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

[Jayg]

Nothing like getting a C&P exam from a PA who's fighting with her husband/other on the phone during your exam. B)

[allan]

Thank you for telling it like it is John.

These new Vets must know the truth about how the DVA will conive and cheat them.

My very first full C&P examination for a "neuromuscular disorder of unknown cause", the DVA provided was a Nurse Practioner. They only have to recieve training someone signs off for. Since the examiner wasn't capable of providing an opinion of any kind, the VARO sent me a letter stating they would have to request another examination with opinion. I went in again & was examined by a PA. This examiner found all issues claimed were service connected in his opinion he sent to the ratingt board. This opinion the VA conceiled from me & my SO, stated they "never" recieved it and two months later went to a paid consultant for an IMO without examination or notice they were doing it. This came back denied for the neumuscular disorder. Two years later I found the favorable C&P in my VAMC medical records. It wasn't in plain view. It was concieled in a packet marked,"for administration perposes only".

A trained VA C&P examiner found me fully service connected in 1997 and I've been appealing ever since and they've been Dr shopping ever since.

They can't do that you say? That's against the law?

Wished I could hear what happens to them if they do.

The ones that should be in jail are running this country and changing the laws to suit them.

[john999]

They accuse us of doctor shopping and they do it all the time until they come up with an opinion that supports denial of compensation. They tried to drag up an 20 year old opinion form a C&P doc to deny my 1973 CUE. My diagnosis was residual schizophrenia in 1973 and they tried to change it 14 years later to anti-social personality disorder. Too late! Especially since it was created out of thin air. No criminal record, no drug abuse, no alcoholism, no family dischord nothing, but the desire to cut off my compensation.