**STAFFING**

**1. REASON FOR ISSUE:** To revise Department of Veterans Affairs (VA)
qualification standards for 21 VA occupations filled under 38 U.S.C. §
7401(3).

**2. SUMMARY OF CONTENTS/MAJOR CHANGES:** These changes are necessary
for full conversion of these occupations from the Title 5 competitive
service employment system into VA's Title 38 Hybrid excepted service
employment system. Authority is given to the Secretary of the VA under
38 U.S.C. § 7402 to prescribe qualifications for occupations identified
in 38 U.S.C. § 7401(3). The pages in this revision are to be inserted at
the corresponding page numbers in part II of VA Handbook 5005. These
changes will be incorporated into the electronic version of VA Handbook
5005 that is maintained on the [Office of Human Resources Management and
Labor Relations Web site](http://vaww.va.gov/ohrm). Significant changes
for each qualification include:

a\. Coverage section added that provides a brief description of the
occupation.

b\. Standard language and sections added (basic requirements,
grandfathering clauses,

deviations, etc.).

c\. Description of creditable experience included in the grade
requirements.

d\. Description of typical assignments and knowledge, skills, abilities,
and other competencies included at each grade level.

**3. RESPONSIBLE OFFICE:** The Recruitment and Placement Policy Service
(059), Office of the Deputy Assistant Secretary for Human Resources
Management and Labor Relations.

**4. RELATED DIRECTIVE:** VA Directive 5005, Staffing.

**5. RESCISSIONS:** None.

**CERTIFIED BY: BY DIRECTION OF THE SECRETARY**

**OF VETERANS AFFAIRS**

/s/Robert N. McFarland /s/R. Allen Pittman

Assistant Secretary for Assistant Secretary for

Information and Technology Human Resources and Administration

ELECTRONIC DISTRIBUTION ONLY

**CONTENTS-CONTINUED**

# PARAGRAPH PAGE

**APPENDICES-Continued**

II-G14. [OCCUPATIONAL THERAPIST QUALIFICATION STANDARD](#AppIIG14)
II-G14-1

II-G15. [LICENSED PHARMACIST QUALIFICATION STANDARD](#AppIIG15) II-G15-1

II-G16 [DOCTOR OF CHIROPRACTIC QUALIFICATIONS STANDARD](#AppIIG16)
II-G16-1

II-G17 [DEVELOPMENT OF QUALIFICATION STANDARDS FOR
VETERANS](http://vaww.va.gov/ohrm/)

[HEALTH ADMINISTRATION (VHA) POSITIONS FILLED
UNDER](http://vaww.va.gov/ohrm/)

[38 U.S.C. **§** 7401(3)](http://vaww.va.gov/ohrm/) II-G17-1

\[II-G18 [PSYCHOLOGIST](#PartIIAppG18) II-G18-1

II-G19 [NUCLEAR MEDICINE TECHNOLOGIST](#PartIIAppG19) II-G19-1

II-G20 [DIETITIAN](#PartIIAppG20) II-G20-1

II-G21 [KINESIOTHERAPIST](#PartIIAppG21) II-G21-1

II-G22 [OCCUPATIONAL THERAPY ASSISTANT](#PartIIAppG22) II-G22-1

II-G23 [PHYSICAL THERAPY ASSISTANT](#PartIIAppG23) II-G23-1

II-G24 [MEDICAL TECHNOLOGIST](#PartIIAppG24) II-G24-1

II-G25 [DIAGNOSTIC RADIOLOGIC TECHNOLOGIST](#PartIIAppG25) II-G25-1

II-G26 [THERAPEUTIC RADIOLOGIC TECHNOLOGIST](#PartIIAppG26) II-G26-1

II-G27 [MEDICAL INSTRUMENT TECHNICIAN](#PartIIAppG27) II-G27-1

II-G28 [PHARMACY TECHNICIAN](#PartIIAppG28) II-G28-1

II-G29 [AUDIOLOGIST](#PartIIAppG29) II-G29-1

II-G30 [SPEECH LANGUAGE PATHOLOGIST](#PartIIAppG30) II-G30-1

II-G31 [AUDIOLOGIST/SPEECH LANGUAGE PATHOLOGIST](#PartIIAppG31) II-G31-1

II-G32 [ORTHOTIST-PROSTHETIST](#PartIIAppG32) II-G32-1

II-G33 [MEDICAL RECORD ADMINISTRATOR](#PartIIAppG33) II-G33-1

II-G34 [PROSTHETIC REPRESENTATIVE](#PartIIAppG34) II-G34-1

II-G35 [MEDICAL RECORD TECHNICIAN](#PartIIAppG35) II-G35-1

II-G36 [DENTAL ASSISTANT](#PartIIAppG36) II-G36-1

II-G37 [DENTAL HYGIENIST](#PartIIAppG37) II-G37-1

II-G38 [BIOMEDICAL ENGINEER](#PartIIAppG38) II-G38-1\]

II-H. [APPOINTMENT PROCEDURES BY OCCUPATION/ASSIGNMENT](#AppIIH1)

II-H1. [PROCEDURES FOR APPOINTING PHYSICIANS TO SERVICE CHIEF](#AppIIH1)

[AND COMPARABLE POSITIONS](#AppIIH1) II-H1-1

II-H2. [PROCEDURES FOR APPOINTING DENTISTS AND EFDAS](#AppIIH2) II-H2-1

II-H3. [PROCEDURES FOR APPOINTING PODIATRISTS](#AppIIH3) II-H3-1

II-H4. [PROCEDURES FOR APPOINTING OPTOMETRISTS](#AppIIH4) II-H4-1

II-H5. [RECRUITMENT, APPOINTMENT, ADVANCEMENT, CHANGE IN](#AppIIH5)

[ASSIGNMENT AND REASSIGNMENT OF REGISTERED NURSES (RNs)](#AppIIH5)

[IN GRADES IV AND V](#AppIIH5) II-H5-1

II-H6. [PROCEDURES FOR APPOINTING NURSE ANESTHETISTS TO](#AppIIH6)

[SECTION CHIEF POSITIONS](#AppIIH6) II-H6-1

II-H7. [PROCEDURES FOR APPOINTING PHYSICIAN ASSISTANTS AT](#AppIIH7)

[CHIEF GRADE](#AppIIH7) II-H7-1

**CONTENTS-CONTINUED**

# PARAGRAPH PAGE

**APPENDICES-Continued**

II-H8. [PROCEDURES FOR APPOINTING CHIEFS OF PHARMACY SERVICE](#AppIIH8)

[(ALL GRADES), CLINICAL PHARMACY/PHARMACY SPECIALISTS,](#AppIIH8)

[AND PROGRAM SPECIALISTS AT GRADES GS-13 AND ABOVE](#AppIIH8) II-H8-1

II-H9. [PROCEDURES FOR APPOINTING OCCUPATIONAL AND PHYSICAL](#AppIIH9)

[THERAPISTS AS SECTION CHIEF](#AppIIH9) II-H9-1

II-H10 [PROCEDURES FOR APPOINTING DOCTORS OF CHIROPRACTIC](#AppIIH10)
II-H10-1

II-I. [ENGLISH LANGUAGE PROFICIENCY](#AppIIi) II-I-1

II-J. [REQUESTS FOR APPROVAL TO PETITION THE UNITED STATES
DEPARTMENT](#AppIIJ)

[OF STATE (DOS) FOR SUPPORT OF A WAIVER OF THE 2-YEAR HOME](#AppIIJ)

[RESIDENCE REQUIREMENT OF THE UNITED STATES EXCHANGE VISITOR](#AppIIJ)

[PROGRAM](#AppIIJ) II-J-1

II-K. [RCVL (RESIDENT/TRAINEE CREDENTIALS VERIFICATION LETTER)](#AppIIK)
II-K-1

II-L. [CREDENTIALING CHECKLIST](#AppIIL) II-L-1

II-M. [SAMPLE CONSULTANT CERTIFICATE](#AppIIM) II-M-1

II-N. [CAREER INTERN PROGRAM](#AppIIN) II-N-1

II-O. [ORGANIZATIONAL LOCATION OF HYBRID TITLE 38 PROFESSIONAL](#AppIIO)

[STANDARDS BOARDS](#AppIIO) II-O-1

II-P. [PROCEDURES FOR SELECTING HYBRID TITLE 38 PROFESSIONAL
STANDARDS](#AppIIP)

[BOARDS MEMBERS](#AppIIP) II-P-1

II-Q. [PRESIDENTIAL MANAGEMENT FELLOWS PROGRAM](#AppQ) II-Q-1

\*Use in conjunction with the OPM Standard.

[]{#PartIIAppG18 .anchor}\[**APPENDIX G18. PSYCHOLOGIST QUALIFICATION
STANDARD**

**GS-180**

**Veterans Health Administration**

**1. COVERAGE.** The following are requirements for appointment as a
psychologist in the Veterans Health Administration (VHA). Psychologists
engage in professional and scientific work which relates to behavior,
capacities, traits, interests, and emotions. These requirements apply to
all VHA psychologists in the GS-180 series, including those assigned to
VA medical centers, Community-based Outpatient Clinical (CBOCs), Vet
Centers, Veterans Integrated Service Network (VISN) offices, the VHA
National Center for Organizational Development and VHA Central Office.
This work may include any one or a combination of the following:
providing professional clinical services, conducting research, carrying
out education and training activities, clinical consultation,
supervision, and administration.

**2. BASIC REQUIREMENTS.** The basic requirements for employment as a
VHA psychologist are prescribed by: Public Law 96-151 codified in Title
38, U.S.C. § 7402. To qualify for appointment, all applicants for the
position of psychologist in VHA must meet the following:

a\. **Citizenship.** Citizen of the United States. (Non-citizens may be
appointed when it is not possible to recruit qualified citizens in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Education**

\(1\) Have a doctoral degree in psychology from a graduate program in
psychology accredited by the American Psychological Association (APA).
The specialty area of the degree must be consistent with the assignment
for which the applicant is to be employed.

**AND**

\(2\) Have successfully completed a professional psychology internship
training program that has been accredited by APA. Exceptions: (1) new
VHA psychology internship programs that are in the process of applying
for APA accreditation are acceptable in fulfillment of the internship
requirement, provided that such programs were sanctioned by the VHA
Central Office Program Director for Psychology and the VHA Central
Office of Academic Affiliations at the time that the individual was an
intern and (2) VHA facilities who offered full one-year pre-doctoral
internships prior to PL 96-151 (pre-1979) are considered to be
acceptable in fulfillment of the internship requirement.

\(c\) **Licensure.** Hold a full, current, and unrestricted license to
practice psychology at the doctoral level in a State, Territory,
Commonwealth of the United States (e.g., Puerto Rico), or the District
of Columbia.

**Exception.** The Secretary may waive the requirement of licensure for
an individual psychologist for a period not to exceed 2 years from the
date of employment on the condition that such a psychologist provide
care only under the supervision of a psychologist who is so licensed.
Non-licensed psychologists who otherwise meet the eligibility
requirements may be given a temporary appointment as

a graduate psychologist under the authority of 38 U.S.C. § 7405 (a) (1)
(D). Failure to obtain licensure

during that period is justification for termination of the temporary
appointment. This may result in termination of employment.

\(d\) **Loss of Credential.** An employee in this occupation who fails
to obtain licensure/certification/

registration within the required time frame, or who fails to maintain
the required licensure/certification/

registration must be removed from the occupation, which may also result
in termination of employment.

For occupations which [require]{.underline} an active credential
(licensure/certification/registration) at all grade levels, at the
discretion of the appointing official, an employee may be reassigned to
another occupation for which he/she qualifies [if]{.underline} a
placement opportunity exists.  For occupations which require an active
credential (licensure/certification/registration) in assignments above
the full-performance level [only]{.underline}, at the discretion of the
appointing official, an employee may remain at an appropriate lower
grade level in the occupation when both of the following apply:  the
credential is not a requirement [and]{.underline} a placement
opportunity exists."

\(e\) **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 Hybrid qualification standards.
Some of these provisions may not apply to this occupation. Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may

be reassigned, promoted, or demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be

reassigned, promoted up to and including the full performance (journey)
level, or demoted within the occupation, but [may not]{.underline} be
promoted beyond the journey level or placed in supervisory or managerial
positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher

grade levels must meet the licensure/certification/registration
requirement before they can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

\(f\) **Physical Requirements.** See VA Directive and Handbook 5019.

\(g\) **English Language Proficiency:** Psychologists must be proficient
in spoken and written English in accordance with chapter 2, section D,
paragraph 5a, this part.

**3. GRADE REQUIREMENTS**

a\. **Definitions**

\(1\) **Creditable Experience**

\(a\) **Current Professional Psychology Practice.** To be creditable,
the experience must be post-doctoral degree and must have required the
use of knowledge, skills, abilities, and other characteristics
associated with current professional psychology practice. Creditable
post-doctoral degree experience can be obtained through employment as a
psychologist or through participating in a supervised post-doctoral
psychology training program. This may be evidenced by one or both of the
following:

[1.]{.underline} Active professional practice. Active professional
practice means paid/non-paid employment as a professional psychologist.

[2.]{.underline} A full, current, and unrestricted license.

\(b\) **Quality of Experience.** Experience is only creditable if it is
post-doctoral degree experience as a professional psychologist directly
related to the duties to be performed. Qualifying experience must also
be at a level comparable to professional psychology experience at the
next lower level.

\(c\) **Part-time Experience.** Part-time experience is creditable
according to its relationship to a full-time workweek. For example, a
psychologist employed 20 hours per week, or on a ½ time basis, would
receive 1 full-time workweek of credit for each 2 weeks of service.

\(2\) **Post-Doctoral Degree Fellowships.** Post-doctoral degree
fellowships are training programs in an advanced area of clinical
practice. Training as a fellow may substitute for creditable experience
on a year-for-year basis.

b\. **Grade Determinations.** In addition to the basic requirements for
employment, the following criteria must be met when determining the
grade of candidates:

\(1\) **GS-11**

\(a\) **Experience.** None beyond the basic requirements.

\(b\) **Assignment.** Staff psychologists at this level diagnose mental
disorders, conduct psychological and/or neuropsychological assessments,
treat mental disorders through a variety of modalities, and provide
adjunctive interventions for treatment of medical disorders. They
practice under the close supervision of a licensed psychologist.

\(2\) **GS-12**

\(a\) **Experience.** In addition to the basic requirements at the GS-11
level, at least 1 year of experience as a professional psychologist
equivalent to the next lower grade level. Individuals assigned as GS-12
psychologists may be in the process of obtaining licensure at the
independent practice level. If unlicensed, the individual must be
supervised by a licensed psychologist and the experience and supervision
must meet the standards for psychology licensure. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Knowledge of, and ability to apply, a wide range of
professional psychological theories and assessment methods to a variety
of patient populations.

[2.]{.underline} Ability to develop coherent treatment strategies.

[3.]{.underline} Ability to incorporate new clinical procedures.

\(c\) **Assignment.** At the GS-12 level, unlicensed psychologists
practice under the supervision of a licensed psychologist, but with less
need for consultation than at the GS-11 grade level. They may be
assigned to any program area.

\(3\) **GS-13**

\(a\) **Licensure.** Hold a full, current, and unrestricted license to
practice psychology at the doctoral level in a State, Territory,
Commonwealth of the United States (e.g., Puerto Rico), or the District
of Columbia.

\(b\) **Experience.** In addition to the experience requirements at the
GS-12 level, at least 1 additional year of experience as a psychologist
equivalent to the next lower grade level. In addition the candidate must
demonstrate the following KSAs**:**

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of, and ability to apply, advanced
professional psychological theories and techniques to the full range of
patient populations.

[2]{.underline}. Ability to provide professional advice and consultation
in areas related to professional psychology and behavioral health.

[3]{.underline}. Knowledge of clinical research literature.

[4]{.underline}. For supervisory assignments

[a]{.underline}. Ability to provide supervision in areas related to
behavioral health and social services provision in order to accomplish
the organizational goals and objectives.

[b]{.underline}. Ability to provide fair, principled and decisive
leadership for a work environment that promotes shared accountability.

\(d\) **Assignments.** This is the full performance level for staff
psychologists. At this level psychologists are licensed at the doctoral
level to practice independently in the provision of psychological
services consulting with peers and supervisors as appropriate. They are
assigned to any VHA program and setting, including inpatient or
outpatient medicine, surgery, mental health, neurology, rehabilitation
medicine, geriatrics, Vet Centers, and the VHA National Center for
Organizational Development.

[1.]{.underline} **Staff Psychologists** diagnose mental disorders,
conduct psychological and/or neuropsychological assessments, treat
mental disorders through a variety of modalities and provide adjunctive
interventions for treatment of medical disorders. Among the modalities
provided are individual, family, and group psychotherapies, and other
interventions such as biofeedback, psychological hypnosis, and
environmental interventions. They consult with medical center staff on a
wide variety of patient care issues. Staff psychologists may be involved
in program evaluation and/or research activities.

[2**.**]{.underline} **Supervisory Psychologists.** At this level
supervisory psychologists typically have collateral supervisory duties
primarily for non-professional staff, although a small number of
professional staff may be supervised as well (i.e., less than three).
Supervisory psychologists at this level may be assigned to any program
area and may be involved in program evaluation and/or research
activities. At this level, supervisory psychologists independently
provide psychological services at all levels of complexity and consult
with peers and supervisors as appropriate.

\(4\) **GS-14**

\(a\) **Licensure.** Hold a full, current, and unrestricted license to
practice psychology at the doctoral level in a State, Territory,
Commonwealth of the United States (e.g., Puerto Rico), or the District
of Columbia.

\(b\) **Experience.** At least 1 year of professional psychologist
experience equivalent to the next lower grade level, and must fully meet
the KSAs for that level. In addition, the candidate must demonstrate the
following professional KSAs and demonstrate the potential to acquire the
assignment specific KSAs designated by an asterisk (\*):

\(c\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Psychology Program Manager.** Psychologist program
managers have broad program management responsibilities which include
the operation and management of key clinical, training, or
administrative programs. The size of the medical center, program
managed, and scope of responsibility are grade determining. Examples
include (but are not limited to) managers of addiction, post traumatic
stress disorder (PTSD), mental health intensive case management (MHICM),
partial hospitalization, residential rehabilitation, domiciliary,
palliative care, neuropsychology, and internship and post-doctoral
fellowship training programs; psychology program oversight and
coordination as a psychology executive; and program oversight and
coordination as Associate Chief of Staff (ACOS) for Education, ACOS for
Research, etc.

Responsibilities include development and implementation of programs,
policies, and procedures; oversight of administrative and programmatic
resources; and monitoring of outcomes using a data-driven quality
assurance process. Decisions made affect staff and other resources
associated with the programs managed and are made while exercising wide
latitude and independent judgment. Such programs deliver specialized,
complex, highly professional services that are important program
components of the medical center and significantly impact the health
care provided to veterans.

Psychologist program managers that serve as psychology executives have
full responsibility for oversight of the professional practice of
psychology to ensure the highest quality of psychological care provided
to veterans throughout the facility and its affiliated clinics. This
responsibility also includes ensuring that all psychologists in the
facility and its affiliated clinics meet the requirements of this
qualification standard.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Ability to organize work, set priorities, delegate
tasks, and meet multiple deadlines

\*([2]{.underline}) Skill in managing and directing the work of others
to accomplish program goals and objectives, and ability to devise ways
to adapt work operations to new and changing programs, staffing, and
budget requirements, etc.

\*([3]{.underline}) Ability to translate management goals and objectives
into well-coordinated and controlled work operations.

\*([4]{.underline}) Ability to establish and monitor production and
performance priorities and standards.

([5]{.underline}) Knowledge of, and ability to appropriately utilize,
evidence based practices and clinical practice guidelines and ability to
guide staff in using these tools.

([6]{.underline}) Ability to deal effectively with individuals or groups
representing widely divergent backgrounds, interests, and points of
view.

\*([7]{.underline}) Ability to analyze organizational and operational
problems and to develop and implement solutions that result in sound
operation of the program.

[2]{.underline}. **Psychologist Clinician Investigator.** Psychologist
clinician investigators are actively involved as principal investigators
or co-principal investigators in peer-reviewed VA, National Institutes
of Health (NIH), or comparably rigorous intramural or extramurally
funded research programs. Responsibilities include peer review
activities for VA and non-VA research, e.g., grant review for VA or NIH
proposals, local research service committees and/or boards, such as
Research and Development (R&D) Service, Health Services Research and
Development (HSR&D) Service, or Institutional Review Board (IRB), and
service as a consulting editor for peer-reviewed journals.

Psychologist clinician investigators have achieved significant
professional recognition by making scientific contributions to research
projects with potential for substantial impact. In addition to active
involvement in peer-reviewed research and other peer review activities
as noted above, this recognition must be demonstrated by attainment of
at least 3 of the following: multiple publications in peer-reviewed
professional literature; a consistent record of presentation of findings
at national scientific meetings; attainment of an academic appointment
at the affiliated medical school or local university, usually at the
rank of associate professor or equivalent; and responsibility for
multiple funded research projects.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of, and ability to apply, appropriate
scientific methods in the design and execution of basic and applied
research.

\*([2]{.underline}) Ability to coordinate work across multiple settings.

\*([3]{.underline}) Ability to convey scientific concepts and
methodological principles to individuals with diverse levels of
technical expertise

[3]{.underline}. **Supervisory Psychologist.** Individuals designated as
supervisory psychologists have supervisory responsibility for
subordinates. Supervisory psychologists also have line and staff
authority for resource allocations within the area of responsibility and
ensure the efficient operation of the organizational unit. Examples of
assignments in this category include (but are not limited to) chief of
psychology, chief of a patient care service line, or department or
division director. Responsibilities include supervision of staff,
professional management, and administrative responsibilities that are
complex in scope and that constitute a significant component of the
medical center. Decisions are made exercising wide latitude and
independent judgment.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Ability to effectively supervise and manage
subordinate employees.

\*([2]{.underline}) Skill in assessing qualifications and abilities of
current and prospective employees.

\*([3]{.underline}) Ability to develop productivity standards
appropriate to each service provided and each venue.

([4]{.underline}) Skill in interpersonal relationships, including
conflict resolution.

([5]{.underline}) Ability to deal effectively with individuals or groups
representing widely divergent backgrounds, interests, and points of
view.

\*([6]{.underline}) Skill in working collaboratively with other
disciplines and supervisors.

[4]{.underline}. **Psychologist Leadership Positions at the VISN or
National Level Assignments.** Leadership positions at the VISN or
national level are characterized by their scope, level of complexity,
significant impact on VHA mission, significant importance to the VISN,
etc. Examples of such assignments include (but are not limited to): VISN
liaison for mental health, associate chief of service at the national
level, associate program manager at the VISN or national level, etc.

GS-14 psychologist leadership positions direct a mental health,
behavioral science, other patient care program component at the VISN or
national level or direct organizational development at the national
level. Leadership positions at the VISN or national level are graded at
the GS-14 level when the duties and responsibilities are such that they
are of substantial importance to the overall functioning of the VISN or
national program. Duties are exercised with wide latitude, autonomy, and
independence. The administrative or technical work is of substantial
difficulty and responsibilities are significant. Individuals at this
level have delegated authority to determine long range work plans and
assure that implementation of the goals and objectives is carried out.
They may serve as consultants to other management officials in the
field, VISN, or national level. Incumbents typically report to managers
of the overall program at the next higher level of supervision.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of, and ability to understand and
communicate, existing policies and regulations.

\*([2]{.underline}) Ability to provide information about VISN or
national policy to a wide variety of audiences in a useable and
understandable manner.

\*([3]{.underline}) Ability to develop and recommend new or revised
policies that are consistent with organizational goals and objectives.

([4]{.underline}) Knowledge of, and ability to utilize, resource
materials as well as ability to develop new materials when needed.

([5]{.underline}) Ability to relate to individuals at many different
levels both within and external to the organization.

([6]{.underline}) Ability to communicate effectively orally and in
writing with a diverse group of professional staff.

**NOTE:** Some psychologists (generally those who are GS-14 program
managers and supervisory psychologists) are assigned duties and
responsibilities at the VISN or national level that are at a higher
level of technical and administrative complexity than their
facility-level responsibilities. In these cases, the higher level duties
must be of significant scope and complexity, and must be of critical
importance to

the VISN or national program. If such higher-level assignments comprise
25 percent or more of the individual's overall duties and
responsibilities, these assignments would be grade controlling at the
higher, i.e., GS-15, level.

\(5\) **GS-15**

\(a\) **Licensure.** Hold a full, current, and unrestricted license to
practice psychology at the doctoral level in a State, Territory,
Commonwealth of the United States (e.g., Puerto Rico), or the District
of Columbia.

\(b\) **Experience.** At least 1 year of professional psychologist
experience equivalent to the next lower grade level, and must fully meet
the KSAs for that level. In addition, the candidate must demonstrate the
following professional KSAs and demonstrate the potential to acquire the
assignment specific KSAs designated by an asterisk (\*).

\(c\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Senior Program Manager.** Senior psychologist program
managers have very broad responsibility for multiple programs or have
responsibility for a large service organization that is of considerable
scope, size, and complexity. Examples of positions are similar to those
listed under the GS-14 program manager heading, but at the GS-15 level,
the size, scope, significance and impact are greater. GS-15 senior
psychologist program managers have oversight for programs that have 10
or more professional staff.

Responsibilities include development of short and long range goals and
plans; development and implementation of policies and procedures to
ensure that plans are carried out and goals are met; administrative and
programmatic resource management; and monitoring outcomes using a
data-driven quality assurance process. Decisions made affect staff and
other resources associated with the programs managed and are made
exercising very wide latitude and independent judgment. The programs
managed are substantial program components that deliver specialized,
complex, highly professional

services and significantly impact the health care provided to veterans.

Senior psychologist program managers have full responsibility for
oversight of the professional practice of psychology in large medical
centers, generally with many psychologists, and ensure the highest
quality of psychological care provided to veterans throughout the
facility and its affiliated clinics. This

responsibility includes ensuring that all psychologists in the facility
and its affiliated clinics meet the requirements of this qualification
standard.

[a.]{.underline} **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Skill in managing and directing the work of large,
complex organizational units and in applying effective management
practices.

\*([2]{.underline}) Ability to balance responsibilities in a complex
environment and to work with great autonomy; ability to set priorities
and delegate tasks, meet multiple deadlines, analyze complex
organizational problems; and ability to develop and implement effective
solutions for those problems.

([3]{.underline}) Skill in persuasion, negotiation, and motivation to
negotiate multiple program policies.

([4]{.underline}) Skill in interpersonal relationships in dealing with
employees and other managers using advanced consultation and problem
solving skills.

\*([5]{.underline}) Ability to assess need for basic and complex
services across multiple programmatic patient care venues.

\*([6]{.underline}) Ability to coordinate the efforts of multiple
program elements across a complex system.

([7]{.underline}) Skill in the application and analysis of measurement
tools to systems issues.

[2]{.underline}. **Senior Psychologist Clinician Investigator.** Senior
psychologist clinician investigators perform assignments at the highest
level of investigative independence involving complex research programs
and/or multi-site/center trials. Responsibilities include active
involvement as principal investigators for peer reviewed VA, NIH, or
comparably rigorous intramural or extramurally funded research programs,
high-level peer review activities for VA and non-VA research (e.g.,
membership on standing scientific review panels for VA or NIH
proposals), and service as editor or associate editor of major
peer-reviewed journals, service on scientific advisory boards (R&D,
HSR&D, NIH, etc.).

Senior psychologist clinician investigators have achieved significant
national professional recognition for research excellence and major
scientific contributions. In addition to high level involvement in
peer-reviewed research and other peer review activities, this
recognition must be demonstrated by attainment of at least 4 the
following: an extensive publication record in the nationally recognized
peer-reviewed professional literature; a consistent record of
presentation of findings at national scientific meetings; recognition by
VA or NIH as a senior career scientist, e.g. Senior Research Career
Scientist; an academic appointment at the affiliated medical school or
local university at the rank of Full Professor or equivalent; and full
responsibility for direction of a complex, multi-program clinical
service or multiply funded research projects.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Ability to balance responsibilities in an extremely
complex environment and to work with great autonomy.

\*([2]{.underline}) Ability to independently create, organize, manage,
and maintain high quality research programs.

\*([3]{.underline}) Knowledge of budget control procedures that includes
funding from multiple sources and may vary annually.

[3]{.underline}. **Senior Supervisory Psychologist.** Senior supervisory
psychologists have supervisory responsibility for subordinates and are
responsible for all professional, management, and administrative

aspects of the service or organizational entity. Examples of positions
are similar to those listed under the GS-14 supervisory psychologist
heading, but at the GS-15 grade level, the size, scope, significance,
and impact are greater.

Supervision and resource management involve major decisions, and work
activities and supervision significantly impact the ability of staff to
provide comprehensive services to veterans. The service or
organizational entity is a major component of the medical center and the
services or programs supervised are highly professional, technical, and
complex. Responsibilities include oversight of a large, complex
organization, always with 10 or more professional staff, that
encompasses several component parts integral to the functioning of the
medical center, or alternatively, 1 large service or organization.
Decisions are made with very wide latitude and independent judgment.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Ability to effectively supervise and manage a large
group of professional staff.

