Hundreds of pages of VA emails that were requested and received by Charles Gatlin and his wife, Ariana Del Negro, testify to the growing rift between the veteran and the agency designated to serve him.

There’s a “Gatlin White Paper,” dated Oct. 21, 2011, which says: “The veteran and his representative, Ariana Del Negro (also his spouse) have alleged that both VHA and the Fort Harrison VARO (VA regional office) have acted unethically in handling the veteran’s claims and that VHA physicians have retaliated against the veteran. Neither VHA nor VGA management have found any evidence to support the allegation.”

Before declining to meet with Gatlin again because he had contacted his congressman, Rep. Denny Rehberg, former Fort Harrison VA Director Steven Young wrote a private inquiry on Aug. 24, 2012, to seven of his colleagues: “I am considering sending the following message and wondering whether anyone finds this objectionable. I don’t necessarily want to raise up the issue that I don’t see any more value in meeting again (Dr. Bonde and I have both met with them).” Dr. Trena Bonde was VA chief of staff at Fort Harrison at the time.

Based on their responses, Young wrote Gatlin: “Subsequent to the last message we exchanged, we have received a formal written inquiry from Congressman Rehberg on your behalf. In light of that formal inquiry, I have a commitment to respond in a formal written manner to the congressman. Consequently, I think it appropriate to not meet at this time and allow the formal process to proceed.”

On Feb. 14, 2013, Koryn Arnold, veterans service center manager at Fort Harrison, alerted her colleagues that Ariana Del Negro was planning to call the office of then-VA Secretary Eric Shinseki. “Also for the first time that I know of, she started using foul language,” Arnold added. “She started dropping the f-bomb. Nice, huh?”

Gatlin filed a complaint with the Montana Board of Psychologist, the state board in Helena that licenses psychologists, arguing that the screening assessment known as RBANS wasn’t adequate to measure his cognitive ability; that staff psychologist Robert J. Bateen wasn’t qualified to interpret it because he wasn’t a neuropsychologist; and that Bateen incorrectly characterized the results of that test. The board began hearing testimony in that case on Oct. 4, 2012, and that case developed a robust conversation within the VA.

On Nov. 13, 2013, Arnold, wrote Dr. Gregory Normandin, Bateen’s boss: “Based on the current situation with Dr. Bateen, do you have any idea how many exams he has conducted in the last 6 months? It’s sounding like my leadership will at least want a second signature on his pending claims that we have not yet rated. We plan on holding pending claims with a Bateen exam for now until we have a chance to talk about the best course of action.”

On Nov. 21, 2013, Arnold again wrote to Dr. Normandin: “We’ve found approximately 10 pending claims with exams performed by Dr. Bateen. We will be returning them as insufficient as we’ll need an additional signature on his exams., I just wanted to give you a heads up.”

Normandin asked why the second signature, and Karl Pfanzelter, assistant director in Salt Lake City, responded, also on Nov. 21: “The status of an examining physician is quite important. I will communicate our concerns with Mr. Ginnity (John Ginnity, former acting medical director at Fort Harrison) since some of the information we have reviewed is quite sensitive in nature. Ultimately, I will ask for some reassurances that no statuses have been changed.”

On Sept. 4, 2014, the Montana Board of Psychologists agreed with Gatlin on all three issues. In particular, it questioned why a full neuropsychological workup was required to diagnose a TBI, but only a simple screening tool like the RBANS test was used to determine the level of disability on which benefits would be paid. Since Bateen was licensed by the state, it directed him to reverse his rating and recommend a full neuropsychological workup.

On Nov. 19, 2013, Amy Kelly, risk manager at Fort Harrison, wrote: “Think I have the ‘silver bullet’ found in Montana code that exempts psychologist when operating under federal duty.”

Subsequently, VA’s interim undersecretary of health, Dr. Carolyn Clancy, wrote Montana Sen. Jon Tester to say that Fort Harrison currently employed three other psychologists who are administering the RBANS tests, adding that they are not licensed by the state and don’t need to be because it is a federal facility.

Dr. Normandin, Bateen’s immediate supervisor, wrote the VA Office of Regional Counsel on Jan. 13, 2015, seeking legal representation for Bateen, saying “The interests of the United States are at stake in that the treatment (RBANS) was within the standard of care.”

But the licensing board decision is not the only issue on which Gatlin and the VA have been locking horns.

On Jan. 6, 2014, Pfanzelter wrote: “Mr. Skelly (Jon Skelly, then director of the Salt Lake City regional VA office), Koryn Arnold and I have all spoke with Mr. Gatlin and his spouse on a number of occasions in the past. He and his wife simply do not agree with the responses we provide to their inquiries. Ultimately, they remain dissatisfied with the process and what answers they receive from any of us. That being said I will reach out and speak with the veteran.”

Early in 2014, Gatlin and his wife began wondering what the VA was saying about them behind their backs, so they filed a Freedom of Information Act request for all VA correspondence relating to them. A Jan 31, 2014, response to what was deemed “sensitive FOIA 14-02123-F request” gave two estimated costs for compiling all that information: one estimate was $1,659 and the other $1,456. That was substantially more than the $150 Gatlin had indicated they’d be willing to pay.

On March 26, 2014, Mary Elwood, executive assistant to the VA chief of staff at Fort Harrison, wrote: “I received a call from the caregiver of a Montana veteran saying she got a letter from the director referring to a provider training module for TBI. She is asking for a copy of this video. Swears it is for personal use only. However, there are some issues with the veteran in question. I am giving this to Gail Wilkerson also and if you could call Gail before you call the caregiver and commit to giving a copy of this video, it would be best.

