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Footnote

α. Auer, Marjorie, Troy Baxley, Joseph Enderle, Caroll McBrine, and Lewis R. Coulson, C&P Service Clinician's Guide, version 3.0, ed. Lewis R. Coulson (Washington, D.C.: Dep't Veterans Aff., Veterans Health Admin., March 2002), 5–15, 181–217, 259.

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Answers to the Quiz

(i) True or False? If a veteran reports a history of childhood abuse, then you should diagnose PTSD only if the veteran received a Purple Heart.

Answer: False. - See Secondary Service-Connection for Substance Use Disorders: Legal Framework to learn why.


(ii) True or False? If an examinee fails 2 out of 3 SVTs or PVTs, you should state in the exam report that he or she was malingering, and assign ICD-10-CM code Z76.5

Answer: False. - Failing two out of three symptom validity tests or performance validity tests is probably significant, but it does not necessarily mean a veteran is malingering. See What you should understand about malingering for more details.


(iii) True or False? Secondary service connection for substance abuse is rare because, per 38 C.F.R. § 3.301(d), an injury or disease shall not be deemed to have been incurred in line of duty, if such injury or disease was a result of a service member's own willful misconduct, including the voluntary consumption of alcohol or other drugs with a desire to experience intoxication.

Answer: False. - Although it might seem that secondary service connection for substance use disorders would be rare, there is important case law that one must consider. See Secondary Service-Connection for Substance Use Disorders: Legal Framework.

(iv) Question: Is there any scientific evidence for the self-medication hypothesis? 

Answer: Yes, a lot. See Secondary Service-Connection for Substance Use Disorders: Selected Research Review.


(v) Question: During an Initial C&P exam for PTSD, you administer the MMPI-2-RF, and F-r = 115. Does that score mean the veteran is probably feigning, or is does the score represent a "cry for help"? 

Answer: It probably represents significant distress, sometimes called a "cry for help". For example, in the study by Goodwin, Sellbom, & Arbisi (2013), F-r ≥ 118 had a Positive Predictive Power of only 0.61 at a 30% base rate. See MMPI-2-RF Validity Scale Statistics for Consideration in VA C&P Exams for PTSD for more information.


(vi) True or False: C&P exams for PTSD and other mental disorders are not forensic psychological (or psychiatric) evaluations because VA disability claim adjudication is a civil, not a criminal proceeding.

Answer: False. See the Recommended Reading List for Psych C&P Examiners for several articles that address this topic.


(vii) True or False: The C&P Service Clinician's Guide (2002) does not have anything to offer modern day examiners because it is so old.

Answer: False. When you review the Clinician's Guide on the pages indicated in the reference below, you will see why.

  • Auer, Marjorie, Troy Baxley, Joseph Enderle, Caroll McBrine, and Lewis R. Coulson, C&P Service Clinician's Guide, version 3.0, ed. Lewis R. Coulson (Washington, D.C.: Dep't Veterans Aff., Veterans Health Admin., March 2002), 5–15, 181–217.


(viii) Imagine a veteran who filed a claim for service connection due to schizophrenia. The first time he was hospitalized for psychosis was 5 years after discharge. What factors would you consider if you were the C&P examiner?

Answer: You would want to see if the veteran exhibited prodromal signs or symptoms during military service or during his or her first year after discharge. See Important Scientific Information About Schizophrenia for more details.


(ix) Is there anything you can learn about conducting a mental status exam (MSE), or have you done so many, you've got it down almost perfectly?

Only you can answer this one, but I encourage you to not get complacent. See Mental Status Exam Resources.

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