After battling a Missoula veteran’s disability rating for a traumatic brain injury for more than three years, the VA has finally blinked.
“The VA’s Appeals Management Center conducted a records review inclusive of my prior neuropsychological test results conducted by the Department of Defense (Army) and determined those original test results were sufficient to overturn the VA’s initial rating decision,” Charles Gatlin said last week.
Meanwhile, a second mental health advisory council to Montana’s governor accused the VA of providing substandard care to vets suffering from TBI.
Gatlin, a former infantry captain, suffered head injuries when a vehicle bomb exploded near him in Iraq in 2006. His wife, Ariana Del Negro, said his concussion was caused by the blast, by the engine block hitting his head, and by hitting his head again when he fell.
After undergoing extensive neurological testing for two days each in 2006, 2007 and 2009, the Army concluded that his injuries were permanent and discharged him with a 70 percent disability rating.
When Gatlin moved to Missoula to attend graduate school at the University of Montana, he went to Fort Harrison for his VA disability rating. His Army medical records were received by the VA in January 2012, but apparently ignored. Instead, Gatlin was given a brief screening assessment called RBANS (Repeatable Battery for the Assessment of Neuropsychological Status).
Then the VA dropped Gatlin’s TBI rating from 70 percent to 10 percent, although it attributed some of his difficulties to PTSD and added a 30 percent disability rating for that.
Gatlin challenged that rating and testified before the VA Board of Appeals in Washington D.C. in October 2013.
Gatlin and Del Negro also took their case before the Montana Board of Psychologists in Helena, arguing that the RBANS test was inadequate to measure mental deficits, that the psychologist who administered the test misinterpreted the results, and that the psychologist, Robert Bateen, wasn’t qualified to interpret the results.
The VA objected strongly, but the state licensing board agreed a year later. It concluded that Bateen was not qualified to provide a neuropsychological assessment of Gatlin, that he had failed to provide an adequate standard of care, and that he could not argue he was merely following VA policy.
“Licensee has an independent professional obligation to ensure his work as a psychologist complies with the statutes and rules governing his license,” concluded the Montana Board of Psychologists, and it barred him from evaluating vets for traumatic brain injuries at Fort Harrison.
In response to a query from Sen. Jon Tester that fall, the VA said it fully supported the test and the psychologist. It also said it had no intention of re-evaluating other vets who had been evaluated by Bateen.
“The stipulation Dr. Bateen signed with the Montana Board has not impacted our ability to conduct residual TBI C&P (compensation and pension) examinations in the state of Montana,” wrote Dr. Carolyn M. Clancy, interim under secretary of health for the VA in Washington, D.C. “The VA Montana Health Care System has three additional licensed psychologists who perform TBI C&P examinations, so there will be no impact on the completion of these examinations.
“These psychologists are not licensed in the state of Montana and need not be because this is a federal jurisdiction,” she added.
Then in May of 2015, after mulling the case for a year and a half, the VA Board of Appeals directed that all of Gatlin’s medical records be added to the case, that he be re-evaluated by “an appropriate medical specialists,” and that the claim be re-adjudicated. If the decision was adverse to the veteran, the appeals board said it wanted to see the case again.
But nothing happened until the Appeals Management Center, the VA’s top medical board actually read the record and reached its decision last summer without new testing.
Then two weeks ago, the Governor’s Traumatic Brain Injury Advisory Council decided to endorse the standards of the Montana Board of Psychologists, specifically citing the letters from Clancy.
“The letters …state the intention to not use methods of evaluation which apply to the condition or injury causing the disability and to not observe the standards of care outlined by the Montana Board of Psychologists,” council Chair Angela Wathan wrote in a letter to PHHS Director Richard Opper.
“It appears to the council that the VA is deliberately adopting a lower standard of care for veterans than that which is accepted for civilians,” she added. “This accepted standard of care is not always achieved in civilian care either, but it is remarkable to see it explicitly rejected by the VA.”
Wathan noted that vets who live more than 40 miles from a VA facility can choose to receive care from civilian providers, adding that she hopes they aren’t forced to abide by “the inadequate standard of care adopted by the VA.”
“Thus, veterans might still be denied access to appropriate specialists, evaluations and interventions,”Wathan wrote. “This would tend to oppose the efforts of the council to improve access and standards of care for all Montanans.”
However, Special Assistant Attorney General Tyler Moss of the state Department of Labor and Industry said Thursday that all psychologists licensed by the state are required to abide by state standards.
A greater concern is apparently that vets who receive blast injuries generally are treated for their physical injuries and possibly for concurrent PTSD, but seldom for neurological damage. The scientific literature shows that repetitive brain injuries can change the metabolic and immune systems. For example, the metabolism of oxygen diminishes in an injured brain, causing a lack of energy, cell damage, inflammation, and potential cell death.
Vets need greater access to neurologists than they’re currently getting, some mental health experts argue.
A spokeswoman for the VA’s, public information office in Washington, D.C., said Friday that she was not aware of any restrictions of private-care service imposed by the VA and that the number of neurologists employed by the VA has increased by about 13 percent in the past five years, from 619 in fiscal 2011 to 700 at the end of 2015.
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