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50. The Relationship between MMPI-2 Validity and Award of Service Connection for PTSD during the Compensation and Pension Evaluation
Arbisi, PA, MVAMC Univeristy of Minnesota CCDOR; Murdoch, M, MVAMC Univeristy of Minnesota CCDOR; Fortier, L, MVAMC Univeristy of Minnesota CCDOR
Objectives: 1) Identify the impact of a psychometric indicator of malingering obtained during the C&P examination on subsequent award of service connection for PTSD.
2) Identify rate of health care utilization in individuals with a high probability of malingering PTSD during the C&P examination two years prior to the examination and two years after the examination.
3) Identify variables that may account for differences in health care utilization in individuals who are strongly suspected to have feigned or exaggerated their condition during the PTSD exam.
Methods: The MMPI-2 contains several validity scales that provide information regarding the accuracy of an examinees self-report. The F(p) a newer MMPI-2 validity scale has shown incremental improvement above other scales in identifying individuals who are feigning or exaggerating psychiatric illness among patients with genuine psychiatric illness. The MMPI-2 was administered as part of a comprehensive, standardized C&P exam at the MVAMC that also included other psychometric measures and a clinical interview. From an initial pool of 699 MMPI-2s obtained as part of C&P examinations for PTSD between 1991 and 1996, we identified 73 individuals based on a raw score above 7 on the F(p) scale. This cut off score corresponds to a T score of 100 in the general population and is associated with an over all hit rate of 98% in identifying individuals who are feigning psychiatric illness. We matched this group with a group who had no significant elevation on the F(p) scale. From the matched groups we were able to obtain health care utilization data from the SIRS data base and subsequent award of service connection for 51 individuals from the high F(p) group and 57 individuals from the low F(p) group.
Results: No statistically significant group differences emerged across any of the parameters examined. 56.9 % of the high F(p) group received service connection for PSTD vs. 61.4% of the low F(p) group (Chi-square=0.23, p<.63). There were no group differences in average number of monthly clinic visits or for number of mental health clinic visits for the two years prior to examination or the two years after the examination. However, both groups significantly decreased average number of clinic visits in the two-year period after the examination.
Conclusions: The rate of award for service connection for PTSD did not differ as a function of MMPI-2 validity. Despite the availability of a reliable and valid means of identifying individuals who may be feigning psychopathology during the C&P examination, this information was not always used at our facility. Individuals with a high probability of feigning were awarded service connection for PTSD and access to VA clinics for treatment of PTSD at rates similar to the rates of individuals who responded candidly to the MMPI-2.
Impact: Failure to identify individuals who misrepresent their psychiatric condition during C&P examinations may result in an inappropriate allocation of medical resources and disability benefits.