Veterans denied treatment due to improper medical testing
By: A.J. Lagoe and Steve Eckert
MISSOULA, Mont. - A ruling by a state medical board suggests that veterans nationwide may have been denied brain injury treatments and disability benefits because the Department of Veterans Affairs is using an improper test, according to a new investigation by KARE 11 News.
Traumatic Brain Injuries - known as TBI's - are often invisible, but they are considered the signature wound of the Iraq and Afghanistan wars.
The findings by the Montana Board of Psychology in the case of Army Captain Charles Gatlin indicate that a test commonly used by the VA to diagnose TBI's is missing too many brain injuries.
"I think that that's a very likely reality," said Dr. Dr. Stuart Hall, a member of the Montana Board which ruled on the Gatlin case.
As a result, wounded warriors coming home are being forced into a new battle. This time with the agency sworn to take care of them.
Captain Gatlin's fight for VA benefits is an example of how difficult the battle can be.
Wounded by a car bomb
Gatlin was a platoon leader in Kirkuk, Iraq in 2006, when a car bomb detonated in front of him.
Knocked down by the blast and flying debris, he was evacuated and subsequently diagnosed with a traumatic brain injury.
Over the next three years, Army medical records show the Purple Heart recipient was given a series of full neuropsychological tests. They showed Gatlin suffered from "persistent frontal lobe dysfunction" along with processing speed deficits and significant attention problems.
His injuries were so serious, Gatlin says he was forced to retire from the Army.
"I had no choice," he said.
A final Army exam in 2009 concluded that since it has already been "3 years post injury" Captain Gatlin's neurological deficits "are likely stable and permanent."
The Army retired Gatlin with a 70 percent disability because of his TBI.
So Gatlin and his wife Ariana Del Negro relocated to Missoula, Montana, hoping to settle into a quiet life.
But the Army's finding of a "permanent" injury apparently wasn't enough for the Department of Veterans Affairs.
In order to qualify for veterans benefits, Gatlin says he was told to report to the VA facility at Fort Harrison, Montana for a re-evaluation.
"And that's where the problems started," Gatlin said.
Records show that Dr. Robert Bateen, a VA staff psychologist, apparently ignored the Army's more thorough tests and used a brief screening tool called an RBANS to evaluate Captain Gatlin.
"I saw this man for 20 minutes," Gatlin recalls. "And a decision was made."
Based on that short RBANS test, Dr. Bateen concluded that Gatlin's so-called "permanent" condition had seemingly vanished. He wrote, "If Mr. Gatlin had a cognitive impairment in the past, it is likely that this has resolved."
As a result, the Department of Veterans Affairs dropped Captain Gatlin's TBI disability rating dramatically: from 70 percent down to just 10 percent.
The Gatlin's appealed the ruling, but the VA defended Dr. Bateen's diagnosis and claimed the psychologist observed the proper procedures.
Gatlin was short-changed
Frustrated by the VA's findings, Charles Gatlin filed a complaint with the Montana Board of Psychologists, the state medical board that licenses psychologists.
Gatlin challenged Dr. Bateen's findings and argued that the testing he used was inadequate.
After reviewing the case, the state Board of Psychologists agreed.
"We felt that in this case the person had been short changed," said Dr. Hall.
"Our board thought the process used by Dr. Bateen was deficient," added Board Chairman Dr. George Watson.
The state board sanctioned the VA psychologist. It ruled Dr. Bateen had violated "accepted standards of practice" when he based his diagnosis on the RBANS.
The state board wrote: "The RBANS is not an appropriate tool for determining the effects of mild TBI."
"It was not sensitive enough to do what the VA purported that it was supposed to do," Dr. Watson told KARE 11. "So we reprimanded the psychologist."
The licensing board ordered Dr. Bateen to reverse his assessment and request that Gatlin be given a full neurological exam.
Just following policy
In his defense, Dr. Bateen stated he was just following VA policy. At a hearing, he said the RBANS evaluation he conducted during the Compensation and Pension exam "is the same one that's conducted at VA centers throughout the United States."
What's more, he said during his VA career he'd performed "about 9,000 of these C&P exams."
"Obviously that's 9,000 opportunities for something to go wrong with a process that has some flaws in it," said Dr. Hall.
KARE 11's A.J. Lagoe asked Dr. Hall if he thought other veterans may not have gotten a fair benefits rating because of the screening process.
Dr. Hall responded: "The way that process is set up, I think that that's a very likely reality."
Earlier this year, KARE 11 exposed how the Minneapolis VA had used unqualified doctors to perform initial TBI exams, denying veterans a fair shot at benefits. According to Department of Veterans Affairs rules, only four types of specialists - including neurosurgeons and neurologists - are allowed to make that diagnosis. But KARE 11 documented cases in which veterans were examined by a nurse practitioner instead.
The Minneapolis VA has since recalled more than 300 veterans for new TBI exams with the appropriate specialists.
In the wake of KARE 11's investigation, Congressman Tim Walz (D-MN) has called on the VA's Office of Inspector General to investigate.
KARE 11 has confirmed a nationwide review of how the Department of Veterans Affairs handles TBI benefits exams is underway, examining the use of unqualified doctors and the testing issues raised in the Gatlin case.
While KARE 11's previous reports questioned the qualifications of individual doctors to perform initial TBI exams, the Gatlin's case in Montana raises broader questions about one of the tests the VA is using across the country.
"No one is getting a fair shake," said Twin Cities based attorney Ben Krause. Krause represented the Gatlins in their fight with the VA over TBI disability benefits.
"The VA is failing veterans across the country by not properly addressing what TBI is and how it affects people on a day to day basis," Krause said. "And they're doing that just to save a buck."
Krause claims the VA is using simple tests - like RBANS - because they're quick and inexpensive, even though the Montana board found that the RBANS training manual itself indicates "mild impairments cannot be detected."
VA defends its evaluations
In spite of that finding, the VA has refused to abide by the Montana Board of Psychologists ruling. It says state rules don't apply to federal facilities.
What's more, the VA is continuing to defend its use of the RBANS test for TBI Compensation and Pension evaluations.
In a letter to Senator Jon Tester (D-MT) the VA's Undersecretary for Health wrote, "The RBANS test is widely used and was an appropriate test for Dr. Bateen to utilize."
KARE 11 questioned the doctors from the Montana Board of Psychology about the VA's position.
Dr. George Watson and Dr. Stuart Hall from the Montana
Lagoe: ""The VA said that what Dr. Bateen did was consistent with VA protocol. What does that statement tell you?"
Dr. Stuart Hall: "It tells me that the VA protocol is not appropriate for all patients that are coming through for C&P evaluations with TBI issues."
Armed with the state board's findings, Captain Gatlin once again appealed his case within the VA. He recently learned that his TBI benefits are being fully reinstated.
In spite of the VA's reversal in Gatlin's case, the agency has refused to re-evaluate the cases of other veterans who were denied benefits based on the RBANS testing.
"At the very least, a records review is owed to the other 8,999 veterans who were seen by Dr. Bateen," argues Gatlin's wife Ariana Del Negro.