 70 or 100 d 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 62 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 63 Concern has been expressed by some RSVRs 64 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 65 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 66 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 67 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 68 Claims for an increased disability rating Edit 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 69 Individual unemployability Edit Under certain conditions 70 veterans receiving service connected disability compensation for PTSD may file a claim for individual unemployability 22 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 71 the veteran will receive disability compensation at the 100 rate even though their schedular rating is less than 100 72 73 PTSD C amp P exam EditAs noted above the VBA almost always requires a compensation and pension examination C amp P exam also known as a VA claim exam 47 for veterans claiming service connected PTSD C amp P exams are forensic mental health evaluations 74 75 There are two types of PTSD C amp 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 76 to evaluate veterans for this purpose 77 The definition of VA psychologist or psychiatrist includes psychologists and psychiatrists in the private sector who conduct C amp P exams for a Medical Disability Evaluation MDE company under contract with the VBA 78 The companies with current VBA contracts 79 80 are Logistics Health Inc LHI 81 Veterans Evaluation Services VES 82 Vet Fed 83 and QTC 84 QTC in turn contracts with Magellan Health to manage their network of providers 85 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 86 Presumption of competence Edit 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 87 However VA medical examiners are presumed competent to provide expert witness testimony 88 89 without having to meet FRE 702 standards 90 91 92 Concerns about reliability Edit Researchers current and former VA psychologists investigative journalists and individual veterans have expressed concerns about the inter rater reliability and validity of C amp P exams for PTSD 93 94 For example Some current or former VA psychologists assert that VA medical centers do not allocate enough time for C amp P psychologists and psychiatrists to conduct a thorough evidence based assessment with less time presumably reducing the reliability and validity of the results 95 Research has demonstrated marked regional variance with regard to the proportion of veteran claimants who receive VA disability compensation for PTSD 96 97 A survey of C amp P examiners psychologists revealed that 85 never or rarely used the Clinician Administered PTSD Scale CAPS 98 99 for PTSD compensation and pension exams 98 even though a VA Best Practice Manual recommends its use during C amp P exams 100 and research has shown that using the CAPS improves PTSD C amp P exam reliability and validity 101 Four possible outcomes of a psychological evaluation including false positive and false negative conclusions Evaluation conclusion Actual true conditionEvaluee has the claimed mental disorder Evaluee does not have the claimed mental disorderEvaluee has the claimed mental disorder True positive False positiveEvaluee does not have the claimed mental disorder False negative True negativeAn empirical study published in 2017 102 suggested C amp P examiner racial bias might have led to an increased rate of false negative 103 conclusions regarding PTSD diagnosis and service connection for Black veterans and a high rate of false positive 104 conclusions for White veterans This finding corresponds with past research 105 106 subsequent research 107 and legal scholarship 108 discussing the potential for implicit racial biases on the part of mental health clinicians in general and C amp P psychologists and psychiatrists in particular Some VA facilities prohibit examiners from using symptom validity tests to screen or assess for malingering and other forms of dissimulation 109 110 Several researchers have published empirical studies in peer reviewed scholarly journals pointing to significant rates of both false positive and false negative PTSD C amp P exam conclusions 111 112 113 Social scientists conducted independent PTSD assessments of veterans who had filed disability benefits claims for PTSD some of whom had been awarded service connected compensation for PTSD and some had not The study found significant rates of both false positive and false negative VBA adjudicative decisions 114 Although VBA adjudicators rely on other sources of evidence in addition to C amp P exam results VBA almost always requests