ptsd Certification Of Clinicians Performing C&p Examinations

[allan]

Department of Veterans Affairs VHA DIRECTIVE 2008-005

Veterans Health Administration

Washington, DC 20420 January 29, 2008

CERTIFICATION OF CLINICIANS PERFORMING COMPENSATION AND PENSION

EXAMINATIONS

1. PURPOSE: This Veterans Health Administration (VHA) Directive establishes policy for the

implementation of an education and certification program for clinicians who perform

compensation and pension (C&P) examinations.

2. BACKGROUND

a. VHA performs over 700,000 C&P examinations yearly. As part of the ongoing quality

assurance program operated by the office of Compensation and Pension Examination Program

(CPEP), and from reports issued by the office of the Department of Veterans Affairs (VA)

Inspector General, it has been concluded that there is observed variation in the performance and

quality of C&P examination reports between Veterans Integrated Service Networks (VISNs).

b. As health care providers traditionally approach examinations in the purely clinical

domain, training is critical to ensure that they have an understanding of the legal ramifications of

the examinations, and what elements are required by the Veterans Benefit Administration (VBA)

in order to make a valid determination. Given the importance of a thorough examination to the

veteran in terms of eligibility for future benefits and compensation, it is critical that standards are

consistently enforced and applied fairly across all VISNs. As a result, VHA and VBA have

determined the need for a training and certification program established for all clinicians

performing C&P examinations, no matter where they are performed. These courses are available

on VA Learning Management System (LMS)

http://www.lms.va.gov to meet the requirements

identified below (search for keyword "CPEP").

c. After completion of the certification process, employees who have demonstrated increased

performance in the efficiency of claims processing, customer satisfaction, and improved quality

of examinations being performed may be acknowledged. In recognition of this increased

performance, VHA physicians and other clinicians who are "certified C&P examiners" on a

prorated basis may receive a one-time incentive award up to $1,000 from their local health

facility. NOTE: Any VHA clinician may take the certification training and receive continuing

medical education (CME) for course completion, but only clinicians designated to perform C&P

examinations are eligible to receive the cash award. Residents and interns assisting with C&P

examinations, as part of their graduate training curriculum under the supervision of a VHA

certified C&P examiner, are encouraged to complete the training modules that are appropriate

to their courses of training, but are not eligible for the cash awards.

3. POLICY: It is VHA policy that all clinicians designated to conduct C&P examinations must

complete the required training modules and post-tests and become certified by CPEP; new

clinicians must be certified prior to being allowed to perform any C&P examination; clinicians

already performing C&P examinations have until July 1, 2008, to be certified; however, they

may still perform C&P examinations during the interim period.

THIS VHA DIRECTIVE EXPIRES ON JANUARY 31, 2013

VHA DIRECTIVE 2008-005

January 29, 2008

2

4. ACTION

a. Under Secretary for Health. The Under Secretary for Health, or designee, is responsible

for joint oversight of CPEP.

b. Compensation and Pension Examination Program (CPEP) Office. The CPEP Office

is directly responsible for:

(1) The development, evolution, management and implementation of the ongoing clinician

certification program.

(2) Working collaboratively with the Employee Education System (EES) to:

(a) Produce the certification training modules, and

(b) Document and track clinicians who have successfully completed the required training.

(3) Coordinating the certification process and providing a list of certified clinicians to the

appropriate field facility.

(4) Monitoring field facilities for compliance with this Directive.

(5) Establishing and chairing the C&P Examiner Certification Review Board (ECRB).

Membership on the board shall include representation from Patient Care Services (PCS),

Employee Education System (EES), C&P Service, Office of Nursing Services, Mental Health

Services, and a field representative from a Medical Center C&P Program Office.

The ECRB shall be responsible for the identification and oversight of all future modules and

updates to existing modules which will be used as content requirements for maintaining

certification. The ECRB will serve in an advisory capacity to the CPEP office which has overall

responsibility for the clinician certification program.

c. EES Office in Northport, NY. The EES Office in Northport, NY, is responsible for the:

(1) Production of C&P training modules in direct collaboration with CPEP and field-based

subject matter experts who perform C&P examinations.

(2) Development and maintenance of the web-based training and testing sites.

(3) Access to course completion and testing data.

d. VISN Director. Each VISN Director is responsible for ensuring:

(1) Certification of all clinicians performing C&P examinations (including fee-for-service

physicians) within their areas of responsibility.

