PTSD Disability Examination Reports: A Comparison of Veterans Health Administration and Contract Examiners.

Background An enormous increase in disability claims for posttraumatic stress disorder (PTSD) has occurred over the past decade. To meet the demand for examinations required to determine diagnosis, causation, and impairment, the US Department of Veterans Affairs Veterans Health Administration (VHA) has increasingly relied on contract examiners. Despite anecdotal reports of poor-quality examinations by contractors, no systematic study comparing VA and contract examinations has been reported. Methods Data from 113 initial PTSD examination reports were coded and rated on variables related to content and quality. Administrative disability decisions rendered by VHA were identified and coded independently. Results Contract examinations reported more symptoms and a greater degree of impairment, resulting in higher VHA disability ratings compared with VHA examiner reports. Contractor examinations were rated as having poorer quality than were VHA examinations on 2 of 3 metrics and included several examination reports that contained no relevant history or discussion required to support opinions about diagnosis or impairment. Conclusions The findings provide 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. The findings have implications for the quality, integrity, and reliability of the VHA PTSD disability claims process and support the need for program oversight, examiner training, and quality assurance.