PTSD Exams Updates

Aug 26, 2021

Wounding Warriors

Wounding Warriors: How Bad Policy Is Making Veterans Sicker and Poorer - New book by LTC Daniel Gade PhD (US Army Ret.) & journalist Dan Xing Huang

Continue reading "Wounding Warriors"

Aug 23, 2021

Expanded Review of June 2021 Advisory Committee Meeting

I expanded my review of the June 2021 Advisory Committee on Disability Compensation meeting so that it now includes:

* Positive Aspects of the June 2021 ACDC Meeting

* Positive Aspect: VASRD Mental Disorders Update

* Concerning Aspect of the June 2021 ACDC Meeting

* Committee Wants More Info on VBA Quality Assurance Program

* VA Office of Inspector General also takes issue with VBA's claim that they measure disability claims outcome

* VA Office of Inspector General reports about VBA's quality assurance program

* My Letter to the Committee re: VA's Misleading "Accuracy" Metric

* VA's Misleading "Accuracy" Metric (5-page PDF document)

* Board of Veterans Appeals also publishes a misleading "accuracy" statistic

Continue reading "Expanded Review of June 2021 Advisory Committee Meeting"

Aug 14, 2021

Review of the June 2021 Meeting of the Advisory Committee on Disability Compensation

* Positive aspects of the meeting.

* More info re: the update to the VA Schedule of Rating Disabilities (VASRD) for Mental Disorders.

* Concerning aspect of the meeting: Erroneous information given by VBA officials.

* New document: VA's Misleading "Accuracy" Metric.

Continue reading "Review of the June 2021 Meeting of the Advisory Committee on Disability Compensation"

Jun 28, 2021

Life Events Checklist: Reliable & Valid Scoring Methods

The Life Events Checklist (LEC) is a widely used self-report measure of trauma history that categorizes events by the proximity of trauma exposure; however, the field has published multiple scoring methods for the LEC.

Note that in this context, "proximity" means "how close to the trauma were you?" For example did a person experience the trauma directly? Observe the trauma? Or did they hear about the trauma?

The authors of this research study propose a novel scoring procedure in which total scores are weighted according to the proximity of trauma. The Weighted Score method assigns relative "weights" to three types of traumatic experiences.

Directly experienced trauma = 3

Observed traumatic event = 2

Heard about traumatic event = 1

For psychologists and psychiatrists who wish to ascertain the overall "trauma load", or "trauma burden", experienced by an examinee or patient, understanding the pros and cons of different LEC scoring methods should prove useful.

Continue reading "Life Events Checklist: Reliable & Valid Scoring Methods"

Jun 28, 2021

Detecting Feigned TBI Using Pupillometry

Pupil dilation patterns are outside of conscious control and provide information regarding neuropsychological processes related to deception and cognitive effort, and familiarity.

This study examined the incremental utility of pupillometry on the Test of Memory Malingering (TOMM) in classifying individuals with verified traumatic brain injury (TBI), individuals simulating TBI, and healthy comparisons.

Continue reading "Detecting Feigned TBI Using Pupillometry"

Jun 06, 2021

Senator Wicker Asks Important Questions About PTSD C&P Exam Quality - VA Responds with Eloquent Obscurantism

Senator Wicker asked the VA to:

"Describe how the VA conducts quality control of PTSD C&P exam results, and C&P examiner performances."

This article critiques the VA's answer to Senator Wicker's questions and covers the following topics:

VA's Response to Senator Wicker

Analysis of VA's Response

Problem: Misleading

Problem: Limited Relevance

Problem: The Audit Review Tool does not measure the quality of a C&P examination.

FY2020 Audit Review Criteria (screenshot; you can also download the actual criteria in PDF format)

Analysis of Audit Review Criteria

What is obscurantism?

Continue reading "Senator Wicker Asks Important Questions About PTSD C&P Exam Quality - VA Responds with Eloquent Obscurantism"

May 21, 2021

Normal Cognitive Test Scores Cannot Be Interpreted as Accurate with Failed PVT

While use of performance validity tests (PVTs) has become a standard of practice in neuropsychology, there are differing opinions regarding whether to interpret cognitive test data when standard scores fall within normal limits despite PVTs being failed.

