Dr. Messler received her Bachelors degree from Cornell University in 2000, graduating at the top of her class with the award of highest distinction in all subjects. She went on to work in research at the Massachusetts General Hospital – Harvard Medical School and at Duke University Medical Center for several years. Following receipt of her masters degree, she received her PhD in clinical psychology from Arizona State University in 2009, where her work was recognized and independently funded by the National Institutes of Health (individual National Research Service Award). During her training, Dr. Messler first-authored a number of publications in peer-reviewed outlets and has presented her research nationally. Her clinical training occurred at the Mayo Clinic and the Medical University of South Carolina/VA Charleston (SC). She subsequently completed a 2-year postdoctoral fellowship in Neuropsychology on the brain injury rehabilitation unit at the VA Northern California Healthcare System, with her neurology didactics training at the University of California, Davis Medical School.
Previously Dr. Messler was the primary clinical supervisor and neuropsychologist for the Polytrauma system of care at VA Puget Sound (Seattle and Tacoma Dept of Veterans Affairs), where she served as Faculty in the training program and as Polytrauma clinical supervisor for fellows and interns rotating through the VA Puget Sound system.
She went on to serve as an active duty Lieutenant in the US Navy from 2012-2015 and was responsible for neuropsychological assessment, cognitive rehabilitation, and psychotherapy provided during Operation Enduring Freedom in Southwest Afghanistan, from 2013-2014. She received the Navy and Marine Corps Achievement Award for her service there.
Dr. Messler served as expert consultant and expert witness to both US Marine Corps Trial Counsel and Defense in cases involving questions of mental responsibility, traumatic brain injury, and posttraumatic stress disorder. She has extensive experience in working with US Marines involved with the military and civilian court and legal systems. While stateside she also performed over 100 fitness for duty evaluations for individuals selected for the USMC Embassy Security Guard program in Quantico, VA. She performed neuropsychological evaluations for individuals seeking clearance to serve on flight crews, using Naval Aeromedical Medical Institute guidelines, generally comparable to FAA guidelines. She performed neuropsychological assessment, psychodiagnostic assessment and psychotherapy for Marines and Sailors, and established the first continuously running neuropsychological assessment clinic at the Tri-Command in Beaufort, SC.
With extensive experience serving as part of multidisciplinary rehabilitation teams, she maintains active psychologist licensure in North Carolina (License # 4746) and California (License # PSY 23702). She is board certified in clinical neuropsychology through the American Board of Professional Psychology and is a Diplomate and full member of the American Academy of Clinical Neuropsychology.
Dr. Messler is a subject matter expert in the assessment and rehabilitation of traumatic brain injury. She authored the traumatic brain injury fact sheets for providers, survivors, and family members available on the Association for Behavioral and Cognitive Therapies (ABCT) website (http://www.abct.org). Her major areas of expertise include assessment of neurobehavioral and cognitive problems related to TBI, dementia, stroke, epilepsy, and other neurologic syndromes. She has expertise in predicting and maximizing functioning in return to work, school, and home/community activities of daily living. She also maintains interest in Christian counseling and is grateful to God for the skills, opportunity, and passion to perform this work.
Dr. Messler is board certified in clinical neuropsychology through the American Academy of Clinical Neuropsychology. It is important to consider selection of a professional who is board certified in clinical neuropsychology for your evaluation. The American Academy of Clinical Neuropsychology is the preeminent boarding organization for neuropsychologists that supports continued maintenance of standards in Clinical Neuropsychology through a rigorous, peer-reviewed, board certification process. Please see http://www.theaacn.org/default.aspx for further details.
Neuropsychological assessment is a valuable clinical tool that provides unique information about diagnosis, prognosis, and clinical management for nearly all cognitive and psychiatric symptoms and disorders as well as many medical conditions. Indications for neuropsychological assessment include a history of a medical or neurological disorder that compromises cognitive or behavioral functioning. Neuropsychological assessment is not limited to patients who have evidence of structural brain damage, and clinicians need not have a specific diagnosis in mind when ordering an assessment. Sometimes we want to understand a decline in functioning over time or track responses to intervention. There are 2 papers that are especially pertinent in discussing the value of clinical neuropsychology and I would be happy to summarize the findings and content for you.