a C amp P exam for PTSD claims 115 and C amp P exam results significantly influence VBA determinations 116 117 Individual combat veterans 118 119 newspaper articles 120 121 and editorials 122 123 assert that a sizable percentage of veterans filing PTSD disability claims exaggerate or feign PTSD symptoms Disability Benefits Questionnaire Edit Mental health professionals document the results of Initial and Review PTSD C amp P exams on a Disability Benefits Questionnaire DBQ 124 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 amp P exam 125 However it is important to note that the VA discourages their mental health clinicians from completing DBQs for their patients 126 Some authors have expressed concern that the DBQ symptom list for example Section VII on the Review PTSD DBQ 127 contains a series of signs symptoms and descriptions of functional impairment without any guidance regarding when these items should be endorsed 128 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 129 VBA s decision to remove publicly available DBQs came in the wake of a VA Office of Inspector General report that recommended the action 130 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 131 Notes Edit Claims that were appealed before August 4 2014 would still use DSM IV PTSD diagnostic criteria See79 Fed Reg 45093 at 45094 The Secretary does not intend for the provisions of this interim final rule to apply to claims that have been certified for appeal to the Board of Veterans Appeals or are pending before the Board of Veterans Appeals the United States Court of Appeals for Veterans Claims or the United States Court of Appeals for the Federal Circuit The CNA report cited herein describes the parity ratio as A ratio of exactly 1 would be perfect parity indicating that the earnings of disabled veterans plus their VA compensation gives them the same lifetime earnings as their peers A ratio of less than one would mean that the service disabled veterans receive less than their peers on average while a ratio of greater than one would mean that they receive more than their peers 24 The abbreviation VSO stands for Veterans Service Organization or Veterans Service Officer Note that the General Rating Formula for Mental Disorders and its associated percentages are unrelated to the concept of parity ratio mentioned earlier in the article The term parity ratio is used by economists generally and in the economic study of veterans receiving compensation for PTSD discussed in the Effectiveness section of this article 23 While important for policy makers to consider the Rating Formula is not based on parity ratio as determined in that research References Edit World Health Organization 6B40 Post traumatic stress disorder International Classification of Diseases 11th Revision 2018 rev April 2019 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 ISBN 9781609181741 World Health Organization Post traumatic stress disorder 6B40 Archived August 1 2018 at archive today International Classification of Diseases 11th rev ICD 11 for Mortality and Morbidity Statistics April 2019 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 ISBN 978 0 19 025944 0 Veterans Benefits Administration VBA Annual Benefits Report Fiscal Year 2018 Compensation p 5 PDF benefits va gov Archived PDF from the original on August 26 2019 Retrieved January 23 2020 Friedman Matthew J PTSD History and Overview National Center for PTSD Archived from the original on October 3 2019 Retrieved October 3 2019 Posttraumatic stress disorder 38 C F R 3 304 f Service connection for posttraumatic stress disorder requires medical evidence diagnosing the condition in accordance with 4 125 a of this chapter a link established by medical evidence between current symptoms and an in service stressor and credible supporting evidence that the claimed in service stressor occurred Diagnosis of mental disorders 38 C F R 4 125 a Diagnostic and Statistical Manual of Mental Disorders Fifth Edition DSM 5 American Psychiatric Association 2013 is incorporated by reference into this section VA disability compensation for PTSD U S Department of Veterans Affairs September 27 2019 Archived from the original on August 30 2019 Retrieved 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 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 Archived October 3 2019 at the Wayback Machine VA Form 21 0781a rev July 2017 Schedule for Rating Disabilities Mental Disorders and Definition of Psychosis for Certain VA Purposes Section 4 125 DSM Reference and DSM 5 Nomenclature Change Archived October 2 2019 at the Wayback Machine 79 Fed Reg 45093 45094 August 4 2014 codified at 38 C F R 4 125 a Direct service connection wartime and peacetime