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  1. Subscribe to the PTSD Exam Newsletter.

  2. Confirm you subscription in the email you receive after you submit the subscription form.

  3. Maintain your subscription. (If you choose to unsubscribe, you can of course keep any documents you download, you just won't have access to VIP benefits added after you unsubscribe.)

That's it!

After you confirm your subscription, you will receive a members-only password, and a link to a password-protected page where you can access several unique or hard-to-find documents—a total of 325 pages in PDF format if you decide to download all the handouts.

Click here to subscribe to the PTSD Exams Newsletter and become a VIP member right now.


Table of Contents


Psych VIP Extras

VIP Extras for Psychological Examiners 

Although, in truth, these documents are for all VIP Members who might benefit from this information, such as:

  1. veterans and their family members;
  2. veterans service officers;
  3. VA-accredited claims agents;
  4. veterans law attorneys; or
  5. VBA staff.
  6. (Plus, I will be adding Vets VIP Extras and Legal VIP Extras in the near future.)
  • Psych VIP Extra #1C&P Exams for PTSD with a History of Pre-military Trauma (4-page PDF).
  • Psych VIP Extra #3: The first eight pages of a guide I'm writing - Best Practice Recommendations for C&P PTSD Exams (8-page PDF).
  • Psych VIP Extra #4: Secondary Service-Connection for Substance Use Disorders: Legal Framework (4-page PDF). 
  • Psych VIP Extra #5Secondary Service-Connection for Substance Use Disorders: Selected Research Review (22-page PDF).
  • Psych VIP Extra #6MMPI-2-RF Validity Scale Statistics for Consideration in VA C&P Exams for PTSD (5-page PDF).α   
  • Psych VIP Extra #7: A nice clean (functional) PDF version of the C&P Service Clinician's Guide.ß  (The Clinician's Guide on the VA website is, unfortunately, a corrupted Word for Windows 95 file. The VIP Member's version is PDF file I prepared.) [268-page PDF]
  • Psych VIP Extra #9: A Mental Status Exam (MSE) Outline and a list of recommended Mental Status Exam Resources (5-page PDF).

  • Psych VIP Extra #10: Informed Consent for Evaluation (Sample) - Not a VA Form - This is a generic, sample consent form based on the written form I had veterans sign when I worked at a VA C&P Clinic. (2-page PDF, TXT, or Google Doc).

  • Psych VIP Extra #11: Recommended Reading List for Psych C&P Examiners - updated August 2020 - as a VIP member your receive Reading List updates before regular website visitors. (16-page PDF).

Quiz

(i) True or False? If a veteran reports a history of childhood abuse, then you should diagnose PTSD only if the veteran received a Purple Heart.


(ii) True or False? If an examinee fails 2 out of 3 SVTs or PVTs, you should state in the exam report that he or she was malingering, and assign ICD-10-CM code Z76.5


(iii) True or False? Secondary service connection for substance abuse is rare because, per 38 C.F.R. § 3.301(d), an injury or disease shall not be deemed to have been incurred in line of duty, if such injury or disease was a result of a service member's own willful misconduct, including the voluntary consumption of alcohol or other drugs with a desire to experience intoxication.



(iv) Question: Is there any scientific evidence for the self-medication hypothesis? 


(v) Question: During an Initial C&P exam for PTSD, you administer the MMPI-2-RF, and F-r = 115. Does that score mean the veteran is probably feigning, or is does the score represent a "cry for help"


(vi) True or False: C&P exams for PTSD and other mental disorders are not forensic psychological (or psychiatric) evaluations because VA disability claim adjudication is a civil, not a criminal proceeding.


(vii) True or False: The C&P Service Clinician's Guide (2002) does not have anything to offer modern day examiners because it is so old.


(viii) Imagine a veteran who filed a claim for service connection due to schizophrenia. The first time he was hospitalized for psychosis was 5 years after discharge. What factors would you consider if you were the C&P examiner?