Gail Wilkerson, congressional liaison at Fort Harrison, responded the same day: “I do not recommend providing this publicly.”

WASHINGTON D.C. – Echoing a state licensing board, a VA appeals board here has ordered the Fort Harrison (Mont.) VA Hospital to provide a full neurological examination for a former University of Montana graduate student with a traumatic brain injury.

It’s a decision that could have implications for thousands of vets with TBI across the state and around the country — but the VA flatly says that won’t happen.

The case involves Charles Gatlin, a Ranger-qualified former Army captain who suffered a brain injury after a large car 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 from the Army 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, who recently graduated from UM with a pair of masters’ degrees, appealed that ruling to the VA Board of Appeals two years ago, but also filed a complaint with the Montana Board of Psychologists, 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 because he wasn’t a neuropsychologist; and that Bateen incorrectly characterized the results of that test.

The licensing board agreed on all counts last September. It directed Bateen to reverse his assessment and request a full neurological examination of Gatlin. Bateen did, but the VA did nothing.

In a ruling released last week, the Board of Veterans Appeals said the Montana Board of Psychologists ruling requires further action. It directed Fort Harrison to do the following:

“Schedule the veteran for a VA TBI examination by a neuropsychologist to determine the severity of service-connected TBI. All subjective and objective manifestations attributable to this disability must be identified and addressed. All necessary tests and studies should be conducted, to include any neuropsychiatric testing necessary for an adequate opinion.”

It ordered a re-adjudication of Gatlin’s claim based on the new examination.

“If any decision is adverse to the veteran, issue a supplemental statement of the case and allow the applicable time for appeal. Then return the case to this board,” directed the panel of three veterans law judges.

In a separate opinion, the VA Board of Appeals also ordered new testing of Gatlin’s depth perception and fine motor skills, and it directed that the claim be handled expeditiously.

Gatlin’s wife, however, remains dubious of any VA re-examination after three years of institutional resistance at Fort Harrison, and within the VA system.

“It is completely and utterly unethical for anyone at Fort Harrison to see Charles related to a benefits examination,” Del Negro explained via email. “Not only because it was mishandled from the get-go, but also because the bounty of emails (from the VA) shows how many people from Ft. Harrison and throughout the entire VA system were in on the mission to protect Dr. Bateen. There is no way for Charles to be able to receive a fair and unbiased evaluation by anyone in that system.

“And because it would be impossible to get a fair shake by an examiner in the system and in this state, the only logical approach is for the VA to conduct a records review and/or defer to a records review that we would have conducted by a specialist,” she added.

But since the Montana Board of Psychologists concluded that the RBANS test wasn’t sufficient to measure neurological impairment due to a TBI and that Bateen wasn’t qualified to make neurological diagnoses, Del Negro argues that all vets diagnosed by Bateen ought to have their cases re-evaluated.

At the Montana Board of Psychologists hearing in December 2012, Bateen estimated he had conducted 9,000 evaluations.

“A records review is also owed to the other 8,999 veterans seen by Dr. Bateen,” Del Negro wrote. “It’s unrealistic to think that neuropsych can see everyone, but at the very least, the system should conduct an independent audit of those cases to determine whether or not a veteran does need more specific testing.”

That’s not going to happen, wrote the VA’s interim undersecretary of health, Dr. Carolyn Clancy, in a letter to Montana Sen. Jon Tester on Nov. 12, 2014.

“The department strongly supports Dr. Bateen’s supervisor and counsel and sent a letter to the Montana Board expressing our strong disagreement with the Montana Board’s conclusions,” Clancy wrote. “As VA was not a party to the stipulation, it does not have any impact on VA or our employees other than Dr. Bateen.”

Fort Harrison currently employs three other psychologists who are administering the RBANS tests, Clancy wrote, adding that they are not licensed by the state and don’t need to be because it is a federal facility.

“Additionally, VA disagrees with the Montana Board’s finding that VA protocols for TBI, C&P (compensation and pension) examinations are insufficient,” she added.

But Del Negro argues that VA raters failed to note Bateen’s misinterpretation of her husband’s screening test results, as well as the vast variance between the full neuropsychological exams and the RBANS.

“The fact that overt problems and inconsistencies were not noted by Fort Harrison Regional Office raters is a major concern,” she said. “It demonstrates that it wasn’t just Bateen who failed — it was the entire system.”

At the Montana Board of Psychologist hearing, Bateen testified that the RBANS screening tests were uniform at VA facilities across the country.

“The evaluation that I conduct is the same one that’s conducted at VA centers throughout the United States,” he said. “They’re standardized procedures, that is, that everyone conducting one of these examinations who is a clinical psychologist will follow the same format, and administer essentially the same test.”

The VA gives him about two hours to do each exam, he testified. Half an hour is spent reviewing the medical records, then an hour is spent getting the history and mental status from the patient. The neuropsychological screening takes the final half hour, he said.

“My screening is the same screening that is done by every psychologist that works for the VA doing a TBI examination,” he added.

One of the hearing examiners asked whether it might be more useful to base assessments on earlier, more extensive neuropsychological testing.

“You may well be correct,” responded Bateen. “But again, I have to operate under the guidelines as established by the VA, and the VA has in essence said that we don’t need to do all of this, that we – Maybe it’s financial. I don’t know. You know? My exam is a whole lot cheaper than doing a two-day neuropsych exam.”