Posttraumatic stress disorder 38 C F R 3 304 f eCFR Code of Federal Regulations archived from the original on July 10 2017 retrieved October 2 2019 Federal Benefits for Veterans Dependents and Survivors 2017 Edition Department of Veterans Affairs Archived from the original on June 6 2018 Retrieved June 24 2018 VA Compensation Rate Table Department of Veterans Affairs Archived from the original on December 1 2018 Retrieved November 24 2018 Benefits A Z Veterans Benefits Administration Department of Veterans Affairs Retrieved May 7 2020 Ridgway J 2011 The splendid isolation revisited Lessons from the history of veterans benefits before judicial review PDF Veterans Law Review 3 135 219 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 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 Economic Systems Inc 2004 VA Disability Compensation Program Legislative History Washington DC VA Office of Policy Planning and Preparedness 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 38 CFR 3 303 Principles relating to service connection Legal Information Institute at Cornell Law School Archived from the original on October 2 2019 Retrieved October 2 2019 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 a b Individual Unemployability Veterans Benefits Administration Compensation Department of Veterans Affairs Archived from the original on August 7 2019 Retrieved August 15 2019 a b c Christensen Eric McMahon Joyce Schaefer Elizabeth Jaditz Ted Harris Dan August 2007 Final Report for the Veterans Disability Benefits Commission Compensation Survey Results and Selected Topics PDF The CNA Corporation p 4 Archived PDF from the original on October 16 2017 Retrieved August 23 2014 Christensen Eric McMahon Joyce Schaefer Elizabeth Jaditz Ted Harris Dan August 2007 Final Report for the Veterans Disability Benefits Commission Compensation Survey Results and Selected Topics PDF The CNA Corporation p 3 Archived PDF from the original on October 16 2017 Retrieved August 23 2014 Murdoch Maureen October 1 2011 Long term outcomes of disability benefits in US veterans with posttraumatic stress disorder Archives of General Psychiatry 68 10 1072 80 doi 10 1001 archgenpsychiatry 2011 105 PMC 9088710 PMID 21969464 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 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 amp Social Work 42 no 1 2017 https doi org 10 1093 hsw hlw051 Scott USA Ret LTG James Terry October 10 2007 Findings Of The Veterans Disability Benefits Commission Testimony before the Committee on Veterans Affairs U S House of Representatives U S Government Printing Office Archived from the original on September 24 2015 Retrieved June 20 2015 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 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 VA disability compensation Actions needed to address hurdles facing program modernization GAO 12 846 U S Government Accountability Office September 10 2012 Archived from the original on October 13 2019 Retrieved January 8 2020 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 Mossman D 1994 At the VA it pays to be sick The Public Interest 114 35 47 Archived from the original on August 13 2014 Retrieved August 13 2014 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 Satel S February 2011 PTSD s diagnostic trap American Enterprise Institute Archived from the original on August 13 2014 Retrieved 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 Gade Daniel A Better Way to Help Veterans PDF National Affairs 16 Summer 2013 53 69 Retrieved August 13 2014 VA benefit policies distort incentives and encourage veterans to live off of government support instead of working to their full capability Gade Daniel M Huang Daniel 2021 Wounding warriors how bad policy is making veterans sicker and poorer Washington DC ISBN 978 1 955026 99 4 Marx Brian P Miller Mark W Sloan Denise M Litz Brett T Kaloupek Danny G Keane Terence M May 2008 Military related PTSD current disability policies and malingering American Journal of Public Health 98 5 773 74 doi 10 2105 AJPH 2007 133223 PMC 2374833 PMID 18381982 Frueh et al present an incomplete picture of the literature and neglect substantial evidence that contradicts their thesis Disability Compensation Eligibility Department of Veterans Affairs Archived from the original on December 3 2012 Retrieved November 30 2012 Moering Robert 2011 Military service records Searching for the truth PDF Psychological Injury and Law 4 3 4 217 34 doi 10 1007 s12207 011 9114 3 S2CID 73163419 Archived PDF from the original on October 19 2013 Retrieved May 19 2013 Duty periods 38 C F R 3 6 2019 Duty periods 38 C F R 3 6 4 2019 38 C F R 3 6 The PTSD Compensation and Pension Examination Institute