WASHINGTON D.C. \u2013 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.<\/p>\n
It\u2019s 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\u2019t happen.<\/p>\n
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.<\/p>\n
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.<\/p>\n
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.<\/p>\n
Gatlin, who recently graduated from UM with a pair of masters\u2019 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\u2019t adequate to measure his cognitive ability; that Bateen wasn\u2019t qualified to make the assessment because he wasn\u2019t a neuropsychologist; and that Bateen incorrectly characterized the results of that test.<\/p>\n
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.<\/p>\n
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:<\/p>\n
\u201cSchedule 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.\u201d<\/p>\n
It ordered a re-adjudication of Gatlin\u2019s claim based on the new examination.<\/p>\n
\u201cIf 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,\u201d directed the panel of three veterans law judges.<\/p>\n
In a separate opinion, the VA Board of Appeals also ordered new testing of Gatlin\u2019s depth perception and fine motor skills, and it directed that the claim be handled expeditiously.<\/p>\n
Gatlin\u2019s wife, however, remains dubious of any VA re-examination after three years of institutional resistance at Fort Harrison, and within the VA system.<\/p>\n
\u201cIt is completely and utterly unethical for anyone at Fort Harrison to see Charles related to a benefits examination,\u201d Del Negro explained via email. \u201cNot 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.<\/p>\n
\u201cAnd 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,\u201d she added.<\/p>\n
But since the Montana Board of Psychologists concluded that the RBANS test wasn\u2019t sufficient to measure neurological impairment due to a TBI and that Bateen wasn\u2019t qualified to make neurological diagnoses, Del Negro argues that all vets diagnosed by Bateen ought to have their cases re-evaluated.<\/p>\n
At the Montana Board of Psychologists hearing in December 2012, Bateen estimated he had conducted 9,000 evaluations.<\/p>\n
\u201cA records review is also owed to the other 8,999 veterans seen by Dr. Bateen,\u201d Del Negro wrote. \u201cIt’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.\u201d<\/p>\n
That\u2019s not going to happen, wrote the VA\u2019s interim undersecretary of health, Dr. Carolyn Clancy, in a letter to Montana Sen. Jon Tester on Nov. 12, 2014.<\/p>\n
\u201cThe 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,\u201d Clancy wrote. \u201cAs VA was not a party to the stipulation, it does not have any impact on VA or our employees other than Dr. Bateen.\u201d<\/p>\n
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\u2019t need to be because it is a federal facility.<\/p>\n
\u201cAdditionally, VA disagrees with the Montana Board\u2019s finding that VA protocols for TBI, C&P (compensation and pension) examinations are insufficient,\u201d she added.<\/p>\n
But Del Negro argues that VA raters failed to note Bateen\u2019s misinterpretation of her husband\u2019s screening test results, as well as the vast variance between the full neuropsychological exams and the RBANS.<\/p>\n
\u201cThe fact that overt problems and inconsistencies were not noted by Fort Harrison Regional Office raters is a major concern,\u201d she said. \u201cIt demonstrates that it wasn’t just Bateen who failed — it was the entire system.\u201d<\/p>\n
At the Montana Board of Psychologist hearing, Bateen testified that the RBANS screening tests were uniform at VA facilities across the country.<\/p>\n
\u201cThe evaluation that I conduct is the same one that\u2019s conducted at VA centers throughout the United States,\u201d he said. \u201cThey\u2019re 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.\u201d<\/p>\n
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.<\/p>\n
\u201cMy screening is the same screening that is done by every psychologist that works for the VA doing a TBI examination,\u201d he added.<\/p>\n
One of the hearing examiners asked whether it might be more useful to base assessments on earlier, more extensive neuropsychological testing.<\/p>\n
\u201cYou may well be correct,\u201d responded Bateen. \u201cBut again, I have to operate under the guidelines as established by the VA, and the VA has in essence said that we don\u2019t need to do all of this, that we \u2013 Maybe it\u2019s financial. I don\u2019t know. You know? My exam is a whole lot cheaper than doing a two-day neuropsych exam.\u201d<\/p>\n
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