Va Directive - Mental Health Exams

[free_spirit_etc]

http://www1.va.gov/VHAPUBLICATIONS/ViewPub...asp?pub_ID=1391

Department of Veterans Affairs VHA DIRECTIVE 2006-013

Veterans Health Administration

Washington, DC 20420 March 7, 2006

QUALIFICATIONS FOR EXAMINERS PERFORMING COMPENSATION AND

PENSION (C&P) MENTAL DISORDER EXAMINATIONS

1. PURPOSE: This Veterans Health Administration (VHA) Directive establishes policy for VHA clinicians and managers regarding the professional qualifications required to perform Compensation and Pension (C&P) examinations for mental disorders.

2. BACKGROUND

a. On February 9, 2005, the Veterans Benefits Administration (VBA) issued C&P Fast Letter 05-01, Qualifications for Examiners Performing Compensation and Pension (C&P) Mental Disorder Examinations. C&P Fast Letter 06-03 revises those instructions and provides additional guidance. This VHA Directive is issued concomitantly to provide congruent directions to VHA personnel.

b. The objective of a C&P mental disorder examination is to obtain competent, critical, objective, and unbiased results. To ensure that examination providers are competent to provide findings and opinions that are valid and necessary for rating purposes, individuals who conduct C&P mental disorder examinations must have specific qualifications. As discussed in subparagraphs 4a and 4b, only certain individuals are permitted to conduct initial mental disorder examinations. In addition to those individuals, certain other individuals are permitted to conduct review or increase mental disorder examinations as discussed in subparagraph 4c.

c. To maintain the integrity of the patient-provider relationship, it is preferable that a veteran’s treating physician not perform the C&P examination for mental disorder.

3. POLICY: It is VHA policy that each mental health professional who conducts a VHA C&P examination for mental disorder must be appropriately qualified.

4. ACTION: Each facility Director, or designee, is responsible for ensuring that the:

a. Mental Health Professional Conducting C&P Examinations for Mental Disorders is Clinically Privileged. The mental health professional who conducts a C&P examination for a mental disorder must be clinically privileged, as governed by applicable law and the policies established at individual VHA facilities, to perform and/or supervise the performance of the following activities as required for all C&P examinations for mental disorders. The mental health professional must be able to:

(1) Diagnose all mental disorders, including personality disorders, using the nomenclature in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

THIS VHA DIRECTIVE EXPIRES MARCH 31, 2011

VHA DIRECTIVE 2006-013

March 7, 2006

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(2) Provide an assessment of each veteran using the multi-axial system as set forth in DSM-IV with a narrative explanation of the Axis V determination.

(3) Determine when clinician-administered psychometric testing is necessary and integrate the results of such testing into the examination reports.

(4) Assess the need for, and effectiveness of, pharmacological and non-pharmacological treatment.

(5) Provide a prognosis with respect to each mental disorder or condition.

(6) When necessary, comment on the significance of the veteran’s prior mental health assessments (as reported) with respect to symptoms, occupational history, social history, and global assessment of functioning.

(7) Identify veterans presenting with complex diagnostic questions or other issues that are beyond the examiner’s expertise, and refer those veterans identified to a board-certified, or board-eligible, psychiatrist or a licensed doctorate-level psychologist who has the expertise necessary to complete the C&P mental disorder examination.

b. Examiner Qualification Requirements for Initial Mental Disorder Examinations Are Met. Mental health professionals with the following credentials are qualified to perform initial C&P examinations for mental disorders. They are:

(1) Board-eligible psychiatrists (those who have completed a psychiatry residency and who are appropriately credentialed and privileged) and board-certified psychiatrists.

(2) Licensed doctorate-level psychologists.

(3) Doctorate-level mental health providers under close supervision by a board-certified, or board-eligible, psychiatrist or a licensed doctorate-level psychologist.

(4) Psychiatry residents under close supervision by a board-certified, or board-eligible, psychiatrist or a licensed doctorate-level psychologist.

(5) Clinical or counseling psychologists completing a one-year internship or residency under close supervision by a board-certified, or board-eligible, psychiatrist or a licensed doctorate-level psychologist. NOTE: Close supervision means that the supervising psychiatrist or psychologist met with the veteran and conferred with the examining mental health professional in providing the diagnosis and the final assessment. The supervising psychiatrist or psychologist must co-sign the examination report.

c. Examiner Qualifications Requirements for Review or Increase C&P Mental Disorder Examinations Are Met. Mental health professionals with the following credentials are qualified to perform review or increase C&P mental disorder examinations. They are:

VHA DIRECTIVE 2006-013

March 7, 2006

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(1) Mental health professionals qualified to perform initial C&P mental disorder examinations (see preceding subpar. 4b).

(2) Other mental health professionals, such as licensed clinical social workers, nurse practitioners, clinical nurse specialists, and physician assistants, any of whom must be under close supervision by a board-certified, or board-eligible, psychiatrist or licensed doctorate-level psychologist. NOTE: Close supervision means that the supervising psychiatrist or psychologist met with the veteran and conferred with the examining mental health professional in providing the diagnosis and the final assessment. The supervising psychiatrist or psychologist must co-sign the examination report.

d. Documentation of Qualified Examiners is Completed. As required in the C&P examination worksheets, examining mental health professionals must sign the reports and, if applicable, obtain the signature of the supervising psychiatrist or psychologist. All signatures must include the individual’s professional credentials (i.e., MD, PhD). NOTE: These signatures denote compliance with the requirements of this Directive.

e. Examinations are Returned as Inadequate for Rating Purposes, if Necessary. A C&P examination for mental health disorder may be returned to VHA by VBA as inadequate for rating purposes, when the exam:

(1) Does not include the examiner’s credentials and signature,

(2) Does not include the signature of a board-certified or board-eligible psychiatrist or a licensed doctorate-level psychologist.

5. REFERENCES: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision), American Psychiatric Association, June 2000.

6. FOLLOW-UP RESPONSIBILITY: The Office of Patient Care Services is responsible for the contents of this Directive. Questions may be directed to (202) 273-8434.

7. RESCISSIONS: None. This VHA Directive expires March 31, 2011.

S/Jonathan B. Perlin, MD, PhD, MSHA, FACP

Under Secretary for Health

DISTRIBUTION:

CO:

E-mailed 3/8/2006

FLD:

VISN, MA, DO, OC, OCRO, and 200 – E-mailed 3/8/2006

[Pete53]

Sounds good on paper. Will the VA comply?

[Testvet]

I have no use for residents or Nurse Practitioners doing C&P exams and having "doctors" sign off on them having the doctor walk in and say Hi does not mean he evaluated the veteran

[cowgirl]

Thanks Free, interesting reading ~ 2006, hmm. wonder what it looked like before; ok, nope dont show me !

Okay, expires after March, 2011? See 4.a.(1)...including personality disorders." Shouldnt ask, but one wonders why this one specified condition gets attention. Maybe pd will expire? my wishful thinking.

cg

[john999]

I had a PA do my heart exam. It was a farce. You would think that the VA would be interested in evaluating heart conditions in the most professional way.....Not! The VBA is cheap above all else.