of Medicine National Academies Press 2007 doi 10 17226 11870 ISBN 978 0 309 10552 1 Archived from the original on November 10 2013 Retrieved October 20 2012 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 Claims Process Compensation Department of Veterans Affairs Archived from the original on September 21 2013 Retrieved September 21 2013 Veterans Service Representative MyCareer VA Department of Veterans Affairs Archived from the original on September 26 2013 Retrieved September 21 2013 The VA claim process after you file your claim Department of Veterans Affairs Veterans Benefits Administration April 30 2020 Retrieved May 10 2020 Veterans Claims Assistance Act of 2000 PDF Public Law 106 475 Nov 9 2000 Government Printing Office Archived PDF from the original on September 26 2013 Retrieved September 22 2013 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 The VA Medical Examination And Disability Rating Process Hearing before the Subcomm Disability Assistance amp Memorial Aff of the H Comm Veterans Aff 110th Congress 63 65 2008 statement of Michael McGeary Archived February 23 2017 at the Wayback Machine Senior Program Officer amp Study Dir Comm Med Evaluation Veterans Disability Benefits Bd Mil amp 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 amp P examination performed by a Veterans Health Administration VHA or contractor clinician a b Veterans Benefits Administration VBA December 2016 Your VA Claim Exam Know What s Next Claim Exam Fact Sheet PDF www VA gov Archived PDF from the original on June 22 2017 Retrieved October 11 2017 The VA claim exam also called a C amp 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 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 Get help filing your claim or appeal U S Department of Veterans Affairs July 4 2022 Archived from the original on October 1 2019 Retrieved July 4 2022 Office of the Secretary Dep t Veterans Aff Veterans and Military Service Organizations and State Directors of Veterans Affairs 2019 Directory Archived October 3 2019 at the Wayback Machine VSO Search VA DoD eBenefits www ebenefits va gov Retrieved July 5 2022 Asknod Veterans Administration Claims What You Need to Know to Be Successful Xlibris 2012 30 31 ISBN 9781477139523 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 5 1 74 doi 10 1007 s12207 012 9119 6 ISSN 1938 9728 Veterans Judicial Review Act P L 100 687 102 Stat 4105 100th Cong Nov 18 1988 codified as amended at 38 U S C 7251 7299 Frequently Asked Questions Board of Veterans Appeals Board of Veterans Appeals va gov Retrieved 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 a b 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 Archived from the original on December 22 2017 Retrieved April 30 2013 a b Veterans Compensation Benefits Rate Tables Veterans Benefits Administration Department of Veterans Affairs Archived from the original on December 28 2013 Retrieved December 28 2013 Current VA disability compensation rates Veterans Affairs April 30 2020 Retrieved May 12 2020 38 CFR Part 4 SCHEDULE FOR RATING DISABILITIES Legal Information Institute Cornell Law School Retrieved May 11 2020 VA Schedule for Rating Disabilities VASRD National Resource Directory nrd gov Retrieved May 11 2020 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 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 Archived from the original on September 23 2015 Retrieved December 28 2013 Simonson Scott 2008 Back from war A battle for benefits Reforming VA s disability ratings system for veterans with post traumatic stress disorder PDF Arizona Law Review 50 1177 1204 Archived PDF from the original on March 4 2016 Retrieved June 10 2014 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 Archived from the original on September 19 2014 Retrieved June 10 2014 Ratings Veterans Service Representative MyCareer VA Department of Veterans Affairs Archived from the original on September 26 2013 Retrieved September 21 2013 Huang Daniel May 11 2015 Automated System Often Unjustly Boosts Veterans Disability Benefits Reduction of VA staff input allows more patients to exaggerate symptoms No May 12 2015 print edition Wall Street Journal p A6 Retrieved May 13 2015 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 U S Gov t Accountability Off GAO 12 846 VA Disability Compensation Actions Needed to Address Hurdles Facing Program Modernization 5 2012 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 Office of the Federal Register A Guide to the Rulemaking Process 2011 See Definitions Initial claim claim for increase Archived August 19 2019 at the Wayback Machine 38 C F R 3 1 p 1 ii See also Veterans Benefits Admin Adjudication Proc Manual Identification of Claims for Increase