Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans (2019) / Chapter Skim
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At VBA, a veterans service representative may determine that there is enough evidence to make a rating or request more information. If there is enough evidence, a ratings veterans' service representative makes a disability rating decision by comparing DBQ results and other evidence to criteria in the Veterans Affairs Schedule for Rating Disabilities (VASRD)
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, and learn what measures the VA has already taken to ensure the quality of its process. In this publication the committee provides recommendations to the VA related to the health care specialists who diagnose TBI, the adequacy of the tools used by the VA to provide clinical examinations and disability ratings for TBI residuals (the DBQ and the VASRD)
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Furthermore, the committee recommends pertinent and ongoing clinical training that is up to date with the state of current knowledge regarding TBI. THE DISABILITY BENEFITS QUESTIONNAIRE AND THE VA SCHEDULE FOR RATING DISABILITIES FOR RESIDUALS OF TRAUMATIC BRAIN INJURY As previously noted, after the claim is filed with VBA, if the VBA employee determines additional medical evidence is needed, a C&P examination is completed by a VHA clinician or a VBA-contracted clinician to provide medical information to VBA to help determine the presence and degree of medical impairment incurred by the veteran.
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The committee recommends that the Department of Veterans Affairs convene experts from both Veterans Health Administration and Veterans Benefits Administration, including clinicians who diagnose and assess residuals of traumatic brain injury, to regularly update the Veterans Affairs Schedule for Rating Disabilities and the Disability Benefits Questionnaires for residuals of TBI to better reflect the current state of medical knowledge. In the committee's review of the residuals of TBI DBQ, it found that there are important residuals that were not included.
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The committee's review of the VA's quality assurance measures found that the VA's quality measures focus on consistency in the disability rating step of the process. One example of a VA quality measure that focuses on consistency of process but with unclear effect on reliability or validity is the measurement of the fraction of diagnoses of TBI that are made by a physician board-certified in one of four specialties: neurology, neurosurgery, physical medicine and rehabilitation, or psychiatry.
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The committee recommends that Veterans Health Administration (VHA) and Veterans Benefits Administration take specific actions to increase transparency at both individual and system-wide levels, including but not limited to providing full access to veterans of the details of their examinations and ratings and providing public access to detailed system-wide data, with separation by geographic location and examination type (e.g., VHA versus contracting examiner)
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SUMMARY 7 to devote its resources to those modifications and enhancements of the disability evaluation system that will have the greatest impact in improving the service provided to injured veterans.
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