\*([2]{.underline}) Ability to correctly assess qualifications and
potential of current and prospective employees.

\*([3]{.underline}) Ability to develop appropriate productivity
standards for professional staff, often across multiple program lines.

([4]{.underline}) Skill in interpersonal relationships including
conflict resolution and ability to work collaboratively with supervisors
from other units.

\*([5]{.underline}) Knowledge of the goals and objectives of the medical
center and VISN and ability to communicate these to subordinates.

[4]{.underline}. **Psychologist Leadership Positions at the VISN or
National Level.** Senior leadership positions at the VISN or national
level are characterized by their size, scope, and high level of
complexity; have significant impact on the VHA mission; and are of
significant importance to the VISN, etc. Examples of positions may be
similar to those listed under the GS-14 Leadership positions heading;
but, at the GS-15 grade level, the individual would have full
responsibility for the program or programs and the size, scope,
significance, and impact of the program(s) are greater. Psychologists at
this level generally provide overall leadership, guidance, and direction
for the VISN or national program or programs.

Directs a large, complex mental health, behavioral science, or other
patient care program at the VISN or national level or may have
responsibility for several programs at the VISN or national level. This
level would include the Director of a national organizational
development program. Psychologists in senior leadership positions at the
VISN or national level will be graded at the GS-15 level when the duties
and

responsibilities exert a major and significant impact on the overall
functioning of the organizational entity, i.e., the impact is VISN or
VHA-wide. Duties are performed with wide latitude, exercising
independent judgment and full, delegated autonomy. Responsibilities
include overall planning, direction, and execution of the area of
responsibility. The administrative or technical work is of exceptional
difficulty and responsibility and consultation is provided to high level
officials at the field, VISN, or national level.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

\(1\) Knowledge of, and ability to effectively communicate, existing
policies and regulations.

\*(2) Ability to develop and recommend new or revised policies that are
consistent with organizational goals and objectives.

\*(3) Skill in leading senior management officials in policy
development.

\*(4) Ability to influence high level officials in adoption of, and
conformance to, performance measures, monitors, and other policy
guidelines.

\(5\) Knowledge of, and ability to utilize, resource materials and to
develop new materials when needed.

\(6\) Ability to communicate effectively orally and in writing with a
diverse group of professional staff and management officials who are
often at the highest management levels.

**NOTE:** Although examples of titles are offered in each section
throughout this Standard, there is little standardization of titles, or
duties associated with those titles, across VHA and psychologists hold
leadership responsibilities that are known by a wide variety of titles
within their individual facility, VISN, or national program. Such titles
are to be considered as subsumed within one of the assignments described
provided that the responsibilities meet the corresponding grade
determining criteria.

### 4. DEVIATIONS

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for
psychologists in VHA whose composite record of accomplishments,
performance, and qualifications, as well as current assignments,
warrants such action based on demonstrated competence to meet the
requirements of the proposed grade.

b\. Under no circumstances will the educational or licensure
requirements be waived.

c\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**

[]{#PartIIAppG19 .anchor}**APPENDIX G19. NUCLEAR MEDICINE TECHNOLOGIST**

**QUALIFICATION STANDARD**

**GS-601**

**Veterans Health Administration**

**1. COVERAGE.** The following are requirements for appointment as a
nuclear medicine technologist in the Veterans Health Administration
(VHA). Nuclear medicine technologists (NMTs) perform a wide variety of
functional studies of organs and/or systems involving static and dynamic
imaging procedures, the injection of radionuclides and
radiopharmaceuticals, and the use of such specialized equipment as
integrated computer/imaging systems, single photon emission tomography,
etc., in combination with a variety of radioimmunoassay (in vitro)
laboratory procedures on biological specimens. The work requires a
professional knowledge of the field of nuclear medicine technology and
those aspects of chemistry, physics, mathematics, and the biomedical
sciences that relate to nuclear medicine.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Be a citizen of the United States. (Non-citizens
may be appointed when it is not possible to recruit qualified citizens
in accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Certification.** All applicants must be certified in nuclear
medicine technology by the Nuclear Medicine Technology Certification
Board (NMTCB) or American Registry of Radiologic Technology (ARRT).
NMTCB or ARRT (N) certification eligibility requirements are normally
satisfied by one of the following: graduation from an educational
program in nuclear medicine technology accredited by the Committee on
Allied Health Education and Accreditation; or national certification as
a registered medical technologist or registered radiologic technologist;
or a bachelor's or associate's degree in one of the physical or
biological sciences, and 4 years of clinical NMT experience.

**NOTE:** Candidates who have obtained NMTCB or ARRT certification in
nuclear medicine through methods other than those listed above meet
minimum requirements for GS-5.

c\. **Exceptions.** Non-certified applicants who otherwise meet the
eligibility requirements for NMTCB or ARRT (N) certification may be
given a temporary appointment as a graduate NMT under the authority of
38 U.S.C. § 7405 (a) (1) (D). Failure to obtain certification during
that period is justification for termination of the temporary
appointment. This may result in termination of employment.

d\. **Loss of Credential.** An employee in this occupation who fails to
obtain licensure/certification/registration within the required time
frame, or who fails to maintain the required
licensure/certification/registration must be removed from the
occupation, which may also result in termination of employment.

For occupations which require an active credential
(licensure/certification/registration) at all grade levels, at the
discretion of the appointing official, an employee may be reassigned to
another occupation for which he/she qualifies if a placement opportunity
exists.  For occupations which require an active credential
(licensure/certification/registration) in assignments above the
full-performance level only, at

the discretion of the appointing official, an employee may remain at an
appropriate lower grade level in the occupation when both of the
following apply:  the credential is not a requirement and a placement
opportunity exists."

[]{.mark}

e\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 hybrid qualification standards.
Some of these provisions may not apply to this occupation. Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

f\. All persons employed in VHA in this occupation on the effective date
of this qualification standard are considered to have met all
qualification requirements for the title, series and grade held,
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

\(1\) Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

\(2\) Such employees in an occupation that requires a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but may not be promoted beyond the journey level or
placed in supervisory or managerial positions.

\(3\) Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to those higher grade levels.

g\. Employees who are appointed on a temporary basis prior to the
effective date of the qualification standard may not have their
temporary appointment extended or be reappointed, on a temporary or
permanent basis, until they fully meet the basic requirements of the
standard.

h\. Employees initially grandfathered into this occupation, who
subsequently obtain additional education and/or
licensure/certification/registration that meet all the basic
requirements of this qualification standard must maintain the required
credentials as a condition of employment in the occupation.

i\. If an employee who was retained in an occupation listed in 38 U.S.C.
§ 7401(3) under this provision leaves that occupation, the employee
loses protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

j\. **Physical Requirements.** See VA Directive and Handbook 5019.

k\. **English Language Proficiency.** Nuclear medicine technologists
must be proficient in spoken and written English in accordance with
chapter 2, section D, paragraph 5a, this part.

**3. GRADE REQUIREMENTS**

a\. **Definitions**

\(1\) **Creditable Experience.** Knowledge of Current Professional
Nuclear Medicine Technology Practices. To be creditable, the experience
must have required the use of knowledge, skills, abilities, and other
characteristics associated with current professional nuclear medicine
technology practice.

\(2\) **Quality of Experience.** Experience is only creditable if it is
earned after passing the NMTCB or ARRT (N) certification exams.
Experience as a graduate NMT is creditable provided the candidate was
utilized as an NMT and subsequently passed the certification
examination.

\(3\) **Part-Time Experience.** Part-time experience as a NMT is
creditable according to its relationship to full-time workweek. For
example, a NMT would receive 1 week of full-time credit for each 2 weeks
of half-time work.

b\. **Grade Determinations.** In addition to the basic requirements for
employment, the following criteria must be met when determining the
grade of candidates.

\(1\) **GS-5**

\(a\) **Experience or Education.** None beyond the basic requirements.
Reference basic requirements in paragraph 2.b. above. Candidates must
demonstrate the following:

\(b\) **Demonstrated Knowledge, Skills and Abilities**

[1]{.underline}. Knowledge of common nuclear medicine procedures and
techniques.

[2]{.underline}. Knowledge of the various diseases such as coronary
artery disease, cancer, and thyroid disease.

[3]{.underline}. Knowledge of routinely used radiopharmaceuticals for
imaging.

[4]{.underline}. Knowledge of radiation safety related to the general
public, patient, and radiation worker.

\(c\) **Assignments.** Candidates at this grade level serve as staff
NMTs. It is expected that they receive guidance from more experienced
staff members for more complex patients and require daily direct
supervision.

\(2\) **GS-7**

[]{.mark}

\(a\) **Experience.** Certification as described in the basic
requirements in paragraph 2.b. above, or completion of 1 year experience
equivalent to the next lower grade level directly related to the
position to be filled, i.e., experience that demonstrates possession of
the knowledge, skills, abilities, and other characteristics needed to
provide nuclear medicine technology services at that level. In addition,
the candidate must demonstrate the following KSAs:

**OR,**

\(b\) **Advanced Entry Level Placement.** See VA Handbook 5005, Appendix
G.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of Nuclear Regulatory Commission (NRC)
regulations.

[2]{.underline}. Knowledge of the medical sciences such as anatomy,
physiology, chemistry, and physics and how they relate to the
cardiovascular, skeletal, endocrine, respiratory, gastrointestinal, and
genitourinary systems of the human body;

[3]{.underline}. Knowledge of radioactive package types, package
surveys, and radioactive materials record management.

[4]{.underline}. Knowledge of exposure rate calculations.

\(d\) **Assignments.** Candidates at this grade level serve as a staff
NMTs requiring minimal oversight. At this grade, NMTs utilize the proper
methods of receipt, use, storage and disposal of radioactive material;
perform and evaluate basic quality control on all imaging and
non-imaging instrumentation and auxiliary equipment, and provide basic
nursing care, recognizing and responding to emergency conditions.

\(3\) **GS-9**

\(a\) **Experience.** Completion of 1 year of experience equivalent to
the next lower grade level directly related to the position to be
filled, i.e., experience that demonstrates possession of the knowledge,
skills, abilities, and other characteristics needed to provide nuclear
medicine technology services at that level. In addition, the candidate
must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to document excessive radiation exposure in the
working environment.

[2]{.underline}. Knowledge of medical events requiring documentation and
the ability to properly document them and make recommendations to the
Radiation Safety Officer (RSO).

[3]{.underline}. Ability to communicate orally and in writing
post-therapy radiation safety precautions.

[4]{.underline}. Ability to troubleshoot gamma camera and auxiliary
equipment problems.

[5]{.underline}. Ability to analyze computer generated data for
technical quality and artifacts and initiate corrective measures.

\(c\) **Assignments.** Candidates at this grade level serve as staff
NMTs. This is the full performance level for the NMT. It is expected
that they receive guidance from higher-level or supervisory staff
members for only the most complex patients.

\(4\) **GS-11**

\(a\) **Experience.** Completion of 1 year of experience equivalent to
the next lower grade level directly related to the position being
filled, and must fully meet the KSAs at that level. In addition, the
candidate must demonstrate the potential to acquire the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to analyze consequences of improper packaging
of radioactive material and take appropriate actions.

[2]{.underline}. Ability to determine personnel needing personal
monitoring devices, analyze personal monitoring results, and recommend
corrective action, if needed.

[3]{.underline}. Ability to analyze instances of increased radiation
exposure levels and recommend measures to reduce.

[4]{.underline}. Ability to calculate exposure rates.

[5]{.underline}. Ability to properly document excessive radiation
exposure.

[6]{.underline}. Ability to develop new protocols for imaging
procedures.

[7]{.underline}. Skill in motivating and/or mentoring staff, if
supervisory position.

[8]{.underline}. Ability to develop continuing education standards, if
supervisory position.

[9]{.underline}. Skill in responding to any decrease in staffing or
increase in workload involving all parties to restructure work
assignments, if encumbering a supervisory position.

\(c\) **Assignments.** NMTs at this level may be senior-level
practitioners in assigned areas, may be in lead positions, or may be
encumbering a position that is supervisory in nature. For all
assignments above the full performance level, the higher-level duties
must consist of significant scope, complexity (difficulty), and range of
variety, and be performed by the incumbent at least 25% of the time.

\(5\) **GS-12**

\(a\) **Experience.** Completion of 1 year experience equivalent to the
next lower grade level directly related to the position to be filled,
i.e., experience that demonstrates possession of the knowledge, skills,
abilities, and other characteristics needed to provide nuclear medicine
technology and administrative services, and must fully meet the KSAs at
that level. This experience must have provided the candidate with an
in-depth knowledge of common and uncommon nuclear medicine procedures,
in-depth knowledge of radiation

safety practices, and knowledge of staffing levels, financial
management, personnel management, and supply management. In addition,
the candidate must demonstrate the following professional KSAs and
demonstrate the potential to acquire the assignment specific KSAs as
designated by an asterisk (\*):

\(b\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Candidates at this grade level are
to be in one of the following assignments:

[1]{.underline}. **Chief Nuclear Medicine Technologist.** Individuals in
this assignment assume full administrative and professional
responsibility for planning and directing the nuclear medicine program
at a medical center or independent outpatient clinic.

([a]{.underline}) Ability to provide complex nuclear medicine patient
procedures;

\*([b]{.underline}) Ability to develop and initiate new protocols which
apply current research findings;

\*([c]{.underline}) Skill in providing administrative reports to
management orally and in writing.

[2]{.underline}. **Supervisory Nuclear Medicine Technologist.**
Individuals in this assignment assume full administrative and
professional responsibility for planning and directing the nuclear
medicine program at a medical center or independent outpatient clinic.
They also have supervisory responsibility over a program.

\*([a]{.underline}) Ability to assign and evaluate work of subordinate
staff as well as resolve problems that may interfere with the delivery
of nuclear medicine services by staff members;

([b]{.underline}) Skill in providing complex nuclear medicine patient
procedures;

\*([c)]{.underline} Ability to develop and initiate new protocols which
apply to current research findings;

\*([d]{.underline}) Skill in providing administrative reports to
management orally and in writing.

\*([e]{.underline}) Ability to interview candidates for positions in the
section; recommend appointments, advancements, or, when appropriate,
disciplinary actions; evaluate performance; and identify continuing
education and training needs.

**4. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for NMTs
in VHA whose composite record of accomplishments, performance, and
qualifications, as well as current assignments, warrant such action
based on demonstrated competence to meet the requirements of the
proposed grade.

b\. Under no circumstances will the certification requirements be
waived.

c\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**

[]{#PartIIAppG20 .anchor}

**APPENDIX G20. DIETITIAN QUALIFICATION STANDARD**

**GS-630**

**Veterans Health Administration**

**1. COVERAGE.** Following are requirements for appointment as a
dietitian in the Veterans Health Administration (VHA). These
requirements apply to all VHA dietitians in the GS-630 series.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizen of the United States. (Non-citizens may be
appointed when it is not possible to recruit qualified candidates in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Education.** The individual must have earned a minimum of a
bachelor's degree from a U.S. regionally accredited college or
university, and fulfilled each of the following criteria:

\(1\) Completed a didactic program in dietetics accredited by the
Commission on Accreditation for Dietetics Education (CADE).

\(2\) Completed a CADE accredited supervised practice program.

\(3\) Passed a national examination administered by the Commission on
Dietetic Registration (CDR), the credentialing branch of the American
Dietetic Association (ADA).

c\. **Registration**

\(1\) All applicants must be registered with the CDR.

\(2\) Non-registered applicants who otherwise meet the minimum
requirements in the basic qualification standard may be appointed as a
graduate dietitian under the authority of 38 U.S.C. § 7405 (a) (1) (D).
Failure to obtain CDR registration during that period is justification
for termination of the temporary appointment. This may result in
termination of employment.

\(3\) **Loss of Credential.** An employee in this occupation who fails
to obtain licensure/certification/

registration within the required time frame, or who fails to maintain
the required licensure/certification

registration must be removed from the occupation, which may also result
in termination of employment.

For occupations which [require]{.underline} an active credential
(licensure/certification/registration) at all grade levels, at the
discretion of the appointing official, an employee may be reassigned to
another occupation for which he/she qualifies [if]{.underline} a
placement opportunity exists.  For occupations which require an active
credential (licensure/certification/registration) in assignments above
the full-performance level [only]{.underline}, at the discretion of the
appointing official, an employee may remain at an appropriate lower
grade level in the occupation when both of the following apply:  the
credential is not a requirement [and]{.underline} a placement
opportunity exists."

d\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 hybrid qualification standards.
Some of these provisions may not apply to this occupation. Please
carefully review the qualification standard to determine the specific
education and/or licensure/certifi- cation/registration requirements
that apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but [may not]{.underline} be promoted beyond the journey
level or placed in supervisory or managerial positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

e\. **Physical Requirements.** See VA Directive and Handbook 5019.

f\. **English Language Proficiency.** Dietitians must be proficient in
spoken and written English in accordance with chapter 2, section D,
paragraph 5a, this part.

**3. GRADE REQUIREMENTS**

a\. **Definitions**

\(1\) **Creditable Experience**

\(a\) **Knowledge of Current Professional Dietitian Practices**. To be
creditable, the experience must have required the use of knowledge,
skills, abilities, and other characteristics associated with current
professional dietetics practice. This may be evidenced by [one or
more]{.underline} of the following:

[1]{.underline}. The equivalent of 1 year of active professional
practice. Active professional practice means paid/non-paid employment as
a registered dietitian.

[2]{.underline}. Academic course work leading to an advanced graduate
degree in nutrition or a related health care field.

\(b\) **Quality of Experience.** Experience is only creditable if it is
post-registration experience as a registered dietitian directly related
to the position to be filled, i.e., the clinical dietitian must have
relevant clinical nutrition healthcare experience; the food service
system dietitian must have relevant food service system management
experience. Qualifying experience must also be at a level comparable to
dietetic experience at the next lower level.

\(c\) **Part-Time Experience.** Part-time experience as a registered
dietitian is credited according to its relationship to the full-time
workweek. For example, a registered dietitian employed 20 hours per
week, or on a half-time basis, would receive 1 full-time work week of
credit for each 2 weeks of service.

\(2\) **Dietetic Internship Program (Supervised Practice Program)**.
Dietetic internship programs are post-baccalaureate degree programs that
provide supervised practice experiences which meet the eligibility
requirements and accreditation standards of the Commission on
Accreditation for Dietetics Education of the American Dietetic
Association. Completion of a coordinated program in dietetics fulfills
the requirements of a supervised practice program. Time spent in a
dietetic internship or supervised practice program does not qualify as
creditable experience.

\(3\) **Fellowship.** Fellowship programs are typically advanced
training programs of varying length in a specialized area of clinical
practice. Applicants for these programs usually possess a master's
degree.

\(4\) **Residency.** The dietetic residency is an 18-month combined
academic and professional program. The resident, assigned to a VA
medical center, performs dietetic duties including activities relating
to the area in which graduate study is being taken. In addition, the
resident attends graduate classes to satisfy the requirements for a
master's degree in dietetics or an allied field.

b\. **Grade Determinations.** In addition to the basic requirements for
employment, the following criteria must be met when determining the
grade of candidates.

\(1\) **GS-7**

\(a\) **Experience or Education.** None beyond the basic requirements.
In addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to provide nutrition counseling to patients,
family members and/or caregivers considering psycho-social issues and
age appropriate guidelines, and to communicate effectively with other
health care professionals.

[2]{.underline}. Ability to plan and organize work consisting of
multi-tasks and priorities under general supervision.

[3]{.underline}. Basic knowledge of computer operations; software,
hardware, terminology, security requirements, and capabilities.

[4]{.underline}. Ability to synthesize nutritional assessment components
to evaluate nutritional status and utilize principles of medical
nutrition therapy using established practice standards and guidelines to
deliver nutritional care.

[5]{.underline}. Knowledge of basic food production and service which
incorporates principles of sanitation, safety, and menu planning within
a healthcare environment.

[6]{.underline}. Knowledge of educational concepts, methods, training
materials, and resources and the ability to implement existing education
and training activities for Nutrition & Food Service employees.

\(c\) **Assignments.** Employees at this grade are closely supervised
and competency with progressively complex tasks is monitored by
supervisor. Employees at this grade level serve in a career development
position.

\(2\) **GS-9**

\(a\) **Experience or Education.** At least 1 year of experience at the
next lower level that demonstrates the core competencies described at
that level, or education equivalent to 2 full years of progressively
higher level graduate education, or master's or equivalent graduate
degree from an accredited university or college in the field of
dietetics or closely related field. In addition, the candidate must
demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to plan and organize work of considerable
difficulty and responsibility under minimal supervision.

\(c\) **For Clinical Dietitian Positions, the following Knowledge,
Skills, and Abilities must be demonstrated:**

[1]{.underline}. Ability to participate in research and performance
improvement studies.

[2]{.underline}. Knowledge of, and ability to, apply the basic
principles of enteral and parenteral nutrition support.

[3]{.underline}. Knowledge of the principles and practices of clinical
dietetics and medical nutrition therapy in order to plan, develop, and
independently coordinate medical nutrition therapy intervention,
interdisciplinary care plans, and nutrition education activities.

\(d\) **For Food Service Systems Management Dietitian Positions, the
following Knowledge, Skills, and Abilities must be demonstrated:**

[1]{.underline}. Knowledge of various food preparation and delivery
systems.

[2]{.underline}. Ability to conduct studies and document findings to
evaluate staff, food, supplies, equipment, and service in order to
improve the efficiency of the operation.

[3]{.underline}. Knowledge of current food service systems management,
principles, and practices within a healthcare environment.

[4]{.underline}. Knowledge of educational concepts, methods, training
materials, and resources and the ability to develop and conduct
education and training programs for Nutrition & Food Service employees.

\(e\) **Assignments.** Employees at this grade level serve in either
staff clinical or food service systems management dietitian positions.
It is expected that they receive guidance from higher-level or
supervisory staff members. Supervision is close for developmental
assignments and more general in nature for assignments in which the
individual has demonstrated competency.

\(3\) **GS-11**

\(a\) **Experience or Education**. At least 1 year of experience at the
next lower level that demonstrates the core competencies described at
that level, or education equivalent to 3 full years of progressively
higher level graduate education, or a Ph.D. or equivalent doctoral
degree from an accredited university or college in the field of
dietetics or closely related field. In addition, the candidate must
demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of basic investigative processes and
techniques in order to participate in the design of studies, collect
data, interpret findings, and translate results into written and oral
communication.

\(c\) **For Clinical Dietitian Positions, the following Knowledge,
Skills, and Abilities must be demonstrated:**

[1]{.underline}. Knowledge of the principles and practices of clinical
dietetics and medical nutrition therapy for patients with complex
medical conditions in order to plan, develop, and coordinate medical
nutrition therapy intervention, interdisciplinary care plans, and
nutrition education activities.

[2]{.underline}. Knowledge of complex areas of clinical nutrition
including management of critically ill and malnourished patients, and
ability to apply medical nutrition therapy to patients with multiple
co-morbidities.

[3]{.underline}. Ability to act as a mentor/consultant for health care
providers including registered dietitians, dietetic interns, nurses,
physicians, medical students, and allied health professionals.

\(d\) **For Food Service Systems Management Dietitian Positions, the
following Knowledge, Skills, and Abilities must be demonstrated:**

[1]{.underline}. Ability to direct food service and production with
focus on customer acceptance and budgetary guidelines to include
principles of menu planning, food purchasing, delivery schedules, and
ability to estimate food quantities.

[2]{.underline}. Ability to develop and maintain a system of internal
reviews and direct quality control and performance improvement studies
to ensure that programs within the nutrition and food service operate at
the optimum level of effectiveness and assure compliance with various
accrediting, regulatory, and agency authorities.

[3]{.underline}. Knowledge of computer software programs and problem
solving techniques relative to food service systems management.

[4]{.underline}. Knowledge of the principles of management required to
establish program goals and objectives, to plan and administer a
program, coordinate associated activities, evaluate program
accomplishments, redefine priorities, and modify objectives.

\(e\) **For food service systems management supervisory positions,
experience must also demonstrate the:**

[1]{.underline}. Ability to manage/supervise, i.e., plan, organize,
delegate, direct, control, and review activities of groups of
non-professional employees.

[2]{.underline}. Knowledge of the principles of management and staff
development required to establish goals and objectives, control,
coordinate, motivate and evaluate training activities of the department,
administer and monitor activities, evaluate outcomes/accomplishments,
redefine priorities, modify goals/objectives and implement changes in
processes/systems, as needed, in specified area of supervisory control.

[3]{.underline}. Ability to assess competence, evaluate, and monitor the
continuing education needs of non- professional staff.

\(f\) **Assignments.** Employees at this grade level serve as staff
dietitians at the full performance level, and may or may not be in a
food service systems management supervisory position.

\(4\) **GS-12**

\(a\) **Experience.** Completion of 1 year of experience equivalent to
the next lower grade level directly related to the position being
filled, and must fully meet the KSAs at that level. In addition, the
candidate must demonstrate the following technical KSAs and demonstrate
the potential to acquire the assignment specific KSAs designed by an
asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of more complex investigative processes and
techniques in order to direct or participate in the design of studies,
collect data, conduct statistical analysis, interpret findings, and
translate results into written and oral communication.

\*[2]{.underline}. Knowledge of, and ability to, apply quality standards
as specified by regulatory and accrediting organizations.

\*[3]{.underline}. Knowledge of the principles of program management and
oversight required to develop program goals and objectives, administer
and monitor program, coordinate associated activities, evaluate program
outcomes/accomplishments, redefine priorities, modify goals/objectives
and implement changes in processes/systems as needed.

\*[4]{.underline}. Ability to assess competence, evaluate, and monitor
the continuing education needs of professional staff.

[5]{.underline}. Ability to set priorities, delegate tasks, meet
multiple deadlines, analyze organizational problems, and develop and
implement effective solutions.

\*[6]{.underline}. Knowledge of human resources administration,
including such functions as the ability to interview and select
qualified applicants, monitor and evaluate performance, and maintain
effective labor management relations within scope of responsibility.

\*[7]{.underline}. Ability to manage/supervise, i.e., plan, organize,
delegate, direct, control, review activities of groups of professional
subordinates.

\(c\) **In addition to the knowledge, skills, abilities, and other
characteristics described above, the dietetic internship director must
also demonstrate the following:**

[1]{.underline}. Knowledge of, and ability to, design the dietetic
internship curriculum to meet accreditation requirements established by
the accrediting agency of the American Dietetic Association (ADA).

\*[2]{.underline}. Ability to ensure curriculum meets and remains
current with accreditation standards and is compatible with regulations
and procedures for associated health trainees established by the VHA
Office of Academic Affiliations.

[3]{.underline}. In depth knowledge of current practice in food service
systems management, nutrition therapy, community nutrition practice, and
business/entrepreneurial dietetics with the ability to integrate
learning experiences in didactic and practice components of the
internship.

\*[4]{.underline}. Ability to design and implement an evaluation system
to assess clinical competency of dietetic interns.

\*[5]{.underline}. Ability to establish and coordinate practice
experiences at affiliated sites.

\*[6]{.underline}. Ability to provide and coordinate the didactic
component of the internship program.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Registered dietitians at this grade
level are to be in one of the following assignments:

[1]{.underline}. **Clinical Nutrition Manager/Clinical Program
Manager.** A clinical nutrition manager/clinical program manager serves
as a supervisory dietitian with primary responsibility for high-level
professional and management support of clinical nutrition program
activities, or a specialized clinical program. He/she integrates
clinical functions with other sections of the nutrition and food
service, other services and units within the medical center, hospital
and community based clinics, and the local community. In addition to
completion of 1 year of creditable experience comparable to the next
lower grade level which is directly related to the position to be
filled, registered dietitians assigned to these positions must
demonstrate the knowledge, skills, abilities, and other characteristics
necessary to satisfactorily complete the following duties:

[a]{.underline}. The full range of supervisory duties. This includes,
but is not limited to, responsibility for assignment of duties;
development of performance standards and performance evaluations;
recommendations for appointments, awards, advancements, and, when
appropriate, disciplinary actions; and identification of continuing
education and training needs.

[b]{.underline}. Serving as a consultant within the nutrition and food
service and with other facility health care staff in evaluating health
care delivery to patients.

[c]{.underline}. Assessing, planning, and evaluating the clinical
nutrition program to ensure proper coordination between the delivery of
clinical nutrition services and the overall delivery of health care.

[2]{.underline}. **Food Service Systems Manager.** A food service
systems manager serves as a supervisory dietitian or with primary
responsibility for high level professional and management support of
patient meal service, which includes food production and food service
activities that are either self-operated or operated through contractual
agreements. The food service systems manager may interface with a
contractual provider when appropriate and interfaces with the clinical
nutrition program to ensure that services provided reflect the
nutritional needs of the patient. In addition to completion of 1 year of
creditable experience comparable to the next lower grade level directly
related to the position to be filled, registered dietitians assigned to
these positions must demonstrate the knowledge, skills, abilities, and
other characteristics necessary to satisfactorily complete the following
duties:

[a]{.underline}. The full range of supervisory duties. This includes,
but is not limited to, responsibility for assignment of duties;
development of performance standards, and performance evaluations;
recommendations for appointments, awards, advancements, and, when
appropriate, disciplinary actions; and identification of continuing
education and training needs.