Archived August 19 2019 at the Wayback Machine M21 1 pt III subpt ii chap 2 sec E subsec 1 Total disability ratings for compensation based on unemployability of the individual 38 CFR 4 16 2018 38 CFR 3 1 Definitions law cornell edu Archived from the original on August 19 2019 Retrieved January 24 2019 Total and permanent total ratings and unemployability 38 C F R 3 340 2018 https www law cornell edu cfr text 38 3 340 Archived August 15 2019 at the Wayback Machine VA Individual Unemployability if you can t work Department of Veterans Affairs April 30 2020 Retrieved May 11 2020 Veterans Benefits Admin Adjudication Proc Manual Compensation Based on Individual Unemployability IU Archived August 15 2019 at the Wayback Machine M21 1 pt IV subpt ii chap 2 sec F July 8 2019 accessed on August 18 2019 Stressor Determinations for Posttraumatic Stress Disorder 75 Fed Reg 39843 39848 July 13 2010 As explained above a C amp P examination is forensic evidence for purposes of determining whether a veteran is entitled to disability compensation for PTSD and if so how much 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 4 3 4 194 doi 10 1007 s12207 011 9115 2 ISSN 1938 971X S2CID 18074279 Archived from the original on August 17 2019 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 Functional Organizational Manual PDF 3 1 Washington DC Department of Veterans Affairs 2016 pp 238 240 Archived PDF from the original on February 10 2017 Retrieved December 21 2017 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 amp P and the Integrated Disability Evaluation System IDES programs Certification of Clinicians Performing VA Disability Evalutions sic VHA Directive 1603 PDF VHA Publications Department of Veterans Affairs Veterans Health Administration April 22 2013 Archived from the original on August 26 2014 Retrieved August 23 2014 Murphy Thomas June 25 2014 Witness Testimony of Mr Thomas Murphy Director Compensation Service Veterans Benefits Administration U S Department of Veterans Affairs VBA and VHA Interactions Ordering and Conducting Medical Examinations U S House of Representatives Committee on Veterans Affairs Archived from the original on August 26 2014 Retrieved August 23 2014 VHA supplements these C amp P clinics capabilities as necessary using contracted disability examination services These contractors support the performance of required disability examinations during surges in claims processing for periods of staffing vacancies or for times when specialists are required VHA may also use these services for Veterans who do not live near a VHA medical facility The use of these on demand services allows VHA to maintain examination timeliness and quality to support VA s goals for processing disability claims VHA medical facilities can use locally contracted services through an individual facility or utilize the centralized national VHA Disability Examination Management DEM contract In addition to examinations completed by VHA VBA contracts with three vendors to conduct C amp P examinations Veterans Benefits Admin Dep t Veterans Aff Contract Examination Reports M21 1 Adjudication Procedures Manual pt III subpt iv chap 3 sec D no 1 subsec b Advisory Committee on Disability Compensation Department of Veterans Affairs June 20 21 Meeting Minutes p 4 2017 https www va gov ADVISORY docs Minutes ACDCJun2017 pdf Archived December 22 2017 at the Wayback Machine LHI Care for Mission Critical logisticshealth com Archived from the original on November 13 2017 Retrieved January 4 2018 Veterans Evaluation Services Archived from the original on October 9 2014 Retrieved August 23 2014 VA MDE VetFed www vetfed com Archived from the original on October 12 2017 Retrieved July 2 2020 In partnership with QTC VetFed locates subcontracts and trains a wide range of General Medicine and Specialty medical professionals in performing medical disability examinations for Veterans and separating service members within the Western Region San Diego and Los Angeles Regional Offices QTC Quality Timeliness Customer Service QTCM com QTC A Lockheed Martin Company Archived from the original on November 29 2012 Retrieved August 23 2014 QTC www magellanprovider com Archived from the original on January 5 2018 Retrieved January 4 2018 QTC has chosen Magellan to maintain a network of providers offering Compensation and Pension C amp P examinations to veterans and service members Review Post Traumatic Stress Disorder PTSD Disability Benefits Questionnaire VA Form 21 0960P 3 PDF Veterans Health Administration October 2012 Archived PDF from the original on October 21 2014 Retrieved August 24 2014 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 Fed R Evid 702 Ridgway James D 2012 Erratum