Two months after a state licensing board reprimanded a VA psychologist for an allegedly improper TBI assessment, there’s been no change – and the VA says there won’t be.
“This points to the issue of federal supremacy, which lies at the foundation of this case,” said a letter to the Montana Board of Psychology, signed by three VA officials in Washington, D.C. “Federal law controls on matters relating to this system.”
The case involves Charles Gatlin, now a graduate student at the University of Montana in Missoula. A Ranger-qualified former Army captain, Gatlin suffered a brain injury after a large truck bomb knocked him unconscious near Kirkuk, Iraq, in 2006.
The Army put Gatlin through a three-day battery of neuropsychological tests in 2006, 2007 and 2009 and concluded he had suffered significant attention problems, processing speed deficits and persistent frontal lobe dysfunction. After three years, the final test concluded, the injuries had stabilized and appeared to be permanent.
Retired with a 70 percent TBI disability rating, Gatlin and his wife, Ariana Del Negro, returned to Montana. At the Fort Harrison VA hospital, staff psychologist Robert Bateen ran Gatlin through a short screening exam, concluded that his cognitive deficits were not significant, and dropped his TBI disability rating to 10 percent, although he also added a 30 percent rating for post-traumatic stress disorder.
Gatlin appealed that ruling to the VA Board of Appeals last year and testified at a hearing in Washington, D.C., in October 2013. He hopes for a ruling next year.
But he also filed a separate challenge with the state board in Helena that licenses psychologists, arguing that the screening assessment wasn’t adequate to measure his cognitive ability, that Bateen wasn’t qualified to make the assessment, and that Bateen incorrectly characterized the results of that test.
The board agreed on all counts last September.
“To the extent Licensee asserts he was following the procedures of the VA, Licensee has an independent professional obligation to ensure his work as a psychologist complies with the statutes and rules governing his license,” said the board, which had the power to suspend his license.
It reprimanded Bateen, and it directed him to reverse his ruling and recommend that the VA find a board-qualified neuropsychologist to assess Gatlin’s brain injury. He did so, but the VA said it sees no reason to change its assessment.
“Based on Dr. Bateen’s education, training and professional experience, Dr. Bateen was practicing within American Psychological Association ethical guidelines and accepted standards of care,” said a letter to the board last September signed by Dr. Thomas G. Lynch, assistant deputy under secretary for health for clinical operations; Lois Mittlestaedt, chief of staff to the under secretary for benefits; and Richard J. Hipolit, deputy general counsel.
“VA believes that Dr. Bateen did not conduct a neuropsychological evaluation, but rather conducted a cognitive screen,” they said, adding that the assessment screen, the Repeatable Battery for the Association of Neuropsychological Status (RBANS) was adequate.
“In the C&P (compensation and pension) examination that Dr. Bateen conducted for the VBA in this case, he did not administer the RBANS as part of a comprehensive neuropsychological battery, but rather administered it as a screening measure consistent with VA protocol,” said the letter. “While literature suggests that the RBANS may not be sensitive to milder forms of brain dysfunction, Dr. Bateen was not evaluating brain dysfunction but rather evaluating functional impairment for purposes of the veteran’s disability compensation claim.”
Furthermore, it said federal law trumps state regulations.
“The Montana Board of Psychology is not a subject matter expert on VA disability assessment for compensation purposes and thus is not in a position to determine what training would be appropriate for a clinical psychologist to conduct C&P examination,” it said.
“Additionally, VA will not abide by the recommendation of Dr. Bateen that ‘(his) former opinions with respect to Charles Gatlin be refused and that Charles Gatlin be reassessed for residual effects of TBI by a neuropsychologist having qualifications consistent with the criteria set forth by the National Academy of Neuropsychology,’” it added. “As stated previously, Dr. Bateen was qualified to conduct the TBI residual examination for VBA in this case.”
Meagan Lutz, a VA spokeswoman in Washington, D.C., said last week that while Bateen remains employed by the VA at Fort Harrison, he is not using the RBANS screening tool or assessing veterans for TBI.
With a growing sense of frustration, Del Negro, Gatlin’s wife, wrote directly to VA Secretary Robert McDonald, who recently took office with a pledge to reform the giant bureaucracy.
“I remain disappointed that the same level of public scrutiny and attention applied to healthcare operations has not also focused on the profound problems underlying disability benefits,” she wrote. “The financial strain placed upon veterans and their families as a result of inadequate, incompetent, and deliberate lowering of disability claims is untenable.”
Del Negro noted that Bateen said he had performed the same screening procedure on “hundreds of vets” and asked that McDonald order a comprehensive re-examination of all of them.
“On behalf of these other veterans and their families, I am asking for your help to ensure that the Fort Harrison VA (and all deciding members) uphold their duties to veterans and their families who may have been harmed by the actions of Dr. Bateen,” she wrote. “It is our hope that instead of expecting veterans to file new claims or appeals, the system will initiate a proactive approach to identify affected veterans and perform a records review and/or re-evaluation, as appropriate.
“Of note, the issues at play here specific to conducting C&P TBI exams are not unique to Fort Harrison,” Del Negro added. “They are endemic.”
Why is it so hard for a decorated war vet to get help from the VA, she asked.
“It is unfortunate that my husband and I find ourselves at war with a system that is supposed to fight for the veteran and his/her family, not against them,” Del Negro wrote, appropriately enough on Veterans’ Day.
“The appeal process for us has taken its toll. Charles and I have been fighting our claim since 2011. The ongoing financial strain placed upon us has been extremely difficult. The amount of energy and time devoted to fixing this situation has been exhausting. We have faced significant backlash, impropriety, and what I believe to be deliberate undermining by the system.”
In a telephone interview last week, Del Negro let a little of the frustration and pain out.
“This has been awful,” she said. “It has permeated every aspect of our existence, and it has exacerbated the impact of my husband’s brain injury. We’ve been living breathing and bleeding the VA every day, morning noon and night.”