[b]{.underline}. Serving as a consultant within the nutrition and food
service and with other facility health care staff in evaluating health
care delivery to patients.

[c]{.underline}. Assessing, planning, and evaluating the food service
systems management program to ensure proper coordination between the
delivery of patient meal service and the overall delivery of health
care.

[d]{.underline}. Ability to develop financial goals, manage a budget and
organize and/or maintain a cost accounting system to forecast
expenditures based on current spending patterns; provide estimates for
planning and adjustments as program and resources change.

[3]{.underline}. **Program Coordinator.** The dietitian program
coordinator provides management, professional, and technical support in
planning, organizing, and coordinating specific aspects of the
nutritional care program for multiple sites, or is responsible for
multiple aspects of the nutritional care and food service program, which
may include, but is not limited to, clinical nutrition management,
quality management coordination, food safety coordination, food service
system computer coordination, or any combination thereof. The dietitian
program coordinator does not have supervisory responsibilities but is
responsible for broad program management. In addition to completion of 1
year of creditable experience comparable to the next lower grade level
directly related to the position to be filled, registered dietitians
assigned to these positions must demonstrate the knowledge, skills,
abilities, and other characteristics necessary to satisfactorily
complete the following duties:

[a]{.underline}. Performs, under general administrative supervision with
wide latitude for the exercise of independent judgment, work of unusual
difficulty and responsibility.

[]{.mark}

[b]{.underline}. Serves as a consultant within the nutrition and food
service and with other facility health care staff in evaluating health
care delivery to patients.

[c]{.underline}. Plans and coordinates activities covering a broad range
of the nutrition and food service programs at individual or multiple
sites.

[4]{.underline}. **Dietetic Internship Director.** A dietetic internship
director has full responsibility for administering all aspects of a
VA-sponsored accredited dietetic internship program which includes the
overall planning, directing, and administering of the accredited
post-baccalaureate degree dietetic internship program at a medical
center, and ensures eligibility requirements and accreditation standards
of the Commission on Accreditation for Dietetics Education of the
American Dietetic Association (CADE) are met. Consistent with CADE
standards, individuals assigned as dietetic internship director must
possess a minimum of a master's degree. In addition to completion of 1
year of creditable experience comparable to the next lower grade level
directly related to the position to be filled, a registered dietitian
assigned to this position must also demonstrate the knowledge, skills,
abilities, and other characteristics necessary to satisfactorily
complete the following duties:

[a]{.underline}. Performs, under general administrative supervision with
wide latitude for the exercise of independent judgment, work of unusual
difficulty and responsibility including the full range of supervisory
duties for a small internship program.

[b]{.underline}. Serves as a consultant within the nutrition and food
service and with other facility health care staff regarding current
nutrition and food service systems management issues, evaluating health
care delivery to patients, and designing nutrition related research
initiatives.

[c]{.underline}. Provides professional and administrative guidance and
supervision to dietetic interns and surveillance of all aspects of the
program. Coordinates and directs the staff dietitians participating in
the clinical and administrative phases of the program.

\(5\) **GS-13**

\(a\) **Experience.** Completion of 1 year of experience equivalent to
the next lower grade level directly related to the position being
filled, and must fully meet the KSAs at that level. In addition, the
candidate must demonstrate the following technical KSAs and demonstrate
the potential to acquire the assignment specific KSAs designed by an
asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of, and skill in applying, the theories and
practices of clinical nutrition and food service systems management
sufficient to resolve complex, controversial, or precedent-setting
matters.

[2]{.underline}. Demonstrated skill in making decisions on problems
presented by subordinate supervisors, team leaders, or other personnel.

[3]{.underline}. Skill and ability to effectively communicate and advise
senior management officials.

\*[4]{.underline}. Ability to evaluate subordinate supervisors or
leaders and serve as the reviewing official on evaluations of
non-supervisory employees rated by subordinate supervisors.

\(c\) **In addition to the knowledge, skills, abilities, and other
characteristics described above, the dietetic internship director must
also demonstrate the following:**

\*[1]{.underline}. Ability to provide and coordinate the didactic
component of the internship program including graduate level course
instruction.

[2]{.underline}. Knowledge of broad functional areas of dietetics,
education, and in-depth knowledge in specialized areas including
research methodology.

\*[3]{.underline}. Ability to provide direction and guidance for all
research projects submitted by dietetic interns to the facility's and/or
affiliated site's Institutional Review Board (IRB).

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Individuals in these assignments
have full responsibility for planning and implementing special programs
characterized by one of the following areas:

[1]{.underline}. **Clinical Nutrition Manager or Food Service Systems
Manager over multiple sites.** A clinical nutrition manager or food
service systems manager serves as a supervisory dietitian with primary
responsibility for high-level professional and management support of
clinical nutrition program, or food service systems activities that
encompass two or more medical center facilities (including consolidated
medical centers), and integrating the clinical or food service system
management functions with the medical centers, with other sections
within the nutrition and food service, other services and units in the
medical center, clinics, and local community. In addition to completion
of 1 year of experience comparable to the next lower grade level,
registered dietitians assigned to these positions must demonstrate the
knowledge, skills, abilities, and other characteristics necessary to
satisfactorily complete the following duties:

[a]{.underline}. The full range of supervisory duties. This includes
responsibility for assignment of duties; development of performance
standards and performance evaluations; recommendations for appointments,
awards, advancements, and, when appropriate, disciplinary actions; and
identification of continuing education and training needs, etc.

[b]{.underline}. Serving as a consultant within the nutrition and food
service and with other facility(s) health care staff in evaluating
health care delivery to patients.

[c]{.underline}. Assessing, planning, and evaluating the clinical
nutrition program or foodservice systems program to ensure proper
coordination between the delivery of clinical nutrition services and the
overall delivery of health care.

[2]{.underline}. **Dietetic Internship Director.** A dietetic internship
director has full responsibility for administering all aspects of a VA
sponsored accredited dietetic internship program which includes the
overall planning, directing, and administering of an accredited
post-baccalaureate degree dietetic internship program at a medical
center affiliated with a university offering graduate credit or a
master's degree. In accordance with national eligibility requirements
and accreditation standards of the Commission on Accreditation for
Dietetics Education of the American Dietetic Association, individuals
assigned as dietetic internship director must possess a minimum of a
master's degree. On occasion, when required by the coordinating
educational institution a doctoral degree may be required. In addition
to completion of 1 year of experience comparable to the next lower grade
level, a registered dietitian assigned to this position must also
demonstrate the knowledge, skills, abilities, and other characteristics
necessary to satisfactorily complete the following duties:

[a]{.underline}. Performs, under broad administrative direction with
wide latitude for independent judgment, work of unusual difficulty and
responsibility requiring extended professional training and experience,
which has demonstrated leadership and marked attainments in the
profession.

[b]{.underline}. The full range of supervisory duties for a medium to
large internship program. This includes responsibility for assignment of
internship duties of professional/non-professional staff and interns,
development of a performance evaluation system, selection or appointment
of dietetic interns, disciplinary actions, and identification of
education and training needs, etc.

[c]{.underline}. Serves as a consultant within the nutrition and food
service and with other facility health care staff regarding current
nutrition and food service systems management issues, evaluating health
care delivery to patients, and designing nutrition related research
initiatives.

[d]{.underline}. Provides professional and administrative guidance and
supervision to dietetic interns and maintains surveillance of all
aspects of the program. Coordinates and directs the staff dietitians
participating in the clinical and administrative phases of the program.

[e]{.underline}. Teaches and/or coordinates graduate level courses
associated with the curriculum.

**4. SERVICE CHIEFS AND ASSISTANT SERVICE CHIEFS**

a\. **Service Chief.** Individuals assigned as service chiefs must have
at least 1 year of creditable experience comparable to the next lower
grade level.  The experience must evidence possession of supervisory and
management skills. Individuals assigned as service chiefs have full
responsibility for managing and supervising all phases of nutrition and
food service operations.

b\. **Assistant Service Chief.** Assignment as an assistant chief is
restricted to those serving as a full assistant to the chief. Assistant
chiefs are to share, with the chief, full responsibility for managing
and supervising all phases of nutrition and food service operations. The
assistant service chief is to be 1 grade less than the appropriate grade
of the chief.

c\. **Grade Levels**

\(1\) **GS-13**

\(a\) **Experience.** Completion of 1 year of experience equivalent to
the next lower grade level directly related to the position being
filled, and must fully meet the KSAs at that level. In addition, the
candidate must demonstrate the following technical KSAs and demonstrate
the potential to acquire the assignment specific KSAs designed by an
asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of clinical nutrition and principles of
medical nutrition therapy sufficient to direct the clinical nutrition
section at multiple sites, and the ability to coordinate clinical
nutrition needs of patients with the administrative section (food
production and service) at multiple medical centers, including
consolidated facilities.

[2]{.underline}. Knowledge of, and ability to, apply appropriate
standards as specified by regulatory and accrediting organizations at
multiple medical centers, including consolidated facilities.

[3]{.underline}. Knowledge of the principles of management required to
establish program goals and objectives, to plan and administer a
program, coordinate associated activities, evaluate program
accomplishments, redefine priorities, and modify objectives at multiple
medical centers, including consolidated facilities.

\*[4]{.underline}. Ability to manage/supervise, i.e., plan, organize,
delegate, direct, control, and review the activities of groups of
subordinates that have diverse functions at multiple medical centers,
including consolidated facilities.

\*[5]{.underline}. Ability to assess the clinical competence, and
evaluate and monitor the continuing education needs of professional
staff at multiple medical centers, including consolidated facilities.

\*[6]{.underline}. Ability to act as a mentor/consultant for health care
providers including registered dietitians, dietetic interns, nurses,
physicians, and allied health professionals at multiple medical centers,
including consolidated facilities.

\(c\) **Assignments.** Employees at this level typically serve as an
assistant chief for the nutrition and food service at a large facility,
or a service chief at a small to mid-size facility. For all assignments
above the full performance level, the higher-level duties must consist
of significant scope, complexity (difficulty), and range of variety, and
be performed by the incumbent at least 25% of the time.

\(2\) **GS-14**

\(a\) **Experience.** Completion of 1 year of experience equivalent to
the next lower grade level directly related to the position being
filled, and must fully meet the KSAs at that level. In addition, the
candidate must demonstrate the following technical KSAs and demonstrate
the potential to acquire the assignment specific KSAs designed by an
asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to perform, under administrative direction,
with wide latitude for the exercise of independent judgment, work of
unusual difficulty and responsibility.

[2]{.underline}. Ability to plan and coordinate activities covering a
broad range of nutrition and other programs involving multiple
departments and/or facilities.

\*[3]{.underline}. Ability to serve as a recognized expert to provide
authoritative advice and coordination of nutrition care programs that
may encompass multiple medical centers, including consolidated
facilities or departments.

\(c\) **Assignments.** Employees at this level typically serve as the
Chiefs of Nutrition and Food Support Service at VA medical centers that
are in the highest complexity level category for VHA facilities, and
which are affiliated, tertiary care facility/health care systems with
comprehensive research programs.  The Chief is a member of the
senior leadership team providing advice for inclusion in integrated care
programs for veterans with multiple diagnoses, ages, and other needs;
and management planning to achieve medical center, VISN, and national
goals. The Chief of Nutrition and Food Support is the highest level
professional position within the organization for the management and
direction of the nutrition and food support program and services. For
all assignments above the full performance level, the higher-level
duties must consist of significant scope, complexity (difficulty), and
range of variety, and be performed by the incumbent at least 25% of the
time.

**5. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for
dietitians in VHA whose composite record of accomplishments,
performance, and qualifications, as well as current assignments, warrant
such action based on demonstrated competence to meet the requirements of
the proposed grade.

b\. Under no circumstances will the educational or registration
requirements be waived.

c\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**

[]{#PartIIAppG21 .anchor}**APPENDIX G21. KINESIOTHERAPIST QUALIFICATION
STANDARD**

**GS-635**

**Veterans Health Administration**

**1.** **COVERAGE.** This standard applies to all kinesiotherapist (KT)
positions in the Veterans Health Administration (VHA). The work requires
the application of knowledge of the concepts, principles, and practices
of kinesiotherapy and the use of therapeutic corrective exercises to
maintain or improve the general state of health of patients by
preventing muscular deterioration, conserving and increasing strength,
maintaining function, and retaining mobility. Kinesiotherapists evaluate
the history of patients by interviews, tests, and measurements and use
such findings and the therapy orders of physicians to develop and
implement kinesiotherapy programs for individual patients. These
teaching activities are directed toward achieving therapeutic objectives
such as instructing patients in ambulation and educating patients to
develop skill and understanding in activities of daily living.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizen of the United States. (Non-citizens may be
appointed when it is not possible to recruit qualified citizens in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Education.** A bachelor's degree in kinesiotherapy, or exercise
science with an emphasis in kinesiotherapy, from an accredited college
or university. This education must have included or been supplemented by
clinical practice in a VA approved training program or its equivalent.

**NOTE:** This VA approved or equivalent training program is the
transitory period between an academic environment and the medical
environment which enables the student to apply textbook knowledge as a
professional kinesiotherapist in an actual medical treatment situation.
Graduates prior to May 1, 1998, completed didactic and clinical
curricula approved by the Council on Professional Standards for
Kinesiotherapy (COPS-KT, Inc.). Graduates from May 1, 1998, to the
present have completed a didactic and clinical curricula approved by the
Committee on Accreditation of Education Programs for Kinesiotherapy
(CoA-KT). As of May 1, 2001, all recognized Kinesiotherapy programs are
accredited by the Commission on Accreditation of Allied Health Education
Programs (CAAHEP).

c\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 hybrid qualification standards.
Some of these provisions may not apply to this occupation. Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but [may not]{.underline} be promoted beyond the journey
level or placed in supervisory or managerial positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

d\. **Physical Requirements.** See VA Directive and Handbook 5019.

e\. **English Language Proficiency.** Kinesiotherapists must be
proficient in spoken and written English in accordance with chapter 2,
section D, paragraph 5a, this part.

**3. GRADE REQUIREMENTS**

**a.** **Definitions**

\(1\) **"Affiliated"** means affiliated for the purposes of health care
training.

\(2\) **Creditable Experience - Knowledge of Professional Kinesiotherapy
Practice.** To be creditable, the experience must demonstrate possession
of the knowledge, skills, abilities, and other characteristics
associated with current kinesiotherapy practice as outlined in the
current scope and standards of practice for kinesiotherapy. One or more
of the following may have evidenced this:

[a]{.underline}. The equivalent of 1 year of active practice. Active
practice means paid/non-paid employment as a kinesiotherapist as defined
by COPS-KT.

[b]{.underline}. Academic course work leading to an advanced degree in
kinesiotherapy or exercise sciences.

\(3\) **Part-Time Experience.** Part-time experience as a professional
KT is credited according to its relationship to the full-time workweek.
For example, a KT would receive 1 week of full-time credit for each 2
weeks of half-time work.

\(4\) **Graduate Education.** Graduate degrees may be substituted for
experience through the GS-11 level. Graduate degrees must be from a
college or university that was regionally or nationally accredited at
the time the candidate completed the program. To substitute the graduate
degree, it must have been completed after the individual met the basic
requirements for appointment.

\(5\) **Content** **Specialty.** Specialized content areas of
kinesiotherapy include, but are not limited to, geriatrics,
cardiopulmonary, orthopedics, driver training, traumatic brain injury
(TBI), spinal cord injury (SCI), and Preservation-Amputation Care and
Treatment (PACT).

b\. **Grade Determination.** In addition to the basic requirements, the
following criteria must be used when determining the appropriate grade
assignment of candidates.

\(1\) **GS-7**

\(a\) **Experience.** None beyond the basic requirements.

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of kinesiology, physiology, anatomy,
psychology, exercise physiology, and pathological conditions.

[2]{.underline}. Knowledge of treatment goals.

[3]{.underline}. Knowledge of medical terminology and written
documentation.

[4]{.underline}. Ability to make recommendations regarding treatment.

\(c\) **Assignment.** Individuals at this grade level serve as
developmental staff KTs. They are responsible for examination,
evaluation, treatment intervention, and prevention of musculoskeletal,
neuromuscular, cardiopulmonary, and integumentary impairments,
functional limitations, and disabilities in most patients. It is
expected that they receive guidance from more experienced staff members
for both routine and the more complex patients.

\(2\) **GS-9**

\(a\) **Experience or Education.** Completion of 1 year of experience
equivalent to the next lower grade level or completion of at least two
full years of progressive graduate education or a masters degree in a
field directly related to the position. In addition, the candidate must
demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of policies and procedures of kinesiotherapy.

[2]{.underline}. Knowledge of assistive devices to make recommendations,
including fit and function of assistive devices.

[3]{.underline}. Skill in applying therapeutic techniques.

[4]{.underline}. Skill in instructing patients and families in a
meaningful exercise program.

[5]{.underline}. Ability to recognize an appropriate prosthesis for the
patient.

\(c\) **Assignment.** Individuals at this grade level serve as staff
KTs. They are responsible for examination, evaluation, treatment
intervention, and prevention of musculoskeletal, neuromuscular,
cardiopulmonary, and integumentary impairments, functional limitations,
and disabilities in most patients. It is expected that they receive
guidance from more experienced staff members for the most complex
patients.

\(3\) **GS-10**

\(a\) **Experience.** Completion of 1 year of experience equivalent to
the next lower grade level. In addition, the candidate must demonstrate
the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge and understanding of highly specialized
complex evaluations and diagnostic tests and procedures.

[2]{.underline}. Ability to properly assess a wide variety of patients
having diverse and multiple disabilities to make recommendations for
assistive devices.

[3]{.underline}. Knowledge of teaching methods and learning principles,
employing unusual motivational techniques and tact.

[4]{.underline}. Ability to recognize an appropriate prosthesis for the
patient, making adaptations and modifications without supervisory
guidance or review.

[5]{.underline}. Skill in coordinating treatment with other
professionals to ensure patient compliance.

[6]{.underline}. Ability to plan, direct, and distribute work
assignments to KTs at lower grade levels.

\(c\) **Assignments.** This is the full performance level for the KT.
Typical assignments at this grade level include but are not limited to:

[1]{.underline}. **Staff Kinesiotherapist.** Individuals in this
assignment may serve as the sole KT at a medical center or an outpatient
clinic. There may be more than one KT at the facility; however,
individuals in this assignment serve as a member of or consultant to a
multidisciplinary or specialty care team.

[2]{.underline}. **Lead** **Kinesiotherapist.** Individuals in this
assignment serve as a consultant and educator to less experienced staff
members. Typical assignments include, but are not limited to, providing
technical oversight necessary for accomplishing the work of the
organizational unit; planning, directing, and distributing the work to
lower level KTs and/or other rehabilitation assistants; providing
feedback to

supervisor on technical aspects of work; resolving informal employee
complaints; instructing and training KTs on new equipment and/or
procedures; and independently performing treatment on more complex
patient issues.

\(4\) **GS-11**

\(a\) **Experience.** Completion of the equivalent of 1 year of
experience equivalent to the next lower grade level or education
equivalent to three full years of progressively higher level graduate
education or a Ph.D. or comparable doctoral degree in a field directly
related to the position to be filled, and must fully meet the KSAs at
that level. In addition, the candidate must demonstrate the following
professional KSAs and demonstrate the potential to acquire the
assignment specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

\*[1]{.underline}. Ability to perform lead and/or supervisory duties for
assigned employees.

[2]{.underline}. Knowledge of educational clinical training programs for
KT students and interns.

\*[3]{.underline}. Ability to independently develop, plan, and
administer clinical training programs.

\*[4]{.underline}. Ability to act as consultant and mentor in evaluating
and treating patients in specialty and program areas.

[5]{.underline}. Knowledge of highly specialized and complex treatments
to act as a subject matter expert in the kinesiotherapy field.

\(c\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Typical assignments for candidates
at this grade level include but are not limited to:

[1]{.underline}. **Staff KT (Clinical Specialist).** Individuals at this
level have duties that typically include at least 3 of the following:
serving as a subject matter expert in the content specialty area and as
a consultant to kinesiotherapy and other medical center staff in
evaluating and treating patients in the specialty area; serving as a
mentor to other therapists evaluating and treating patients in the
content specialty or program area; providing in-service and clinical
training programs in the content specialty or program area.

[2]{.underline}. **Supervisory** **Kinesiotherapist.** Functions as a
first-line supervisor and is typically responsible for assessing,
planning, and delivering care within a special program or component of a
kinesiotherapy department, e.g., SCI, Preservation-Amputation Care and
Treatment (PACT), Cardiopulmonary Program Manager, etc., or to the KT
section. Plans work schedules to assure an even flow and distribution of
work; explains work requirements and assigns work; sets deadlines and
priorities; recommends methods to improve work quality and productivity;
reviews the work of staff supervised; directs training for employees;
advises employees of the performance requirements of their positions;
keeps them informed of their progress in meeting these requirements; and
prepares formal evaluations of employee performance.

[3]{.underline}. **Lead Kinesiotherapist.** Functions as a Lead KT for
lower level staff who provide the full range of KT assignments. Typical
duties include, but are not limited to, providing technical oversight
necessary for accomplishing the work of the organizational unit;
planning, directing, and distributing the work to KTs and/or other lower
level rehabilitation staff; providing feedback to supervisor on
technical aspects of the work; resolving informal employee complaints;
instructing and training KTs on newly acquired equipment; leading
treatment teams in review of outcomes data and special reports and
assisting in initiating action for improvement of team processes and
specific care activities.

\(5\) **GS-12**

\(a\) **Experience.** Completion of 1 year of experience equivalent to
the next lower grade level, and must fully meet the KSAs at that level.
In addition, the candidate must demonstrate the following professional
KSAs and demonstrate the potential to acquire the assignment specific
KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

\*[1]{.underline}. Demonstrated ability to supervise, motivate, and
effectively manage staff to include organizing work, setting priorities,
and delegating tasks and responsibilities.

\*[2]{.underline}. Ability to identify group dynamics, objectively
observe, and modify behaviors.

[3]{.underline}. Ability to disseminate appropriate information through
various media as a consultant or mentor.

[4]{.underline}. Skill in interpersonal relationships in dealing with
employees, other team leaders, and managers.

[5]{.underline}. Knowledge of specialized programs, and the ability to
perform the administrative duties of special programs and/or components
of a KT section.

[6]{.underline}. Knowledge of decision making principles necessary to
adjust programs on a day-to-day basis, to develop short term and long
range goals, and/or to plan for future utilization of human resources,
and the reassignment of staff to enhance/develop the value of existing
or new programs.

\(c\) **Assignment.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. KTs at this grade level may be
appointed to one of the following assignments:

[1]{.underline}. **Supervisory KT.** Functions in a supervisory position
for a multidisciplinary professional staff assuring that a complete
range of skills are available for a diverse patient population at
active, affiliated medical centers or outpatient clinics. Has full
supervisory responsibility for a staff that may include clinical
specialists, lower level supervisory or lead KT positions, or program
managers. At this level, the kinesiotherapy program typically includes a
variety of specialties, an extensive educational program, and
involvement in research activities. Evaluates new products and
equipment, making recommendations concerning upgrades/new purchases that
would improve operations. Informs higher level management of

anticipated staffing variances and recommends promotions, reassignments,
or other personnel changes such as retention or release of probationary
employees. Recommends recognition of superior performance when
applicable.

[2]{.underline}. **Lead KT.** Functions as a Lead KT and is principally
responsible for a full range of clinical and administrative functions
associated with the daily operation of a specific KT program, ensuring
that physician referrals for rehabilitation assignments are processed,
treatments are provided, and documentation is completed according to the
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
and service policies. At this level, the employee coordinates and leads
a multidisciplinary professional staff to assure that a complete range
of skills is available for a diverse patient population who have varying
degrees of highly complex physical and/or mental problems. Plans,
develops, leads, and administers programs/clinics on restorative and
intermediate wards, long term care, psychiatry, chemical dependency and
outpatients, and acute medical, surgical, and chronic psychiatric ward
programs. Leads ongoing specialized programs and modalities that are
beyond the general practice of KT such as prosthetics/amputees,
therapeutic swimming, pneumatic compression therapy, pressure gradient
stocking measurements, and whirlpool therapy.

**4. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for
kinesiotherapists in VHA whose composite record of accomplishments,
performance, and qualifications, as well as current assignments, warrant
such action based on demonstrated competence to meet the requirements of
the proposed grade.

b\. Under no circumstances will the educational requirements be waived.

c\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**

**APPENDIX G22.** []{#PartIIAppG22 .anchor}**OCCUPATIONAL THERAPY
ASSISTANT QUALIFICATION STANDARD**

**GS-636**

**Veterans Health Administration**

**1. COVERAGE.** This standard applies to all occupational therapy
assistant (OTA) positions in the Veterans Health Administration (VHA).
Under the supervision of an occupational therapist, the OTA provides
rehabilitative services to persons with mental, physical, emotional, or
developmental impair-ments. The ultimate goal is to improve clients'
quality of life and ability to perform activities of daily living. The
OTA participates with the occupational therapist in planning and
implementing complex treatment programs and applies occupational therapy
procedures to patients under the general supervision of an occupational
therapist.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizen of the United States. (Non-citizens may be
appointed when it is not possible to recruit qualified citizens in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Education.** Successful completion of an associate's degree in
occupational therapy from a college or university accredited by the
Accreditation Council for Occupational Therapy Education (ACOTE) of the
American Occupational Therapy Association (AOTA).

c\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 hybrid qualification standards.
Some of these provisions may not apply to this occupation. Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but [may not]{.underline} be promoted beyond the journey
level or placed in supervisory or managerial positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

d\. **Physical Requirements**. See VA Directive and Handbook 5019.

e\. **English Language Proficiency.** OTAs must be proficient in spoken
and written English in accordance with chapter 2, section D, paragraph
5a, this part.

**3. GRADE REQUIREMENTS**

a\. **Definitions**

\(1\) **Creditable Experience.** To be creditable, the experience must
have required the use of knowledge, skills, abilities, and other
characteristics (KSAs) (also referred to as core competencies),
associated with the scope of OTA practice.

\(2\) **Part-time Experience.** Part-time experience as an OTA is
credited according to its relationship to the full-time workweek. For
example, an OTA would receive 1 week of full-time credit for each 2
weeks of half-time work.

b\. **Grade Determination**. In addition to the basic requirements for
employment, the following criteria must be met when determining the
grade of candidates.

\(1\) **GS-4**

\(a\) Experience. None beyond the basic requirements.

\(b\) Demonstrated Knowledge, Skills, and Abilities

[1]{.underline}. Ability to review patient data and make a preliminary
determination of their needs.

[2]{.underline}. Ability to obtain subjective history.

[3]{.underline}. Ability to interpret information gained through
subjective history.

[4]{.underline}. Ability to communicate with health care providers,
patients, and staff for optimal patient care.

\(c\) **Assignment.** Employees at this grade level serve as staff OTAs.
It is expected that they receive guidance from more experienced staff
members for more complex patient issues and require daily direct insight
supervision by the treating occupational therapist.

\(2\) **GS-5**

\(a\) **Experience.** In addition to the basic requirements, 6 months of
experience comparable to the next lower grade level. Experience may have
been gained as an OTA, rehabilitation aide, technician, volunteer, or in
the medical health services field. In addition, the candidate must
demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to assist in the development of treatment
goals/objectives.

[2]{.underline}. Ability to implement a patient care plan incorporating
activity analysis theory.

[3]{.underline}. Skill in written communication to document preliminary
data, progress/change in status, discharge status, and patient or
caregiver education.

[4]{.underline}. Knowledge of basic group techniques and interpersonal
communications.

[5]{.underline}. Ability to assist in the use of standardized assessment
tools to the area of practice assigned.

\(c\) **Assignment.** Employees at this grade level serve as staff OTAs.
It is expected that they receive guidance from more experienced staff
members for more complex patient issues and require daily and direct
contact at the site of work from the assigned supervisor.

\(3\) **GS--6**

\(a\) **Experience.** In addition to the basic requirements, 1 year of
experience comparable to the next lower grade level. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of a variety of standardized assessment tools
in order to provide a more comprehensive intervention under the
supervision of an occupational therapist.

[2]{.underline}. Ability to use problem-solving skills when providing
therapeutic interventions for patients who have a wide range of
diagnoses and disabilities.

[3]{.underline}. Ability to provide complex/multi-step instructions to
patients, caregivers, and other health care professionals adapting
instructions to meet the learning needs of the individual.

[4]{.underline}. Ability to promote occupational therapy services
effectively, providing training and interventions within the assigned
areas.

\(c\) **Assignment.** Employees at this grade level serve as staff OTAs,
receiving little to no guidance from more experienced staff members for
more complex patient issues and require general supervision by the
treating occupational therapist.

\(4\) **GS-7**

\(a\) **Experience.** In addition to the basic requirements, 1 year of
experience comparable to the next lower grade level. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to utilize more complex therapeutic techniques
and interventions, utilizing problem-solving skills, to maximize
patient's functional status.