1) Braun et al. (2011). Neuropsychological Assessment: A Valuable Tool in the Diagnosis and Management of Neurological, Neurodevelopmental, Medical, and Psychiatric Disorders. Cognitive and Behavioral Neurology, 24(3), 107-114.
2) Kniele, K., et al. 2013). Hospital service utilization is reduced following neuropsychological evaluation in a sample of U.S. Veterans. The Clinical Neuropsychologist, 27, 750-761.
An independent medical examination (IME) for brain injury is a type of evaluation frequently performed by a neuropsychologist who is not already involved in your care. A neuropsychologist is a licensed psychologist who has had additional training (often a postdoctoral fellowship and additional credentials) in order to understand the relationship between brain functioning and behavior. Disorders of and injuries to the brain can affect behavior and cognitive functioning (for example, attention, memory, and speed of your thinking).
The purpose of the independent medical evaluation for brain injury is to identify whether a claimed condition is work-related, and, if so, whether permanent impairment resulted from the injury that will now affect gainful employment. Diagnosis, prognosis, and recommendations are provided. The evaluation can also determine whether the individual has reached maximum benefit from treatment. A worker’s compensation insurance carrier has a legal right to request this evaluation. Also, an attorney, on behalf of an individual or an insurance company, might contact a neuropsychologist to determine if a claimed brain injury from an auto accident led to brain damage that decreased that person’s functioning.
If an independent medical examination for brain injury determines that your medical condition is not work-related, the insurer can deny the claim and refuse payment. Results are forwarded to the referral source (could be the insurance company disability insurance carrier, workers compensation organization) and are not given to you the claimant directly by the neuropsychologist performing the evaluation.
The independent medical examination that is completed by a neuropsychologist documents the cognitive and behavioral impact, if any, of brain injury. The neuropsychologist will ask you about your medical history and will ask you to participate in cognitive or neuropsychological testing. Tests may ask you to remember things or put puzzles together. Tests are used to assess your thinking skills or day to day functioning. Tests look at the brain’s abilities. Very few people get every question correct on every test, and it is important to understand that your performance is not viewed as a “pass/fail” experience as in school. The purpose of the tests is rather to understand how your brain functions.
Tips on participating in an independent medical examination for brain injury are provided:
- There is nothing you need to study or prepare before your neuropsychological evaluation. The examiner is trying to get a sense of what you are able to do now, so there is no need to learn any new information or practice new skills.
- Obtain plenty of rest the night before.
- Bring a snack or money to purchase lunch. The exam could take a full day with the tests.
- Bring medical records that are related to the claimed condition unless otherwise instructed not to.
- Bring glasses or hearing amplification to the appointment.
- Try to relax on the day of the evaluation. Participating in an independent medical evaluation is not necessarily a bad thing. Try your best on the evaluation. Do not attempt to exaggerate symptoms, and be honest. Remember that that is the best anyone can do under these circumstances. Do not take the lack of feedback or the exam process personally.
- The examination process can be tiring. Some people feel frustrated or upset if they feel they do not know all the answers, but some people say the tests are interesting.
- Remember that the examining doctor has an ethical obligation to perform an objective evaluation and is not your treating doctor. At the same time, the examiner is not a “hired gun” for the insurance company and has ethical obligations to both the retaining party and the examinee. In their training, neuropsychologists are cautioned to guard against bias and to strive to interpret neuropsychological functioning objectively.
A forensic neuropsychologist conducts neuropsychological evaluations that are intended for consumption by the legal system. The forensic neuropsychologist is hired to make an independent determination regarding neuropsychological functioning, often following brain injury. Generally, one goal of a forensic neuropsychological assessment is to determine if changes have occurred in the claimant’s attention, memory, language, problem solving, or other thinking skills. The same would be asked of behavior or personality changes.