(ix) Is there anything you can learn about conducting a mental status exam (MSE), or have you done so many, you've got it down almost perfectly?


Note: I provide the answers to the Quiz on the VIP Members site if you choose to join.



VIP Member Benefits

Thoth - Egyptian god of reckoning, learning, writingThoth - Egyptian god of reckoning, learning, writing, and science. Man with an ibis head. Vector image by Jeff Dahl. License: CC BY-SA 4.0

Psychologist and psychiatrist C&P examiners are the primary intended audience for PTSDexams.net

However, many of the articles I publish provide helpful information for U.S. military veterans, veterans service officers, VA-accredited claims agents, and veterans law attorneys.

And I also try to write a few articles specifically for veterans, such as advice if you have an upcoming PTSD C&P exam.

~ ~ ~

 Regarding our friend Thoth—the Egyptian god of reckoning, learning, writing, and science over to the left—I wondered exactly what the word "reckoning" means in this context. Well, I learned it covers a lot, and it really fits with how the Egyptians viewed this deity (known as Djhuty in Egyptian).

Here's the scoop on "reckoning":

reckoning noun 1 a : the act or an instance of computing or calculating ... 2 : the act or an instance of settling accounts ... 3 : the act of accounting for one's conduct or the fact of being called to account ... 4 : the act or an instance of judging : a summing up : appraisal.

Reference
Webster's Third New International Dictionary of the English Language, Unabridged, ed. Philip B. Gove (Springfield, MA: G. & C. Merriam, 1961, rev. 2016 [Merriam-Webster, Inc.], periodically updated as Merriam-Webster Unabridged), https://unabridged.merriam-webster.com/unabridged/reckoning.



VIP Extras for Psychological Examiners

Although the these handouts are written primarily for psychologist and psychiatrist examiners, if you are a VIP Member, you can download any of the documents, whether you are a C&P examiner or not. There are no restrictions.

Plus, many of the following "psych" documents will prove helpful to other groups, such as:

  • Veterans and their family members

  • Veterans service officers

  • VA-accredited claims agents

  • Veterans law attorneys

  • Veterans Affairs Committee staff members

  • Public policy professionals

  • VBA staff

Psych VIP Extra #1

  • How should you (the examiner) take adverse childhood experiences, such as sexual abuse, into account when evaluating a veteran for PTSD? 

  • Are there relevant laws (statutes, regulations, or case law) you should know about? 

  • VIP members can download a 4-page PDF document that succinctly answers those questions, with legal references and suggestions about how to think through and conduct such exams.

  • The document is titled, C&P Exams for PTSD with a History of Pre-military Trauma.


Psych VIP Extra #2

  • What is malingering exactly?

  • Where can you find the best definition for the word? (Hint: It is not in the DSM-5.)

  • If you say someone is malingering in a report, do you need evidence of conscious intention to feign symptoms in order to receive unmerited recompense?

  • VIP members can download a pithy 3-page PDF document that contains the best definition of malingering—one that most psychiatrists and psychologists don't even know about!

  • The document includes additional definitions and discussions, including a quote from a prominent Canadian psychologist whose tremendous contributions to forensic psychology are unknown to most American clinicians.

  • Of course, all quotes are carefully referenced with links to the original publications where possible.
  • The document is called What you should understand about malingering.


Psych VIP Extra #3

  • VIP Members receive a work-in-progress titled, Best Practice Recommendations for C&P PTSD Exams

  • VIP Members can download what I have written thus far—a 6-page PDF document.
     
  • As I add content this Best Practice guide, you will receive exclusive updates as a VIP Member.

  • After I complete this document, which will essentially be a good first draft, I plan to solicit co-authors and reviewers to improve it. 

  • If you are interested in contributing, let me know. I would love your help make it a stellar guide!


Psych VIP Extra #4

  • Should you understand relevant law when trying to determine if a veteran's substance use disorder is proximately due to, or the result of, service-related PTSD or another mental disorder?