[2]{.underline}. Ability to modify and adapt therapeutic interventions
for simple and complex cases with a wide range of diagnoses and
disabilities.

[3]{.underline}. Ability to identify and recommend complex adaptive and
assistive devices and durable medical equipment.

\(c\) **Assignment.** Employees at this grade level serve as staff OTAs.
This is the full performance level for the OTA requiring routine and
less frequent supervision. Assignments include: supervising OTA
students, and overseeing their clinical training experiences at the
technical level of education; providing department in-service training;
and providing caregiver and home management training to patients and
families. OTAs at this level receive minimum guidance from the
occupational therapist.

\(5\) **GS-8**

\(a\) **Experience.** Completion of 1 year of creditable experience
comparable to the next lower grade level is required, and must fully
meet the KSAs at the next lower level. In addition, the candidate must
demonstrate the following technical KSAs and the potential to acquire
the assignment specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of specialized skills in the assigned area of
practice.

[2]{.underline}. Superior skills in the utilization of assessment tools
and intervention techniques.

\*[3]{.underline}. Ability to utilize complex/multi-step instructions
with patients, caregivers, and other health care professionals and adapt
those instructions according to the learning styles of the trainees or
individuals receiving the instructions.

[4]{.underline}. Ability to effectively promote occupational therapy
services and provide training within the assigned areas, medical
center-wide and off station.

\(c\) **Assignment.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Employees at this grade level serve
as senior OTAs. Candidates for

assignment at this level must possess and demonstrate a level of
clinical competence to serve as a consultant to other OTAs. Typical
assignments for candidates at this grade level include, but are not
limited to, 1 or more of the following:

[1]{.underline}. Coordinating occupational therapy programming within
single or multiple specialized clinical programs with advanced skills in
physical and/or psychosocial dysfunction.

[2]{.underline}. Serving as a Team Leader or Lead OTA.

[3]{.underline}. Coordinating overall clinical experiences and training
for OTA students, to include developing training plans, scheduling
rotation assignments, providing feedback on students\' performance, and
participating in clinical training education for OTA students.

**4. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for OTAs
in VHA whose composite record of accomplishments, performance, and
qualifications, as well as current assignments, warrant such action
based on demonstrated competence to meet the requirements on the
proposed grade.

b\. Under no circumstances will the educational requirements be waived.

c\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**

[]{#PartIIAppG23 .anchor}**APPENDIX G23. PHYSICAL THERAPY ASSISTANT
QUALIFICATION STANDARD**

**GS-636**

**Veterans Health Administration**

**1. COVERAGE.** This standard applies to all physical therapy assistant
(PTA) positions in the Veterans Health Administration (VHA). Under the
supervision of a physical therapist, the PTA provides services that
promote the prevention, remediation, and rehabilitation of acute and
chronic physical dysfunction. The PTA participates with the physical
therapist in planning and implementing complex treatment programs and
applies physical therapy procedures to patients under the general
supervision of a Physical Therapist.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizen of the United States. (Non-citizens may be
appointed when it is not possible to recruit qualified citizens in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Education.** Successful completion of an associate's degree from
an accredited community college, junior college, college, or university
in a physical therapy assistant education program accredited by the
Commission on Accreditation in Physical Therapy Education (CAPTE).

c**. Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 hybrid qualification standards.
Some of these provisions may not apply to this occupation. Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

-   Such employees in an occupation that does not require a
    licensure/certification/registration, may be reassigned, promoted,
    or demoted within the occupation.

-   Such employees in an occupation that [requires]{.underline} a
    licensure/certification/registration, may be reassigned, promoted up
    to and including the full performance (journey) level, or demoted
    within the occupation, but [may not]{.underline} be promoted beyond
    the journey level or placed in supervisory or managerial positions.

-   Such employees in an occupation that requires a
    licensure/certification/registration only at higher grade levels
    must meet the licensure/certification/registration requirement
    before they can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

d\. **Physical Requirements.** See VA Directive and Handbook 5019.

e\. **English Language Proficiency.** PTAs must be proficient in spoken
and written English in accordance with chapter 2, section D, paragraph
5a, this part.

**3. GRADE REQUIREMENTS**

a\. **Definitions**

\(1\) **Creditable Experience.** To be creditable, the experience must
have required the use of knowledge, skills, abilities, and other
characteristics (KSAs), also referred to as core competencies,
associated with the scope of PTA practice.

\(2\) **Part-Time Experience.** Part-time experience as a PTA is
creditable according to its relationship to the full-time workweek. For
example, a PTA would receive 1 week of full-time credit for each two 2
weeks of half-time work.

b\. **Grade Determination.** In addition to the basic requirements for
employment, the following criteria must be met when determining the
grade of candidates.

\(1\) **GS-4**

\(a\) **Experience.** None beyond the basic requirements.

\(b\) Demonstrated Knowledge, Skills, and Abilities

[1]{.underline}. Ability to perform chart review.

[2]{.underline}. Ability to obtain subjective history.

[3]{.underline}. Ability to interpret information gained through
subjective history.

[4]{.underline}. Ability to communicate verbally and in writing with the
patient, the physical therapist, health care providers, and others.

\(c\) **Assignment.** Employees at this grade level serve as staff PTAs.
It is expected that they receive guidance from more experienced staff
members for more complex patients and require direct supervision by the
treating physical therapist.

\(2\) **GS-5**

\(a\) **Experience.** In addition to the basic requirements, 6 months of
experience comparable to the next lower grade level. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated** **Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to assess changes in physical, mental, and/or
medical status.

[2]{.underline}. Knowledge of treatment techniques needed to assess
changes in physical, mental, and/or medical status.

[3.]{.underline} Ability to recognize individual and cultural
differences and respond appropriately in all aspects of physical therapy
services.

\(c\) **Assignment.** Employees at this grade level serve as staff PTAs.
It is expected that they receive guidance from more experienced staff
members for more complex patients and require direct supervision by the
treating physical therapist.

\(3\) GS-6

\(a\) **Experience.** In addition to the basic requirements, 1 year of
experience comparable to the next lower grade level. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

a\. Knowledge of evidence based physical therapy practice.

b\. Knowledge of physical therapy data collection and ongoing assessment
techniques in order to perform specified aspects of patient evaluation
and interventions.

c\. Knowledge of basic biological and medical science to assess patient
data; make a preliminary determination of their needs; develop treatment
goals and objectives; and implement patient treatment plans.

\(c\) **Assignment.** Employees at this grade level serve as staff PTAs
receiving little to no guidance from more experienced staff members for
more complex patients and require general supervision by the treating
physical therapist.

\(4\) **GS-7**

\(a\) **Experience.** In addition to the basic requirements, 1 year of
experience comparable to the next lower grade level. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to organize data, format that data into a
presentation, and present information pertinent to patient care in
formal or informal settings. Examples may include providing in-service
training to staff or formal presentations to the treatment team.

[2]{.underline}. Knowledge of contemporary physical therapy practice.
This may be demonstrated through continuing education courses,
in-service training, or journal article reviews.

[3]{.underline}. Ability to independently implement selected components
of interventions identified in the plan of care established by the
physical therapist.

\(c\) **Assignment.** Employees at this grade level serve as staff PTAs.
This is the full performance level for the PTA. Assignments include:
service as an active team member in a comprehensive inpatient
rehabilitation program such as geriatrics, amputee, traumatic brain
injury, spinal cord injury, cardiac rehabilitation, aquatics,
orthopedics, or wound care, etc.; prepare, provide, and supervise
clinical training experiences for PTA students; and independently
provide patient education to patients and their caregivers.

\(5\) **GS-8**

\(a\) **Experience.** Completion of 1 year of creditable experience
equivalent to the next lower grade level, and must fully meet the KSAs
at that level. In addition, the candidate must demonstrate the following
technical KSAs and demonstrate the potential to acquire the assignment
specific KSAs designated by an asterisk:

\(b\) **Demonstrated** **Knowledge, Skills, and Abilities**

[1]{.underline}. Advanced knowledge of treatment techniques in order to
assess changes in physical, mental, and/or medical status.

[2]{.underline}. Advanced knowledge of physical therapy data collection
and assessment techniques in order to perform specified aspects of
patient evaluations and interventions.

\*[3]{.underline}. Skill to manage and/or maintain responsibility for a
specialty program.

\*[4]{.underline}. Ability to lead a group of employees and communicate
information regarding work assignments and scheduling.

\*[5]{.underline}. Ability to instruct students and manage a trainee
program for PTA students.

\(c\) **Assignment.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Employees at this grade level serve
as senior PTAs. Candidates for assignment at this level must possess and
demonstrate a level of clinical competence to serve as a consultant to
other PTAs. Typical assignments for candidates at this grade level
include, but are not limited to, one or more of the following:

[1]{.underline}. Serve as a lead PTA for a group of PTAs.

[2]{.underline}. Coordinates PTA programming responsibility for a
specialty program.

[3]{.underline}. Serves as the medical center coordinator for clinical
education for PTA students, to include developing training plans,
scheduling rotation assignments, providing feedback on students\'
performance, and participating in clinical training education for PTA
students.

**4. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for PTAs
in VHA whose composite record of accomplishments, performance, and
qualifications, as well as current assignments, warrants such action
based on demonstrated competence to meet the requirements of the
proposed grade.

b\. Under no circumstances will the educational requirements be waived.

c\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**

**APPENDIX G24. MEDICAL TECHNOLOGIST QUALIFICATION STANDARD**

**GS-644**

**Veterans Health Administration**

**1.** **COVERAGE.** The following are the requirements for appointment
as a Medical Technologist (MT) in the Veterans Health Administration
(VHA). These requirements apply to all VHA MTs in the General Schedule
(GS)-644 series. In the health care community, MTs are generally
referred to as "clinical laboratory scientists (CLS)," and this term is
considered to be synonymous where stated in this qualification standard.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizenship of the United States. (Non-citizens may
be appointed when it is not possible to recruit qualified citizens in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Education and/or Experience Combination.** An associate's degree
in laboratory science or medical laboratory technology from an
accredited institution or an equivalent program composed of at least 60
semester hours, from an accredited institution that, at a minimum,
includes either: (a) 24 semester hours of medical laboratory technology
courses; or (b) 24 semester hours of science courses that includes 6
semester hours of chemistry; 6 semester hours of biology; and 12
semester hours of chemistry, biology, or medical laboratory technology
in any combination; and have laboratory training that includes
completion of a NAACLS approved clinical laboratory training program
with at least 3 months documented laboratory training in each specialty
that the individual performs high complexity testing. In addition to the
associate's degree, must possess at least 3 years of directly related,
full time work experience.

c\. **Certification.** All candidates must currently possess or be
eligible for and pass within one year the appropriate certification
examination as a medical technologist or clinical laboratory scientist
given by the American Society of Clinical Pathology Board of Registry
(ASCP-BOR), the National Credentialing Agency (NCA), American
Association of Clinical Chemists (AACC) or American Medical
Technologists (AMT), or the American Association of Bioanalysts (AAB).

\(1\) Non-certified applicants who otherwise meet the eligibility
requirements for certification may be given a temporary appointment as a
graduate medical technologist under the authority of 38 U.S.C. **§**
7405 (a) (1) (D). Failure to obtain certification during that period is
justification for termination of the temporary appointment. This may
result in termination of employment.

\(2\) **Loss of Credential.** An employee in this occupation who fails
to obtain licensure/certification/

registration within the required time frame, or who fails to maintain
the required licensure/certification/

registration must be removed from the occupation, which may also result
in termination of employment.

For occupations which [require]{.underline} an active credential
(licensure/certification/registration) at all grade levels, at the
discretion of the appointing official, an employee may be reassigned to
another occupation for which he/she qualifies [if]{.underline} a
placement opportunity exists.  For occupations which require an active
credential (licensure/certification/registration) in assignments above
the full-performance level [only]{.underline}, at

the discretion of the appointing official, an employee may remain at an
appropriate lower grade level in the occupation when both of the
following apply:  the credential is not a requirement [and]{.underline}
a placement opportunity exists."

d\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 hybrid qualification standards.
Some of these provisions may not apply to this occupation.  Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but [may not]{.underline} be promoted beyond the journey
level or placed in supervisory or managerial positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

e\. **Physical Requirements.** See VA Directive and Handbook 5019.

f\. **English Language Proficiency.** Medical technologists must be
proficient in spoken and written English in accordance with chapter 2,
section D, paragraph 5a, this part.

**3. GRADE REQUIREMENTS**

a\. **Definitions**

\(1\) **Creditable Experience**

\(a\) **Knowledge of Current Professional Laboratory Practice.** To be
creditable, the experience must have required the use of knowledge,
skills, abilities, and other characteristics (also referred to as "core
competencies") associated with active professional laboratory practice.
(Active professional practice is paid/non-paid employment as a
professional MT/CLS as defined by NAACLS.) This may have been evidenced
by one or more of the following:

[1]{.underline}. The equivalent of 1 year of active professional
practice in medical technology/clinical laboratory science performing
moderate and/or high complexity testing as a certified or
certificate-eligible MT/CLS; [or]{.underline}

[2]{.underline}. The equivalent of 1 year of professional practice in
one of the disciplines or specialized areas of medical
technology/clinical laboratory science performing moderate and/or high
complexity testing as a certified or certificate-eligible MT/CLS;
[or]{.underline}

[3]{.underline}. The equivalent of 1 year of active professional
practice in a field directly related and applicable to the position to
be filled; [or]{.underline}

[4]{.underline}. Academic coursework leading to an advanced degree in
medical technology or a directly related health care field.

\(b\) **Quality of Experience.** Experience is only creditable if it was
earned after completion of the basic requirements in paragraph 2.b.
above. Qualifying experience must also be at a level comparable to
laboratory experience at the next lower level.

\(c\) **Part-time Experience.** Part-time experience as a medical
technologist is creditable according to its relationship to full-time
workweek. For example, a MT would receive 1 week of full-time credit for
each 2 weeks of half-time work.

\(2\) **Graduate Education.** Graduate education and graduate degrees
may be substituted for experience through the GS-11 grade level, but
only if from an accredited college or university in a field related to
medical technology/clinical laboratory science, e.g., biochemistry,
chemistry, microbiology, immunology, hematology, immunohematology,
biological science, physiology, allied health education, health systems
administration, infection control, and preventive medicine. Graduate
education or a graduate degree in a field related to MT/CLS must be from
a college or university, which was accredited at the time the candidate
completed the program.

b\. **Grade Determinations.** In addition to the basic requirements for
employment, the following criteria must be met when determining the
grade of candidates.

\(1\) **GS-5.** None beyond basic requirements.

\(a\) **Assignment.** Employees at this grade level serve in an MT
career development position under close supervision.

\(2\) **GS-7**

\(a\) **Experience.** In addition to the basic requirements, at least 1
year of experience comparable to the next lower grade level. In
addition, the candidate must demonstrate the following KSAs:

**OR,**

\(b\) **Education.** A bachelor's degree in medical technology/clinical
laboratory science or a [related]{.underline} science [and]{.underline}
completion of a medical technology clinical practice program. Both the
education and the clinical practice program must have been approved by
the National Accrediting Agency for Clinical Laboratory Sciences
(NAACLS). The professional curriculum may have consisted of a
post-baccalaureate certificate program or be integrated into a 4-year
program of study that culminated in a baccalaureate degree.

\(c\) **Foreign Graduates.** Graduates of foreign baccalaureate degree
programs meet the educational requirements if their degree is found to
be equivalent to degree programs recognized by the NAACLS. This finding
may be based on any of the following:

[1]{.underline}. A letter from a college or university with a
baccalaureate program recognized by the NAACLS stating that the
individual's foreign degree has been evaluated and been found to be
equivalent to its bachelor of medical technology degree.

[2]{.underline}. A letter from the American Society for Clinical
Pathology Board of Registry (ASCP-BOR), the National Credentialing
Agency (NCA), or the American Medical Technologists (AMT) stating that
the individual is eligible for the certification examination, or
documentation from any other recognized organization that evaluates
education.

\(d\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Demonstrated knowledge of professional medical
technology principles, practices, concepts, and theories.

[2]{.underline}. Demonstrated knowledge of laboratory quality control
and assurance procedures and principles of performance improvement.

[3]{.underline}. Knowledge of laboratory equipment and ability to
maintain, troubleshoot, and repair.

[4]{.underline}. Ability to plan, organize, set priorities, work as a
team member, and effectively complete assignments.

[5]{.underline}. Skill in informatics and processes, and the ability to
communicate effectively electronically, orally, and in writing.

\(e\) **Assignments.** Duties and responsibilities may include any
combination of those found at the GS-9 grade level; however, individuals
in these assignments work under closer supervision and are not given the
freedom of action typically found at the higher level.

\(3\) **GS-9**

\(a\) **Minimum Requirements.** Appointment or promotion to the GS-9
level requires a bachelor's degree in medical technology/clinical
laboratory science or in a [related]{.underline} science
[and]{.underline} completion of a medical technology clinical practice
program. Both the education and the clinical practice program must have
been approved by the National Accrediting Agency for Clinical Laboratory
Sciences (NAACLS). The professional curriculum may have consisted of a
post-baccalaureate certificate program or be integrated into a four-year
program of study that culminated in a baccalaureate degree. In addition,
candidates for GS-9 must possess either (b) or (c) below:

\(b\) **Experience.** Completion of 1 year of experience at the next
lower grade level which demonstrates the knowledge, skills, abilities,
and other characteristics related to the duties of the position to be
filled.

**OR,**

\(c\) **Education.** Must have 2 years of progressively higher-level
graduate education leading to a master's degree in medical technology or
directly related field, or equivalent graduate degree provided the
applicant's total background demonstrates the core competencies for GS-9
level assignment.

\(d\) **Demonstrated Knowledge, Skills, and Abilities.** In addition,
the candidate must demonstrate the following KSAs:

[1]{.underline}. Comprehensive knowledge of professional medical
technology/clinical laboratory science principles, practices, concepts,
and theories providing for sound independent work.

[2]{.underline}. Comprehensive knowledge of laboratory quality control
and assurance procedures and principles of performance improvement
providing for sound independent work.

[3]{.underline}. Knowledge of laboratory equipment and ability to
maintain, troubleshoot, and repair instrumentation.

[4]{.underline}. Ability to use independent technical judgment to
analyze and interpret laboratory results.

[5]{.underline}. Ability to interpret and apply complex written
instructions.

[6]{.underline}. Ability to communicate, consult, and interact with
other members of the healthcare team, external relations, customer
service, and patient education.

\(e\) **Assignment.** This is considered the full performance level for
nonsupervisory positions. An MT/CLS at this level develops, performs,
evaluates, interprets, correlates, and validates the accuracy of
laboratory procedures and results. Testing procedures are performed on a
variety of biological specimens and/or environmental samples using
manual or automated techniques, and require a broad exercise of
independent judgment and responsibility with minimal technical
supervision. The work performed is in a variety of laboratory
disciplines, such as bacteriology, chemistry (including endocrinology
and toxicology), molecular biology, coagulation, flow cytometry,
genetics, hematology, immunology, immunohematology (blood banking),
mycology, parasitology, serology, urinalysis, and virology. Such
positions include

requirements to monitor quality control systems and measures;
collaborate in the diagnosis and treatment

of patients; and provide education for laboratory and other healthcare
professionals, and others in the medical center setting including the
public.

\(4\) **GS-10**

\(a\) **Experience**. Completion of 1 year of experience at the next
lower grade level which demonstrates the knowledge, skills, abilities
and other characteristics that are directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following professional KSAs
and demonstrate the potential to acquire the assignment specific KSAs as
indicated by an asterisk (\*):

\(b\) **Demonstrated Knowledge Skills and Abilities**

[1]{.underline}. Comprehensive knowledge of and skill in applying a wide
range of concepts principles and methodology of the field to perform
advanced techniques.

[2]{.underline}. Ability and knowledge to modify or adapt established
methods, procedures, or techniques to resolve difficult or complex
problems.

[3]{.underline}.The ability to perform sound, independent work.

\*[4]{.underline}. Ability to perform lead and/or supervisory duties for
such assignments.

\*[5]{.underline}. For supervisory or lead position, ability to provide
or coordinate staff development and training.

\(c\) **Assignments.** An MT/CLS at the GS-10 level carries out all of
the testing responsibilities of the GS-9, but has higher levels of
professional responsibilities and expertise. Technologists at this level
generally have professional oversight responsibilities and may have
responsibility for a specific large scale automated analytical
instrument system; a specific area of laboratory functions, such as
employee competency records, supply functions, quality control review,
new method development, or employee or student training; or provide
professional and technical advice to other technicians and technologists
on evening or night shifts. For all assignments above the full
performance level, the higher-level duties must consist of significant
scope, complexity (difficulty), and range of variety, and be performed
by the incumbent at least 25% of the time.

[1]{.underline}. **Team Leader.** Serves as an expert providing
authoritative advice and consultation for more difficult, complex, or
unique tests requiring special knowledge. Assists the supervisor in
technical phases of the organizational level on various aspects of the
specialized testing including appropriateness that takes into
consideration clinical context. Facilitates team or unit processes by
working in collaboration with team members to ensure that tasks,
priorities, goals are coordinated with management.

[2]{.underline}. **Sole MT/CLS.** Individuals in this assignment serve
as the sole MT/CLS at a medical center or an outpatient clinic.
Individuals serving as sole MT/CLS may be graded at the GS-11 level or
higher if the complexity of their assignment is comparable to those
assignments.

[3]{.underline}. **Senior Staff Specialist.** In addition to performing
the full range of the GS-9 assignment, the MT/CLS must demonstrate the
knowledge, skills, and abilities required to perform more complex
laboratory functions. Duties and responsibilities may include any
combination of those found at the GS-11 level; however, individuals in
these assignments are not given the freedom of action typically found at
the higher level. For example, their duties may include any of the
following.

[a]{.underline}. Attends vendor training for a complex analytical
instrument and is responsible for training employees in its operation.
Performs complex maintenance procedures and is consulted as the in-house
expert for troubleshooting problems.

[b]{.underline}. Is responsible for updating procedure manuals for a
specific laboratory function.

[c]{.underline}. Supervises the clinical training experiences of
technical and professional level technologist or technician training
programs to fulfill educational and professional requirements (where
training programs exist).

[d]{.underline}. Recommends updated guidelines and policies for
non-routine or complex assignments.

[e]{.underline}. Coordinates the laboratory competency program.

[4]{.underline}. **Supervisory Technologist.** Serves as a first-line
supervisory medical technologist. Plans work schedules to assure an even
flow and distribution of work; explains work requirements and assigns
work; sets deadlines and priorities; recommends methods to improve work
quality and productivity; reviews the work of staff supervised; directs
training for employees; advises employees of the performance
requirements of their positions; keeps them informed of their progress
in meeting these requirements; and prepares formal evaluations of
employee performance.

\(4\) **GS-11**

\(a\) **Experience.** MTs must have the equivalent of 1 year of
creditable, progressively responsible experience comparable to the next
lower grade level, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following professional KSAs
and demonstrate the potential to acquire the assignment specific KSAs as
indicated by an asterisk (\*):

**OR,**

\(b\) **Education.** Must have 3 full years of progressively
higher-level graduate education or a Ph.D. or equivalent doctoral degree
in medical technology or a directly related field, provided the
applicant's total background demonstrates evidence of knowledge, skills,
and abilities necessary to perform the work of the position to be
filled.

\(c\) **Assignments.** These assignments require specialized training
and experience. Employees must have advanced knowledge of specialized
and complex subject matter extending beyond the duties of test
performance. They have wide latitude for exercising independent
judgment. For all assignments above the full performance level, the
higher-level duties must consist of significant scope, complexity
(difficulty), and

range of variety, and be performed by the incumbent at least 25% of the
time. Individuals at the GS-11 grade level in these laboratories spend a
majority of their time in the following assignments:

[1]{.underline}. **Technical Specialist.** The incumbent serves as an
expert providing authoritative advice and consultation for more
difficult, complex, or unique tests requiring special knowledge, e.g.,
flow cytometry and molecular pathology. Advises all organizational
levels on various aspects of the specialized testing including
appropriateness that takes into consideration clinical context. The
technical specialist often works independently and is given freedom of
action under the general guidance of a pathologist or other laboratory
practitioner. In addition to the required core competencies, the
technical specialist must demonstrate the following:

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Advanced knowledge and understanding of regulatory and
accrediting agency requirements, medicolegal requirements, and pertinent
statistics sufficient to perform complex diagnostic tests.

([2]{.underline}) Knowledge and skill sufficient to apply standard
medical technology techniques to conduct a variety of difficult and
complex test systems.

\*([3]{.underline}) Ability to apply new scientific/technical
developments and theories to laboratory testing.

([4]{.underline}) Knowledge of instructional techniques to instruct
newly hired technologists and clinical pathology residents in proper
performance of tests and applications of the laboratory procedures.

([5]{.underline}) Knowledge to develop procedures for new tests, and
modify existing procedures and methods in order to resolve problems
relative to complex and difficult situations.

[2]{.underline}. **Laboratory Information Systems Manager.** The
incumbent develops and recommends new policies and procedures regarding
the installation and use of the laboratory information system (LIS) in
conjunction with the overall the hospital information system (HIS).
Provides authoritative advice and consultation on the information system
as they apply to the clinical laboratory. Advises all organizational
levels on functions and capabilities of the LIS. Implements and
maintains coding and mapping for laboratory test ordering, reporting,
billing, and workload recording taking into account compliance
principles. Analyzes emerging trends, software, and technology and
adopts appropriate methods for local programs to meet agency goals. In
addition to the required core competencies, must demonstrate the
following:

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of concepts, principles and methodology of
clinical laboratory technology sufficient to revise standard methods to
improve or extend test systems; and evaluate, modify, or adapt new
methods to meet the requirements of particular testing situations.

([2]{.underline}) Knowledge and understanding of laboratory operations
and their relationship to the organization sufficient to provide
advisory, inspection, training, and problem-solving services on specific
projects, programs, or functions.

([3]{.underline}) Knowledge of laboratory information systems and
programming techniques sufficient to develop, adapt, and maintain
computer systems for accomplishing diagnostic laboratory work and
quality assurance.

\*([4]{.underline}) Ability to adapt, implement, and integrate the use
of software to specific laboratory applications and processes.

([5]{.underline}) Knowledge of compliance requirements for laboratory
functions.

\*([6]{.underline}) Knowledge of computer system analysis, computer
language, and program design sufficient to implement various laboratory
associated packages and sustain operation of the laboratory system.

[3]{.underline}. **Laboratory Education Coordinator.** The incumbent
provides authoritative representation and interaction with cooperating
or affiliated universities or colleges, resource organizations, and
state and federal officials in order to coordinate program goals,
objectives, and policies. Candidates in this assignment spend a
significant amount of time administering clinical training programs for
medical technology students, facility staff, and others assigned for
medical technology training. They design, teach, and evaluate the
training programs. These assignments occur at active, affiliated VHA
facilities. Individuals establish, negotiate, and maintain affiliation
agreements and schedule students for appropriate rotation. They also may
serve on curriculum or admission committees of the affiliated colleges
after formal appointment as a faculty member. They may arrange formal
in-service programs for the laboratory. In addition to the required core
competencies, must demonstrate the following:

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of medical technology concepts, principles,
and practices sufficient to plan and direct an educational program for
student medical technologists and continuing education programs for the
staff of a large clinical laboratory.

([2]{.underline}) Skill in using educational design, development, and
evaluation techniques.

\*([3]{.underline}) Knowledge of the standards of the education
program's accrediting organization.

\*([4]{.underline}) Knowledge of affiliated organizations and their
agreements.

([5]{.underline}) Knowledge and skill in teaching methods.

([6]{.underline}) Knowledge of instructor development and skill
sufficient to conduct continuing education sessions in principles of
learning and teaching techniques.

[4]{.underline}. **Quality Management Technologist.** The incumbent
provides authoritative consultative services to management at all levels
of the organization as it applies to quality management in a clinical
laboratory setting. Maintains a laboratory performance improvement
program and ensures monitoring of components and customer feedback.
Interacts with management officials and organizations involved in
inter-laboratory quality assurance and proficiency testing. In addition
to the required core competencies, must demonstrate the following:

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of the concepts, principles, and practices
of medical technology sufficient to perform the full range of duties
involved in planning, coordinating, and evaluating laboratory services.

([2]{.underline}) Knowledge of performance management standards,
including preventive maintenance and performance testing procedures.

\*([3]{.underline}) Knowledge of accrediting agency and regulatory
requirements pertaining to laboratory operations.

([4]{.underline}) Comprehensive knowledge of statistical evaluation and
analysis.

([5]{.underline}) Knowledge and understanding of laboratory operations
and relationships to the organization.

([6]{.underline}) Comprehensive knowledge of laboratory quality
control/assurance policies, procedures and principles.

([7]{.underline}) Comprehensive knowledge of safety practices and
regulations.

