VA changes mental health C&P exam duration estimate from 2 to 4 hours to 2 to 4 minutes
VA changes mental health C&P exam duration estimate from 2 to 4 hours to 2 to 4 minutes
Washington, DC; April 1, 2024: How long should a VA compensation and pension mental disorders DBQ (disability benefits questionnaire) exam or initial PTSD DBQ exam or review PTSD DBQ exam take? Today, April 1, 2024, the VA provided additional information and changed guidance to reduce the recommended amount of time. While historically we’d think an initial PTSD exam would typically take 90 minutes or so spent interviewing the Veteran, things change.
The VA provides a fact sheet for Veterans which notes that a mental health evaluation for their VA disability benefits typically takes 2 to 4 hours. This could include testing. They announced today, however, that this fact sheet will soon be revised to make the estimate more in line with actual practices from VA contract examiners. The fact sheet will now read 2 to 4 MINUTES for a psychological evaluation instead of 2 to 4 hours. Contract examiners will now be expected to say hello to the Veteran prior to saying goodbye and signing the DBQ form with next to no history in the history fields or explanation for their medical opinion. They will not be expected to actually ask about the relevant symptoms used for rating purposes or how they might impact a Veteran’s life. They of course won’t be expected to justify their diagnosis or lack of a diagnosis. They certainly won’t be required to build any rapport with the Veteran or give them any time to get comfortable discussing their mental health in a high-stakes situation. …and read the c-file with thousands of pages? Are you kidding? They will only be required to check the box that they did, not demonstrate any awareness of what was in the file.
The VA also noted that it will have to scrap its plans of using the CAPS-5 for initial PTSD DBQ examinations. The full CAPS-5 interview alone takes 45-60 minutes to administer. The VA indicated that they would not be able to make this work with their new guidance of 2 to 4 minutes per mental health contract C&P examination. They noted contract C&P exams are a “volume business” and in order to meet the financial needs of contract examiners they would not be requiring the CAPS-5. It has nothing to do with the CAPS-5 having limited utility in actually assessing impairment, however. But if you want to read more criticisms of the VA’s proposed changes for assessing mental health you can do that here.
The VA feels that reducing the amount of time contract examiners spend reviewing records and talking to Veterans down to 2 to 4 minutes total will improve accuracy. As you are likely aware, per the VA’s own OIG “some of the exams produced by vendors have not met contractual accuracy requirements. As a result, claims processors may have used inaccurate or insufficient medical evidence to decide veterans’ claims.“ The OIG found that the contractors QTC, VES and LHI “failed to consistently provide VBA with the accurate exams required by the contracts.” The OIG notes that “ALL THREE VENDORS HAVE BEEN BELOW THE CONTRACT’S 92% ACCURACY REQUIREMENT SINCE AT LEAST 2017.” Most errors– including a significant number that “had the potential to affect claims decisions–” aren’t corrected before the claims processors decided the claims per the OIG. [See: https://www.va.gov/oig/publications/report-summary.asp?id=5152]
The VA’s own researchers have also identified contract exams as being plagued with errors. The VA researchers noted “there are several possible explanations for the observed deficiencies in contract exams, including lack of supervision, more limited access to VA treatment records, and inadequate training and experience. An additional explanation is that, unlike exams by salaried VA staff, contractors are paid a flat fee for each exam which is a small fraction of the typical fees paid for forensic psychological evaluation in the community. Thus, there is a financial incentive to complete exams quickly, which would preclude careful record review, psychological testing, and detailed report preparation.” The authors go on to suggest that “anecdotally, it is not uncommon for veterans seen by contractors needing to be reexamined, at times with requests for second and even third opinions to resolve “conflicting medical evidence” after a contract examiner rendered an opinion that contradicted those in the veteran’s records or in previous C&P exams. Inefficiencies resulting from poor exams increase the workload for both examiners and VBA personnel and increase the costs for VA C&P operations overall” [see Meisler, A. W., & Gianoli, M. O. (2022). The Department of Veterans Affairs disability examination program for PTSD: Critical analysis and strategies for remediation. Psychology, Public Policy, and Law].
Therefore, in order to address the quality problems with contract examinations, the VA will be reducing the amount of time listed on their fact sheet from 2 to 4 hours to 2 to 4 minutes.
This post is, of course, April 1st satire. If you’d like to read more April 1st satire posts from me– dating all the way back to 2016– you can do that by checking out this link: https://psychology.news/news/category/april-the-first/
Thanks,
…and yes, if you know a Veteran who doesn’t agree with the outcome of their mental health C&P examination and/or would like an independent DBQ or a second opinion from a psychologist I’d be happy to help. You can send them to NexusLetters.com to learn more. While I once was a contract examiner years ago for both VES and QTC, please don’t hold that against me. 😉