ptsd Best Practice Manual For Posttraumatic Stress Disorder (Ptsd)

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NOTE:

Best Practice Manual PTSD.pdf

I have kept all information in this manual. The Table of Contents page numbers are not valid for this version since I have eliminated all of them. They interfered in the actual information for this version. I have also altered some paragraphs to make them easier to read. Some tables have also been remade since I could not make the actual tables. If you are wishing to quote, be aware. You might want to find the link and quote direct from the document. If the link disappears, this will, hopefully, still be here.

Department of Veterans Affairs

Best Practice Manual for Posttraumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder

Compensation and Pension Examinations

Executive Summary

This document provides information on Posttraumatic Stress Disorder and current recommendations regarding what is known about "best practice" procedures for assessing PTSD among veteran populations. A Veterans Benefits Administration (VBA) review of 143 initial claims for PTSD revealed that PTSD was diagnosed in 77% of the cases, that the exam was not adequate for rating in at least 8%, but that inadequate exams were not routinely returned for correction. A common problem was that the examiner did not describe how Diagnostic and Statistical Manual for Mental Disorders-IV (DSM-IV) diagnostic criteria were met. Good exams delineated how the PTSD diagnostic criteria were met by giving specific examples. Other noted problems were the examiner using DSM-III rather than DSM-IV criteria, and the examiner sometimes failing to discuss whether other mental disorders that were diagnosed are due to or part of PTSD. The VBA and Veterans Health Administration (VHA) are committed to improving these services to veterans, and improving the quality of compensation and pension examinations for PTSD.

Included in this manual are an assessment protocol based on best practices for assessing PTSD, and disability examination worksheets which correlate with the protocol. Included in the protocol are guidelines on:

I. Trauma Exposure Assessment

• The objective of trauma assessment

• DSM-IV Stressor Criterion

• Sources of information used in trauma assessment

• Guidelines for interview assessment of trauma exposure

• Orienting the claimant to trauma assessment

• Documentation of trauma-related information.

• Suggested interview queries

• Orienting statement

• Administration of the Clinician-Administered PTSD Scale (CAPS) Life

Event Checklist

• Recommended Instruments for Trauma Assessment.

II. Assessment of PTSD

• Four objectives which should be addressed:

a. Establishing the presence or absence of a diagnosis of PTSD

b. Determining the severity of PTSD symptoms

c. Establishing a logical relationship between exposure to military stressors and current PTSD symptomatology

d. Describing how PTSD symptoms impair social and occupational functioning and quality of life.

• DSM-IV Diagnostic Criteria for PTSD

• Diagnostic interview assessment of PTSD.

• Psychometric assessment of PTSD

III. Recommended Time Allotment for Completing Examination

• Initial PTSD compensation and pension evaluations typically require about three hours, but complex cases may demand additional time.

• Follow-up evaluations usually require an hour to an hour and a half.

IV. Professionals Qualified to Conduct Compensation and Pension Examinations for PTSD

The VHA encourages use of this protocol when examining veterans for compensation purposes to ensure that a detailed history is obtained from the veteran and a comprehensive evaluation is performed and documented.

Comprehensive report templates have also been included as guides when writing reports.

Also included in this manual as reference material are:

• The VBA training letter based on a PTSD case review

• The governing regulation from 38 CFR, Part 3 for Service Connection for PTSD

• Excerpts from VBA's Adjudication Procedures manual concerning the adjudication of claims for PTSD

• Background research on PTSD and the Global Assessment of Functioning (GAF)

• The GAF Scale

• Scoring rules for Mississippi and PTSD checklist

• Examples of trauma history and PTSD symptom narratives

• A social history questionnaire.

It is anticipated that this document will raise the quality and standards of PTSD Compensation and Pension (C&P) examinations. This increased quality will require increased time and expense allotted to the evaluation process. Under current VA standards, with local and regional variations in time mandated for exams, clinical expertise, and resources, the examiners must use their discretion in selecting the most relevant information for completing a competent, comprehensive examination for PTSD.

The examination protocol can be accessed electronically through VA's Veterans Health Information Systems and Technology Architecture (VISTA) computer system – formerly the Decentralized Hospital Computer System (DHCP).

Clinicians may receive assistance in accessing this protocol from C&P clerks, information Resources Management (IRM) staff, chiefs of Health Administration Services (HAS), or other staff members, depending on the facility's local organization.