A Veterans Administration psychologist at Fort Harrison violated several of Montana’s administrative rules when he dropped an Iraqi vet’s traumatic brain injury disability rating from 70 to 10 percent, a state licensing board has concluded in a relatively rare order.

Although it’s a state ruling, it’s an important case for all vets because it clearly sets forth the professional standards of care that alkl psychologists should use in evaluating a vet’s TBI.

In its nine-page ruling, a screening panel of the state Board of Psychology concluded late last week that Robert J. Bateen of Helena was not qualified to make the TBI diagnosis, that he used an inadequate test, and that he incorrectly characterized the results of that test.

“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,” added the panel, noting that the board has the power to revoke, suspend or limit Bateen’s license to practice.

A spokeswoman for the federal agency was asked Tuesday whether the Fort Harrison VA would change its policies, continue to employ Bateen, and re-evaluate the other TBI diagnoses he has made over his years on the job.

“Since the matter is pending before the State of Montana Board of Psychology, we are unable to provide comment,” Terrie Casey, voluntary services chief for the VA at Fort Harrison, responded Tuesday.

The case involves Charles Gatlin, now a 38-year-old 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, 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 has appealed that decision to the Board of Veteran Appeals in Washington, D.C., and he also filed a complaint more than a year ago with the state licensing board.

In its decision Friday, a screening panel found that Bateen was not qualified to evaluate Gatlin’s disabilities because he is not a clinical neuropsychologist. It also said Bateen should not have used the Repeatable Battery for the Association of Neuropsychological Status (RBANS) screening tool because it was designed to assess dementia in elderly patients, not executive brain dysfunction. And it said Bateen also concluded Gatlin’s score was in the average range when it was not.

“Because Gatlin’s medical history established that he had a TBI and had significant deficits three years post injury, it was improper for Licensee to use RBANS as the testing instrument to determine Gatlin’s cognitive functioning and to use it as the basis to formulate his evaluation  conclusions,” said the screening panel.

“Incorrectly categorizing Gatlin’s attention score and erroneously ascribing it to PTSD and generally failing to address or reconcile Licensee’s findings with those of the previous evaluations are examples of Licensee’s failure to conduct the assessment in accordance with the applicable standard or care,” it said.

That violated two sections of the state regulations for the practice of psychology, said the ruling signed by Special Assistant Attorney General Tyler G. Moss.

“Licensee created an unreasonable risk of physical or mental harm or serious financial loss to Gatlin, regardless of whether actual physical or mental injury or harm was suffered by Gatlin, when Licensee (a) used the incorrect assessment tool; (b) failed to incorporate or properly consider prior, applicable evaluations; (c) offered opinions in a specialized area of psychology for which he was not qualified; or (d) failed to meet the standard of care,” concluded the ruling.

Bateen now has 20 days to decide whether to accept the ruling or appeal it to the full board, which has a range of 10 disciplinary measures ranging from revocation of his license down to a fine not to exceed $1,000 for each violation.

“Generally, most of the licensees enter into stipulations to agree to remedy the situation somehow after receiving such a ruling,” the chief counsel for the Montana Department of Labor and Industry, Judy Bovington, said Tuesday. “They agree they did something that wasn’t right and agree to change the way they practice. The percentage of these cases that choose to litigate is fairly small.”

Bovington said only two of Montana’s 236 licensed psychologists have faced disciplinary action in the past five years.  There have been 33 complaints in that time period, and four complaints are still pending before the board.