a qualified rater performs the evaluation in a timely manner. Because raters do not directly evaluate claimants but rather evaluate the information produced by clinicians and other members of the C&P team, the committee does not believe that this would necessarily cause problems with the delivery of services. However, it is up to VA to implement the program in a manner that facilitates open communications between clinicians, remote raters, and other dispersed personnel and ensures that the claimants and those who help them are not disadvantaged.
The Institute of Medicine report A 21st Century System for Evaluating Veterans for Disability Benefits, which will be released in summer 2007, will also address and offer recommendations regarding the C&P examination and disability rating processes.
On the basis of the review of the papers, reports, and other information presented in this chapter, the committee has reached the following findings, conclusions, and recommendations, and identified the following research needs.
The VASRD criteria for rating mental disorders disability levels are at best a crude and overly general instrument for the assessment of PTSD disability.
Data fields recording the application and reevaluation of benefits should be preserved over time rather than being overwritten when final determinations are made. Data should also be gathered at two points in the process where there is currently little information available: before claims are made and after compensation decisions are rendered.
New VASRD rating criteria specific to PTSD and based on the DSM should be developed and implemented. A multidimensional framework for characterizing PTSD disability—detailed in this chapter—should be considered when formulating these criteria.
VA should establish a certification program for raters who deal with PTSD claims, with the training to support it, as well as periodic recertification. PTSD certification requirements should be regularly reviewed and updated to include medical advances and to reflect lessons learned. The program should provide specialized training on the psychological and medical issues (including common comorbidities) that characterize the claimant