[5]{.underline}. **Lead Medical Technologist/Clinical Laboratory
Scientist.** The incumbent facilitates team or unit processes by working
in collaboration with team members to ensure that tasks, priorities,
goals needs, and achievements are coordinated with management. Acts as a
liaison to other departments of the medical center for the appropriate
laboratory specialty. In addition to the required core competencies,
must demonstrate the following:

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of medical technology applicable to a wide
range of duties in all areas of the laboratory, and a high level of
skill in applying this knowledge in solving very complex problems
involving diverse aspects of clinical laboratory practice.

([2]{.underline}) Knowledge of regulatory, licensing and accrediting
agency requirements, and statutes governing clinical laboratory
operations sufficient to use in planning, implementing, or monitoring
laboratory programs and services.

\*([3]{.underline}) Management, administrative, and professional
knowledge sufficient to effectively oversee and coordinate daily work
activities and assignments in a section.

([4]{.underline}) Knowledge of laboratory instrumentation, and the
ability to maintain, troubleshoot, and repair instrumentation.

\*([5]{.underline}) Ability to provide technical oversight and assign
personnel and tasks to be accomplished in a manner that assures
completion of the workload.

[6]{.underline}. **Supervisory Technologist.** In smaller, less complex
laboratories having no GS-11 positions, a supervisory technologist may
be a GS-11. In a larger, more complex laboratory may serve as a
supervisor

in a designated area of the laboratory with the primary responsibility
for providing direction to non-testing personnel, such as medical
technicians, aides, and health care technicians in specimen collection,
specimen processing and accessioning, and quality control activities of
the section. Employees in this assignment perform the full range of
supervisory duties for one or more sections of the laboratory, including
responsibility for assignment of work performed; performance
evaluations; recommendations for appointment, awards, advancement, and,
when appropriate, disciplinary actions; identification of continuing
education and training needs. The individual assures compliance with
accrediting agency and regulatory requirements; establishes and monitors
the quality of the pre-analytical processes as part of the overall
laboratory quality management program, and assures corrective action is
initiated as needed. The supervisor assures orientation and competency
of assigned staff. In addition to the required core competencies, must
demonstrate the following:

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of federal and state laws and regulations,
laboratory accrediting and regulatory requirements sufficient to develop
section plans and procedures consistent with requirements.

([2]{.underline}) Knowledge of quality management principles sufficient
to establish and monitor a laboratory quality management program, and/or
education and training of laboratory staff.

([3]{.underline}) Skill in interpersonal relations and conflict
resolution to deal with employees, team leaders, and managers.

\*([4]{.underline}) Ability to perform the full range of supervisory
duties and skill in supervising a group of individuals.

\*([5]{.underline}) Ability to plan, organize, set priorities, work as a
team member, and effectively complete assignments.

([6]{.underline}) Knowledge of specimen requirements for tests performed
in-house and referred to reference laboratories.

\*([7]{.underline}) Ability to set short and/or long term goals for the
section and conduct studies on technical and administrative problems,
including personnel shortages, organizational structure, new technology,
etc.

[7.]{.underline} **Senior Technologist.** The incumbent serves in one or
more sections of a clinical laboratory and is assigned specialized and
complex laboratory tasks beyond providing patient test results.
Assignments may include laboratory test development or modification,
method validation/performance evaluation, and/or providing consultation
services to health care providers. In addition to the required core
competencies, must demonstrate the following:

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Comprehensive knowledge of, and skill in applying, a
wide range of concepts, principles, and methodology of the field to
perform advanced techniques.

([2]{.underline}) Ability to modify or adapt established methods,
procedures, or techniques to resolve difficult or complex problems.

([3]{.underline}) Ability to recognize methodology limitations such as
linearity, interference, sensitivity, and specificity to draw
conclusions about the validity of testing results.

([4]{.underline}) Ability to perform validation/method verification
studies for new systems and make recommendations.

([5]{.underline}) Skill to provide advisory services to technicians,
technologists, and other specialists.

\(5\) **GS-12**

\(a\) **Experience**. Completion of the equivalent of 1 year of
creditable experience at the next lower grade level, which is directly
related to the duties of the position to be filled, and must fully meet
the KSAs at that level. In addition, the candidate must demonstrate the
following professional KSAs and demonstrate the potential to acquire the
assignment specific KSAs as indicated by an asterisk (\*):

\(b\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Candidates at this grade level are
in one of the following assignments:

[1]{.underline}. **Supervisory Technologist.** The incumbent at this
level has full supervisory responsibility for a large staff of
nonsupervisory personnel, including GS-9 and GS-11 MTs, and at least 1
subordinate team leader or supervisor at the next lower grade level.
Recommends appointment, plans and assigns work, gives advice and counsel
and evaluates work of subordinates. Is responsible for monitoring test
analyses and specimen examinations to ensure acceptable levels of
performance. Assures corrective action is initiated. Assures
orientation, training and competency assessment of assigned staff.
Develops and updates technical policy and procedure manuals. Ensures all
staff and affiliate staff are in compliance with accrediting and
regulating bodies. Adjusts staffing levels or work procedures to
accommodate resource allocation decisions made at the executive level.
In addition to the required core competencies, must demonstrate the
following:

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Skill to develop new policies and guidelines,
formulate plans, and the ability to judge effectiveness of the
operation.

([2]{.underline}) Knowledge of laboratory quality management procedures
and principles.

\*([3]{.underline}) Knowledge of, and ability to, provide the full range
of supervisory duties which would include responsibility for assignment
of work to be performed; performance evaluations; selection of staff;
and recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

([4]{.underline}) Ability to analyze organizational, technical, and
administrative problems to develop and implement solutions that result
in efficient overall laboratory operation.

([5]{.underline}) Ability to successfully apply principles and
techniques of sound human resources and labor management.

\*([6]{.underline}) Knowledge and ability to manage fiscal matters of
the functions supervised, forecast resource and equipment needs, and
administer the allocated budget.

[2]{.underline}. **Ancillary Testing Coordinator.** The incumbent
develops and recommends policies and procedures for the procurement and
service requirements for ancillary testing (testing outside the physical
confines of the main laboratory as mandated by VHA). Must have knowledge
of accrediting agencies and regulatory requirements. In addition to the
required core competencies, must demonstrate the following:

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

\(1\) Knowledge of medical technology concepts, principles, practices,
and methodologies sufficient to perform the full range of maintenance of
both a technical and safety accreditation/testing program.

\(2\) Comprehensive knowledge to apply new scientific/technological
developments and theories to laboratory testing and a grasp of complex
laboratory testing issues.

\(3\) Knowledge of mathematics and statistics as related to quality
control, quality assurance, proficiency testing, inspection and
accreditation, and continuous quality improvement.

\(4\) Knowledge of the types of surveillance needed to monitor variables
that affect quality of services and skill in evaluating, interpreting,
and teaching others to use quality control procedures and implementing
corrective actions.

\(5\) Knowledge of federal, VHA, and state laws and regulations,
reference standards, medicolegal responsibilities, and certifying and
accrediting agency requirements to carry out the work in each ancillary
testing site.

[3]{.underline}. **Laboratory Manager/Chief
Technologist/Administrator.** The incumbent works in a smaller, less
complex laboratory and is responsible for managing and supervising all
phases of laboratory service operations. Provides guidance and serves as
an authority on laboratory medicine. Develops guidelines, assesses
laboratory effectiveness, establishes, and maintains quality assurance
and performance improvement programs. Consults with local and network
officials. In addition to the required core competencies, must
demonstrate the following:

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Ability to understand the balance between
administrative and clinical functions to coordinate and control programs
and resources.

\*([2]{.underline}) Knowledge and skill in management/administration,
which includes program planning, coordination, interpretation,
supervision, consultation, negotiation, problem solving, formulation of
policy and guidelines, and monitoring of laboratory programs.

([3]{.underline}) Ability to plan and execute long and short-range plans
and goals.

([4]{.underline}) Ability to effectively communicate, both orally and in
writing, on technical information with a wide variety of individuals
including senior VHA managers in the medical center, Veterans Integrated
Service Network (VISN) level staff, and VHA Central Office staff.

([5]{.underline}) Skill in applying analytical and evaluative methods
and techniques to the measurement and improvement of program
effectiveness and/or organizational productivity.

([6]{.underline}) Skill to develop new or modified work methods,
organizational structures, records and files, management processes,
staffing patterns, etc.

([7]{.underline}) Knowledge of regulatory, licensing, and accrediting
agency requirements, and statutes governing clinical laboratory
operations to use in planning, implementing, and monitoring laboratory
programs and services.

\(6\) **GS-13**

\(a\) **Experience**. Completion of the equivalent of 1 year of
creditable experience at the next lower grade level, which is directly
related to the position to be filled, and must fully meet the KSAs at
that level. In addition, the candidate must demonstrate the following
professional KSAs and demonstrate the potential to acquire the
assignment specific KSAs as indicated by an asterisk (\*):

\(b\) **Assignments.** Advancement of the laboratory
director/manager/chief technologist/administrator to the GS-13 level is
generally restricted to those serving at larger medical facilities with
comprehensive and complex laboratory services (typically active,
affiliated medical centers or outpatient clinics) and having full
supervisory responsibility for a large staff including GS-11 and GS-12
personnel. Individuals supervising more than one large service within a
facility, or more than one medical center laboratory at different
geographic locations, may also be assigned at the GS-13 level. For all
assignments above the full performance level, the higher-level duties
must consist of significant scope, complexity (difficulty), and range of
variety, and be performed by the incumbent at least 25% of the time.
Candidates at this grade level are in one of the following assignments.

[1]{.underline}. **Regional Commissioner Technologist.** The incumbent
serves as an authority to multiple laboratories in a region to assure
compliance with inspection and accreditation requirements and
regulations. Provides direction and guidance to resolve technical
problems and provides interpretation of existing regulations. Requires
verbal, written, and electronic communication with accrediting and
regulatory bodies. Works under the direction and guidance of the VHA
Enforcement Officer in VHA Central Office. These positions were
established in accordance with Public Law 102-139, Sec. 101(a). In
addition to the required core competencies, must demonstrate the
following:

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of concepts, principles, and methodology of
medical technology sufficient to assess and monitor quality control,
quality assurance, and proficiency testing in all areas of the
laboratory.

([2]{.underline}) Knowledge of accrediting and regulatory agency
requirements regarding consolidated oversight of clinical laboratories.

([3]{.underline}) Knowledge and understanding of laboratory operations
and relationships to the organization.

\*([4]{.underline}) Ability to organize and present lectures on the
inspection and accreditation rules, regulations, and standards of all
laboratory accrediting agencies.

([5]{.underline}) Ability to delineate and interpret accreditation
standards.

[2]{.underline}. **Laboratory Director/Manager/Chief**
**Technologist/Administrator.** The incumbent shares, with the chief of
laboratory service/medical director, full responsibility for managing
and supervising all phases of laboratory service operations. Provides
guidance and serves as an authority on laboratory medicine. Develops
guidelines, assesses laboratory effectiveness, establishes, and
maintains quality assurance and performance improvement programs. Serves
as a consultant to local, network, and national program officials. In
addition to the required core competencies, must demonstrate the
following:

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Advanced knowledge of concepts, principles, and
methodology of a major clinical laboratory program and operations to
assess program effectiveness and provide authoritative guidance for
operations, personnel, and management.

\*([2]{.underline}) Ability to work collaboratively with other
disciplines, upper management, VHA Central Office and/or VISN level
staff.

([3]{.underline}) Ability to plan and execute short and long range
programs.

\*([4]{.underline}) Skill in administrative management, i.e., budgeting,
contracting, procurement, and property management.

([5]{.underline}) Ability to provide advisory, planning, and
surveillance services to clinicians, laboratory directors, and
supervisors on specific functions, programs, or problems that are
particularly difficult, widespread, or persistent.

([6]{.underline}) Ability to solve complex problems concerned with
unique or controversial aspects of medical technology or laboratory
management, new or unconventional methods, program changes, or conflicts
between scientific/technological requirements and regulatory or program
(i.e., cost effectiveness) requirements.

**4. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for
medical technologists in VHA whose composite record of accomplishments,
performance, and qualifications, as well as current assignments, warrant
such action based on demonstrated competence to meet the requirements of
the proposed grade.

b\. Under no circumstances will the certification or educational
requirements as a medical technologist be waived.

c\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**

[]{#PartIIAppG24 .anchor}

##### APPENDIX G25. DIAGNOSTIC RADIOLOGIC TECHNOLOGIST

##### QUALIFICATION STANDARD

**GS-647**

# Veterans Health Administration

**1. COVERAGE.** The following are the requirements for appointment as a
Diagnostic Radiologic Technologist (DRT) in the Veterans Health
Administration (VHA). Diagnostic imaging embraces imagery produced using
ionizing radiation as well as other nonionizing radiation techniques,
including ultrasound, computed tomography, and magnetic resonance
imaging scans. These requirements apply to all VHA DRTs in the General
Schedule (GS)-647 series.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizen of the United States. (Non-citizens may be
appointed when it is not possible to recruit qualified candidates in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Certification.** All applicants must be certified in general
radiologic technology by the American Registry of Radiologic Technology
(ARRT) (R).

c\. **Experience or Education.** Completion of a full-time training
course of at least 24 months duration (or the equivalent) in a post-high
school diagnostic radiologic technology program, evidenced by a
certificate or an associate's degree, accredited by the Joint Review
Committee on Education in Radiologic Technology (JRCERT), and
certification by the American Registry of Radiologic Technologists
(ARRT) in radiology.

\(1\) Public Law 97-35, the Consumer-Patient Radiation Health and Safety
Act of 1981, requires that persons who administer radiologic procedures
meet the credentialing standards in 42 CFR Part 75, Standards for the
Accreditation of Educational Programs and the Credentialing of
Radiographic Personnel. Essentially, they must have successfully
completed an educational program that meets or exceeds the standards
described in that regulation, and is accredited by an organization
recognized by the Department of Education, [and]{.underline} be
certified as radiographers in their field.

\(2\) Non-certified applicants who otherwise meet the eligibility
requirements for ARRT (R) certification may be given a temporary
appointment as a graduate DRT under the authority of 38 U.S.C. § 7405
(a) (1) (D). Failure to obtain certification during that period is
justification for termination of the temporary appointment. This may
result in termination of employment.

\(3\) **Loss of Credential.** An employee in this occupation who fails
to obtain licensure/certification/

registration within the required time frame, or who fails to maintain
the required licensure/certification/

registration must be removed from the occupation, which may also result
in termination of employment.

For occupations which [require]{.underline} an active credential
(licensure/certification/registration) at all grade levels, at the
discretion of the appointing official, an employee may be reassigned to
another occupation for which he/she qualifies [if]{.underline} a
placement opportunity exists. For occupations which require an active
credential (licensure/certification/registration) in assignments above
the full-performance level [only]{.underline}, at the discretion of the
appointing official, an employee may remain at an appropriate lower
grade level in the occupation when both of the following apply:  the
credential is not a requirement [and]{.underline} a placement
opportunity exists.

d\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 hybrid qualification standards.
Some of these provisions may not apply to this occupation.  Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but [may not]{.underline} be promoted beyond the journey
level or placed in supervisory or managerial positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

**NOTE:** Each uncertified VA Diagnostic Radiologic Technologist who was
permanently employed on June 21, 1986, and whose competence in the safe
administration of ionizing radiation was affirmed, in writing, by a VA
licensed physician not later than January 1, 1987, is considered fully
qualified. These employees may be promoted, demoted or reassigned within
the GS-647 occupational series. Any employee initially retained in this
manner who leaves this job series loses protected status and must meet
the full requirements in effect at the time of reentry.

e\. **Physical Requirements.** See VA Directive and Handbook 5019.

f\. **English Language Proficiency.** Diagnostic Radiologic
Technologists must be proficient in spoken and written English in
accordance with chapter 2, section D, paragraph 5a, this part.

# 3. GRADE REQUIREMENTS

a\. **Definitions**

\(1\) **Creditable Experience**

\(a\) **Knowledge of Current Radiologic Technology Practice.** To be
creditable, experience must have demonstrated possession of the
knowledge, skills, abilities, and other characteristics (also referred
to as "core competencies") associated with current radiologic technology
practice. This may have been evidenced by the equivalent of 1 year of
active practice, which is paid or non-paid employment as a DRT as
defined by ARRT.

\(b\) **Quality of Experience.** Experience is only creditable if it was
earned after completion of the basic requirements identified in
paragraph 2.b. above. Experience as a graduate DRT is creditable
provided the candidate functioned as a DRT and subsequently passed the
certification examination.

\(c\) **Part-Time Experience.** Part-time experience as a DRT is
creditable according to its relationship to full-time workweek. For
example, a DRT would receive 1 week of full-time credit for each 2 weeks
of half-time work.

\(2\) **Specialized Assignment Definitions.** Specialized areas of
radiologic technology include general diagnostic radiologic technology
(R), bone densitometry (BD), mammography (M), diagnostic ultrasound (S),
computed tomography (CT), positron emission tomography/computed
tomography (PET/CT), magnetic resonance imaging (MR),
cardiovascular-interventional technology (CV), and quality management
(QM).

\(a\) **General Radiologic Technology (R).** Diagnostic radiologic
technologists perform procedures and examinations in hospitals or
clinics under the direction of radiologists and other medical officers.
The objective of the examinations and procedures is to produce
radiographic studies that are used in medical diagnosis and interpreted
by medical officers to locate injuries, foreign bodies, pathological
conditions, or lesions within the body. They prepare and administer
contrast media and medications in accordance with State and Federal
regulations. All diagnostic radiologic technologists must be
knowledgeable in Computerized Radiography (CR) and Picture Archiving and
Communications Systems (PACS).

\(b\) **Bone Densitometry (BD).** This non-invasive test measures bone
mineral content to diagnose a systemic skeletal disease (osteoporosis)
characterized by low bone mass and microarchitectural distortion of bone
tissue, with a consequent increase in bone fragility and susceptibility
to fracture.

\(c\) **Mammography (M).** The complex nature of breast disease involves
multiple imaging modalities. This specialty involves the specific
knowledge and abilities to perform complex imaging of the breast. They
must be able to employ specialized mammographic image techniques such as
magnification views and implant views of the breast. The mammographer is
required to be completely familiar with, and adhere to, all U.S Food and
Drug Administration (FDA) guidelines regulating the practice of
mammography, radiation safety, and quality assurance requirements.
Mammographers are subject to the Mammography Quality Standards Act of
1992 (MQSA) and regulated by the FDA.

\(d\) **Diagnostic Ultrasound (Sonography) (S).** Positions should be
assigned to the DRT, GS-647 series, when [both]{.underline} ultrasound
and other modalities which require the delivery of ionizing radiation
are performed. Positions in which ultrasound duties are performed
exclusively (no other modalities are performed), should be assigned to
the Medical Instrument Technician, GS-649 series, since ultrasound
duties solely do not require the delivery of ionizing radiation.
Diagnostic ultrasound uses high frequency sound waves and other
diagnostic techniques for medical purposes. The practitioner must be
competent in the production, use, recognition, and analysis of
ultrasound images and patterns used for patient diagnosis and treatment.
The sonographer is regarded as the expert source of all ultrasound
imaging, and the interpreting radiologist relies heavily on the skills,
knowledge, and abilities of the sonographers in providing a final
interpretation. Within this specialization there is a diverse range of
ultrasound imaging sub-specialties. These include: 1) diagnostic medical
sonography -- abdominal, neurologic, obstetrical/gynecologic, and
ophthalmic; 2) cardiac sonography -- adult and pediatric
echocardiography; and 3) vascular technology -- vascular and related
organs.

\(e\) **Computed Tomography (CT).** This specialty modality requires
specific knowledge of cross sectional human anatomy and its application
in spiral, and/or, multi-slice computer tomography, inclusive of 3-D
reconstruction scans, including drainages, biopsies, and peripheral
vascular examinations. The technologist requires specific knowledge and
training in the location, appearance, and function of the various major
and minor systems susceptible to radiological illumination; to interpret
the examination request accurately; to understand the functioning and
inter-relationship of the various organs; to use the methods and
techniques which will identify organs appearing on the digital display

monitor, or on film, and the various stages of the examination to judge
the acceptability of the image and/or scan for diagnostic use and to
emphasize the aspects of particular interest to the physician.

\(f\) **Positron Emission Tomography**/**Computed Tomography (PET/CT).**
PET/CT is part of the progression of fusion imaging, combining one
specialty modality with another. This technology combines metabolic
function with anatomic form. Registered technologists in diagnostic
radiologic technology, nuclear medicine and/or radiation therapy may
operate PET/CT when the appropriate core competencies are evidenced.
Technologists performing these procedures must be competent in every
aspect of the examination in order to maximize quality and minimize
dose. Technologists must be knowledgeable in contrast media, power
injectors, and CR systems and PACS.

\(g\) **Magnetic Resonance Imaging (MR).** This specialty modality
requires additional knowledge of super conducting magnets, the physics
of superconducting magnets, and how they relate to the human anatomy in
medical imaging. The technologist must be educated in the safety factors
governing a magnetic environment that patients, visitors, and equipment
enter into. The practitioner must have specific specialized knowledge of
cross sectional anatomy and how it relates to the soft tissues and
vessels of the human body. The technologist must also have specialized
knowledge in the radio-frequency surface coils required for each
specific anatomical area to be imaged. The technologist requires
knowledge of image acquisition in Computerized Radiography (CR) and
Picture Archiving and Communication Systems (PACS).

\(h\) **Cardiovascular-Interventional Technology (CV).**
Cardiovascular-interventional technologists (CV) use specialized
equipment to perform diagnostic angiographic procedures and complex
vascular and nonvascular interventional and therapeutic procedures. This
specialty requires additional knowledge of vascular systems and major
vessel anatomy. The technologist must be

knowledgeable in the specialized equipment employed for digital
subtraction systems and interventional procedures. The technologist
administers contrast media under the supervision of the staff
radiologist and confers with the radiologist to establish requirements
with reference to contrast agents, vital signs,

medications, and physiologic monitoring to perform procedures. CV
technologists must be knowledgeable in Computerized Radiography (CR) and
Picture Archiving and Communications Systems (PACS).

\(i\) **Quality Management Technologist (QM).** Performs daily
inspection of radiographic units to ensure proper mechanical
functionality. Performs daily sensitometric and densitometer testing on
all x-ray film processors. Performs monthly, quarterly, semi-annual, and
annual Quality Control testing; i.e., dark room fog, sensitometer
consistency, and densitometer calibrations. Ensures daily functionality
of CR readers. Provides in-service training to technologists and other
personnel involved in the operation and maintenance of x-ray film
processors, CR readers, and other PACS type of operations maintained
within the department. Coordinates all scheduling of preventative
maintenance for modalities either through biomedical engineering or
local contractor service. Works with physicists to ensure compliance
with radiation safety program and for acceptance testing of all new
installations of equipment. Maintains accurate records, as required by
management, for quality assurance analysis, quality control, performance
improvement, and other related purposes.

b\. **Grade Determinations.** In addition to the basic requirements for
appointment, the following criteria must be used when determining the
appropriate grade assignment of candidates:

\(1\) **GS-5**

\(a\) **Experience or Education.** None beyond the basic requirements.

\(b\) **Assignment.** Employees at this level serve in a DRT career
development position. It is expected that they receive guidance from
more experienced staff members for more complex patient issues, and
require daily and direct supervision.

\(2\) **GS-6**

\(a\) **Experience.** At least 1 year of experience at the next lower
grade level that demonstrates the core competencies described at that
level, i.e., experience that demonstrates possession of the knowledge,
skills, abilities, and other characteristics needed to provide general
radiologic technology services in a therapeutic setting. In addition,
the candidate must demonstrate the following KSAs:

**OR,**

\(b\) **Education.** The successful completion of a 4-year baccalaureate
degree program in radiography or other directly related field to
diagnostic radiology/imaging.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of basic technique standards for minimum
radiographic exposure;

[2]{.underline}. Knowledge of anatomy and positioning;

[3]{.underline}. Knowledge of all patient safety procedures;

[4]{.underline}. Knowledge of radiographic producing equipment; and

[5]{.underline}. Ability to learn basic computer functions.

\(d\) **Assignment.** Candidates at this grade level serve as staff
DRTs. It is expected that they receive guidance from more experienced
staff members for more complex patient issues and require direct
supervision in any assignment area of general radiologic technology.

\(3\) **GS-7**

\(a\) **Experience.** At least 1 year of experience at the next lower
grade level that demonstrates the core competencies described at that
level, i.e., experience that demonstrates possession of the knowledge,
skills, abilities, and other characteristics needed to provide general
radiologic technology services in a therapeutic setting and/or in a
specialized area. In addition, the candidate must demonstrate the
following KSAs:

**OR,**

\(b\) **Education.** The successful completion of 1 full academic year
of graduate education leading to a degree program in radiography or
other directly related field related to diagnostic radiology/imaging.
Education may relate to the duties of a specific position or to the
occupation, but must be appropriate for the position being filled.

\(c\) **Certification.** Certification by ARRT in one of the specialized
areas of radiologic technology is highly desirable, in addition to
certification by ARRT as a general radiologic technologist.

\(d\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of the technical adequacy of the digital
image, including the ability to adjust the image quality in the digital
system;

[2]{.underline}. Knowledge of different contrast material required for
the requested study;

[3]{.underline}. Knowledge of radiation protection standards, minimum
radiographic exposure techniques, appropriate beam limitation to
anatomical area, and employing lead shielding when performing standard
or fluoroscopic procedures;

[4]{.underline}. Knowledge of the function of computed radiography,
Phosphor cassettes and computed radiography (CR) readers;

[5]{.underline}. Knowledge of PACS systems, CDROMS, and basic computer
skills;

[6]{.underline}. If the position is supervisory in nature, ability to
manage and supervise employees; and

[7]{.underline}. If the position is supervisory in nature, ability to
coordinate staff development and training.

\(e\) **Assignments.** Staff DRT assignments at this level represent the
advanced developmental level leading to the full performance level,
performing a substantially full range of duties but receiving guidance
and directions regarding unfamiliar or unusual situations for more
complex patient issues. Employees may also be assigned to team leader
and supervisory positions at this level.

[1]{.underline}. **Staff** **DRT.** Candidates at this grade level are
to be qualified to provide services in specialized areas of radiologic
technology listed above and/or general radiologic technology services.

[2]{.underline}. **Diagnostic Radiologic Technology Team Leader.**
Functions as a lead technologist for a group of DRTs at the GS-6 level
or lower, who provide the full range of general radiographic imaging
procedures. Typical assignments include, but are not limited to:
providing technical oversight necessary for accomplishing the work of
the organizational unit; planning, directing, and distributing the work
to technologists at lower grade levels; providing feedback to supervisor
on technical aspects of work; resolving informal employee complaints;
instructing and training technologists on newly acquired equipment; and
independently performing a variety of general and/or specialized
radiographic imaging procedures in more complex cases.

[3]{.underline}. **Supervisory** **Diagnostic Radiologic Technologist.**
Functions as a first-level supervisor for a group of DRTs at the GS-6
level or lower, who provide the full range of general radiographic
imaging procedures. Plans work schedules to assure an even flow and
distribution of work; explains work requirements and assigns work on a
daily and weekly basis, accounting for weekend and evening shifts (if
necessary); sets deadlines and priorities; develops operating
instructions; identifies equipment requirements; recommends methods to
improve work quality and productivity; reviews the work in progress or
upon completion by spot checking, as appropriate. Directs on-the-job
training for employees and provides back-up skills by cross training.
Confers with radiologists to develop standard and non-standard exam
protocols. Advises employees of the performance requirements of their
positions, keeps them informed of their progress in meeting the
requirements, and prepares formal evaluations of employee performance.

\(4\) **GS-8**

\(a\) **Experience.** At least 1 year of experience at the next lower
grade level that demonstrates the core competencies described at that
level, i.e., experience that demonstrates possession of the knowledge,
skills, abilities, and other characteristics needed to provide general
radiologic technology services in a therapeutic setting and/or in a
specialized area. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Certification.** Certification by ARRT in one of the specialized
areas of radiologic technology is highly desirable, in addition to
certification by ARRT as a general radiologic technologist.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to check system for operation and assess
acceptable performance based on established guidelines;

[2]{.underline}. Knowledge of calibration parameters and the ability to
make adjustments as needed;

[3]{.underline}. Knowledge of patient's clinical record, diagnosis, and
laboratory results;

[4]{.underline}. Ability to monitor patient's physiologic changes during
the procedure and keep the radiologist informed;

[5]{.underline}. Skill in using tact, diplomacy, and courtesy in
dealings with the customer base, patients, staff, family, visitors, and
volunteers; and

[6]{.underline}. Knowledge of anatomy and physiology, and
cross-sectional anatomy, recognizing unusual images, and determining
proper positioning to best demonstrate areas of interest.

[7]{.underline}. If the position is supervisory in nature, the ability
to manage and supervise employees; and

[8]{.underline}. If the position is supervisory in nature, the ability
to coordinate staff development and training.

\(d\) **Assignments.** Employees at this grade level serve as staff DRTs
at the full performance level, and may be appointed to one of the
following assignments:

[1]{.underline}. **Staff DRT.** Candidates at this grade level are to be
qualified to provide services in specialized areas of radiologic
technology listed above and/or general radiologic technology services.