This study is the first to empirically determine whether normal cognitive test scores underrepresent functioning when PVTs are failed.

Continue reading "Normal Cognitive Test Scores Cannot Be Interpreted as Accurate with Failed PVT"

May 19, 2021

Advisory Committee on Disability Compensation, June 23-24 Meeting

The next meeting of the VA Advisory Committee on Disability Compensation is June 22-23, 2021 from 0900 to 1200 EDT. This post contains:

* Meeting Agenda

* NEW Call-in Number to listen to the meeting

* How to send the Committee a public comment

* Time Zone chart to find the meeting start time in your location

Click the link below to read this post.

Continue reading "Advisory Committee on Disability Compensation, June 23-24 Meeting"

May 13, 2021

SIMS - Structured Inventory of Malingered Symptomatology

SIMS cut score: What is the best cut score for the Structured Inventory of Malingered Symptomatology (SIMS)?

Continue reading "SIMS - Structured Inventory of Malingered Symptomatology"

May 12, 2021

Service Members Seeking Disability Compensation Did Not Progress in Intensive Outpatient Treatment for PTSD

These results provide preliminary data indicating that participation in disability separation may attenuate the effect of PTSD treatment ...

Continue reading "Service Members Seeking Disability Compensation Did Not Progress in Intensive Outpatient Treatment for PTSD"

May 12, 2021

PTSD: Comorbid Mental Disorders, Chronic Pain, and Medical Conditions

Post-traumatic stress disorder (PTSD) is an often disabling mental disorder whose management typically focuses on reducing PTSD symptoms. Chronic pain and other comorbidities that commonly accompany PTSD symptoms may also be independently associated with disability.

...

Common comorbidities thus significantly influence disability associated with PTSD, often more strongly than PTSD symptoms.

...

If you conduct a Review PTSD exam, and you determine that one or more comorbid psychiatric, medical, or chronic pain disorders are secondary to PTSD, but the veteran did not file a secondary condition claim, consider either

(i) writing an Opinion and Rationale about the secondary conditions anyway; or

(ii) include a sentence or two indicating the possibility of PTSD-related secondary conditions.

Continue reading "PTSD: Comorbid Mental Disorders, Chronic Pain, and Medical Conditions"

May 12, 2021

MST Associated with Poor Sexual Functioning & Decreased Satisfaction Among Female Veterans

Sexual dysfunction and decreased sexual satisfaction would seem to constitute empirically-grounded "behavioral markers" for MST-related C&P exams.

Continue reading "MST Associated with Poor Sexual Functioning & Decreased Satisfaction Among Female Veterans"

May 12, 2021

MMPI-2: Detecting Feigned PTSD

This study found that many of the MMPI-2 validity scales are similar in their utility in differentiating genuine from nongenuine responders. However, the FB scale, the O-S scale, and the F-K index had the largest effect sizes in detecting the difference between genuine or nonclinical control samples and those feigning PTSD.

Continue reading "MMPI-2: Detecting Feigned PTSD"

May 12, 2021

Long-term PTSD Course Among OEF & OIF Veterans

Implications for C&P Examiners: When veterans file a claim for an increased disability rating, keep in mind that, in general, PTSD symptoms very gradually subside, but remain above the threshold for a PTSD diagnosis. Thus, increasingly worse symptoms over time goes against the general trend. [But read the entire article for important details.]

Effect of disability compensation? ==> VA service-connected disability for PTSD at T1 [was] significantly associated with greater PTSD symptom severity at each time point. [But read the entire article for important details.]

Continue reading "Long-term PTSD Course Among OEF & OIF Veterans"

May 08, 2021

Military Sexual Assault Worse Than Civilian Sexual Assault for Women

Implications for C&P Examiners: Even if a female service member or veteran suffered pre-military sexual trauma, this research suggests that military sexual assault likely ... For male survivors of military sexual assault, examiners should be familiar with the literature on ...

Continue reading "Military Sexual Assault Worse Than Civilian Sexual Assault for Women"