Healthcare Inspection - Review of Montana Board of Psychologists Complaint and Assessment of VA Protocols for Traumatic Brain Injury Compensation and Pension Examinations

The VA Office of Inspector General (OIG) assessed all identified 2015 initial Traumatic Brain Injury (TBI) Compensation and Pension (C&P) Examinations to determine if the examiners met certain VA stipulations. The OIG conducted the review in response to a legislative mandate and it was expanded at the request of Representatives Tim Walz (MN) and Mike Coffman (CO) to inform the House Committee on Veterans’ Affairs about whether qualified care providers are conducting TBI C&P examinations. Also, as directed by Congress, the OIG reviewed a veteran’s case and related complaint to the Montana Board of Psychologists to help inform the review. The OIG found that among the 13,301 contractor examinations and 17,778 examinations performed by Veterans Health Administration staff, VA practice was generally consistent with stipulations related to the specialty and training of providers. The OIG determined, however, that the training curriculum requirements for conducting examinations lacked rigor. In addition, the documentation of TBI C&P examination findings was insufficient to identify what the basis was for assessment of findings of cognitive impairment or residuals (the symptoms and affected bodily functions) of TBI. The OIG recommended that the VA’s Executive in Charge, performing the duties of the Under Secretary for Health and the Acting Under Secretary for Benefits convene experts to develop a plan that: 1) Ensures personnel performing TBI C&P examinations have comprehensive training on the evaluation of TBI, including the assessment and evaluation of cognitive disorders; 2) Develops requirements for documenting the TBI C&P examination process, including the basis for determinations; and 3) Considers whether disability ratings should be provided to veterans with claims arising from cognitive issues based on their clinical signs and symptoms, rather than primarily on the diagnoses or causes of their cognitive deficits.