Many of the problems and issues identified by the committee in previous chapters can be addressed by consistently allocating and applying the time and resources needed for a thorough PTSD C&P clinical examination. This measure will facilitate:

  • more comprehensive and consistent assessment of veteran reports of exposure to trauma;

  • more complete assessment of the presence and impact of comorbid conditions;

  • the conduct of standardized psychological testing where appropriate;

  • more accurate assessment of the social and vocational impacts of identified disabilities;

  • evaluation of any suspected malingering or dissembling using multiple strategies including standardized tests, if appropriate, and clinical face-to-face assessment;

  • more detailed documentation of the claimant’s condition to inform the rater’s decision (and thus potentially lead to better and more consistent decisions); and

  • an informed, case-specific determination of whether reexamination is appropriate and, if so, when.

The committee recognizes the sometimes difficult circumstances under which VA professionals operate, and this conclusion should not be read as a criticism of the work they are doing. Indeed, the committee was impressed by the scholarship and dedication of these people who gave presentations in open meetings and responded to the committee’s questions. Still, anecdotal remarks to the committee suggest that not all evaluations are currently performed in a thorough manner.

The VA may well incur increased up-front costs by implementing more consistently detailed examinations for all veterans who present for initial and review C&P evaluations for PTSD. It is not possible, though, to make an informed estimate of what the additional costs may be because the total will depend on many variables whose values are not available or are difficult to derive from public sources—notably, the time currently spent on examinations and the costs associated with those examinations. Further uncertainty is introduced by the fact that a change in policies regarding the exams may lead to changes in the number and characteristics of claimants.

As noted in Chapter 6, information available to the committee indicates that clinicians currently spend from as little as 20 minutes (Arbisi, 2006) to as much as three hours or more (Watson et al., 2000) to conduct a PTSD C&P examination. There are no data characterizing the distribution of time spent or the average amount of time spent on examinations, and the

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