VHA DIRECTIVE 2008-005

January 29, 2008

3

(2) The VISN C&P Contact Person compiles and maintains a list of providers who perform

C&P examinations at each facility, and submits the list to CPEP Office.

(3) Additional instructions provided by CPEP on the certification process are distributed to

the VISN facilities.

e. Facility Director. Each facility Director is responsible for ensuring:

(1) Certification of all clinicians performing C&P examinations (including fee-for-service

physicians) within their area of responsibility.

(2) Consideration of cash awards acknowledging successful completion of certification.

(3) Local record keeping strategies are developed and implemented to track employees’

completion of C&P certification training.

(4) All clinicians who perform VA C&P examinations (for VHA this means all employee

and Fee-For-Service Providers) complete the interactive video module on "CPEP General

Certification Course."

(5) All clinicians who perform VA C&P examinations (for VHA this means all employee

and Fee-For-Service Providers) successfully complete the post-test examination.

(6) Requirements are met for certain special examinations. In addition to completing the

interactive video module on "CPEP General Certification Course," and successfully completing

the post-test examination, those:

(a) Clinicians performing joint, feet, and spine examinations, must complete the module on

the "Musculoskeletal Examination," and successfully complete the post-test.

(b) Psychiatrists and clinical psychologists performing initial mental disorders examinations,

must complete the "Mental Disorders Initial Examination" module, and successfully complete

the post-test.

© Psychiatrists and clinical psychologists performing initial Post Traumatic Stress Disorder

(PTSD) examinations must complete the "Initial PTSD Examination" module and successfully

complete the post-test.

(d) Clinicians who perform mental disorder review examinations (including nurse

practitioners, physician assistants, and licensed social workers) must complete the module for

"Mental Disorders Review Examinations," and successfully complete the post-test.

(e) Clinicians who perform Post-traumatic Stress Disorder (PTSD) review and/or increase

examinations, (including nurse practitioners, physician assistants and licensed social workers)

must complete the module for "PTSD Review and/or Increase Examinations," and successfully

complete the post-test.

VHA DIRECTIVE 2008-005

January 29, 2008

(7) Timely completion of updates to existing modules and any new module requirements

that may be added in the future for enhancing the efficacy of the clinician certification program.

(8) The completion of the certification process is linked to increased performance in the

efficiency of claims processing, customer satisfaction, and improved quality of examinations

being performed. In recognition of this increased performance, VHA physicians and other

clinicians who become "certified" C&P examiners, and are involved in the actual performance of

C&P examinations, may receive a one-time incentive cash award up to $1000. The decision to

grant any cash award is the responsibility of the facility Director, as is the determination of the

actual amount of the award that each clinician may be eligible to receive. NOTE: Any VHA

clinician may take the certification training and receive continuing medical education (CME) for

course completion, but only clinicians designated to perform C&P examinations are eligible to

receive the cash award. Residents and interns assisting with C&P examinations as part of their

graduate training curriculum under the supervision of a VHA certified C&P examiner, are

encouraged to complete the training modules that are appropriate to their courses of training,

but are not eligible for the cash awards.

5. REFERENCES: None.

6. FOLLOW-UP RESPONSIBLITIES: The Office of Department of Defense (DOD)

Coordination (10D) is responsible for the contents of this Directive. Questions may be addressed

to the Office of DOD Coordination at (202) 461-6082.

7. RESCISSIONS: None. This VHA Directive expires on January 31, 2013.

Michael J. Kussman, MD, MS, MACP

Under Secretary for Health

DISTRIBUTION: CO: E-mailed 1/30/08

FLD: VISN, MA, DO, OC, OCRO and 200 – E-mailed 1/30/08

[carlie]

allan,

Thanks for posting this

e. Facility Director. Each facility Director is responsible for ensuring:

(1) Certification of all clinicians performing C&P examinations (including fee-for-service

physicians) within their area of responsibility.

(2) Consideration of cash awards acknowledging successful completion of certification.

** Looks like they can receive a bonus for meeting some of their basic employment requirements.

(5) All clinicians who perform VA C&P examinations (for VHA this means all employee

and Fee-For-Service Providers) successfully complete the post-test examination.

** I wonder how they will judge successful completion -- in favor of VA or in favor of claimant ?

I feel successful completion can only be accomplished by C&P examiner's:

1) adhearing to the regulations set forth to perform the Specific C&P's.