[2]{.underline}. **Diagnostic Radiologic Technology Team Leader.**
Functions as a lead technologist for a group of DRTs at the GS-7 level
or lower, who provides the full range of general radiographic imaging
procedures. Provides feedback to supervisor on technical aspects of
work. Evaluates new products and equipment and makes recommendations to
supervisor concerning developments that would improve operations.
Ensures all equipment is in safe working order, reporting all equipment
problems as appropriate. Maintains supplies for work areas.

[3]{.underline}. **Supervisory** **Diagnostic Radiologic Technologist.**
Functions as a first-level supervisor for a group of DRTs at the GS-7
level or lower, who provides the full range of general radiographic
imaging procedures. Oversees attendance and leave, including approval of
ordinary sick and annual leave and vacation schedules. Informs higher
level management of anticipated vacancies or increases in workload;
recommends promotions, reassignments, or other changes of assigned
personnel, such as retention or release of probationary employees,
annual salary step increases, and recommending recognition of superior
performance. Holds corrective interviews with employees, referring
disciplinary problems to higher levels of management; resolves informal
complaints of employees; deals with union representatives on matters
involving action by an immediate supervisor. Provides technical
supervision necessary for accomplishing the work of the organizational
unit.

\(5\) **GS-9**

\(a\) **Experience.** Completion of 1 year of experience equivalent to
the next lower grade level directly related to the position being
filled, and must fully meet the KSAs at that level. In addition, the
candidate must demonstrate the following technical KSAs and demonstrate
the potential to acquire the assignment specific KSAs designated by an
asterisk (\*)

\(b\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. DRTs at this grade level may be
appointed to one of the following assignments:

[1]{.underline}. **Staff DRT.** Employees at this level are fully
functional as a DRT and are able to carry out their assigned tasks
independently. DRTs at this level may have varying assignments including
special and complex radiographic procedures. Regardless of the nature of
the specific assignment, the work must be of sufficient scope and
complexity to meet the knowledge, skills, and abilities to perform at
this level.

[a]{.underline}. Demonstrated Knowledge, Skills, and Abilities

\*(1) Ability to balance the needs of the patients and staff while still
performing complex scans and procedures;

([2]{.underline}) Skill to demonstrate appropriate techniques to gather
relevant information from the medical record, significant others, and
health care providers;

\*([3]{.underline}) Ability to assess factors that may contraindicate
the procedure;

([4]{.underline}) Knowledge of basic first aid and basic life support
practices related to radiography;

([5]{.underline}) Knowledge of physical assessment, aseptic techniques,
intravenous skills, and universal precautions; and

([6]{.underline}) Knowledgeable in pre-procedural, procedural, and
post-procedural care of patients.

[2]{.underline}. **Diagnostic Radiologic Team Leader.** Functions as a
lead DRT for a group of DRTs.

[a]{.underline}. Demonstrated Knowledge, Skills, and Abilities

\*([1]{.underline}) Ability to provide technical oversight and assign
personnel and tasks to be accomplished in a manner that assures
completion of the workload utilizing the personnel to the greatest
advantage thus providing the optimal level of patient care within the
workday;

\*([2]{.underline}) Ability to plan, direct, and distribute work
assignments to diagnostic radiologic technologists at lower grade
levels;

\*([3]{.underline}) Skill in instructing and training DRTs on newly
acquired equipment; and

\*([4]{.underline}) Ability to plan and project staffing needs.

[3]{.underline}. **Supervisory Diagnostic Radiologic Technologist.**
Functions as a supervisor for a group of DRTs and may include support
staff. Advises employees of the performance requirements of their
positions, informs them of their progress in meeting the requirements,
and prepares formal evaluations of employee performance. Conducts
corrective interviews with employees, referring disciplinary problems to
higher levels of manage-ment; resolves informal complaints of employees;
and deals with union representatives as appropriate.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

\*([1]{.underline}) Ability to organize work, set priorities, delegate
tasks and responsibilities;

([2]{.underline}) Skill in interpersonal relationships in dealing with
employees, team leaders, and managers;

\*([3]{.underline}) Skill in assessing qualifications and abilities of
current and prospective employees;

\*([4]{.underline}) Ability to consult with radiologist to develop
standard and non-standard treatment/exam protocols; and

([5]{.underline}) Skill to independently perform general and specialized
diagnostic radiologic procedures in advanced levels of complex treatment
situations.

\(6\) **GS-10**

\(a\) **Experience.** Completion of 1 year of experience equivalent to
the next lower grade level directly related to the position being
filled, and must fully meet the KSAs at that level. In addition the
candidate must meet following technical KSAs and demonstrate the
potential to acquire the assignment specific KSAs designated by an
asterisk (\*):

\(b\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. DRTs at this grade level may be
appointed to one of the following assignments:

[1]{.underline}. **Staff DRT.** Employees at this level who are not
leads or supervisors may be assigned varying duties related to
diagnostic imaging. Employees are trained to work in one or more
difficult and complex modalities performing procedures related to these
modalities as well as providing general diagnostic procedures in a
therapeutic setting. At this grade level, it is expected that such
assignments be unique, perhaps with expert specialization in complex
areas of radiologic technology.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

\*([1]{.underline}) Thorough knowledge of radiation protection
standards, devices and techniques including concepts of accumulated
dosage and genetic changes;

\*([2]{.underline}) Skill to recognize changes in equipment and
procedures that might result in increased exposures, and recommend
methods to prevent such exposures;

\*([3]{.underline}) Knowledge of basic physics including concepts of
energy, electric power, magnetic fields, and properties of x-ray, in
order to understand the operation of the equipment; and

([4]{.underline}) Knowledge and skill in positioning of patients for a
wide variety of difficult radiographic (CT, MRI, Special Procedures,
Mammography, etc.) studies.

[2]{.underline}. **Diagnostic Radiologic Team Leader.** Functions as a
lead DRT for a group of DRTs. Provides a full range of general
radiologic treatment procedures, has a broad knowledge of the different
modalities within the diagnostic radiologic area, and is accountable to
the next higher-level supervisor.

a\. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Ability to provide feedback to supervisor on technical
aspects of work;

\*([2]{.underline}) Ability to resolve informal employee complaints;

\*([3]{.underline}) Ability to monitor and report on the status and
progress of work, and make adjustments to accomplish the workload in
accordance with established procedures; and

([4]{.underline}) Skill to independently perform general and specialized
diagnostic radiologic procedures in advanced levels of complex treatment
situations.

[3]{.underline}. **Supervisory Diagnostic Radiologic Technologist.**
Functions as a supervisor for a group of DRTs which may include support
staff. Evaluates new products and equipment, making recommendations to
supervisor concerning upgrades/new purchases that would improve
operations. Informs higher level management of anticipated staffing
variances and informally recommends promotions, reassignments, or other
personnel changes such as retention or release of probationary
employees, and recommending recognition of superior performance in the
diagnostic radiologic area.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

\*([1]{.underline}) Ability to analyze organizational, technical, and
administrative problems and to develop and implement solutions that
result in efficient section operation;

\*([2]{.underline}) Skill to evaluate quality management procedures and
processes;

\*([3]{.underline}) Ability to analyze and use data effectively to
manage workload, quality, performance, and productivity;

\*([4]{.underline}) Skill to develop new policies and guidelines as
needed; and

([5]{.underline}) Skill in problem solving and conflict resolution.

\(7\) **GS-11**

\(a\) **Experience.** Completion of 1 year of experience at the next
lower grade level, that is directly related to the position to be filled
and that demonstrates possession of the knowledge, skills, abilities and
other characteristics needed to provide services as a quality control
technologist, diagnostic radiologic technology team leader, supervisory
radiologic technologist, or an assistant chief radiologic technologist.
In addition, the candidate must demonstrate the following technical KSAs
and demonstrate the potential to acquire the assignment specific KSAs
designated by an asterisk (\*):

\(b\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. DRTs at this grade level may be
appointed to one of the following assignments:

[1]{.underline}. **Quality Management Technologist (QM).** Performs
daily inspection of radiographic units to ensure proper mechanical
functionality. Performs daily sensitometric and densitometer testing on
all x-ray film processors. Performs monthly, quarterly, semi-annual, and
annual QC testing; i.e., dark room fog, sensitometer consistency,
densitometer calibrations. Ensures daily functionality of CR readers.
Provides in-service training to technologists and other personnel
involved in the operation and maintenance of x-ray film processors, CR
readers, and other PACS type of operations maintained within the
department. Coordinates all scheduling of preventative maintenance for
modalities either through biomedical engineering or local contractor
service. Works with physicists to ensure compliance with radiation
safety program and for acceptance testing of all new installations of
equipment. Maintains accurate records, as required by management, for
quality assurance analysis, quality control, performance improvement,
and other related purposes.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

**\***([1]{.underline}) Knowledge of all Joint Commission on
Accreditation of Healthcare Organizations (JCAHO), Occupational Safety
and Health Administration (OSHA), and VA standards regarding radiology
quality assurance and other technical functions;

\*([2]{.underline}) Skill to properly train staff on quality assurance
and control;

**\***([3]{.underline}) Knowledge of Automated Management Information
System (AMIS) preparation and fill usage reports for monthly and
quarterly reporting of activity and usage data;

([4]{.underline}) Thorough knowledge of x-ray and other image-producing
machinery, film processors, and intensifying screens in order to design
and operate a complete radiology quality assurance program; and

([5]{.underline}) Knowledge of physics and chemistry to enable the
incumbent to diagnose difficulties in x-ray machinery and processors.

[2]{.underline}. **Diagnostic Radiologic Technologist Team Leader**.
Functions as a lead technologist for a group of DRTs. Provides a full
range of general radiologic treatment procedures and a broad knowledge
of the different modalities within the diagnostic radiologic area, and
is accountable to the next higher-level supervisor.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

\*([1]{.underline}) Skill in directing on-the-job training for
employees;

\*([2]{.underline}) Ability to evaluate work performance of lower level
employees and recommend performance ratings;

\*([3]{.underline}) Skill in technical planning and oversight to set and
adjust work priorities, and assure that work requirements are met based
on employee capabilities;

([4]{.underline}) Knowledge and skill to provide care appropriate to the
age of the patients served, including knowledge of growth and
development; and

\*([5]{.underline}) Knowledge of medical center, VHA, and
government-wide human resources management regulations, policies and
procedures.

[3]{.underline}. **Supervisory Diagnostic Radiologic Technologist
(Chief).** Employees in this assignment assume full administrative and
professional responsibility for planning and directing the radiologic
technology program at a medical center or independent outpatient clinic
that does not meet the level of complexity described at the GS-12 level
for a chief radiologic technologist and has significant supervisory
responsibility for staff.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

\*([1]{.underline}) Ability to develop and initiate new imaging services
that apply current research findings;

\*([2]{.underline}) Ability to participate as an instructor in the
facility's in-service clinical training findings;

\*([3]{.underline}) Skill to interview and evaluate candidates for
positions in the section and recommend appointments, advancements, or,
when appropriate, disciplinary actions;

\*([4]{.underline}) Ability to evaluate performance, identify continuing
education and training needs, etc.; and

\*([5]{.underline}) Ability to analyze organizational, technical, and
administrative problems and to develop and implement solutions that
result in efficient section operation.

[4]{.underline}. **Supervisory Diagnostic** **Radiologic Technologist
(Assistant Chief).** This assignment is restricted to employees serving
as a full assistant to a GS-12 chief radiologic technologist.
Individuals in this assignment share full responsibility for managing
the radiologic technology section.

[a.]{.underline} **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of overall radiology department operations,
and the ability to judge effectiveness of the operation;

\*([2]{.underline}) Ability to monitor and evaluate subordinate
supervisors' performance;

\*([3]{.underline}) Ability to formulate plans, delegate authority, and
follow-up on delegated tasks;

([4]{.underline}) Knowledge of new and recent developments in the field;

\*([5]{.underline}) Skill in participating in organizational national
initiatives and/or intra agency workgroups, or committees; and

\*([6]{.underline}) Ability to draft and/or recommend organizational
national policies and/or directives.

\(8\) **GS-12**

\(a\) **Experience.** Completion of 1 year of experience comparable to
the next lower grade level and must fully meet the KSAs at that level.
Examples include:

[1]{.underline}. Experience in a supervisory capacity or as a quality
control technologist, or a diagnostic radiologic technology team leader;

[2]{.underline}. Experience in planning or assisting in the
establishment of a completely integrated radiologic technology program
at a medical center or comparable facility; or

[3]{.underline}. Experience in the management or administration of a
radiologic technology or closely related program.

In addition, the candidate must demonstrate the following technical KSAs
and demonstrate the potential to acquire the assignment specific KSAs
designated by an asterisk (\*):

\(b\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. DRTs at this grade level may be
appointed to one of the following assignments:

[1]{.underline}. **Supervisory Diagnostic Radiologic Technologist
(Chief).** Assignment to this grade level is restricted to those serving
as the chief radiologic technologist at medical facilities with
comprehensive and complex radiographic and imaging programs. Employees
in these assignments plan and direct the radiologic technology program
at active, affiliated medical centers or outpatient clinics, and have
full supervisory responsibility for a large staff of nonsupervisory
personnel, including GS-10 DRTs, and at least 1 subordinate team leader
or supervisor at the next lower grade level, and any clerical or
administrative support staff. At this level, the radiologic technology
program typically includes the full variety of specialties.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

\*([1]{.underline}) Ability to perform the full range of supervisory
duties, including responsibility for assignment of work performed;
performance evaluation; recommendations for appointment, awards,
advancement, and, when appropriate, disciplinary actions; and
identification of continuing education and training needs;

([2]{.underline}) Skill to serve as a consultant to other facility
personnel in evaluating and planning radiologic technology services for
the most complex cases;

\*([3]{.underline}) Ability to participate in research studies and/or as
a consultant to others conducting research;

\*([4]{.underline}) Ability to consult with staff and resident
physicians through patient presentation, attending ward rounds, and
specialty clinics and/or conferences, etc.; and

\*([5]{.underline}) Skill to assess, plan, and evaluate the delivery of
radiologic technology services at the facility.

[2]{.underline}. **Radiology Administrator.** Assignment to this grade
level is restricted to those serving as the radiology administrator at
medical facilities with comprehensive and complex radiographic and
imaging

programs. Employees in these assignments plan and direct the technical
and administrative operations of the radiology program at active,
affiliated medical centers, and have full supervisory responsibility for
a large staff of nonsupervisory personnel, including GS-10 DRTs, at
least 1 subordinate team leader or supervisor at the next lower level,
and the clerical and administrative support personnel. At this level,
the radiologic technology program typically includes the full variety of
specialties.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

\*([1]{.underline}) Knowledge of the fiscal matters of the radiology
program, including VHA funds and several addi-tional fund controls, and
ability to administer the scarce medical specialist contracts for
professional services;

\*([2]{.underline}) Skill to make short and long-term supply, equipment,
and major space alteration recommendations, and prepare specifications
for radiographic equipment purchases and remodeling requests;

([3]{.underline}) Ability to recommend program effectiveness
improvements to meet VHA and JCAHO accreditation standards;

\*([4]{.underline}) Ability to make and implement major managerial
recommendations for the radiology program, such as organizational
improvements including changes in structure and delegation; maintain
realistic cost/benefit ratios; and policy and procedure changes to
improve service to patients; and

\*([5]{.underline}) Ability to perform the full range of supervisory
duties, including responsibility for assignment of work performed;
performance evaluation; recommendations for appointment, awards,
advancement, and, when appropriate, disciplinary actions; and
identification of continuing education and training needs.

\(9\) **GS-13**

\(a\) **Experience.** Completion of 1 year of experience comparable to
the next lower grade level and must fully meet the KSAs at that level.
In addition, the candidate must demonstrate the following technical KSAs
and demonstrate the potential to acquire the assignment specific KSAs
designated by an asterisk (\*):

\*[1]{.underline}. Knowledge of national initiatives and/or intra-agency
workgroups or committees;

[2]{.underline}. Ability to draft and/or recommend national policies
and/or directives;

\*[3]{.underline}. Ability to perform VHA Central Office special
projects and activities; and

[4]{.underline}. Skill in managing resources, i.e., space, equipment,
supplies, personnel at the national level.

\(b\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. DRTs at this level function as
program specialists responsible for the management of national
initiatives having a high degree of visibility and a significant impact
on VHA health care delivery. Examples include national initiatives in
the care and treatment of patients, educational programs, program

evaluation, quality assurance, etc. These programs typically include
collaboration with other Federal and State agencies, professional
organizations, etc.

# 4. DEVIATIONS

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for
diagnostic radiologic technologists in VHA whose composite record of
accomplishments, performance, and qualifications, as well as current
assignments, warrant such action based on demonstrated competence to
meet the requirements on the proposed grade.

b\. Under no circumstances will the certification requirements of
radiologic competence and ARRT (R) certification/registration be waived.

c\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**

[]{#PartIIAppG26 .anchor}**APPENDIX G26. THERAPEUTIC RADIOLOGIC
TECHNOLOGIST**

**QUALIFICATION STANDARD**

**GS-648**

**Veterans Health Administration**

**1. COVERAGE.** The following are the requirements for appointment as a
Therapeutic Radiologic Technologist (TRT) in the Veterans Health
Administration (VHA). TRTs assist in the localization of tumors,
participate in treatment planning, and deliver high doses of ionizing
radiation as prescribed by the radiation oncologists. These requirements
apply to all VHA TRTs in the General Schedule (GS)-648 series.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizen of the United States. (Non-citizens may be
appointed when it is not possible to recruit qualified candidates in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Certification**

\(1\) All applicants must be certified in therapeutic radiologic
technology by the American Registry of Radiologic Technology (ARRT) (T).

\(2\) Certification in Medical Dosimetry is not a basic requirement for
this occupation; however, it is strongly desirable as evidence of
possession of the essential knowledge, skills, and abilities.
Certification is required for assignments at the GS-12 grade level.

c\. **Experience or Education.** Completion of a program in therapeutic
radiologic technology, evidenced by a certificate or an associate's
degree, accredited by the Joint Review Committee on Education in
Radiologic Technology (JRCERT); certification by the American Registry
of Radiologic Technologists (ARRT) in Radiology, and the subsequent
completion of a 12-month JRCERT approved program in therapeutic
radiologic technology. JRCERT is the accrediting agency for the
radiation therapy programs recognized by the US Department of Education.

\(1\) Public Law 97-35 requires that persons who administer radiologic
procedures meet the credentialing standards in 42 CFR Part 75.
Essentially, they must have successfully completed an educational
program that meets or exceeds the standards described in that
regulation, and is accredited by an organization recognized by the
Department of Education, [and]{.underline} be certified (registered) as
radiation therapists in their field.

\(2\) Non-certified applicants who otherwise meet the eligibility
requirements for ARRT (T) certification may be given a temporary
appointment as a graduate TRT under the authority of 38 U.S.C. § 7405
(a) (1) (D). Failure to obtain certification during that period is
justification for termination of the temporary appointment. This may
result in termination of employment.

\(3\) **Loss of Credential.** An employee in this occupation who fails
to obtain licensure/certification/registration within the required time
frame, or who fails to maintain the required
licensure/certification/registration must be removed from the
occupation, which may also result in termination of employment.

For occupations which [require]{.underline} an active credential
(licensure/certification/registration) at all grade levels, at the
discretion of the appointing official, an employee may be reassigned to
another occupation for which he/she qualifies [if]{.underline} a
placement opportunity exists.  For occupations which require an active
credential (licensure/certification/registration) in assignments above
the full-performance level [only]{.underline}, at the discretion of the
appointing official, an employee may remain at an appropriate lower
grade level in the occupation when both of the following apply:  the
credential is not a requirement [and]{.underline} a placement
opportunity exists."

d\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 Hybrid qualification standards.
Some of these provisions may not apply to this occupation. Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but [may not]{.underline} be promoted beyond the journey
level or placed in supervisory or managerial positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

**NOTE:** Each uncertified VA Therapeutic Radiologic Technologist who
was permanently employed on June 21, 1986, and whose competence in the
safe administration of ionizing radiation was affirmed, in writing, by a
VA licensed physician not later than January 1, 1987, is considered
fully qualified. These

employees may be promoted, demoted or reassigned within the GS-648
occupational series. Any employee initially retained in this manner who
leaves this job series loses protected status and must meet the full
requirements in effect at the time of reentry.

e\. **Physical Requirements.** The work requires long periods of
standing and walking. There is some bending and carrying of moderately
heavy articles such as film cassettes, treatment devices, and molds with
heavier lifting of wedges and specially designed shielding blocks.
Patients often are assisted to achieve proper positioning, which may
require reaching, lifting, or working in strained positions. The
deterioration of the patient due to disease progression often requires
lifting of the patient from stretchers or wheelchairs to treatment and
examination tables utilizing special techniques designed to minimize the
discomfort of the patient. See VA Directive and Handbook 5019.

f\. **English Language Proficiency.** TRTs must be proficient in spoken
and written English in accordance with chapter 2, section D, paragraph
5a, this part.

**3. GRADE REQUIREMENTS**

a\. **Definitions**

\(1\) **Creditable Experience**

\(a\) **Knowledge of Current Therapeutic Radiologic Technology
Practice.** To be creditable, experience must have demonstrated
possession of the knowledge, skills, abilities, and other
characteristics associated with current therapeutic radiologic
technology practice including Picture Archiving Communication Systems
(PACS), digital imaging, and Computed Radiography (CR) readers.

\(b\) **Quality of Experience.** Experience is only creditable if it was
earned after completion of the basic requirements identified in
paragraph 2.b. above. Experience as a graduate TRT is creditable
provided the candidate functioned as a TRT and subsequently passed the
certification examination.

\(c\) **Part-Time Experience.** Part-time experience as a TRT is
creditable according to its relationship to full-time workweek. For
example, a TRT would receive 1 week of full-time credit for each 2 weeks
of half-time work.

\(2\) **Specialized Assignment Definitions.** Specialized areas of
therapeutic radiologic technology include general therapeutic radiologic
technology, simulation, mold room, treatment planning, and medical
dosimetry.

\(a\) **General Therapeutic Radiologic Technology.** Therapeutic
radiologic technologists administer ionizing radiation to specifically
determined sites, following prescriptions of the radiation oncologist to
deliver high dose levels of ionizing radiation to predetermined areas of
malignant tumors as well as certain benign disorders. The objective of
the radiation treatments and procedures is to accurately deliver a
therapeutic dose level of ionizing radiation to a precise site. The
therapists utilize combinations of wedges, blocks, treatment devices,
multileaf collimators, record and verify systems, portal vision, and
other specialized methodologies to accomplish treatment goals in
accordance with State and Federal regulations.

\(b\) **Simulation.** Simulation utilizes X-ray and Positron Emission
Tomography (PET)/Computerized Axial Tomography (CT) imaging to produce
multiple axial computer generated images of the human anatomy with
emphasis placed on areas determined to be relevant to treatment fields
planned to be irradiated with high energy ionizing radiation following
the written prescription of the radiation oncologist. This includes
selecting and designing multiple types of positioning devices, with
positioning and restraint methods addressed to maximize accuracy of
positioning for reproduction during treatment process, and addressing
the numerous complications brought about by the disease processes.
Accuracy of the method used to attain PET/CT images during simulation
procedures with data transfer to dosimetry and subsequently to the
treatment machines is critical to the reproductively level of planned
treatment fields.

\(c\) **Mold Room.** Mold room technology utilizes many varied types of
materials and methodologies to design and fabricate molds, shields,
stints, bite blocks, positioning devices and other specified devices as
prescribed by the radiation oncologist. Mold room functions are varied
and present high-level challenges in designing and fabricating devices
to be used in a wide variety of situations, e.g., removal of nose, eye,
ear, tissue loss due to extensive surgical procedures resulting in
removal of or loss of uniformity in anatomical structures.

\(d\) **Treatment Planning.** Radiation therapy planning is the
pretreatment process that allows radiation oncologists to model,
predict, and optimize the total dose of radiation to target/tumor
volumes and minimize dose to critical normal surrounding tissues before
delivery of the prescribed radiation treatment. The treatment planning
team is comprised of the radiation oncologist, the physicist, the
dosimetrist, and the therapeutic radiologic technologist. Each of these
members brings a unique contribution to the treatment planning process.

\(e\) **Medical Dosimetry.** The medical dosimetrist is a member of the
radiation oncology team who has an in depth knowledge of high dose
ionizing radiation and of the overall characteristics and clinical
relevance of radiation oncology treatment machines and equipment; is
cognizant of procedures commonly used in brachytherapy; and has the
education and expertise necessary to independently generate radiation
dose distributions and dose calculations in collaboration with the
medical physicist and radiation oncologist. The TRT-Dosimetrist may
attain certification in one of two ways, either a progressive learning
program within radiation oncology overseen by a qualified medical
physicist and radiation oncologist encompassing approximately 3 years of
intense training and education or with the completion of a 1-year
intensive course in an approved medical dosimetry program, and then
taking and achieving board certification as a Certified Medical
Dosimetrist (CMD).

b\. **Grade Determinations.** In addition to the basic requirements for
employment, the following criteria must be met when determining the
grade of candidates.

\(1\) **GS-5**

\(a\) **Experience or Education.** None beyond the basic requirements.

\(b\) **Assignment.** Employees at this level serve in TRT career
development positions. It is expected that they receive guidance from
more experienced staff members for more complex patient issues and
require daily and direct supervision.

\(2\) **GS-6**

\(a\) **Experience.** At least 1 year of experience equivalent to the
next lower grade level that demonstrates the core competencies described
at that level and which demonstrates possession of the knowledge,
skills, abilities, and other characteristics needed to provide radiation
therapy services. In addition, the candidate must demonstrate the
following KSAs:

**OR,**

\(b\) **Education.** The successful completion of a 4-year baccalaureate
degree program in radiation therapy or other health related field.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of operation of radiation detection devices;

[2]{.underline}. Ability to determine appropriateness of posted signs;

[3]{.underline}. Knowledge of basic nursing procedures and patient
support devices;

[4]{.underline}. Skill to operate appropriate patient support devices;
and

[5]{.underline}. Ability to communicate both orally and in writing with
patient.

\(d\) **Assignment.** Candidates at this grade level serve as staff TRTs
in developmental or advanced entry level assignments. It is expected
that they receive guidance from more experienced staff members for more
complex patient issues and require direct supervision in any assignment
of radiation therapy.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience equivalent to the
next lower grade level that demonstrates the knowledge, skills, and
abilities (also referred to as "core competencies") described at that
level. In addition, the candidate must demonstrate the following KSAs:

**OR,**

\(b\) **Education.** The successful completion of 1 full academic year
of graduate education leading to a degree program in radiation therapy
or other field directly related to therapeutic radiology. Education may
relate to the duties of a specific position or to the occupation, but
must be appropriate for the position being filled.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of radioactive package types;

[2]{.underline}. Knowledge of Nuclear Regulatory Commission (NRC)
regulations;

[3]{.underline}. Knowledge of types, characteristics and proper use of
personal monitoring devices;

[4]{.underline}. Knowledge of quality control procedures to evaluate
machine output and operation;

[5]{.underline}. Knowledge of examination preparation and
contraindications; and

[6]{.underline}. Ability to communicate orally exam preparations/special
orders to patients and hospital staff.

\(d\) **Assignment.** Staff TRT assignments at this level represent the
advanced developmental level leading to the full performance level,
performing a substantially full range of duties but receiving guidance
and directions regarding unfamiliar or unusual situations for more
complex patient issues. Employees may also be assigned to lead positions
at this level.

[1]{.underline}. **Staff TRT.** Candidates at this grade level are to be
qualified to provide services in specialized areas of therapeutic
radiology listed above and/or in general therapeutic radiologic
technology services.

[2]{.underline}. **TRT Team Leader.** Functions as a lead TRT for a
group of TRTs at lower levels who provide the full range of therapeutic
radiolologic procedures, but with some oversight. Typical assignments
include, but are not limited to, providing technical oversight necessary
for accomplishing the work of the organizational unit; planning,
directing, and distributing the work to TRTs at lower grade levels;
providing feedback to supervisor on technical aspects of the work;
resolving informal employee complaints; instructing and training TRTs on
newly acquired equipment; and independently performing a variety of
general or specialized procedures on more complex cases.

\(3\) **GS-8**

\(a\) **Experience.** At least 1 year of experience equivalent to the
next lower grade level that demonstrates the core competencies described
at that level, i.e., experience that demonstrates possession of the KSAs
needed to provide therapeutic radiologic services in any specialized
area. In addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of consultation, simulation, treatment
planning, and treatment procedures;

[2]{.underline}. Ability to recognize abnormalities in relevant lab
procedures and notify oncologist/nurse of abnormalities;

[3]{.underline}. Knowledge of various energy and output levels of
radiation treatment machines;

[4]{.underline}. Knowledge of different types of radioactive sources;

[5]{.underline}. Skill to operate equipment to determine correct dose
and field uniformity; and

[6]{.underline}. Knowledge of computer operations to insure proper
control of patient data input to insure accuracy of data output and of
complex computer applications relating to treatment plan.

