PTSD disability examinations in the Department of Veterans Affairs: A comparison of telehealth and in-person exams.

Abstract

It is estimated that the VA will have rendered decisions on roughly 1.4 million disability claims in 2021. A substantial percentage of these are for mental health conditions, specifically posttraumatic stress disorder (PTSD). Prior to the COVID-19 pandemic, almost all Compensation and Pension (C&P) examinations for PTSD were completed in-person;since March 2020, most have been conducted using telehealth. However, the content and quality of such exams, relative to those conducted in-person, have not been studied. The present study compared Initial PTSD examinations by telehealth to those completed in-person. Overall, 105 reports (51 in-person and 54 telehealth) were randomly selected from all Initial PTSD C&P exams completed within VA Connecticut between 2019 and 2020 (1 year preceding the pandemic and the first year of the pandemic). Raters were masked to all information indicating examiner, mode, and date of exam. Exam content was recorded, and exam quality was rated using three metrics that demonstrated adequate reliability and sensitivity in a prior study. There were no statistically significant differences between in-person and tele-exams on any relevant report content variables, report quality metrics, or VA disability rating outcomes. Results support the validity of the use of telehealth for conducting psychological exams for PTSD disability claims within the VA. Implications for the use of telehealth technology in improving operational breadth and reducing barriers to examination and care, both in the VA and beyond, are discussed.