or vasrd. the rating schedule for mental disorders is called the "general rating formula for mental disorders" (38 c.f.r. § 4.130), which specifies criteria for disability ratings of 0%, 10%, 30%, 50%, 70%, or 100%. some argue that by relying on the current rating formula, "va uses decades-old regulations developed for mental disorders that do not resemble ptsd", and consequently, "rrelevant criteria ... may outweigh ... more relevant factors, leading va to undercompensate veterans with valid diagnoses of ptsd." similarly, veterans service organizations have argued, for example, that a "... veteran service connected for schizophrenia and another veteran service connected for another psychiatric disorder should not be evaluated using the same general formula" and have supported efforts to revise the rating formula. concern has been expressed by some rsvrs (vba "raters" who adjudicate claims) that automated software discourages their use of independent judgment to evaluate the claim as a whole, a charge senior va officials reject. in 2012 the general accountability office reported that "va's modifications of the medical information in the disability criteria have been slow and have not fully incorporated advances in technology and medicine. moreover, the rating schedule has not been adjusted since its creation in 1945 to reflect ongoing changes in the labor market." on february 15, 2022 the department of veterans affairs (va) proposed to substantially change their disability rating schedule regarding mental disorders, including revising the general rating formula for mental disorders. this "proposed rule", part of the executive branch's rulemaking process, will not become law until after va reviews public comments, makes revisions, and publishes a "final rule". claims for an increased disability rating a veteran currently receiving compensation for service-connected ptsd may file a claim for an increase in his or her disability rating if ptsd symptom severity and related functional impairment has worsened. individual unemployability under certain conditions, veterans receiving service-connected disability compensation for ptsd may file a claim for individual unemployability. if the vba concludes that ptsd, either alone or in combination with other service-connected disabilities, would make it "... impossible for the average person to follow a substantially gainful occupation...", the veteran will receive disability compensation at the 100% rate, even though their schedular rating is less than 100%. ptsd c&p exam as noted above, the vba almost always requires a compensation and pension examination (c&p exam), also known as a "va claim exam", for veterans claiming service-connected ptsd. c&p exams are forensic mental health evaluations. there are two types of ptsd c&p exams: initial and review. the initial ptsd exam must be conducted by a va psychologist or psychiatrist certified by the vha office of disability and medical assessment (dma) to evaluate veterans for this purpose. the definition of "va psychologist or psychiatrist" includes psychologists and psychiatrists in the private sector who conduct c&p exams for a medical disability evaluation (mde) company under contract with the vba. the companies with current vba contracts are logistics health, inc. (lhi); veterans evaluation services (ves); vet fed; and qtc (qtc in turn contracts with magellan health to manage their network of providers). the review ptsd exam may be completed by va or non-va psychologists and psychiatrists. clinical or counseling psychology interns, psychiatric residents, licensed clinical social workers, nurse practitioners, physician assistants, and clinical nurse specialists may also conduct review ptsd exams, although they must be "closely supervised" by a psychologist or psychiatrist. presumption of competence in most federal legal proceedings a psychologist or psychiatrist must demonstrate that they are competent to testify as an expert witness by satisfying standards specified in the federal rules of evidence, particularly rule 702, "testimony by expert witnesses" (fre 702). however, va medical examiners are presumed competent to provide expert witness testimony without having to meet fre 702 standards. concerns about reliability researchers, current and former va psychologists, investigative journalists, and individual veterans have expressed concerns about the inter-rater reliability and validity of c&p exams for ptsd. for example: some current or former va psychologists assert that va medical centers do not allocate enough time for c&p psychologists and psychiatrists to conduct a thorough, evidence-based assessment, with less time presumably reducing the reliability and validity of the results. research has demonstrated marked regional variance with regard to the proportion of veteran claimants who receive va disability compensation for ptsd. a survey of c&p examiners (psychologists) revealed that 85% "never" or "rarely" used the clinician-administered ptsd scale (caps), for ptsd compensation and pension exams, even though a va best