to Mind Reading and the Art of Drafting Medical Opinions in Veterans Benefits Claims Psychological Injury and Law 5 1 72 87 doi 10 1007 s12207 012 9119 6 ISSN 1938 971X S2CID 59476790 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 Nieves Rodriguez v Peake 22 Vet App 295 304 2008 both VA medical examiners and private physicians offering medical opinions in veterans benefits cases are nothing more or less than expert witnesses 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 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 Angela K Drake Yelena Duterte and Stacey Rae Simcox Review of Recent Veterans Law Decisions of the Federal Circuit 2020 Edition 70 Am U L Rev 1381 1401 1414 2021 history and analysis of the presumption of competence for VA medical examiners 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 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 doi 10 1037 law0000359 ISSN 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 Institute of Medicine and National Research Council May 8 2007 PTSD Compensation and Military service National Academies Press pp 204 05 Archived from the original on August 14 2011 Retrieved November 16 2014 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 ISSN 0091 634X PMID 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 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 doi 10 1097 00005650 200502000 00004 ISSN 0025 7079 PMID 15655424 S2CID 22099834 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 a b Jackson J C et al October 2011 Variation in practices and attitudes of clinicians assessing PTSD related disability among veterans Journal of Traumatic Stress 24 5 610 doi 10 1002 jts 20688 PMID 21913226 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 Clinician Administered PTSD Scale for DSM 5 CAPS 5 PTSD For Professionals National Center for PTSD Archived from the original on November 9 2014 Retrieved November 16 2014 The CAPS is the gold standard in PTSD assessment Watson P McFall M McBrine C Schnurr P P Friedman M J Keane T Hamblen J L 2002 Best Practice Manual for Posttraumatic Stress Disorder PTSD Compensation and Pension Examinations PDF Department of Veterans Affairs p 20 Archived PDF from the original on April 23 2015 Retrieved 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 Speroff T et al December 2012 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 25 6 607 15 doi 10 1002 jts 21759 PMID 23225029 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 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 2017 The influence of veteran race and psychometric testing on veterans affairs posttraumatic stress disorder PTSD disability exam outcomes Psychological Assessment 29 6 710 719 doi 10 1037 pas0000378 PMID 28594214 among veterans diagnosed with PTSD by an independent evaluator Black veterans were significantly less likely than White veterans to receive both a C amp 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 amp P PTSD status and PTSD service connection status O Toole Marie T ed 2013 Mosby s Medical Dictionary Kindle edition 9th ed St Louis MO Elsevier Health Sciences Kindle Locations 77966 77971 ISBN 978 0 323 08541 0 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 Colman Andrew M 2015 False positive A Dictionary of Psychology 4th ed Oxford University Press doi 10 1093 acref 9780199657681 001 0001 ISBN 9780199657681 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 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 doi 10 1097 01 MLR 0000053232 67079 A5 ISSN 0025 7079 PMID 12665717 S2CID 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 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 doi 10 1176 appi ps 201100526 ISSN 1075 2730 PMC 3677046 PMID 23318842 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 185 Supplement 1 296 302 doi 10 1093 milmed usz208 ISSN 0026 4075 PMID 32074380 Despite being diagnosed with PTSD at similar rates to their referent categories females and Black veterans are less likely to receive PTSD disability awards Wandler Hillary A Spring 2013 The Role of Culture in Advocating for Accurate Diagnosis and Rating of Veterans Psychological Disabilities Mental Health Law amp 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 Russo Arthur March 5 2014 Assessing veteran symptom validity PDF Psychological Injury and Law 7 2 178 90 doi 10 1007 s12207 014 9190 2 S2CID 54869033 Archived PDF from the original on November 29 2014 Retrieved November 16 2014 Poyner G May 27 2010 Psychological evaluations of veterans claiming PTSD disability with the Department of Veterans Affairs A clinician s viewpoint Psychological Injury and Law 3 2 130 32 doi 10 1007 s12207 010 9076 x Arbisi P A Murdoch M