\(c\) **Assignment.** Employees at this level serve as staff TRTs at the
full performance level and may be appointed to one of the following
assignments:

[1]{.underline}. **Staff TRT.** Candidates at this grade level are to be
qualified to provide services in the specialized areas of therapeutic
radiologic technology listed above and/or in general therapeutic
radiologic technology services. Dosimetry assignments at this level are
developmental in nature.

[2]{.underline}. **TRT Team Leader.** Functions as a lead TRT for a
group of lower level TRTs who provide the full range of therapeutic
radiologic technology services. Provides feedback to supervisor on the
technical aspects of the work. Evaluates new products and equipment and
makes recommendations to supervisory concerning developments that would
improve operations. Ensures all equipment is in safe working order,
reporting all equipment problems as appropriate. Maintains supplies for
the work areas.

\(4\) **GS-9**

\(a\) **Experience.** At least 1 year of experience equivalent to the
next lower grade level directly related to the position being filled and
must fully meet the KSAs at that level. In addition, the candidate must
demonstrate the following technical KSAs and demonstrate the potential
to acquire the assignment specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** Additional
assignment-specific KSAs are listed with the assignments that follow.

[1]{.underline}. Knowledge of hazardous materials in the handling and
fabrication of special molds, blocks, and compensators;

[2]{.underline}. Skill in operating highly complex and technical
equipment including linear accelerators, teletherapy units, patient
management systems, record and verify systems, electronic portal
imaging, 3-D conformal radiation therapy systems, multi-leaf collimator,
and intensity modulated radiation therapy (IMRT);

\*[3]{.underline}. Ability to recognize abnormalities in relevant lab
procedures and notify oncologist/nurse of abnormalities;

[4]{.underline}. Ability to determine the appropriate timely sequence
for patient studies and any special orders required; and

\*[5]{.underline}. Ability to coordinate scheduling of simulation,
planning, and treatment procedures.

\(c\) **Assignments.** Employees at this level serve as staff TRTs
independently carrying out procedures which have varying assignments,
including special and complex therapeutic radiological procedures, which
exceed the full performance level. Regardless of the nature of the
specific assignment, the work must be of sufficient scope and complexity
to meet the knowledge, skills, and abilities to perform at this level.
They

may be assigned to any area of radiation therapy and be assigned lead or
supervisory positions. For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Staff TRT.** Candidates at this grade level function
as staff TRTs and are able to carry out their assigned tasks with
minimal supervisory controls. Apply full knowledge in compliance with
Nuclear Regulatory Commission (NRC) regulations in handling and storage
of radioactive materials and the education of patient, family, and staff
of procedures to follow after the administration of ionizing radiation.
Inspect equipment for safety and operability and troubleshoots for
problems. Schedule patient treatments and needed studies, ensuring
appropriate sequence of multiple procedures and interacts with staff
regarding examination preparation.

[2]{.underline}. **Therapeutic Radiologic Technology Team Leader.**
Functions as a lead TRT for a group of TRTs who provide the full range
of general therapeutic radiologic oncology treatment procedures.
Provides technical oversight necessary for accomplishing the work of the
radiation oncology unit. Plans, directs, and distributes work
assignments to therapeutic radiologic technologists at lower grade
levels. Provides feedback to supervisor on the technical aspects of
work. Resolves informal employee complaints and approves leave request
for a few hours or in emergency situations. Instructs and trains TRT
staff on newly acquired equipment.

\*[a]{.underline}. Ability to provide technical oversight and assign
personnel and tasks to be accomplished in a manner that assures
completion of the workload utilizing personnel to the greatest advantage
thus providing the optimal level of patient care within the workday;

\*[b]{.underline}. Ability to plan, direct, and distribute work
assignments to TRTs at lower grade levels;

\*[c]{.underline}. Skill in instructing and training TRTs on newly
acquired equipment; and

\*[d]{.underline}. Ability to plan and project staffing needs.

[3]{.underline}. **Supervisory Therapeutic Radiologic Technologist.**
Functions as a supervisor for a group of TRTs who provide general
therapeutic radiologic radiation oncology services. Plans work schedules
to assure an even flow and distribution of work, adjusting work
assignments as needed for daily operation; sets deadlines and
priorities; identifies equipment requirements; recommends methods to
improve productivity; and continuously reviews treatment procedure and
delivery. Oversees attendance and leave of employees, including approval
of ordinary sick and annual leave requests and vacation schedules.
Informs higher level management of anticipated staffing variances and
recommends promotions, reassignments, or other personnel changes such as
retention or release of probationary employees, periodic step increases,
and recommending recognition of superior performance in the therapeutic
radiologic oncology area.

\*[a]{.underline}. Ability to organize work, set priorities, and
delegate tasks and responsibilities;

\*[b]{.underline}. Skill in interpersonal relationships in dealing with
employees, team leaders, and managers;

\*[c]{.underline}. Skill in assessing qualifications and abilities of
current and prospective employees;

\*[d]{.underline}. Ability to consult with radiation oncologist to
develop standard and non-standard treatment/exam protocols; and

\*[e]{.underline}. Ability to independently perform general and the most
complex therapeutic radiological procedures in advanced levels of
complex treatment situations.

[4]{.underline}. **TRT (Dosimetrist).** Employees at this level are
fully functional as Staff TRTs and are able to carry out procedures as
Dosimetrists under general supervision. This represents the advanced
developmental level leading to the full performance level for
Dosimetrist assignments. Certification in medical dosimetry (CMD) is
highly desirable.

[a]{.underline}. Knowledge of computer treatment planning and patient
treatment plans and the ability to follow the prescription outlined by
the radiation oncologist;

[b.]{.underline} Knowledge of quality control procedures for radiation
therapy including weekly chart checks for data accuracy and completion
and quality assurance procedures on the treatment planning computer(s);

\*[c]{.underline}. Ability to assist in preparation and design of custom
molds, boluses, templates, and compensating devices; and

\*[d]{.underline}. Ability to assist in computed tomography (CT) scans
for tumor localization in radiation treatment planning, and performs
accurate patient contours for transfer to treatment planning devices

\(5\) **GS-10**

\(a\) **Experience.** At least 1 year of experience equivalent to the
next lower grade level that demonstrates the core competencies described
at that level, and must fully meet the KSAs at the next lower level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs are
defined in the assignments which follow.

\(c\) **Assignment.** TRTs at this grade level may be appointed to one
of the following assignments. For all assignments above the full
performance level, the higher-level duties must consist of significant
scope, complexity (difficulty), and range of variety, and be performed
by the incumbent at least 25% of the time:

[1]{.underline}. **Staff TRT.** Employees at this level who are not
leads or supervisors are able to carry out their assigned tasks
independently in all areas of radiation therapy, requiring TRT
competencies which substantially exceed the full performance level and
are unique and require advanced knowledge in all areas of radiation
therapy specialties. Regardless of the nature of the specific
assignment, the work must be of sufficient scope and complexity to meet
the knowledge, skills, and abilities to perform at this grade level.

[a]{.underline}. Ability to confer with radiation oncologist regarding
simulation/CT procedure needed to yield the most optimal images needed
for treatment planning procedures to be performed;

[b]{.underline}. Knowledge of disease process, co-morbid conditions, and
other factors relating to individual patients in selecting appropriate
positioning devices for procedure to be performed;

[c]{.underline}. Knowledge of radiographic fluoroscopic, CT, and
combinations of modalities and ability to obtain the images for review
by the radiation oncologist for localization of tumors, their extent,
and ancillary areas needing treatment; and

\*[d]{.underline}. Ability to accurately transfer radiographic images to
treatment planning and dosimetry for use in development of computer
generated treatment plans.

[2]{.underline}. **Dosimetrist (Treatment Planning).** Employees at this
level are fully functional as TRTs and are able to carry out their
assigned tasks independently. This is considered to be the full
performance level for Dosimetrist assignments. Certification in medical
dosimetry (CMD) is highly desirable.

[a]{.underline}. Skill in computer treatment planning to design patient
treatment plans with awareness to dose limitations to critical
structures following the prescription outlined by the radiation
oncologist;

[b]{.underline}. Ability to perform quality control procedures for
radiation therapy including weekly chart checks for data accuracy and
completion and quality assurance procedures on the treatment planning
computer(s);

\*[c]{.underline}. Ability to assist in preparation and design of custom
molds, boluses, templates, and compensating devices; and

\*[d]{.underline}. Ability to coordinate and assist in computed
tomography (CT) scans for tumor localization in radiation treatment
planning, and perform accurate patient contours for transfer to
treatment planning devices.

[3]{.underline}. **Therapeutic Radiologic Team Leader.** Functions as a
lead TRT for a group of TRTs. Provides the full range of radiation
therapy procedures, has a broad knowledge of the different modalities
within the therapeutic radiologic area, and is accountable to the next
higher-level supervisor.

\*[a]{.underline}. Ability to provide technical oversight and assign
personnel and tasks to be accomplished in a manner that assures
completion of the workload utilizing the personnel to the greatest
advantage thus providing the optimal level of patient care within the
workday;

\*[b]{.underline}. Ability to plan, direct, and distribute work
assignments to therapeutic radiologic technologists at lower grade
levels;

\*[c]{.underline}. Skill in instructing and training therapeutic
radiologic technologists on newly acquired equipment; and

[d]{.underline}. Knowledge of contrast medium, contraindications to
contrast medium, and adverse reactions to contrast medium.

[4]{.underline}. **Supervisory Therapeutic Radiologic Technologist.**
Functions as a supervisor for a group of TRTs which may include support
staff, and lower level lead and/or supervisory TRTs. Advises employees
of the performance requirements of their positions; informs them of
their progress in meeting the requirements; and prepares formal
evaluations of employee performance. Holds corrective interviews with
employees,

referring disciplinary problems to higher levels of management; resolves
informal complaints of employees; deals with union representatives on
matters involving action by an immediate supervisor. Provides technical
supervision necessary for accomplishing the work of the therapeutic
radiologic oncology area.

[a]{.underline}. Ability to organize work, set priorities, and delegate
tasks and responsibilities;

\*[b]{.underline}. Skill in interpersonal relationships in dealing with
employees, team leaders, and managers;

\*[c]{.underline}. Skill in assessing qualifications and abilities of
current and prospective employees;

[d]{.underline}. Ability to confer with radiation oncologist to develop
standard and non-standard treatment/exam protocols; and

[e]{.underline}. Skill to independently perform general and specialized
therapeutic radiologic oncology procedures in advanced level of
complexity treatment situations.

\(6\) **GS-11**

\(a\) **Experience.** Completion of at least 1 year of experience
equivalent to the next lower grade level, that is directly related to
the position to be filled and that demonstrates possession of the
knowledge, skills, and abilities needed to provide services as a
dosimetrist, therapeutic radiologic technology team leader, or
supervisory TRT, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and demonstrate the potential to acquire the assignment specific KSAs
designated by an asterisk (\*):

\(b\) **Certification.** For employees in a dosimetrist position at this
level, certification in medical dosimetry (CMD) is highly desirable.

\(c\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs are
defined in the assignments which follow.

d\) **Assignment.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. TRTs at this grade level may be
appointed to one of the following assignments:

[1]{.underline}. **Staff TRT (Dosimetrist).** Employees at this level
are fully functional and are able to carry out their assigned tasks
independently in all areas of radiation therapy, requiring TRT
competencies which substantially exceed the full performance level.
Regardless of the nature of the specific assignment, the work must be of
sufficient scope and complexity to meet the knowledge, skills, and
abilities to perform at this grade level. The candidate at this position
is either a TRT who has additional assignments or a dosimetrist.

[a]{.underline}. Ability to apply in depth knowledge of anatomy,
physiology, and numerous types of tumors and their routes of spread to
design multiple plans for oncologist approval and selection;

[b]{.underline}. Ability to calculate the needed monitor units according
to oncologist prescription with distributions of the dose to be
delivered in various ratios applying extensive knowledge of critical
structures and their tolerances to accurately deliver the prescribed
dose; and

\*[c]{.underline}. Ability to troubleshoot and assist other TRTs in the
resolution of patient set-up problems.

[2]{.underline}. **Therapeutic Radiologic Team Leader.** Functions as a
lead TRT for a group of TRTs. Provides a full range of general
therapeutic radiologic oncology treatment procedures and a broad
knowledge of the different modalities within the therapeutic radiologic
oncology area and is accountable to the next higher-level supervisor.

[a]{.underline}. Ability to provide feedback to supervisor on technical
aspects of work;

\*[b]{.underline}. Ability to resolve informal employee complaints;

\*[c]{.underline}. Ability to monitor and report on the status and
progress of work and make adjustments to accomplish the workload in
accordance with established procedures; and

[d]{.underline}. Ability to independently perform general and
specialized therapeutic radiologic oncology procedures in advanced level
of complexity treatment situations.

[3]{.underline}. **Supervisory Therapeutic Radiologic Technologist.**
Functions as a supervisor for a group of TRTs which includes employees
assigned to TRT positions above the full performance level. Evaluates
new products and equipment to make recommendations to supervisor
concerning upgrades or new purchases that would improve operations.
Informs higher level management of anticipated staffing variances and
recommends promotions, reassignments, or other personnel changes such as
retention or release of probationary employees, periodic step increases,
and recommending recognition of superior performance in the therapeutic
radiologic oncology area.

\*[a]{.underline}. Ability to analyze organizational and operational
problems and to develop and implement solutions that result in efficient
section operation;

\*[b]{.underline}. Ability to evaluate quality management procedures and
processes;

\*[c]{.underline}. Ability to analyze and use data effectively to manage
workload, quality, performance, and productivity;

\*[d]{.underline}. Ability to develop new policies and guidelines as
needed; and

[e]{.underline}. Skill in problem solving and conflict resolution.

\(7\) **GS-12**

\(a\) **Experience.** At least 1 year of experience equivalent to the
next lower grade level that demonstrates the core competencies described
at that level, and must fully meet the KSAs at that level. In addition,
the candidate must demonstrate the following technical KSAs and
demonstrate the potential to acquire the assignment specific KSAs
designated by an asterisk (\*):

\(b\) **Certification.** For employees in a dosimetrist position at this
level, certification in medical dosimetry (CMD) is required.

\(c\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs are
defined in the assignments which follow.

\(d\) **Assignment.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. TRTs at this grade level may be
appointed to one of the following assignments.

[1]{.underline}. **Staff TRT (Dosimetrist).** Employees at this level
are fully functional as a dosimetrist with the knowledge and experience
to apply an advanced level of treatment planning and dosimetry
procedures. Employees will have an in depth knowledge of computer
programs and operations, and methodologies of data transfer and
reconstruction. Performs complex 2D-3D treatment plans and presents to
radiation oncologists for review and acceptance. Serves as an integral
team member for brachytherapy procedures, utilizing ultrasound to
determine volumetric data, positioning of templates for insertion of
radioactive sources, and transfer of data from ultrasound equipment to
treatment planning computers for generation of dose volume histograms
(DVH).

\*[a]{.underline}. Ability to perform quality assurance procedures for
brachytherapy procedures and oversee brachytherapy planning;

\*[b]{.underline}. Ability to develop and update policy and procedures
for the dosimetry area with the oversight of the medical physicist;

[c]{.underline}. Ability to work with the medical physicist to perform
monthly, quarterly, semi-annual, and annual testing of equipment.
Verifies accuracy of machine setting, output, congruence, and other
mandated measurements, recording them accurately for review;

[d]{.underline}. Extensive knowledge level of human anatomy, physiology,
malignant tumors, routes of spread, critical structures, and tolerance
levels of all sites of the body to plan complex, multi-field treatment
plans; and

\*[e]{.underline}. Skill to oversee initial set-ups of complex treatment
plans, giving assistance as needed to make any modifications needed
prior to any treatment being administered.

[2]{.underline}. **Supervisory Therapeutic Radiologic Technologist.**
Functions as a TRT supervisor with full administrative and professional
responsibility for planning and directing the work of TRTs and support
staff in the medical center's therapeutic radiologic technology program.
Develops and updates technical policy and procedure manuals. Develops
and implements department and medical center guidelines and policies.
Maintains timely records of equipment and/or use and its problems,
competency of the technical staff, current technical protocols,
radiation safety, and quality management for a teleimaging network.
Ensures all staff and affiliate staffs are in compliance with
accrediting and regulating bodies. Adjusts staffing levels or work
procedures to accommodate resource allocation decisions made at the
executive level. Provides for the budgeting and financial management of
the radiation oncology service.

[a]{.underline}. Knowledge of systematic data collection;

\*[b]{.underline}. Ability to balance staffing levels and work
procedures within resources allocated;

\*[c]{.underline}. Ability to coordinate staffing and work procedures
with resources allowed;

\*[d]{.underline}. Ability to evaluate and adjust resources when needed;

\*[e]{.underline}. Knowledge of budget allocation and finances and
ability to utilize resources and remain within allocated budget; and

\*[f]{.underline}. Ability to manage and direct work of others to
accomplish program goals.

**4**. **DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for TRTs
in VHA whose composite record of accomplishments, performance, and
qualifications, as well as current assignments, warrant such action
based on demonstrated competence to meet the requirements on the
proposed grade.

b\. Under no circumstances will the basic certification requirements of
radiologic competence and ARRT (T) certification/registration, or
certification in medical dosimetry where required, be waived.

c\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**

[]{#PartIIAppG27 .anchor}**APPENDIX G27. MEDICAL INSTRUMENT TECHNICIAN**

**QUALIFICATION STANDARD**

**GS-649**

**Veterans Health Administration**

**1. COVERAGE.** The following are requirements for appointment as a
Medical Instrument Technician (MIT) in the Veterans Health
Administration (VHA). This series includes positions that perform
diagnostic examinations or medical treatment procedures as part of the
diagnosis and treatment of patients. The work involves operating or
monitoring diagnostic and therapeutic medical instruments and equipment
associated with cardiac catheterization, pulmonary examinations and
evaluations, heart bypass surgery/heart-lung transplant surgery
(perfusion), electrocardiography, electroencephalography,
polysomnography, hemodialysis, ultrasonography, and vascular sonography.
Positions in this series require knowledge of the capabilities and
operating characteristics of one or more kinds of instruments and a
practical knowledge of human anatomy and physiology. Positions also
require a practical understanding of medical data generated by
patient/equipment connections. Some positions may also require a
practical knowledge of chemistry, pharmacology, physics, and
mathematics.

Coverage under this standard and assignment of individuals to this
occupation are restricted to the specific subspecialties identified
above and those DIRECTLY DERIVED from these current subspecialties. For
example, electroencephalography and polysomnography technicians perform
duties using the same types of equipment and measure brain waves, the
primary difference being the wake or sleep state of the patient. No
individual will be assigned to this series (GS-649) without an approved
parenthetical title.

Any additional parenthetical specialties developed as the result of new
technologies must be directly derived from current specialties and must
be approved by the Office of Human Resources Management & Labor
Relations, Compensation & Classification Service (055) in VA Central
Office (VACO). Only after a decision has been made to include the
identified new specialty in this qualification standard, and an approved
parenthetical title and code have been developed, will an individual be
assigned to this series.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizenship of the United States. (Non-citizens may
be appointed when it is not possible to recruit qualified citizens in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Education.** There are no specific educational requirements for
this occupation. Education may be substituted for experience only at the
GS-4 and GS-5 levels. See the grade requirements part of this standard
for information regarding educational substitutions.

c\. **Licensure or Certification.** Licensure or Certification is not
required for this occupation; however, it is strongly desirable at GS-6
or above as evidence of possession of the essential knowledge, skills,
and abilities. For certain functional areas at the higher levels or
supervisory assignments, specific certifications appropriate to the
specialty are indicated in this standard under "Titles and
Certification/Registrations".

For all specialties identified in this standard, Basic and Advanced
Cardiac Life Support certifications are desirable. Training which does
not result in official certification does not meet this definition.

d\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 Hybrid qualification standards.
Some of these provisions may not apply to this occupation. Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but [may not]{.underline} be promoted beyond the journey
level or placed in supervisory or managerial positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

e\. **Physical Requirements.** See VA Directive and Handbook 5019.

f\. **English Language Proficiency.** Medical Instrument Technicians
must be proficient in spoken and written English in accordance with
chapter 2, section D, paragraph 5a, this part.

**3. GRADE REQUIREMENTS**

a\. **Definitions:** For purposes of this qualification standard the
specialty areas of this occupation have been grouped into six functional
areas. These are:

Cardiovascular (Electrocardiograph Technician, Cardiac Catheterization
Technician)

Medical (Hemodialysis Technician)

Surgical (Perfusion Technician, Anesthesia Technician)

Neurology (Electroencephalograph Technician, Polysomnography Technician)

Pulmonary (Pulmonary Function Technician), and

Imaging (Diagnostic Ultrasound Technician, Echocardiograph Technician,
and Vascular Technician).

Medical Instrument Technicians at GS-6 and above will have a functional
assignment and reference should be made to the appropriate appendix for
qualifications evaluation.

Grade level criteria, KSAs (core competencies), and typical assignment
information for all GS-4 and GS-5 levels are defined generically in this
part of the qualification standard. For higher level positions where the
grade level/assignment is based on supervisory and/or managerial
responsibilities, criteria are also included in the general portion of
this qualification standard (for individuals in multiple function
assignments) and/or the specific appendices.

For non-supervisory positions at GS-6 and above and for supervisory
positions in a single specialty, the grade level criteria, KSAs, and
types of assignments are discussed in appendices matching the title
areas listed below. Reference should be made to the appropriate appendix
in evaluating the qualifications of individuals for this occupation.

\(1\) **[Titles and Certifications/Registrations:]{.underline}** All
individuals assigned to this occupation MUST have an approved
parenthetical title. For individuals at the GS-4 and GS-5 levels, the
approved title will be Medical Instrument Technician (Trainee). For
supervisory positions over two or more approved specialties, the
approved title will be Supervisory Medical Instrument Technician
(Multiple Function). Supervisors over a single specialty will have that
specialty as the parenthetical title; for example, Supervisory Medical
Instrument Technician (Cardiac Catheterization). Non-supervisory
individuals whose assignments involve two or more specialty areas will
be assigned the parenthetical title for the predominant specialty
considering both the intended function and qualifications background of
the individual.

\(a\) **Anesthesia Technicians** perform logistical and technical
support to anesthesiologists and nurse anesthetists. They maintain
anesthesiology supplies and equipment, set-up anesthetizing locations
and operate, monitor, and collect data from anesthesia related
equipment. In some cases Anesthesia Technicians will perform clinical
laboratory functions, equipment preventive maintenance/repair, and
specialized cardiac procedures such as cardiac output measurement,
intra-aortic balloon pumping, vessel cannulation, and autotransfusion
services. Certification at two distinct levels is offered by the
American Society of Anesthesia Technologists and Technicians (ASATT).
(See Appendix A)

\(b\) **Cardiac Catheterization Technicians** perform, under a
physician's direction, diagnostic tests, both invasive and noninvasive,
of the pulmonary system (lung) and the cardiovascular system (heart and
circulation). They operate, monitor, and collect data from instruments
used in procedures such as

cardiac catheterization, angiography, valvuloplasty, angioplasty,
electrophysiology studies, cardiac pacing, or cardiac pacemaker or
leadwire insertion. Registration is offered by Cardiovascular

Credentialing International (CCI) as a Registered Cardiovascular
Invasive Specialist (RCIS). (See Appendix B)

\(c\) **Diagnostic Ultrasound Technicians** operate diagnostic
ultrasonic scanning equipment to produce cross sectional and two
dimensional pictures of internal organs and body structures used to
diagnose diseases and other medical conditions. Registration is offered
by Cardiovascular Credentialing International (CCI) or by the American
Registry of Diagnostic Medical Sonographers (ARDMS). (See Appendix C)

Positions should be assigned to the Diagnostic Radiologic Technologist
(DRT), GS-647 series, when [both]{.underline} ultrasound and other
modalities which require the delivery of ionizing radiation are
performed. Positions in which ultrasound duties are performed
exclusively (no other modalities are performed), should be assigned to
the Medical Instrument Technician, GS-649 series, since ultrasound
duties solely do not require the delivery of ionizing radiation.

\(d\) **Echocardiography Technicians** operate diagnostic equipment to
graphically record the position and motion of the heart walls or the
internal structure of the heart and neighboring tissue by the echo
obtained from beams of ultrasonic waves directed through the chest wall.
Registration is offered by Cardiovascular Credentialing International
(CCI), as a Registered Cardiac Sonographer (RCS) or by the American
Registry of Diagnostic Medical Sonographers (ARDMS) as a Registered
Diagnostic Cardiac Sonographer (RDCS). (See Appendix D)

\(e\) **Electrocardiograph Technicians (EKG)** operate instruments used
to record electrocardiograms, exercise tolerance tests, 24-48 heart
monitoring and scanning, and pacemaker evaluations. Certification is
offered by Cardiovascular Credentialing International (CCI) as a
Certified Cardiographic Technician (CCT). (See Appendix E)

\(f\) **Electroencephalograph (EEG) Technicians** operate the
electroencephalograph and other devices such as evoked potential
equipment to record the electrical activity of the brain. Registration
is offered by the American Board of Registration of EEG, CNIM & EP
Technologists (ABRET) or the American Association of Electrodiagnostic
Techs (AAET). (See Appendix F)

\(g\) **Hemodialysis Technicians** operate and monitor kidney dialysis
instruments to provide dialysis treatment to patients with kidney
failure or to maintain patients with irreversible kidney disorders. The
agencies that offer national certification are Nephrology Certification
Commission (NNCC), Board of Nephrology Examiners, Inc., Nursing and
Technology (BONENT), National Nephrology Certification Organization
(NNCO), and the International Certification Commission for Clinical
Engineering and Biomedical Technology (ICC) in conjunction with the
United States Certification Commission (USCC). (See Appendix G)

\(h\) **Perfusion Technicians** operate the heart-lung apparatus to take
over functions of the patient's heart and lungs during coronary bypass
surgery, heart and/or lung transplantation surgery, valve replacement,
or respiratory failure. Certification is offered by the American Board
of Cardiovascular Perfusion (ABCP). (See Appendix H)

\(i\) **Polysomnography Technicians** operate the electroencephalograph
and other devices to record the electrical activity of the brain during
sleep. Registration is offered by the Board of Registered
Polysomnographic Technologists (BRPT). (See Appendix I)

\(j\) **Pulmonary Function Technicians** operate instruments to perform
blood gas analysis; bronchoscopy with lung sampling; cardiopulmonary
exercise stress tests; lung volume tests including spirometry (both pre
and post medication); total lung capacity, functional residual capacity,
and flow volume loops. Certification (RPFT) is offered by the National
Board of Respiratory Care. (See Appendix J)

\(k\) **Vascular technicians** or **vascular sonographers** operate
diagnostic equipment using ultrasound to record vascular information
such as vascular blood flow, blood pressure, limb volume changes, oxygen
saturation, cerebral circulation, peripheral circulation, and abdominal
circulation. Registration is offered by Cardiovascular Credentialing
International, (CCI) as a Registered Vascular Specialist (RVS) or by the
American Registry of Diagnostic Medical Sonographers (ARDMS) as a
Registered Vascular Technologist (RVT). (See Appendix K)

\(2\) **Creditable Experience - Knowledge of Current Medical Instrument
Technician Practices.** To be creditable, the experience must have
required the use of knowledge, skills, abilities and other
characteristics associated with current Medical Instrument Technician
practice appropriate to the identified specialty area.

\(3\) **Quality of Experience.** Experience is only creditable if it is
equivalent to at least the next lower grade level and is directly
related to the position/specialty to be filled.

\(4\) **Part-time Experience.** Part time experience is credited
according to its relationship to a full time work week. For example, an
individual employed 20 hours per week, or on a ½ time basis would
receive one work week credit for each two weeks of service.

\(5\) **Fellowships.** N/A

\(6\) **Internships.** N/A

b\. **Grade Determinations.** In addition to the basic requirements for
employment, the criteria discussed in the applicable headings, or that
defined in the appendices, must be met when determining the grade of
candidates.

c\. **Education/Training.** To be creditable education must have been
gained in an accredited Community College, College, or University.

**Foreign Education:** To be creditable, education completed outside the
U.S. must have been submitted to a private organization that specializes
in the interpretation of foreign educational credentials and such
education must have been deemed at least equivalent to that gained in
conventional U.S. programs.

Completion of appropriate training such as in-service training programs,
on the job training, training acquired while in the Armed Forces,
government sponsored developmental training programs, and/or training
under physicians certified in the functional area will be allowed on a
month-for-month basis through the GS-5 level.

Specialized developmental experience obtained under supervision of
appropriately certified individuals may be credited at higher levels and
is addressed in individual appendices.

d\. **Basic Developmental Levels**

\(1\) **GS-4**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
position to be filled. Six months of this experience may have been in
medically related fields such as nursing assistant, practical nursing,
or similar fields. The remaining six months must have been in operating
diagnostic and therapeutic equipment covered by this occupation.
Experience gained in the operation of equipment for animal diagnosis or
treatment may be credited at this level. In addition, the candidate must
demonstrate the following KSAs:

**OR,**

[1]{.underline}. **Education.** Successful completion of two years of
education above high school or an associate's degree with a major field
of study directly related to the medical instrument technician
occupation.

