Study Reveals Racial Differences in Veterans' Perception of the Quality of PTSD Compensation Examinations
Many Veterans find the PTSD compensation interview to be stressful, and indicate that compensation examinations are conducted by examiners who do not understand them, question them skeptically, and display unfamiliarity with the military. As compensation examinations are a potential portal of entry to engagement in VA treatment, an off-putting interview might make Veterans less likely to engage in VA treatment. This study examined factors potentially associated with Veterans' perceptions of the quality of their PTSD compensation examination, including racial differences. As part of a larger clinical trial of Veterans being evaluated for an initial PTSD service-connection claim, 384 Veterans were randomly assigned either to examiners who conducted their usual examination or to examiners who incorporated semi-structured assessments of PTSD and associated functional impairment into the interview. Immediately after the interview, Veterans completed ratings of the examination's quality and of their examiner's interpersonal qualities and competence. Investigators evaluated factors related to Veterans (e.g., demographics, PTSD and/or substance use diagnosed by examiner, and functional score), examiners (e.g., perceptions of Veteran malingering and/or minimizing symptoms, training and experience), and the examination (e.g., time spent conducting the exam, presence of third party).
- The overall quality of PTSD compensation examinations was predominantly rated as "excellent" or "very good" by both African American and Caucasian Veterans. However, compared to Caucasian Veterans, African American Veterans rated their examinations as having been of lower quality. They also rated their examiners lower on interpersonal qualities but not on competence.
- Of Veterans participating in this study, 47% of Caucasian Veterans vs. 34% of African American Veterans rated the quality of their examination as "excellent."
- Ratings were not significantly related to the Veterans' age, gender, marital status, eventual diagnosis with PTSD, functioning score, the examiners' perception of the prevalence of malingering, or the presence of a third party in the examination.
- The authors note that the Veterans' perspective is only one component of the quality of the PTSD compensation examination.
- The methods employed do not allow for conclusions about what components of examinations might account for racial differences in perceived quality of the examination.
This study was partly funded by HSR&D's Quality Enhancement Research Initiative (QUERI; SDR 06-331) and the VISN 1 MIRECC. Dr. Rosen is part of the VA Connecticut Health Care System.
Rosen M, Afshartous D, Nwosu S, Scott M, et al. Racial Differences in Veterans’ Satisfaction with PTSD Disability Examination. Psychiatric Services April 1, 2013;64(4):354-59.