Fortier L McNulty J 2004 MMPI 2 validity and award of service connection for PTSD during the VA compensation and pension evaluation Psychological Services 1 1 56 67 doi 10 1037 1541 1559 1 1 56 Freeman T Powell M Kimbrell T April 15 2008 Measuring symptom exaggeration in veterans with chronic posttraumatic stress disorder Psychiatry Research 158 3 374 80 doi 10 1016 j psychres 2007 04 002 PMID 18294699 S2CID 9304082 Wisdom N M et al 2014 PTSD and cognitive functioning Importance of including performance validity testing The Clinical Neuropsychologist 28 1 128 45 doi 10 1080 13854046 2013 863977 PMID 24354897 S2CID 205810338 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 77 4 517 522 doi 10 4088 jcp 14m09666 ISSN 0160 6689 PMID 26797388 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 The VA Medical Examination And Disability Rating Process Hearing before the Subcomm Disability Assistance amp Memorial Aff of the H Comm Veterans Aff 110th Congress 63 65 2008 statement of Michael McGeary Senior Program Officer amp Study Dir Comm Med Evaluation Veterans Disability Benefits Bd Mil amp Veterans Health Inst of Med Nat l Acad GPO Serial No 110 70 Archived February 23 2017 at the Wayback Machine 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 amp P examination performed by a Veterans Health Administration VHA or contractor clinician 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 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 Archived June 18 2017 at the Wayback Machine VBA adjudicators generally rely on examiners assessments when deciding whether to approve a claim Hernandez Christopher February 26 2014 PTSD Reading Comprehension and the Great American Love of Victimhood Breach Bang Clear Archived from the original on October 13 2017 Retrieved October 13 2017 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 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 Zarembo Alan August 3 2014 As disability awards grow so do concerns with veracity of PTSD claims Los Angeles Times Archived from the original on November 11 2014 Retrieved November 19 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 Huang Daniel October 27 2014 VA Disability Claims Soar Some See Higher Fraud Risk as More Vets Seek Compensation Overloading Doctors The Wall Street Journal Dow Jones amp Company Retrieved November 19 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 McVay Mark June 21 2014 When PTSD benefits are abused Denver Post Archived from the original on June 20 2015 Retrieved June 20 2015 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 Harbaugh Ken June 1 2015 The Risk of Over Thanking Our Veterans The New York Times Archived from the original on June 7 2015 Retrieved June 20 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 Disability Benefits Questionnaire Veterans Health Administration Archived from the original on August 24 2014 Retrieved August 24 2014 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 PDF U S Senate Committee on Veterans Affairs March 13 2013 p 12 Archived PDF from the original on August 26 2014 Retrieved August 24 2014 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 Documentation of Medical Evidence for Disability Evaluation Purposes VHA Directive 2013 002 PDF 4 e 1 c Veterans Health Administration January 14 2013 p 4 Archived from the original on October 19 2013 Retrieved August 24 2014 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 a href Template Cite web html title Template Cite web cite web a CS1 maint location link Review Post Traumatic Stress Disorder PTSD Disability Benefits Questionnaire VA Form 21 0960P 3 OCT 2012 PDF VBA Forms Department of Veterans Affairs Archived PDF from the original on February 26 2015 Retrieved May 13 2015 Worthen M D Moering R G December 2011 A Practical Guide to Conducting VA Compensation and Pension Exams for PTSD and Other Mental Disorders Psychological Injury and Law 4 3 4 192 doi 10 1007 s12207 011 9115 2 S2CID 18074279 Archived PDF from the original on October 21 2014 Retrieved June 10 2014 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 Discontinuance of Publicly Available Disability Benefits Questionnaires DBQs Veterans Benefits Administration April 2 2020 Retrieved April 3 2020 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 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 External links EditDepartment of Veterans Affairs website National Center for PTSD Department of Veterans Affairs Retrieved from https en wikipedia org w index php title Veterans benefits for post traumatic stress disorder in the United States amp oldid 1136074913, wikipedia, wiki, book, books, library,

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