Shrinksflation (aka “Shrink’s-flation and Shrinks-flation) is not to be confused with the generic term shrinkflation, though it could be considered a specific form of shrinkflation. “Shrink’s-flation” is a term coined by psychologist Dr. Todd Finnerty in 2026. It can be written however is most amusing or convenient to the writer at any given time. Shrinks-flation is a term applied to VA disability mental health C&P exams, especially contract disability exams. It describes the impact over time of poorer and poorer quality contract C&P psychologists and psychiatrists and lower quality and shorter examinations from these contract examiners over time. The reimbursement for contract exams has not even come close to keeping pace with inflation over the years, so the quality and experience of the C&P examiners recruited has grown poorer over time. Meanwhile, contract examiners have also started using poor pay as an excuse to do poor quality work. So DBQ’s that were once a standard way of reporting a psychological evaluation to the VA have become 3-sentence postcards from these contract “shrinks” with no resemblance to a psychological evaluation that would actually meet the standards of our field.
Used in a sentence: The “Shrink’s-flation” from these contract examiners is maddening; Dr. Finnerty’s free consultation call lasted longer than my entire C&P exam.”
A Survey about your experience at your VA C&P exam(s) for mental health conditions
Dr. Finnerty will soon be conducting a survey related to Veterans’ experiences with mental health related C&P VA disability exams.
A note from Dr. Todd Finnerty:
I have been a licensed psychologist since 2003 and have had experience working with various disability programs since 2004. I have developed significant expertise in evaluating functional impairment. I also have extensive training related to VA disability claims as I was a C&P examiner for both VES and QTC in the past. I have since done extensive work with Veterans’ attorneys and Veterans themselves. I have had the same amount of training or more training than the third-party contractors used by the VA. I also spent 19 years as an in-house consultant helping to make decisions on Social Security disability claims for the state of Ohio and also helping to train their adjudicators. In this role I was named the 2012 “Disability Review Physician of the Year” by the National Association of Disability Examiners, Great Lakes Region and the 2010 “Consultant of the Year” by the Ohio Association of Disability Examiners.
I am a forensic specialist, and I adhere to the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct as well as the APA’s Specialty Guidelines for Forensic Psychology (https://www.apa.org/practice/guidelines/forensic-psychology). These guidelines include the responsibilities of integrity, impartiality and fairness and note: “When offering expert opinions to be relied upon by a decision maker, providing forensic therapeutic services, or teaching or conducting research, forensic practitioners strive for accuracy, impartiality, fairness, and independence. Forensic practitioners recognize the adversarial nature of the legal system and strive to treat all participants and weigh all data, opinions, and rival hypotheses impartially. When conducting forensic examinations, forensic practitioners strive to be unbiased and impartial, and avoid partisan presentation of unrepresentative, incomplete, or inaccurate evidence that might mislead finders of fact. This guideline does not preclude forceful presentation of the data and reasoning upon which a conclusion or professional product is based.”
While it would be convenient if Veterans in need of first or second opinions on mental health related claims could seek them from treatment providers at the VA, VA policy outlined in VHA Directive 1134(2) Provision of Medical Statements and Completion of Forms by VA Health Care Providers recommends that VA mental health treatment providers not complete forms such as “mental health DBQ’s” in order to “maintain the integrity of the patient-provider relationship.” This is also consistent with the ethics in our field, which maintain that treatment providers should avoid multiple relationships such as could be involved in providing independent forensic opinions (given that the treatment provider’s relationship with the patient could introduce potential bias and also negatively impact the treatment relationship and course of treatment). Therefore, both the VA and Veterans must sometimes seek forensic specialists outside of a treatment relationship to provide opinions related to their case.
If a Veteran disagrees with a poorly performed C&P examination or inadequate and inconsistent medical opinion they have the option of consulting independent forensic practitioners. An ethical forensic practitioner is not simply a hired gun with a cash register and a copy-and-pasted template. For example, given my years of experience, extensive history with Veterans and their attorneys, and the fact that I write a blog on my website NexusLetters.com, I have more referrals than I can handle. There is no need for me to accept a case without merit (and there is no incentive for a Veteran to pay me for an opinion I won’t give them). Interestingly, I offer the option of free consultation calls to all Veterans who wish to have me review their case. Veterans often tell me that I spent longer with them on my free consultation call than the C&P examiner did in their entire examination (and that is before I even perform the psychological evaluation in cases where I perform a psychological evaluation). My psychological evaluations also are in line with the standard in our field whereas many C&P exams do not meet the standards for a forensic disability exam. Based on the data, this is particularly true of contract exams.
As you are likely aware, per the VA’s own OIG “some of the exams produced by vendors have not met contractual accuracy requirements. As a result, claims processors may have used inaccurate or insufficient medical evidence to decide veterans’ claims.“ The OIG found that the contractors QTC, VES and LHI “failed to consistently provide VBA with the accurate exams required by the contracts.” The OIG notes that “ALL THREE VENDORS HAVE BEEN BELOW THE CONTRACT’S 92% ACCURACY REQUIREMENT SINCE AT LEAST 2017.” Most errors– including a significant number that “had the potential to affect claims decisions–” aren’t corrected before the claims processors decided the claims per the OIG [See: https://www.va.gov/oig/publications/report-summary.asp?id=5152].
The VA’s own researchers have also identified contract exams as being plagued with errors. The VA researchers noted “there are several possible explanations for the observed deficiencies in contract exams, including lack of supervision, more limited access to VA treatment records, and inadequate training and experience. An additional explanation is that, unlike exams by salaried VA staff, contractors are paid a flat fee for each exam which is a small fraction of the typical fees paid for forensic psychological evaluation in the community. Thus, there is a financial incentive to complete exams quickly, which would preclude careful record review, psychological testing, and detailed report preparation.” The authors go on to suggest that “anecdotally, it is not uncommon for veterans seen by contractors needing to be reexamined, at times with requests for second and even third opinions to resolve “conflicting medical evidence” after a contract examiner rendered an opinion that contradicted those in the veteran’s records or in previous C&P exams. Inefficiencies resulting from poor exams increase the workload for both examiners and VBA personnel and increase the costs for VA C&P operations overall” [see Meisler, A. W., & Gianoli, M. O. (2022). The Department of Veterans Affairs disability examination program for PTSD: Critical analysis and strategies for remediation. Psychology, Public Policy, and Law].
A history of C&P exams
C&P exams for mental health conditions weren’t always 3-sentence postcards. They weren’t always brief exams where the contract examiner says hello and goodbye seemingly in the same sentence. It is time to get back to having C&P disability exams that meet the standards in the field. In the meantime, good professionals like Dr. Finnerty are available to help when contract exams go bad. You can get a free consultation with Dr. Finnerty now: https://nexusletters.com/free-consultation/