Towards Balanced VA and SSA Policies in Psychological Injury Disability Assessment

Abstract

The area of forensic disability and related assessments requires comprehensive assessments that are scientifically-informed and impartial. This is especially true for disability assessments at public institutions that have millions of disability recipients, such as the Veteran Affairs (VA) and the Social Security Administration (SSA). However, the official policies at these institutions generally preclude this type of comprehensive assessment, and this might be part of their resulting reason for the disability epidemics, for example, concerning posttraumatic stress disorder (PTSD). This paper first examines these policies, and then discusses the literature in support of a more balanced approach in disability assessments, including determination of malingering. With respect to testing, the paper scrutinizes the recent research for the tests that are reliable and valid in this assessment context, especially for performance validity tests (PVTs, e.g., the Test of Memory Malingering (TOMM; Tombaugh, 1996)) and tests with scales for detecting negative response bias (symptom validity tests, SVTs, e.g., the Minnesota Multiphasic Personality Inventory, Second Edition, Restructured Form (MMPI-2-RF; Ben-Porath and Tellegen, 2008/2011)). The paper reviews the literature regarding how to combine tests in systems aimed at detecting malingering (e.g., Larrabee, 2012, Arch Clin Neuropsychol 29:364–373, 2014; Young, 2014a, Psychol Inj Law 8:169–183, 2015b), while reviewing recent research that disputes the value of certain algorithms used in the field (e.g., Odland et al., Psychol Inj Law 8:46–63, 2015). As for ethics, the paper refers to, among others, the position statement of the Association for Scientific Advancement in Psychological Injury and Law (ASAPIL) (Bush et al., Psychol Inj Law 7:197–205, 2014; Young, Psychol Inj Law 7:206–235, 2014b) on the importance of screening for malingering in these types of evaluations using PVTs and SVTs. The Institute of Medicine (2015) book on this topic is consistent with the present approach, and it is referred to throughout. Conclusions deal briefly with diagnosis and treatment, and they present a model regarding evaluation issues of intention, deception, malingering, and other problematic presentations and performances.