  • Yes! Understanding the statutes, regulations, and case law in this area is crucial.

  • VIP Members may download a 4-page PDF document that concisely summarizes what you need to know. 

  • The document is titled, Secondary Service Connection for Substance Use Disorders: Legal Framework.


Psych VIP Extra #5

VIP Members receive Secondary Service-Connection for Substance Use Disorders: Research, a 22-page PDF document concentrating on relevant research.

There hundreds of studies examining the relationship between PTSD and substance use disorders. Consequently, this document reviews only some of the important research in this area. 

I tried to select the most recent systematic reviews and meta-analysis, plus a collection of articles about Alcohol & Stress that I have found enlightening, and two classic articles by Edward J. Khantzian, M.D.

Here is an outline of this 22-page PDF, available only to VIP Members:

  • How to Find Journal Articles and Books

  • Select Research Relevant to PTSD and Substance Use Disorder Comorbidity

  • Alcohol & Stress

  • Other Mental Disorders & Substance Abuse

  • Alcohol Use Disorder Among Veterans Generally

  • Historically Important Articles


Psych VIP Extra #6

VIP Members of PTSDexams.net receive a 5-page PDF document, MMPI-2-RF Validity Scale Statistics for Consideration in VA C&P Exams for PTSD.α

Introduction
The MMPI-2-RF includes validity scales that detect significant exaggeration or feigning as good as or better than any other psychological instrument.

However, it is important to recognize that genuine PTSD patients produce elevated validity scale scores.

For example, across studies, the average F-r score for genuine PTSD patients is 79 with a standard deviation of 24.

Thus, a t-score of 127 is two standard deviations above the mean for genuine PTSD patients. But the standard MMPI-2-RF score report does not calculate and report t-scores above 120.

Consequently, if the MMPI-2-RF score report indicates that the F-r score is "120" (which actually means it is 120 or above), you should hand-score the F-r scale to determine the exact T-score. This need to hand-score also applies to some of the other validity scales.

This document tells you how to do that, along with other helpful statistics and information so that you interpret MMPI-2-RF validity scales accurately.

MMPI-2-RF Validity Scale Statistics for Consideration in VA C&P Exams for PTSD: Contents

  • Suggested interpretation of F-r, Fp-r, Fs, FBS-r, and RBS validity scale scores when evaluating veterans presenting for a C&P exam for PTSD (initial or review exam).

  • Suggested interpretation of Ds-rf scores, including how to hand-score this validity scale, since it is not calculated or provided in the standard MMPI-2-RF score report.

  • How to calculate t-scores above 120.

  • Means and standard deviations for F-r, Fp-r, Fs, FBS-r, RBS, L-r, and K-r (you need these statistics to compute t-scores).

  • Important points from a 2017 MMPI-2-RF meta-analysis, particularly with regard to: 
  1. classification accuracy

  2. whether you should consider a high score a screen for possible dissimulation or an indicator; and 

  3. the importance of understanding the measurement error surrounding scores right at, or very close to, the cut score.


Psych VIP Extra #7

VIP Extra #7 is a nice clean version of the C&P Service Clinician's Guide,ß a 268-page PDF document, developed by VA in 2002. (Yes, that's a long time ago, but sometimes "old" is better.)

By "clean version", I mean one that you can download without having to deal with a corrupt Word for Windows 95 file.

When you attempt to download the Clinician's Service Guide from the VA website you receive this message:

Error message you receive if you try to download the C&P Service Clinician's Guide from the VA website.Error message you receive if you try to download the C&P Service Clinician's Guide from the VA website.

If you have advanced computer skills, you may know how to repair or convert such files, but most people do not possess such knowledge.



What's so special about the C&P Service Clinician's Guide?ß

A group of VA physicians, including psychiatrists; psychologists; audiologists; and others—all of whom were committed to improving C&P exam quality—wrote the Clinician's Guide in 2002.

