ABSTRACT
Objective: Research has demonstrated that over-reporting and under-reporting, when detected by the MMPI-2-RF Validity Scales, generalize to responses to other self-report measures. The purpose of this study was to investigate whether the same is true for the Minnesota Multiphasic Personality Inventory–3 (MMPI-3) Validity Scales. We examined the generalizability of over-reporting and under-reporting detected by MMPI-3 Validity Scales to extra-test self-report, performance-based, and performance validity measures.

Method: The sample included 665 majority White, male disability claimants who, in addition to the MMPI-3, were administered several self-report measures, some with embedded symptom validity tests (SVTs), performance-based measures, and performance validity tests (PVTs). Three groups were identified based on MMPI-3 Validity Scale scores as over-reporting (n = 276), under-reporting (n = 100), or scoring within normal limits (WNL; n = 289).

Results: Over-reporting on the MMPI-3 generalized to symptom over-reporting on concurrently administered self-report measures of psychopathology and was associated with evidence of over-reporting from other embedded SVTs.

It was also associated with poorer performance on concurrently administered measures of cognitive functioning and PVTs.

Under-reporting on the MMPI-3 generalized to symptom minimization on collateral measures of psychopathology. 

Conclusions: MMPI-3 Validity Scales can identify possible over- and under-reporting on concurrently administered measures. This can be of particular value when such measures lack validity indicators.

[Note: Slightly edited for brevity; line breaks and emphasis added to improve online readability.]

      

ABSTRACT
The purpose of this investigation is to provide descriptive information on veteran response styles for compensation and pension (C&P) evaluations Veterans Affairs (VA) referral types using the Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF), which has well-supported embedded validity scales capturing invalid response styles.

The total sample included 356 veterans from a single VA psychological testing clinic who were administered the MMPI-2-RF during a broader psychological evaluation, with 201 veterans undergoing C&P evaluations [56.5%].

This study examines frequencies of protocol invalidity based on the MMPI-2-RF’s validity scales and provides comprehensive descriptive findings on validity scale scores across appointment types (i.e., C&P and non-C&P). Three distinct trends emerged:

(1) Veterans generally produced valid MMPI-2-RF profiles, 

(2) when more than one elevation emerges, it is likely to be thematically consistent (e.g., overreporting scales), and 

(3) overreporting generally captured the highest frequency of validity scale elevations relative to underreporting or noncontent-based invalid responding.

Implications and limitations for practice and the utility of the MMPI-2-RF within VA testing clinics are discussed.

QUOTE from article:
Observed elevation rates differ in their frequency between C&P and non-C&P focused evaluations; however, these differences were relatively small in effect and unlikely to cause major variations in test taking approach with respect to needed cut scores.

One potential reason for a lack of difference between these two groups in score performance, given the generally similar scores and discrepant referral reasons, is the enmeshment of disability processes with routine care within the VA (see Worthen & Moering, 2011).

Thus, despite small effects magnitudes, the inherent forensic enmeshment of C&P evaluations remains critical to consider during service provision (Ray, 2017), and inclusion of multiple sources of performance and symptom validity testing to support diagnostic or clinical decision making remains necessary (see Sweet et al., 2021). 

[Note: Slightly edited for brevity; line breaks and emphasis added to improve online readability.]

      

Abstract
The field of psychological injury and law is marked by use of psychometrically sound validity tests that use empirically derived cut scores to determine the credibility of cognitive deficits and psychological symptoms in forensic and related disability assessments (FDRA).

Performance validity tests (PVTs) are used in neuropsychological/cognitive assessments to determine the extent to which test scores reflect true ability levels.

Symptom validity tests (SVTs) are designed to evaluate the credibility of self-reported level of excessive report in behaviors, emotions, and thoughts. They monitor the rate of endorsement of rare, absurd, impossible, and improbable symptoms.

The authors argue for a 30% rule as a tentative multivariate threshold for invalid presentation (with provisos). In other words, failure on about one third of the PVTs/SVTs administered should be required before deeming the overall profile non-credible to control for the threat of inflated false positive error due to the increasing number of instruments used.

Typically, workers in the field use the multivariate threshold of ≥ 2 PVT failures in FDRA [forensic and related disability assessments] to deem an entire profile invalid, without considering the number of tests administered.

The proposed 30% rule accommodates this face validity question. It is tentatively proposed as a starting point for future research, and with sufficient empirical support, a general guideline for FDRA [forensic and related disability assessments] (emphasis added).

      

ABSTRACT

Background: Annually, thousands of Veterans file Department of Veterans Affairs' (VA) disability claims (“service connection”) for posttraumatic stress disorder (PTSD) related to military sexual trauma (MST). Service connection provides free covered healthcare and compensation. To qualify, Veterans must meet PTSD diagnostic criteria, have sufficient evidence of the MST, and establish a link between their PTSD symptoms and MST.

