Department of Veterans Affairs (VA)

Fact Sheet for Honorable Daniel K. Akaka

Practices in the Diagnosis of Post Traumatic Stress

Disorder (PTSD) and Compensation and Pension Examinations for PTSD

Issue: To provide follow-up information to Senator Akaka on questions in his

May 2008 letter to Secretary Peake regarding the PTSD compensation and pension
exam process and guidance to the field regarding the diagnosis of PTSD in veterans.

Description: Senator Akaka requested the Veterans Health Administration’s (VHA)

National Center for PTSD conduct a comprehensive study of PTSD compensation and
pension (C&P) exams including information on: (1) the amount of time taken to conduct
PTSD examinations; (2) the adequacy of the examination, including the need for any
additional testing of claimants; (3) the number of cases in which a "rule out PTSD"
diagnosis was provided; and (4) whether or not another diagnosis was provided to
veterans in cases where the evidence suggested that a diagnosis of PTSD is
determined to be more appropriate. The National Center for PTSD is currently engaged
in the E3-PTSD (Enhancing Equitable and Effective PTSD Disability Assessment) study
with Veterans Benefits Administration (VBA) colleagues. E3-PTSD is a randomized
clinical trial comparing two arms: C&P examinations as usual, and exams with the
addition of a Clinician Assisted PTSD Scale and World Health Organization Disability
Assessment Scale to provide structured assessment of PTSD and functioning,
respectively. The exams in both conditions are audio taped and sent to the National
Center, where experts rate the exams for adequacy, accuracy, and other measures.
E3-PTSD should provide answers relevant to the questions posed. It should be noted
that,with regard to question (3), a “rule out” diagnosis is considered inappropriate by
VBA.

There are daily communications to the field and memoranda that have been issued to
the field regarding mental health care. Attached are: a copy of the "Best Practice
Manual for Post-traumatic Stress Disorder (PTSD) Compensation and Pension
Examinations" (2002) and VHA Directive 2008-005, which establishes policy for the
implementation of an education and certification program for clinicians who perform
compensation and pension examinations. An online training program was specially
created for the certification process. The "Best Practice Manual for Post-traumatic
Stress Disorder (PTSD) Compensation and Pension Examinations" provides information
Page 2.

on PTSD and current recommendations regarding what is known about "best practice"
procedures for assessing PTSD among veteran populations. In addition basic
information on diagnosis of PTSD is found in the joint VA/Department of Defense PTSD
Clinical Practice Guidelines (2004).

Veterans Health Administration

October 2008

Attachments: PTSD Clinical Practice Guideline (2004)

Best Practice Manual for Post-traumatic Stress Disorder (PTSD)
VHA Directive 2008-005 Compensation and Pension Examinations