Despite its age, the Clinician's Guide still contains excellent advice for psychologist and psychiatrist C&P examiners—advice not available elsewhere. (The mandatory C&P examiner training contains some of the information, but not all of it, and not in a written format you can refer to easily.)


Psych VIP Extra #8

The eighth extra for VIP Members is: 

Important Scientific Information About Schizophrenia (12-page PDF).

Over the years, I have seen several erroneous C&P exam opinions in which the psychologist opined that the veteran's mental illness was not related to his military service.

In these cases, the psychologist did not know some important scientific facts about schizophrenia, which led to their mistaken opinion. (I have not seen many psychiatrists make these errors, probably because psychiatrists tend to have more experience assessing and treating patients with schizophrenia-spectrum disorders.)Γ

These errors cause significant problems and very real potential harm to these veterans, in part because most veterans service connected for schizophrenia receive a 100% rating and they very much need all those benefits.

When VBA denys a veteran's schizophrenia claim, because of a flawed C&P examiner's opinion, the veteran suffers since they must rely on very limited public mental health services, and since they miss out on VA's help with finances, vocational assistance, medical care, psychology and social work services, etc.

So don't make these mistakes yourself! Become a VIP Member by subscribing to the PTSDexams.net Newsletter (no cost), and then download this essential information.

By the way, in addition to psychologist and psychiatrist examiners, this handout will likely prove helpful to:

  • veterans service officers,

  • VA-accredited claims agents,

  • veterans law attorneys, and

  • family members of veterans suffering from schizophrenia-spectrum disorders.


Psych VIP Extra #9

Many mental health clinicians think they conduct good mental status exams, when they actually miss important aspects of the process.

This omission often occurs because the clinician forgets (or never fully grasped) the reasons for the various MSE components.

I fortunately had a great supervisor in grad school who grilled me about my mental status exams with patients. I felt nervous and inadequate at first, but I am so glad she insisted that I understand how to conduct a thorough mental status exam, and why each component is potentially important.

Even after 30 years as a psychologist, I still find it helpful to periodically review books and articles about this important part of every psychological C&P exam.

VIP Members have access to:

  • Mental Status Exam (MSE) - A concise introduction and an MSE outline by a psychiatry professor at one of the top medical schools in the United States (4-page PDF).

  • Mental Status Exam Resources - 3 recommended books and links to 2 recommended online guides to the MSE (1-page PDF).


Psych VIP Extra #10

Informed Consent for Evaluation (Sample) - Not a VA Form - This is a generic, sample consent form based on the written form I had veterans sign when I worked at a VA C&P Clinic. (2-page PDF, TXT, or Google Doc).

Example items from the consent form:

1. I understand that I filed a claim with the VA indicating that I suffer from a mental disorder, which causes noticeable social and occupational impairment. 

     .     .     .     

10. Initial PTSD exams only - Dr. _____ must document one or more traumatic stressors that I believe caused me to develop posttraumatic stress disorder. I do not need to tell Dr. _____ every single detail-just a general description of what happened and how it affected me. Dr. _____ might need to ask some follow-up questions, but, in general, he/she/they intends for this part of the interview to be relatively brief and to the point. (This does not mean that he/she/they will rush me- he/she/they won't. And if I need to describe what happened in a fair amount of detail, for whatever reason, that is fine too.) 



Psych VIP Extra #11

Recommended Reading List for Psych C&P Examiners - updated August 2020 - as a VIP member your receive Reading List updates before regular website visitors. (16-page PDF).

New in this update:

► Instructions on the effective use of UnPaywall.org for journal articles available without a subscription.

► Explanation of the PDF symbol below, and how to increase your chances of seeing it when you search for journal articles.

5 new articles added to the reading list.

§ How to Find ...

  • Statutes;
  • Regulations;
  • Case Law; and
  • VBA Policy & Procedures.

§ Reference Texts - To enhance understanding of legal terms and concepts, statistical concepts, etc.