practice manual recommends its use during c&p exams, and research has shown that using the caps improves ptsd c&p exam reliability and validity. four possible outcomes of a psychological evaluation, including false positive and false negative conclusions. evaluation conclusion actual (true) condition evaluee has the claimed mental disorder evaluee does not have the claimed mental disorder evaluee has the claimed mental disorder true positive false positive evaluee does not have the claimed mental disorder false negative true negative an empirical study published in 2017 suggested c&p examiner racial bias might have led to an increased rate of false negative conclusions (regarding ptsd diagnosis and service connection) for black veterans, and a high rate of false positive conclusions for white veterans. this finding corresponds with past research, subsequent research, and legal scholarship discussing the potential for implicit racial biases on the part of mental health clinicians in general, and c&p psychologists and psychiatrists in particular. some va facilities prohibit examiners from using symptom validity tests to screen or assess for malingering and other forms of dissimulation. several researchers have published empirical studies in peer-reviewed scholarly journals pointing to significant rates of both false positive and false negative ptsd c&p exam conclusions. social scientists conducted independent ptsd assessments of veterans who had filed disability benefits claims for ptsd, some of whom had been awarded service-connected compensation for ptsd and some had not. the study found significant rates of both false positive and false negative vba adjudicative decisions. although vba adjudicators rely on other sources of evidence, in addition to c&p exam results, vba almost always requests a c&p exam for ptsd claims, and c&p exam results significantly influence vba determinations. individual combat veterans, newspaper articles and editorials, assert that a sizable percentage of veterans filing ptsd disability claims exaggerate or feign ptsd symptoms. disability benefits questionnaire mental health professionals document the results of initial and review ptsd c&p exams on a disability benefits questionnaire (dbq). va developed disability benefit questionnaires (dbqs) to streamline the vba ratings process and thereby complete the claims process faster. in addition, veterans may ask their treating clinicians to complete a dbq and possibly bypass the need for a c&p exam. however, it is important to note that the va discourages their mental health clinicians from completing dbqs for their patients. some authors have expressed concern that the dbq symptom list (for example, section vii on the review ptsd dbq) contains a series of signs, symptoms, and descriptions of functional impairment without any guidance regarding when these items should be endorsed. the veterans benefits administration (vba) discontinued publicly available dbqs in april 2020, explaining that the lengthy approval process for publicly available government forms often meant dbqs contained outdated information. in addition, vba indicated that in recent years "... a growing industry of individuals and companies marketing the service of completing dbqs for veterans ... engaged in questionable, even fraudulent, practices ...." vba's decision to remove publicly available dbqs came in the wake of a va office of inspector general report that recommended the action. however, the u.s. congress negated va's decision, passing a law in december 2020 requiring the agency to post the dbqs on the va website. notes claims that were appealed before august 4, 2014 would still use dsm-iv ptsd diagnostic criteria. see 79 fed. reg. 45093 at 45094 ("the secretary does not intend for the provisions of this interim final rule to apply to claims that have been certified for appeal to the board of veterans' appeals or are pending before the board of veterans' appeals, the united states court of appeals for veterans claims, or the united states court of appeals for the federal circuit.") the cna report cited herein describes the "parity ratio" as: "a ratio of exactly 1 would be perfect parity, indicating that the earnings of disabled veterans, plus their va compensation, gives them the same lifetime earnings as their peers. a ratio of less than one would mean that the service-disabled veterans receive less than their peers on average, while a ratio of greater than one would mean that they receive more than their peers." the abbreviation "vso" stands for veterans service organization or veterans service officer. note that the general rating formula for mental disorders, and its associated percentages, are unrelated to the concept of "parity ratio" mentioned earlier in the article. the term "parity ratio" is used by economists generally and in the economic study of veterans receiving compensation for ptsd discussed in the effectiveness section of this article. while important for policy-makers to consider, the rating formula is not based on parity ratio as determined in that research.