Methods: Among VA-enrolled Veterans who filed for MST-related PTSD service connection between 2017 and 2022 (N = 19,509), we modeled the probability of denied PTSD service connection as a function of MST type (i.e., assault versus harassment) and any instance of a psychiatric diagnosis in the VA electronic health record prior to PTSD claim decision, while controlling for demographics, PTSD diagnosis, and VA MST screen.

Results: Veterans with sexual harassment claims had 2.86 times (d = 0.37) higher odds of being denied (42.7 %) compared to those with sexual assault claims (20.7 %). Diagnoses of personality disorders, anxiety disorders, substance use disorders, bipolar disorders, and schizophrenia spectrum disorders were associated with increased odds of PTSD claims being denied (OR = 1.20–2.01).

Limitations: While the full population of Veterans filing MST claims during this timeframe, the sample included relatively few harassment-only claims and was limited to demographic information in VA records, possibly resulting in overlooked confounders or determinants.

Conclusion: Skilled claims assistance and equitable evidentiary requirements for MST-related PTSD claims compared to PTSD claims not related to MST, and for any trauma claims for a non-PTSD diagnosis (e.g., anxiety or depression) may reduce disparities in service connection.

      

» Free Programmed Excel Spreadsheet Automatically Scores 28 Psychological Questionnaires – A gift from some Australian psychologists: a free user-programmed Excel sheet that automatically scores a variety of screeners and assessment instruments. 

» Workshop: PTSD Assessment Frequently Asked Questions – A National Center for PTSD one-hour presentation on 17 July 2024 @ 2 PM EDT / 11 AM PDT – 1.0 CE credit available. 

» Updated Recommended Reading for C&P Psychologists (web page) or download the PDF.

» Psychological Insights for Veterans Law Attorneys is a monthly newsletter for veterans law attorneys and VA-accredited claims agents. The most recent issue discusses PTSD due to cumulative trauma, and VBA red flags for inauthentic DBQs.

      

Worthen & Moering (2011) recommended that C&P examiners consider using the Morel Emotional Numbing Test (MENT) during PTSD exams, but we cautioned that “it is not yet known how many combat veterans with genuine PTSD intentionally perform poorly on the test because they naively believe that they are ‘supposed to’ fail the test because they have PTSD.”^[1]

Recent research supports our concern. Williamson et al. (2024) suggest that a psychological phenomenon, diagnosis threat, exerts an influence on some veterans, resulting in higher MENT error scores even if they have genuine PTSD.  Read more ...

Bufkin v. McDonough Heads to the U.S. Supreme Court

Veterans Joshua E. Bufkin and Norman F. Thornton jointly appealed a U.S. Court of Appeals for the Federal Circuit decision to the U.S. Supreme Court. The cases were consolidated as Bufkin v. McDonough.

On 29 April 2024 the Supreme Court granted certiorari, which means the Court will hear the case during their next term (October 2024).

This is an important case because the Federal Circuit, and the Veterans Court before them, have, according to the petitioners and four amici curiae, ignored the clear intent of Congress, viz., that the Veterans Court take due account of the Secretary’s application of the benefit-of-the-doubt rule.

On the other hand, the Federal Circuit agreed with the Veterans Court that the underlying Board of Veterans Appeals decision was "not clearly erroneous" and therefore "the benefit of the doubt doctrine does not apply." Bufkin v. McDonough, 75 F.4th 1368, 1370 (Fed. Cir. 2023).

Learn more on the Compensation and Pension Exam News page or jump to specific sections of my writeup:

• Supreme Court Grants Certiorari re: Veterans Court Application of Benefit-of-the-Doubt Rule - Bufkin v. McDonough 
  » Question Presented
  » writ, n.
  » Petition for Certiorari
  » Supreme Court Certiorari Process
  » Footnotes

      

"There is no prohibition against acceptance of a VA examination report for rating purposes from a fee-based medical examiner who has previously submitted a statement on the claimant’s behalf."

I have often wondered, what exactly does "who has previously submitted a statement on the claimant’s behalf" mean?

I submitted an inquiry to the updated, and quite helpful, Ask VA site, and I received a reply that indirectly answered my question.

Here are the links to my write up of that inquiry and the conclusion I reached:

"... Who Has Previously Submitted a Statement on the Claimant’s Behalf"

» My Inquiry to Ask VA (what exactly does that phrase mean?)

» Ask VA's Response 

» Conclusion

I am writing an article tentatively titled: Why So Many Substandard Psychological C&P Exams? 

For experienced C&P psychologists you will not find any earth-shattering new insights, but it might offer a slightly new perspective.

If you would like to read a sneak preview (first 500 words), click here to download a copy. I welcome your feedback. 

      

Among other disabilities, he suffers from the effects of multiple traumatic brain injuries and legal blindness and receives VA disability compensation at the 100% rating level. He and his wife began receiving VHA Caregiver Program benefits in 2013.

When Mr. Beaudette and his wife received notice in 2017 about a regular reassessment of Caregiver Program eligibility they asked for a delay until after Mr. Beaudette had recovered sufficiently from recent major surgies so that he could participate in the reassessment. 