Note: The section symbol (§) means this is a new section added to the Reading List.


VIP Extras for Everyone

The categories, "VIP extras for psychological examiners" and "VIP extras for everyone" are arbitrary.

They are designed to make it easier for you to find documents of most interest to you, but they are not perfect. There is some overlap.

The good news is that you can download any of the documents regardless of your background.

  • VIP Extra for Everyone #1How to Subscribe to Advisory Committee Meeting Notices - This document describes how to setup an account with the Federal Register, and subscribe to notices about upcoming meetings of the Advisory Committee on Disability Compensation.
    This basic process also works if you want to receive emails about new Proposed Rules.π [4-page PDF]

  • VIP Extra for Everyone #2A nice clean (functional) PDF version of the C&P Service Clinician's Guide.ß  (The Clinician's Guide on the VA website is, unfortunately, a corrupted Word for Windows 95 file. The VIP Member's version is PDF file I prepared.) [268-page PDF]

  • VIP Extra for Everyone #3Recommended Reading List for Psych C&P Examiners - updated August 2020 - as a VIP member your receive Reading List updates before regular website visitors. [16-page PDF]

Click here to learn how to become a VIP Member and download these documents.


Footnotes

α. I highly recommend that you also read this excellent article by a very experienced psychologist-examiner:

  • Ray, Christopher L. "Practical Use of MMPI-2-RF Validity Indicators in VA Compensation and Pension Examinations." Psychological Injury and Law 10, no. 3 (2017): 223–233. https://doi.org/10.1007/s12207-017-9289-3

ß. C&P Clinician's Service Guide citation for psychological examiners:

  • Auer, Marjorie, Troy Baxley, Joseph Enderle, Caroll McBrine, and Lewis R. Coulson, C&P Service Clinician's Guide, version 3.0, ed. Lewis R. Coulson (Washington, D.C.: Dep't Veterans Aff., Veterans Health Admin., March 2002), 5–15, 181–217.

Γ. The online Abnormal Psychology textbook referenced immediately below contains a well-written, succinct overview of schizophrenia spectrum disorders:

  • Deanna M. Barch, "Schizophrenia Spectrum Disorders," chap. 6, pt. 1 in PSY 142 - Abnormal Psychology (South Bronx, NY: Hostos Community College, 26 May 2020 ver.), https://perma.cc/UNK5-EK4L.

π.  What is a "Proposed Rule"? The following paragraph is paraphrased from A Guide to the Rulemaking Process (Office of Federal Register):

  • "The proposed rule, or Notice of Proposed Rulemaking (NPRM), is the official document that announces and explains the agency’s plan to address a problem or accomplish a goal. All proposed rules must be published in the Federal Register to notify the public and to give them an opportunity to submit comments. The proposed rule and the public comments received on it form the basis of the final rule."


Become a VIP Member - Here's How

Becoming a VIP Member is easy and free.

  1. Subscribe to the PTSD Exam Newsletter (updates).

  2. Confirm you subscription in the email you receive after you submit the subscription form.

  3. Maintain your subscription. (If you choose to unsubscribe, you can of course keep any documents you download, you just won't have access to VIP benefits added after you unsubscribe.)

That's it!

After you confirm your subscription, you will receive a members-only password, and a link to a password-protected page where you can access several unique or hard-to-find documents—a total of 325 pages in PDF format if you decide to download all the handouts.

Although the VIP Extras are divided into "Psych VIP Extras", "Vet VIP Extras", etc., you can download any of the documents, regardless of your profession, veteran status, etc. There are no restrictions.

In addition, although a handout might be listed under the "Psych" category, for example, many of the documents will prove helpful to other groups, such as:

  • Veterans and their family members

  • Veterans service officers

  • VA-accredited claims agents

  • Veterans law attorneys

  • Veterans Affairs Committee staff members

  • Public policy professionals

  • VBA staff



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