Abstract

1. The cost of malingering mTBI-related cognitive deficits during Compensation and Pension evaluations in the Veterans Affairs Healthcare System John Denning, Ph.D. TN Valley Healthcare System, Alvin C. York VA Hospital, Murfreesboro, TN Abstract In the Department of Veterans Affairs, Neuropsychologists often make determinations of whether an individual is exaggerating cognitive deficits for disability purposes. This study provides a preliminary analysis of Veterans failing the Medical Symptom Validity Test (MSVT) and/or Trial 1 of the Test of Memory Malingering (TOMM1 < 40) during mTBI Compensation & Pension (C&P) evaluations over a 12-month period. Individuals from one VA Medical Center with mTBI and no other neurological conditions were included (n = 75, Mean: Age = 40, Education = 12.8; Male = 96%, Caucasian = 75%, African American = 23%). Results indicated that 52% failed either the MSVT or TOMM1 with 33% failing both measures. For those failing either measure, 50% still received disability compensation for TBI with a cumulative total of approximately $121,000/per year (tax free). For those who passed both measures, 66% received a total of approximately $108,000/per year (tax free). Given that mTBI deficits remit within several days to several weeks for the majority of those injured, it is questionable whether disability payouts for those exaggerating mTBI-related cognitive deficits is appropriate. Incorporating neuropsychologist’s opinions regarding test validity/exaggeration in determining disability compensation may be helpful in this regard. • Results • No group differences on demographics or mTBI features • 50% of “Fail” group received compensation • 66% of “Pass” group received compensation • Most received either 10% or 40% disability for mTBI • Total payments for mTBI are roughly equivalent to the salary of 2.5 additional full-time Psychologists at our facility • Introduction • A significant percentage of recent Veterans have been diagnosed with mild traumatic brain injury (mTBI). • It is critical they receive an accurate assessment of their injuries and compensated appropriately. • However, high rates of malingering/exaggeration of mTBI-related deficits are seen in compensation-seeking samples. • The current study provides failure rates on validity tests as well as estimated costs of disability paid out for mTBI. • Conclusions • Consistent with prior studies, roughly 50% of those claiming mTBI-related deficits showed evidence of exaggeration. • Despite this, 50% still received a total of $121,000/year for mTBI-related disability. • With recovery from mTBI typically being several days to several weeks, injuries > 1 yr would not tend to negatively impact functioning (Average > 10 yrs in our sample). • Incorporating Neuropsychologist’s opinions regarding exaggeration during disability evaluations may be helpful. • Given the limited resources throughout the VA healthcare System, more efficient allocation of resources to assist those with disabling psychiatric disorders should be explored. • * The views expressed in this poster are those of the author and does not reflect the position of the DVA or United States Government. This work was supported by the resources at the TN Valley Healthcare System, Alvin C. York Hospital, Murfreesboro, TN • Participants • 75 Veterans presenting for C&P evaluations for TBI • Examined over a 12-month period (2009-2010) • Excluded those with any neurological disorders • ACRM definition of mTBI used for diagnosis • Mean: Age = 40, Education = 12.8 • 96% Male • 75% Caucasian, 23% African-American • 50% reported ANY LOC and/or PTA • 100% > 1 year since mTBI • Mean Time Since mTBI = 13.2 years • Most common mechanisms of injury: Blast, MVA • Diagnosis of PTSD = 75%, Depression = 37% • Methods • Passing MSVT and TOMM1 > 40 = “Pass” • Failing MSVT or TOMM1 < 40 = “Fail” • Collected Service-Connected disability percentage for TBI • Disability benefit estimated based on Veteran being married with 1 child (tax-free payments) • Cumulative total (yearly) disability payout for each group