2) claims files actually being available to the examiner (when required by regulations) prior to and during the C&P, and the examiner being allowed the time necessary to review the c-file.

3) VA rater's requesting the Correct C&P for the claimant's Medical Issues whether

Mental, Physical or both.

jmho,

carlie

[allan]

** I wonder how they will judge successful completion -- in favor of VA or in favor of claimant ?

I've had honest evaluations from VA C&P examiners. The ones that symply copy the previous SOC's denial without looking at the evidence, really gets me.

The last one the AMC ordered from a contract Dr in New Jersey.

I can except an honest and therough evaluation if it comes back unfavorable. As long as all my records were properly weighed and a medical reason a bases for denying it was included. I hav't seen an honest evaluation since my records went to the BVA. Is COVA just as crooked? I hope not.

When these crooks start doin time for lyin to cheat vets and widows out of their benefits, than we'll start to remove some of the backlog of remands.

[Stretch]

I almost missed this post. Thank you Allan.

Seems the determining factor, as aways, will be the DoD. 'Conflict of Interest'

RESPONSIBILITIES is spelled wrong, they left the I out between the B and L.

----------------------------

6. FOLLOW-UP RESPONSIBLITIES: <SPAN style="FONT-FAMILY: TimesNewRomanPSMT">The Office of Department of Defense (DOD)

Coordination (10D) is responsible for the contents of this Directive. Questions may be addressed

<DIV align=left>to the Office of DOD Coordination at

[Mcafee]

I have a question Referencing a C+P exam i had two with in a period of 8 months and both times i recorded this examination what was said and done and what is put on paper whether it be by the physician or whomever there ENGLISH CREATIVE WRITER is.This is a blantant untruth short story at best. I filed a NOD with the VARO and they have never acknowledged this how do i proceed now ? Thank You.

[allan]

This is a blantant untruth short story at best. I filed a NOD with the VARO and they have never acknowledged this how do i proceed now?

Mcafee,

Send in another. It goes in your C-file unless they're shredding it. Wouldn't surprise me if they did.

Send it in again, "Registered returned receipt".

You can also request, in writing, a local hearing at the VARO. At a local hearing, Veterans may submit evidence and discuss their case face to face. Request a formal hearing & get a copy of the sworn statement, in case you need to take it all the way to court.

How to get around the VARO/BVA remanded exam/IMO that will likely come back unfavorable?

Get an independent examination or medical opinion, "OUTSIDE" of the DVA. If that comes back favorable, submit it along with your NOD or at the hearing.

Example:

For my hearing loss & tinnitus claim, I went to one of those free hearing test thats offered by many clinics across the country, who sell hearing aides. I submitted that as evidence along with the claim. The RO sent me to a C&P examination. Those results came back different than the one I submitted. After the rater insinuated I was lying about working around boilers in his denial, by stating" claimant was a truck driver in the Navy.

I requested a hearing & showed another rater my DD-2-14, which proved nearly four years of sea duty as a Boilerman in the US Navy. That got me another independent hearing loss examination. Since that came back favorable, I won the 10% for tinnitus.

Don't give up if you know your injuries/illness are service connected. Never, never give up.

F these people! I served honorably and I'm not going to let the VA/DOD or the state of California, make me feel like shi* over it.

[john999]

When I read all this high sounding rehtoric about how well the C&P examiners are trained and screened it makes me laugh. The training might consist of a film or a 2 hour training computer test. Everything the VA says has to be looked at through the smoke and mirros of the system and their true objectives. Cost is what drives these people. How do we reduce costs? If they can train a bunch of PA's to do C&P exams cheaply then they will do it, and damn the vets. When a smart vet has an opportunity to hire a board certified specialist to write a report they should do it. I cannot believe the VA wants to compensate a million new vets from Iraq and Afghanistan without taking them over hurdles. I worked with medical exams from workers compensation, VA and even my disability insurance company. It is pretty much the same thing with those who are willing to prostitute themselves behind an MD. Many doctors do nothing but write medical opinions for institutions to deny people disability. Most of these guys are doctors who have problems with their ethics and licenses in other states. They whore themselves out to make a living, and some do damn well at it. They don't even have malpractice insurance because they never touch a patient. The VA does their part to hire the very elderly. Some of their docs still bleed patients and sniff their urine to diagnose them.