In a baffling bureaucratic decision, VHA denied their request and made their reassessmemt decision based on medical records alone without interviewing the veteran and his wife, and ended their eligibility for the Caregiver Program. 

The Beaudettes followed VHA rules for appealing an adverse decision but to no avail. They finally appealed to the Board of Veterans' Appeals, but the Board ruled they did not have jurisdiction to review the VHA decision. The Beaudettes petitioned the U.S. Court of Appeals for Veterans Claims for a writ of mandamus. 

The Beaudette's fortitude and determination to hold VA to account for a bonehead decision led to significant federal appeals court decisions overturning VA's legal mistakes. 

• Beaudette v. McDonough (Fed. Cir. 2024)
• Excerpts from Federal Circuit Opinion in Beaudette v. McDonough (2024)
• VA Had to Notify 400,000 Veterans and Families about their Right to Appeal Adverse Procedural Decisions
• Terminology: Writ, mandamus, writ of mandamus
• Levels of appeal for VA disability claims decisions

      

• reports from veterans about examiners who had not reviewed their records;
• exams conducted in hotel rooms or broomclosets; and that
• VA still does not have a genuine quality assurance program for C&P exams. → Read more ...

And here is a highly relevant research article:

Andrew Meisler & Mayumi O. Gianoli, PTSD Disability Examination Reports: A Comparison of Veterans Health Administration and Contract Examiners, Fᴇᴅ. Pʀᴀᴄ. (2022).

This study offers "the first systematic evidence of greater symptom/impairment reporting and poorer overall quality in contract examinations for PTSD disability claims compared with those conducted by VHA examiners, with resulting differential outcomes in VHA disability ratings."

You might be interested in a newsletter I started recently:

Psychological Insights for Veterans Law Attorneys - a monthly newsletter that empowers attorneys and VA-accredited claims agents to effectively challenge the credibility of VA psychological exams.

Subscribers receive a unique guide I wrote recently: How To Challenge the Presumption of Competency for VA Mental Health Examiners.

The April 2024 issue offers a brief summary and PDF regarding: 

• Important Considerations for Telemental Health C&P Exams, 

and addresses the question:

• Should a Private Examiner Complete an Initial PTSD DBQ?

      

But that has not happened. I therefore must conclude that either I misunderstood the new law or perhaps the first bill did not conform to proper statutory construction. For more on this topic, see:

MST that Causes Depressive, Anxiety, & Other Mental Disorders Should Be Covered ... and

VA Standard of Proof for non-PTSD, MST-related Disability Claims

My (Revised) Comment on Proposed Changes to VA Mental Health Ratings

On 15 Feb 2022, the Department of Veterans Affairs published a proposed rule to update the VA Schedule for Rating Disabilities (VASRD), which includes the General Rating Formula for Mental Disorders.

I submitted my comment, a 12-page document, on 8 Mar 2022. I have since revised it (3 Apr 2022), clarifying a couple of points and correcting some minor errors. It's on this page:

VA Mental Health Ratings 

Update: Correct VA Medical Records

I recently updated my article: How to Correct VA Medical Records. 

Thanks to veteran Mark Yelton, who asked a question in the Comments section (near the bottom of the page), I clarified recommendations for sending a letter to your local VAMC requesting a correction to your medical records.

And I added a CHECKLIST for Requesting a Correction, available online or as a PDF you can download.

See also 7 Reasons to Review Your VA Medical Records.

In brief ...

Navy Veteran Defrauds VA & SSA for Over $1 Million in Disability Benefits

Are You a Veteran with Law Enforcement Experience?

     

The Federal Circuit found that the Veterans Court applied an erroneous legal standard by requiring a “direct relationship” between the evidence and the claim before the Board.

The court articulated the standard for the Board’s constructive possession as “relevance and reasonableness.”

According to the Federal Ciruit Court: "Because the Veterans Court applied an erroneous legal standard when it concluded the Board did not have constructive possession of the NAS Update 2014 [National Academy of Sciences, Veterans and Agent Orange: Update 2014], we vacate and remand."

Zachary Stolz of Chisholm Chisholm & Kilpatrick (CCK) argued for the veteran before the Federal Circuit Court.

Case citation: Euzebio v. McDonough, No. 2020-1072 (Fed. Cir. Mar. 3, 2021).

     

There's a Senate bill, approved by the Senate Committee on Veterans' Affairs—the Toxic Exposure in the American Military (TEAM) Act of 2020—and a companion House bill (still at the committee level) that would make certain medical conditions "presumptive" for disability benefits purposes.

But at present, some veterans receive service-connected disability compensation for claimed burn-pit-related illness and some do not. 

A 10 December 2020 Military Times article reported that "according to Beth Murphy, VA’s executive director of compensation services, about 64 percent of GWOT veterans who claim respiratory issues related to burn pits are eventually determined eligible for benefits."

However, a 3 March 2021 Military.com article indicated that as of January 2021, "the VA had approved disability claims related to burn-pit exposure for 3,442 veterans out of 13,830 [25%] ...."

Over 230,000 veterans have been added to the Airborne Hazards and Open Burn Pit Registry.