VAOIG Inspection of Temple, Texas VA

Healthcare Inspection Allegations of Mental Health Diagnosis Irregularities at the Olin E. Teague VA Medical Center Temple, Texas 01/30/09. OIG reviewed allegations regarding a March 20, 2008, e-mail written by a staff psychologist of the Central Texas VA Healthcare System (CTVAHCS). This e-mail to colleagues was obtained by local and national media; it was widely disseminated and was the subject of a June 4, 2008, Senate Veterans’ Affairs Committee hearing. The e-mail was broadly interpreted as advocating that for veterans being seen by the post-traumatic stress disorder (PTSD) Clinical Team (PCT), a diagnosis of “adjustment disorder” be made over other psychiatric diagnoses, particularly PTSD. The e-mail also raised related issues regarding VA’s diagnosis, treatment, and compensation of veterans with mental health conditions such as PTSD. The e-mail message which prompted this review was an interoffice communication to clinic staff. Our interviews with all recipients of the message revealed no consistent perception that inappropriate diagnoses should be rendered. The e-mail was written on the author’s initiative, without direct or indirect instruction from local, regional, or national VA leadership. PCT clinic patient encounters were coded as adjustment disorders at similar rates before and after the e-mail message. For both PCT clinic and compensation and pension examination diagnoses and service-connection determinations, we observed no pattern in temporal relation to the e-mail. There was no discernible change in the appropriateness of diagnoses occurring before and after the e-mail. We made no recommendations. VAOIG