and financial support in times of need and would in part remove the incentive to “stay sick” that some suggest is a flaw of the current system.

PERIODIC REEXAMINATIONS AND REEVALUATIONS

In its charge to the committee, the VA noted that:


VBA currently has no set schedule for re-examining veterans receiving compensation for PTSD. It would be very helpful to us if the committee would address whether such a re-examination schedule is advisable and, if so, what it might be (Szybala, 2006).


With a few exceptions,12 regulation does not offer specific advice on when such reexaminations are required. The Automated Medical Information Exchange worksheet for review evaluations for PTSD (reproduced in Appendix C) does provide a template for the information to be gathered when such examinations are conducted. This includes details of the beneficiary’s psychosocial adjustment since the last examination and the clinician’s evaluation of the effect and effectiveness of any treatments received. Since disability determinations are dependent on the degree of impairment, it is thus possible that compensation could be adjusted downward for a veteran who showed improvement as a result of treatment. However, VA does not code the information needed to evaluate how often this happens.

Based on the information provided to the committee, it does not appear to be standard practice to require periodic reexaminations after a disability rating has been established, although a notation for a follow-up examination after a specified time has elapsed may be placed in a beneficiary’s record. Data are not available on the number or percentage of PTSD disability cases that are scheduled for reexamination by raters or the extent to which disability ratings change as a result of such evaluations.13

The VA’s primary motivation for conducting reexamination is presumably to determine if an improvement in disability status has occurred since the last disability rating. A veteran, or a representative acting on her or his behalf, can file an appeal to a disability determination or rating by requesting a reexamination. It is reasonable to assume that veterans will initiate such requests if they believe that the initial rating was in error or if their

12

There are circumstances under which regulation mandates a single reexamination for rating purposes after a set period of time—for example, six months after surgery to treat certain heart problems. General guidance on the scheduling of review examinations is contained in 38 CFR §3.327.

13

Data are available on the numbers of beneficiaries who have PTSD among their compensable conditions and who have reexaminations. However, many beneficiaries receive compensation for more than one condition, and VA does not code which condition prompted the reexamination.



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement