A Practitioner Survey of Department of Veterans Affairs Psychologists who Provide Neuropsychological Assessments.

OBJECTIVE: The provision of neuropsychological assessments is an important part of the assessment and treatment of our veterans, yet little is known regarding who provides these assessments within Veterans Health Administration (VHA) settings, and of what they consist. The current survey provides information regarding the professional characteristics and assessment practices of VHA psychologists who provide neuropsychological assessments within VHA settings. METHODS: Survey invitations were emailed to 4740 psychologists who worked for the VHA, resulting in surveys from 123 VHA psychologists who self-identified as providing and/or supervising neuropsychological assessments within VHA settings. RESULTS: One hundred and twenty-three VHA doctoral level psychologists provided information regarding professional characteristics, such as demographic, training, and exerience, as well as assessment practices, such as number and types of assessment instruments used. CONCLUSIONS: This professional practice survey is the first survey of VHA psytchologists who provide neuropsychological assessments within VHA settings. As such, it provides baseline information which will aid in assesment and treatment provision, policy developement, and allow future surveys to assess changes in neuropsychological assessment practices over time.

Consistency of Self-Reported Neurocognitive Symptoms, Post-Traumatic Stress Disorder Symptoms, and Concussive Events From End of First Deployment to Veteran Health Administration Comprehensive Traumatic Brain Injury Evaluation by Operations Enduring Freedom/Iraqi Freedom/New Dawn Veterans.

OBJECTIVE: This study examined the consistency of self-reported symptoms and concussive events in combat veterans who reported experiencing concussive events. METHOD: One hundred and forty, single deployed, Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn combat veterans with Veteran Health Administration (VHA) Comprehensive Traumatic Brain Injury Evaluations (CTBIE) and no post-deployment head injury were examined to assess consistency of self-reported (a) traumatic brain injury (TBI)-related symptoms, (b) post-traumatic stress disorder (PTSD)-related symptoms, and (c) TBI-related concussive events from soon after deployment to time of VHA CTBIE. RESULTS: Compared to their self-report of symptoms and traumatic events at the time of their Post-Deployment Health Assessment, at the time of their comprehensive VHA evaluation, subjects reported significantly greater impairment in concentration, decision making, memory, headache, and sleep. In addition, although half the subjects denied any PTSD symptoms post-deployment, approximately three quarters reported experiencing all four PTSD screening symptoms near the time of the VHA CTBIEs. At the latter time, subjects also reported significantly more TBI-related concussive events, as well as more post-concussive sequelae such as loss of consciousness immediately following these concussive events. Finally, although 84% reported a level of impairment so severe as to render all but the simplest activity doable, the vast majority simultaneously reported working and/or attending college. CONCLUSIONS: These findings raise questions regarding the accuracy of veteran self-report of both near and distant traumatic events, and argue for the inclusion of contemporaneous Department of Defense (DOD) records in veteran assessment and treatment planning.

Symptom validity test performance and consistency of self-reported memory functioning of Operation Enduring Freedom/Operation Iraqi freedom veterans with positive Veteran Health Administration Comprehensive Traumatic Brain Injury evaluations.

Operation Enduring Freedom and Operation Iraqi Freedom combat veterans given definite diagnoses of mild Traumatic Brain Injury (TBI) during the Veteran Health Administration (VHA) Comprehensive TBI evaluation and reporting no post-deployment head injury were examined to assess (a) consistency of self-reported memory impairment and (b) symptom validity test (SVT) performance via a two-part study. Study 1 found that while 49 of 50 veterans reported moderate to very severe memory impairment during the VHA Comprehensive TBI evaluation, only 7 had reported any memory problem at the time of their Department of Defense (DOD) post-deployment health assessment. Study 2 found that of 38 veterans referred for neuropsychological evaluations following a positive VHA Comprehensive TBI evaluation, 68.4% failed the Word Memory Test, a forced choice memory recognition symptom validity task. Together, these studies raise questions concerning the use of veteran symptom self-report for TBI assessments and argue for the inclusion of SVTs and the expanded use of contemporaneous DOD records to improve the diagnostic accuracy of the VHA Comprehensive TBI evaluation.