Qualifications For (c&p) Mental Disorder Examiners

[Guest allanopie]

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

2

(2) Provide an assessment of each veteran using the multi-axial system as set forth in DSMIV

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 cosign

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

3

(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 cosign

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

Source:

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1391

[Berta]

I hope all read this carefully-thanks Allan

The shrink pecking order is there -

what I mean is -if you have a good IMO from a psychiatrist-this should overrulle a VA opinion from anyone not as qualified as the psychatrist-

another point-

we had a vet's wife at the old board who bombarded many of us with emails-and put many posts at hadit regarding her husband-who never posted-

as to getting him sced for a mental disorder.

They finally paid for an IMO- however ,not only did it not help the claim ,it was done after a sole phone interview between the doc and the veteran.(or maybe the wife did all the talking)

It was therefore meaningless to the VA-

Mental disabilities -for service connection-unless supported by inservice MOS ,etc, most always involve direct contact between the vet and the doctor. An IMO must reflect that.

I am surprised at how recent this directive is-

then again- there has been a lot of criticism within the veteran's community as to lousy C & P exams.

Maybe this will help resolve that problem.

I am printing this off and if I get a local vet who might need this for a proper mental disorder C & P ,

they can take a copy to the C & P doctor if they need to.

We really have to do VA's work for them- I am convinced that our claims can succeed by

anticipating every way possible under VA regs ,that the claim could succeed and then-

even if it takes showing the VA (doctors or VAROs) their own regs-and training letters-

this is something we can and should do-if needed.

If anyone of you got a lousy C & P recently-use this training letter to fight back.

Berta

Edited April 6, 2006 by Berta

[mssoup1]

I like this part of the directive:

"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 cosign

the examination report."

Not only does this not happen in the mental C & P exams, but my husband has never had this to happen in any of his C & P exams for anything. While the supervising physician does sign off on the exam, they never at any time meet with my husband. How can they sign off on a report done by someone else when they have never even seen the vet for themselves.

Anyone else ever have a C & P exam by someone who had to have a supervising physician sign off on the report, yet they never met with the supervising physician?

Am I reading too much into this? Your thoughts......

mssoup