The terminology “independent medical evaluation” or “independent neuropsychological evaluation” are used in personal injury cases.
In civil litigation, a forensic neuropsychologist can answer questions about residual symptoms, causality, prognosis, diagnosis, medical necessity of treatment, disability status, and functioning in legal cases. For example, an attorney, on behalf of an individual or an insurance company, might contact a neuropsychologist to determine if the claimant’s brain injury from a motor vehicle accident led to brain damage that decreased his or her functioning. It is common when someone is an accident, is injured, and sees physicians for evaluation and treatment, that the insurance carrier, workers compensation board, or attorney representing the plaintiff or defense will also request an examination by an expert forensic neuropsychologist.
A forensic neuropsychologist can also comment on criminal responsibility and competency to stand trial. For example, a criminal court may need to know whether a defendant was not mentally responsible at the time that person was accused of committing the crime or can meaningfully participate in court proceedings involving him or her, due to a brain injury. More commonly, in my experience, is the influence of the neuropsychological evaluation on sentencing and mitigation.
The forensic neuropsychologist has an important role in the courtroom and forensic neuropsychologists have been providing important contributions to landmark personal injury and criminal cases for a number of years. The scientific basis for our work (e.g., neuropsychological tests) is well accepted and utilized in the courtroom.
People participate in neuropsychological assessment for many different reasons. Some people are referred by their physicians or attorneys to get more information about a problem they have described with their memory or attention, or to find out how a medical or psychological problem may be affecting their brain functioning. You can be referred for a neuropsychological evaluation after being involved in a car accident, fall, or work-related injury to determine whether there is residual injury to brain functioning. Your attorney or workers compensation company will arrange the appointment in that case. Adults sometimes seek assessments to see whether they have undiagnosed learning disabilities and/or ADHD. People of all ages can benefit from an assessment after there has been a change in brain health, such as a stroke, traumatic brain injury, or dementia. Neuropsychological assessment can help with diagnosis and can provide key information about a person’s strengths and weaknesses, ability to complete daily tasks and maintain independence, and treatment needs/recommendations.
Only a neuropsychologist (who has a Ph.D.) can accurately diagnose cognitive dysfunction through comprehensive, objective, and valid testing. We directly address any loss of function. Our expertise is in cognitive testing, and we provide accurate and verifiable information regarding a plaintiff’s cognitive skills. We provide testimony regarding cognitive functioning. Since many individuals achieve remarkable recovery after neurologic injury, the magnitude of the initial injury is only one part of an evaluation, with the most significant part in forensic cases being documentation of residual function.
While a neuropsychologist is not a physician, physicians are not trained to objectively measure cognitive dysfunction to the extent that the neuropsychologist is. In many court cases or personal injury claims, what is at issue is not only the nature of the initial brain injury, but whether the person who has experienced a brain injury has any loss in cognitive functioning from the alleged brain injury. Rather than relying only on self-report, neuropsychologists rely on established diagnostic algorithms, including detailed review of records and testing. The neuropsychologist also looks at published algorithms for determining the presence of a neurologic event or psychological disorder. The neuropsychologist is not to be an advocate for a particular side of the case but rather to bring to bear what the objective literature and data show on understanding the case.
Dr. Ana Messler is a clinical neuropsychologist, a specialty that documents whether there are cognitive, emotional, behavioral, and personality changes as a result of neurologic injury such as traumatic brain injury, and/or other factors (such as psychiatric). The neuropsychologist determines strengths and weaknesses in cognitive functioning, whether there is disability, treatment needs, and potential for future employability. Clinical neuropsychology is a specialty within clinical psychology that is devoted to the analysis of brain-behavior relationships. The neuropsychologist’s area of expertise is in objectively measuring cognitive dysfunction and documents loss in (or maintenance of) cognitive dysfunction.