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.”