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of basic medical terminology.

[2]{.underline}. Ability to learn the components, operating
characteristics, and settings of the equipment to be used.

[3]{.underline}. Ability to learn typical patient reactions to the basic
procedures involved and ability to recognize signs of distress.

[4]{.underline}. Ability to learn the standard positions for the
procedure being conducted.

[5.]{.underline} Ability to communicate orally and in writing.

\(c\) **Assignments.** At this level assignments are trainee in nature.
The medical instrument technician trainee is performing limited routine
assignments of a developmental nature under close supervision.

\(2\) **GS-5**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
position to be filled. This would be experience in operating equipment
related to the particular specialization for which application is made
or in related functional areas. Experience gained in the operation of
equipment for animal diagnosis or treatment may be credited through this
grade level. In addition, the candidate must demonstrate the following
KSAs:

**OR,**

\(b\) **Education.** Successful completion of a bachelor's degree in a
major field of study appropriate to medical instrument technician
functions.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of standard medical terminology to interpret
physician orders or instructions.

[2]{.underline}. Knowledge of common physical disabilities and ability
to position patients for the examination or treatment.

[3]{.underline}. Ability to learn the normal and abnormal results for
routine procedures to recognize and report obvious abnormalities.

[4]{.underline}. Ability to operate the equipment to administer
routine/standard diagnostic treatment or procedures.

[5]{.underline}. Ability to perform standard operator maintenance on the
equipment including the ability to disassemble, clean, reassemble, and
calibrate the machine.

\(d\) **Assignment.** Medical Instrument Technicians (Trainee) at this
level operate and monitor commonly used equipment performing routine
procedures under normal supervision. The technician functions somewhat
independently in carrying out these standardized procedures of limited
complexity. Deviations from regular procedures, unanticipated problems,
and unfamiliar situations are referred to the supervisor for a decision
or help. Some assignments at this level also include developmental
duties involving more complex procedures designed to prepare the
technician for promotion to higher grades in a functional area. Such
duties would be performed under closer supervision.

e\. **Non-Supervisory positions at GS-6 and above.** For medical
instrument technician positions with functional specialty titles, see
the appropriate appendix for creditable experience, KSAs, and assignment
definitions.

f\. **Supervisory Medical Instrument Technician.** Supervisory positions
in single specialties will be addressed in the applicable appendix, for
example supervisory medical instrument technician (cardiac
catheterization).

Typically, assignments for supervisory positions will be one grade
(first line supervisor) or two grade (second line supervisor) levels
above the full performance level of the employees supervised. The full
performance levels are clearly identified in the separate appendices.

Supervisory medical instrument technician positions having oversight for
two or more functional specialties will have "Multiple Function" as the
parenthetical title. Grade levels for these positions should be
determined by the full performance level of the positions supervised and
other program management responsibilities. Individual appendices
indicate the full performance level of identified specialties. Levels
and complexity of supervisory positions are described below.

\(1\) **First Level Supervisor**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
experience must demonstrate possession of the knowledge required in
order to provide medical instrument technician services in the
functional specialties supervised. In addition, the candidate must
demonstrate the following technical KSAs and the potential to acquire
the assignment specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of the more complex examination and treatment
procedures and techniques.

\*[2]{.underline}. Ability to manage and supervise employees in two or
more functional specialties.

\*[3]{.underline}. Knowledge of Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) and other regulatory requirements.

[4]{.underline}. Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[5]{.underline}. Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** At this level, it is highly desirable that
supervisors possess certification in one or more appropriate functional
areas.

\(d\) **Assignment.** Typically these positions are established one
grade above the full performance level of the technicians supervised.
Individuals in this assignment assume full administrative and
professional responsibility for planning and directing the work of
subordinate technicians. Typically these duties include assigning and
evaluating the work of subordinate staff; providing Medical Instrument
Technician services in more complex cases; reviewing and making
recommendations regarding new and emerging procedures; providing
instruction and training to new staff; interviewing candidates for
positions; recommending selections, advancements, promotions; evaluating
performance; taking disciplinary action when necessary; and identifying
educational or training needs. For all assignments above the full
performance level, the higher-level duties must consist of significant
scope, complexity (difficulty), and range of variety, and be performed
by the incumbent at least 25% of the time.

\(2\) **Higher Level Supervisor**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be specialized experience as a first level supervisor which
demonstrates possession of the knowledge required to provide medical
instrument technician services in the functional specialties supervised
as well as supervisory knowledge, skills, and abilities. In addition,
the candidate must demonstrate the following technical KSAs and the
potential to acquire the assignment specific KSAs designated by an
asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Advanced knowledge of complex and non-standard
treatment and examination procedures and techniques.

\*[2]{.underline}. Ability to plan and assist in the establishment of a
completely integrated treatment and examination program.

\*[3]{.underline}. Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4]{.underline}. Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts, and equipment
expenditures), forecast resource and equipment needs, and administer the
allocated budget.

\*[5]{.underline}. Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

\(c\) **Certification.** At this level, it is highly desirable that
supervisors possess certification in two or more functional specialties.
Participation in recognized professional organizations as a Board
examiner, in the development of curricula for training, or testing for
the Board is evidence of competence.

\(d\) **Assignment.** Individuals at this level plan and direct programs
at affiliated medical centers and their satellite outpatient clinics and
have full supervisory responsibility for a large staff of
non-supervisory personnel and at least one subordinate team leader or
supervisor. Typically these duties include assigning and evaluating the
work of subordinate staff resolving problems which may interfere with
patient examination

or treatment; providing medical instrument technician services in more
complex and non-standard cases; evaluating new products and equipment
and making recommendations concerning developments which would improve
operations; participating as an instructor in the facility's clinical
training program; making final decisions on selections based on
recommendations from subordinate supervisors or leads; evaluating
performance; taking disciplinary action when necessary; and identifying
educational or training needs. For all assignments above the full
performance level, the higher-level duties must consist of significant
scope, complexity (difficulty), and range of variety, and be performed
by the incumbent at least 25% of the time.

**4. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for
medical instrument technicians in VHA whose composite record of
accomplishments, performance, and qualifications, as well as current
assignments, warrant such action based on demonstrated competence to
meet the requirements of the proposed grade.

b\. There will be some positions which properly belong in this
occupational series but for which there have been no authorized
parenthetical specialty titles developed. Such positions may represent
specialties for which there are relatively few positions or may be the
result of new technologies. In either case the work of the position must
be directly derived from the specialties identified in the coverage
portion of this standard. Before any individual may be assigned to such
a position in this series, the proposed parenthetical title must be
approved by the Office of Human Resources Management & Labor Relations,
Compensation and Classification Service in VA Central Office.

c\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. § 7304; 7402.**

**Appendix A -- Medical Instrument Technician (Anesthesia)**

\(1\) **GS-6**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills and Abilities**

[1]{.underline}. Knowledge of human anatomy and physiology (specifically
cardiac and pulmonary).

[2]{.underline}. Knowledge and application of safety and infection
control processes.

3\. Ability to serve as a circulating technician for supplies and to
assist with documentation of hemodynamic patient data.

[4]{.underline}. Knowledge of anesthesiology supplies and equipment
appropriate to less complex anesthetic procedures, such as those found
in Ambulatory Surgery.

\(c\) **Certification.** No certification is required; however, it is
desirable that employees at this level have Basic Cardiac Life Support
(BCLS) certification.

\(d\) **Assignment.** The anesthesia technician at this level aids
anesthesiologists and nurse anesthetists in less-complex anesthetic
procedures such as regional anesthesia (epidural and spinal), laryngeal
mask anesthesia, and monitored anesthesia care under close supervision.
Technicians will exercise minimal independent judgment in anesthesia
technology duties.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills and Abilities**

[1]{.underline}. Knowledge of the fundamentals of standard equipment
operation, calibration and function.

[2]{.underline}. Knowledge of correct use of non-invasive patient
monitoring equipment specific to anesthesiology.

[3]{.underline}. Ability to appropriately interact with patients during
anesthetic procedures.

[4]{.underline}. Knowledge of anesthesiology supplies and equipment
appropriate to routine anesthetic procedures, such as those found in
typical inpatient settings.

\(c\) **Certification.** No certification is required; however, it is
desirable that employees at this level have Basic Cardiac Life Support
(BCLS) certification.

\(d\) **Assignment.** The anesthesia technician at this level assists
anesthesiologists and nurse anesthetists in routine anesthetic
procedures under general supervision. The technician will connect and
operate non-invasive hemodynamic monitoring equipment, blood and fluid
warmers (e.g., Hot Line and Ranger) and patient warming devices (e.g.,
Bair Hugger). The technician will exercise moderate independent judgment
in anesthesia technology duties.

\(3\) **GS-8**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills and Abilities**

[1]{.underline}. Knowledge of the correct use of invasive patient
monitoring equipment specific to anesthesiology.

[2]{.underline}. Knowledge of basic electrocardiography (EKG).

[3]{.underline}. Skill and ability to troubleshoot equipment, often
while the patient is anesthetized.

[4]{.underline}. Skill and ability to maintain sterility during
procedures.

[5]{.underline}. Knowledge and understanding of arterial pressure line
wave forms including the ability to recognize and distinguish normal
from abnormal, artifact from abnormality, and forewarn the physician or
anesthetist of an impending life-threatening situation.

[6]{.underline}. Knowledge of anesthesiology supplies, medications, and
equipment appropriate to more difficult anesthetic procedures such as
those found in inpatient settings with more acutely ill patients.

\(c\) **Certification.** No certification is required; however, it is
desirable that employees at this level have Basic Cardiac Life Support
(BCLS) certification.

\(d\) **Assignment.** This represents the full performance level. The
anesthesia technician at this level assists anesthesiologists and nurse
anesthetists in difficult anesthetic procedures under minimal
supervision. The technician will connect and operate invasive
hemodynamic monitoring equipment (e.g., arterial pressure monitors),
anesthesia machines, ventilators, intubation bronchoscopes, and
ultrasonic scanning devices. Technicians prepare and administer
medications as directed by the attending physician. They mentor and
train lower graded technicians, nurses, medical students, and anesthesia
residents on anesthesia technology procedures and assist the
supervisor/manager with quality control and performance improvement
activities. The technician will exercise a high degree of independent
judgment in anesthesia technology duties.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
full performance level, positions at this level may be lead,
supervisory, or non-supervisory with specialized advanced knowledge and
duties.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would include specialized experience as an anesthesia technician which
demonstrates possession of the knowledge,

skills, and abilities required to provide all aspects of anesthesia
technician services including specialized duties. In addition, the
candidate must demonstrate the following technical KSAs and the
potential to acquire the assignment specific KSAs designated by an
asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1 through
6 are appropriate for all positions at this level. KSAs 7 and 8 are to
be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Knowledge and comprehensive understanding of laboratory
testing procedures to include maintenance, calibration, and quality
control procedures. This includes the ability to perform these lab tests
accurately and correctly.

[2]{.underline}. Advanced knowledge of electronics and anesthesia
equipment with skill in repairing and maintaining this equipment and
repairing complex problems.

\*[3]{.underline}. Comprehensive knowledge of central venous and
pulmonary artery (Swan-Ganz) catheterization procedures including
measuring cardiac outputs and intra-aortic balloon counterpulsation
procedures (i.e., balloon pump).

[4]{.underline}. Knowledge and ability to assist with airway management
techniques.

\*[5]{.underline}. Knowledge of JCAHO and other regulatory requirements.

[6]{.underline}. Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[7]{.underline}. Ability to manage and supervise employees.

\*[8]{.underline}. Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** Anesthesia technician certification through the
American Society of Anesthesia Technologists and Technicians (ASATT) is
highly desirable. Basic Cardiac Life Support (BCLS) and Advanced Cardiac
Life Support (ACLS) certifications are also desirable for employees at
this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Special Assignments.** Perioperative programs at some
facilities require that anesthesia technicians perform duties that
exceed the full performance level. The anesthesia technician at this
level performs difficult and responsible anesthesia technology duties
with considerable latitude for the exercise of independent judgment. The
technician may perform clinical laboratory tests for the unit (i.e.,
blood gas, activated clotting time and glucose) or perform more
difficult equipment repairs. The technician may also participate in
large-vessel cannulations (with subsequent monitoring) characteristic of
open-heart, transplant and major vascular surgeries. These assignments
are expected to be relatively few in number ad must represent
substantial additional responsibility over the full performance level.

[2]{.underline}. **Lead Anesthesia Technician.** There may be some
perioperative programs that do not need a technician functioning at the
full supervisory level. However, daily guidance of the anesthesia
technicians

may still be required and can be accomplished through a lead technician.
Typically, the lead technician will only have the responsibility of
seeing that the work flows smoothly, assuring coverage if needed and
assigning work. Authority to approve leave, take disciplinary action,
etc. will only be assigned to full supervisory positions.

[3]{.underline}. **Supervisory Anesthesia Technician.** Individuals in
this assignment assume full administrative and professional
responsibility for planning and directing the work of subordinate
technicians. Typically these duties include assigning and evaluating the
work of subordinate staff; providing anesthesia technician services in
more complex cases; reviewing and making recommendations regarding new
and emerging procedures; providing instruction and training to new
staff; interviewing candidates for positions; recommending selections,
advancements, promotions; evaluating performance; taking disciplinary
action when necessary; and identifying educational or training needs.

\(5\) **GS-10.** In addition to the core competencies defined at the
GS-9 level, positions at this grade may be supervisory or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Knowledge of the more complex procedures and techniques
in the practice of anesthesiology such as extracorporeal blood salvage,
washing and return to patient (also known as autotransfusion or cell
saving) and arterial and/or venous cannulation for the establishment of
arterial pressure monitoring or intravenous fluid/medication delivery.

\*[2]{.underline}. Ability to plan and assist in the establishment of a
completely integrated treatment and procedure program.

\*[3]{.underline}. Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4]{.underline}. Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts and equipment
expenditures), forecast resource and equipment needs and administer the
allocated budget.

\*[5]{.underline}. Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements and, when appropriate,
disciplinary actions.

\(c\) **Certification.** Anesthesia technician certification through the
American Society of Anesthesia Technologists and Technicians (ASATT) is
highly desired. Basic Cardiac Life Support (BCLS) and

Advanced Cardiac Life Support (ACLS) certifications are also desirable
for employees at this level. Participation in recognized professional
organizations as a Board examiner, in the development of curricula for
training, or testing for the Board is evidence of competence.

\(d\) **Assignments.** In addition to the core competencies defined at
the GS-9 level, positions at this level may be supervisory or
non-supervisory with specialized advanced knowledge and duties. For all
assignments above the full performance level, the higher-level duties
must consist of significant scope, complexity (difficulty), and range of
variety, and be performed by the incumbent at least 25% of the time.

[1]{.underline}. **Special Assignments.** Perioperative programs at some
facilities require that anesthesia technicians perform duties that
exceed the full performance level. The anesthesia technician at this
level performs highly difficult and responsible anesthesia technology
duties with considerable latitude for the exercise of independent
judgment. The anesthesia technician may perform autotransfusion services
to ensure that the patient is receiving the safest possible blood
transfusion (his/her own blood) and that the regional blood bank supply
is not unnecessarily depleted. Additionally, the anesthesia technician
may be an integral part of the Anesthesia Care Team and prepare the
patients for surgery by establishing arterial or venous access for the
anesthesiologists and nurse anesthetists.

[2]{.underline}. **Supervisory Anesthesiology Technician.** Individuals
at this level plan and direct programs at affiliated medical centers and
their satellite outpatient clinics and have full supervisory
responsibility for a large staff of non-supervisory personnel and at
least one subordinate team leader or supervisor. Typically these duties
include assigning and evaluating the work of subordinate staff;
resolving problems which may interfere with patient examination or
treatment; providing anesthesia technician services in more complex and
non-standard cases; evaluating new products and equipment and making
recommendations concerning developments which would improve operations;
participating as an instructor in the facility's clinical training
program; making final decisions on selections based on recommendations
from subordinate supervisors or leads; evaluation performance; taking
disciplinary action when necessary; and identifying educational or
training needs.

**Appendix B -- Medical Instrument (Cardiac Catheterization)**

\(1\) **GS-6**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of cardiac anatomy, physiology, and basic
electrocardiography.

[2]{.underline}. Knowledge of sterile techniques, catheterization
laboratory supplies, and equipment used in the procedures.

[3]{.underline}. Ability to circulate, assist, monitor, and document
hemodynamics and electrocardiograms during the procedure.

[4]{.underline}. Knowledge of and ability to prepare intra-aortic
balloon catheters.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) certification
is desirable.

\(d\) **Assignment.** The cardiac catheterization technician at this
level aids physicians in aspects of cardiac catheterization and related
invasive procedures such as coronary angioplasty, pulmonary angioplasty,
and intra-aortic balloon insertion. The technician must be able to
recognize cardiac arrhythmias and take appropriate action.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to assist with insertion of temporary
transvenous pacemaker catheters.

[2]{.underline}. Ability to maintain intra-aortic balloon pump equipment
during procedures.

[3]{.underline}. Ability to complete individual cases by pulling sheaths
and holding pressure to obtain hemostasis.

[4]{.underline}. Ability to assist with closure devices.

[5]{.underline}. Ability to appropriately educate patients and patient
families regarding procedures and post-catheterization care.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are desirable.

\(d\) **Assignment.** Cardiac catheterization technicians at this level
aid physicians in all aspects of standard cardiac catheterization and
related invasive procedures such as coronary angioplasty, pulmonary
angioplasty, and intra-aortic balloon insertion. They select, set up,
and calibrate surgical instruments, catheters, radiographic contrast
injectors, and radiographic imaging devices. They prepare cardiac
medication for administration by the physician and must be able to
recognize cardiac arrhythmias and take appropriate action.

\(3\) **GS-8**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics of the positions to be filled. In
addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to scrub, circulate, and monitor advanced
procedures (including electrophysiological) to include rotoblation,
intravascular ultrasound, RADI or wave-wire, angiojet, filter wires,
myocardial biopsies EPS, permanent pacemaker insertions, AICD
insertions, and biventricular pacemaker insertion.

[2]{.underline}. Advanced knowledge of equipment, medications, and
supplies used in the Cardiac Catheterization Laboratory and the ability
to set-up, calibrate, operate, and troubleshoot this equipment.

[3]{.underline}. Knowledge and understanding of wave forms from the
great vessels and all chambers of the heart including the ability to
recognize and distinguish normal from abnormal, artifact from
abnormality, and forewarn the physician of an impending life-threatening
situation.

[4]{.underline}. Knowledge of quality control and performance
improvement indicators for the Cardiac Catheterization Laboratory and
ability to prepare and analyze quality control of test results.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are desirable.

\(d\) **Assignment.** This represents the full performance level.
Cardiac catheterization technicians at this level function as full
members of the Cardiac Catheterization Laboratory Team. They scrub,
circulate, operate equipment, etc., on the most complex examination and
treatment procedures including procedures such as endocardial biopsy,
radio frequency ablation procedures, and intra-aortic balloon pump
therapy for very critical patients. They prepare and administer cardiac
medications as directed by the attending physician. They mentor and
train lower graded technicians, nurses, nursing students, and
cardiopulmonary technology students on cardiac catheterization
laboratory procedures and assist the supervisor/manager with quality
control and performance improvement activities.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
full performance level, positions at this grade may be lead,
supervisory, or non-supervisory with specialized advanced knowledge and
assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be experience which demonstrates possession of the knowledge
required in order to provide all aspects of cardiac catheterization
technician services. In addition, the candidate must demonstrate the
following technical KSAs and the potential to acquire the assignment
specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**. KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Knowledge of the more complex examination and treatment
procedures and techniques in order to provide training and supervision
in these procedures, to evaluate and initiate performance improvement
projects, and to write policies, procedures, and protocols, that pertain
to the Cardiac Catheterization Laboratory.

\*[2]{.underline}. Knowledge of JCAHO and other regulatory requirements.

[3]{.underline}. Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[4]{.underline}. Ability to manage and supervise employees.

\*[5]{.underline}. Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** Registration by Cardiovascular Credentialing
International (CCI) as a registered Cardiovascular Invasive Specialist
(RCIS) is highly desirable. Basic Cardiac Life Support (BCLS) and
Advanced Cardiac Life Support (ACLS) certifications are also desirable
for employees at this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Special Assignments.** Non-supervisory medical
instrument technician (cardiac catheterization) may have assignments
that because of their nature substantially exceed the full performance
level. The Professional Standards Board will review proposed
non-supervisory special assignments for the GS-9 level and make a
determination regarding their appropriateness. These assignments are
expected to be relatively few in number and must represent substantial
additional responsibility over the full performance level.

[2]{.underline}. **Lead Medical Instrument Technician (Cardiac
Catheterization).** In certain programs, either because of their size
and scope or because of a lack of specific supervisory positions, lead
positions may be appropriate.

[3]{.underline}. **Supervisory Cardiac Catheterization Technician.**
Individuals in this assignment assume full administrative and
professional responsibility for planning and directing the work of
subordinate technicians. Typically these duties include assigning and
evaluating the work of subordinate staff; providing cardiac
catheterization technician services in more complex cases; reviewing and
making recommendations regarding new and emerging procedures; providing
instruction and training to new staff; interviewing

candidates for positions; recommending selections, advancements,
promotions; evaluating performance; taking disciplinary action when
necessary; and identifying educational or training needs.

\(5\) **GS-10.** In addition to the core competencies defined at the
GS-9 level, positions at this grade may be supervisory or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be experience that demonstrates possession of the knowledge
required to provide the most complex cardiac catheterization technician
services and/or supervisory knowledge, skills, and abilities. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Advanced knowledge of complex and non-standard
treatment and examination procedures and techniques.

\*[2]{.underline}. Ability to plan and assist in the establishment of a
completely integrated treatment and examination program.

\*[3]{.underline}. Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4]{.underline}. Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts, and equipment
expenditures), forecast resource and equipment needs, and administer the
allocated budget.

\*[5]{.underline}. Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

\(c\) **Certification.** Registration by Cardiovascular Credentialing
International (CCI) as a registered Cardiovascular Invasive Specialist
(RCIS) is highly desirable. Basic Cardiac Life Support (BCLS) and
Advanced Cardiac Life Support (ACLS) certifications are also desirable
for employees at this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Special Assignments.** There may be a rare
non-supervisory position supporting this grade level. Such a position
would typically include maintaining all data and research protocols for
cardiac procedures and investigations as well as writing policies,
procedures, and protocols for a cardiac catheterization laboratory.

[2]{.underline}. **Supervisory Cardiac Catheterization Technician.**
Individuals at this level plan and direct programs at affiliated medical
centers and satellite outpatient clinics and have full supervisory
responsibility for a large staff of non-supervisory personnel and at
least one subordinate team leader or supervisor. Typically these duties
include assigning and evaluating the work of subordinate staff resolving
problems which may interfere with patient examination or treatment;
providing cardiac catheterization technician services in more complex

and non-standard cases; evaluating new products and equipment and making
recommendations concerning developments which would improve operations;
participating as an instructor in the facility's clinical training
program; making final decisions on selections based on recommendations
from subordinate supervisors or leads; evaluating performance; taking
disciplinary action when necessary; and identifying educational or
training needs.

**Appendix C -- Medical Instrument Technician (Diagnostic Ultrasound)**

**NOTE:** Positions should be assigned to the DRT, GS-647 series, when
[both]{.underline} ultrasound and other modalities which require the
delivery of ionizing radiation are performed. Positions in which
ultrasound duties are performed exclusively (no other modalities are
performed), should be assigned to the Medical Instrument Technician,
GS-649 series, since ultrasound duties solely do not require the
delivery of ionizing radiation.

\(1\) **GS-6**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of medical terminology and human anatomy in
order to receive and interpret physician requests for routine,
standardized ultrasonography procedures.

[2]{.underline}. Knowledge of tissue harmonics and soundwave propagation
within the body to adjust TGC (Time Gain Compensation) for optimal image
quality.

[3]{.underline}. Knowledge of the physics of velocity, frequency of
soundwaves, and their physical properties.

[4]{.underline}. Ability to set up and adjust the ultrasound equipment
to meet the conditions of the examination and the patient and to operate
the equipment for standardized, routine procedures.

[5]{.underline}. Ability to interact with patients explaining procedures
and positioning the patient for the procedure.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) certification
is desirable.

\(d\) **Assignment.** At this level, medical instrument technicians
(diagnostic ultrasound) perform examinations which are routine and
standardized in nature. They position the patient as needed for the best
test results, set up and adjust the ultrasound equipment to meet the
condition of the examination and patient, move and adjust depths and
types of scan in accordance with procedures, perform operator preventive
maintenance and care of equipment, and assist higher graded technicians
in performing more complicated examinations.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided the
individual with the knowledge, skills, and abilities to independently
conduct difficult but standardized diagnostic ultrasonography
examinations. In addition, the candidate must demonstrate the following
KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to set up and adjust the ultrasound equipment
to meet the conditions of the examination and the patient and to operate
the equipment for more complex, but standardized procedures.

[2]{.underline}. Knowledge of zoom, expansion, prospectus, color
Doppler, and pulsed echo Doppler.

[3]{.underline}. Knowledge of the digital transmission of images.

[4]{.underline}. Ability to alter standard, but complex procedures and
protocols to meet patient needs and physical limitations.

\(c\) **Certification**. Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are desirable.

\(d\) **Experience.** At this level the medical instrument technician
(diagnostic ultrasound) performs complex, standardized procedures
independently. They have the knowledge to alter procedures, equipment
settings, transducers used, etc., to accommodate patient needs and still
produce a quality image for diagnostic purposes. They will also be
required to assist with the performance of more complicated procedures
and non-standardized procedures in a developmental capacity.

\(3\) **GS-8**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided the
overall knowledge, skills, and abilities to conduct diagnostic
ultrasound examinations in complex and unusual cases. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to perform diagnostic ultrasound examination on
multiple areas of the body, including, but not limited to, the abdomen,
pelvis, transvaginal, chest, small parts, thyroid, breast, and scrotum.

[2]{.underline}. Ability to perform vascular studies such as vertebral,
renal artery, aortic aneurysm, portal-systemic shunts, etc.

[3]{.underline}. Ability to assist radiologists with biopsy procedures
determining the location, depth, and required needle angle for the
lesion to be sampled.

[4]{.underline}. Ability to assist in surgical procedures and fluid
aspirations.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are desirable.

\(d\) **Assignment**. This represents the full performance level for
medical instrument technician (diagnostic ultrasound). At this level the
technician is required to perform a full range of procedures including
special

complicated examinations for which there are no standard instructions or
procedures. They perform independent portable ultrasound examinations in
the intensive care units, emergency room, surgery, and throughout the
Medical Center when required. They also work independently on evenings,
nights, and weekend tours of duty as scheduled and/or when on call.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
full performance level, positions at this grade may be lead,
supervisory, or non-supervisory with specialized advanced knowledge and
assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be specialized experience which demonstrates possession of the
knowledge required in order to provide all aspects of diagnostic
ultrasonography services. In addition, the candidate must demonstrate
the following technical KSAs and the potential to acquire the assignment
specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Knowledge of the more complex examination and treatment
procedures and techniques in order to provide training and supervision
in these procedures, to evaluate and initiate performance improvement
projects, and to write policies, procedures, and protocols that pertain
to diagnostic ultrasonography.

\*[2]{.underline}. Knowledge of JCAHO and other regulatory requirements.

[3]{.underline}. Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[4]{.underline}. Ability to manage and supervise employees.

\*[5]{.underline}. Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** Registration by Cardiovascular Credentialing
International (CCI) or by the American Registry of Diagnostic Medical
Sonographers (ARDMS) is highly desirable. Basic Cardiac Life Support
(BCLS) and Advanced Cardiac Life Support (ACLS) certifications are also
desirable.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Special Assignments.** Non-supervisory diagnostic
ultrasound technicians may have assignments that because of their nature
substantially exceed the full performance level. The Professional
Standards Board will review proposed non-supervisory special assignments
for the GS-9 level and make a determination regarding their
appropriateness. These assignments are expected to be relatively few in
number and must represent substantial additional responsibility over the
full performance level.

[2]{.underline}. **Lead Diagnostic Ultrasound Technician.** In certain
programs, either because of their size and scope or because of a lack of
specific supervisory positions, lead positions may be appropriate.

[3]{.underline}. **Supervisory Diagnostic Ultrasound Technician.**
Individuals in this assignment assume full administrative and
professional responsibility for planning and directing the work of
subordinate technicians. Typically these duties include assigning and
evaluating the work of subordinate staff; providing diagnostic
ultrasound technician services in more complex cases; reviewing and
making recommendations regarding new and emerging procedures; providing
instruction and training to new staff; interviewing candidates for
positions; recommending selections, advancements, promotions; evaluating
performance; taking disciplinary action when necessary; and identifying
educational or training needs.

\(5\) **GS-10.** In addition to the core competencies defined at the
GS-9 level, positions at this grade may be supervisory or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience**. At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Advanced knowledge of complex and non-standard
treatment and examination procedures and techniques.

\*[2]{.underline}. Ability to plan and assist in the establishment of a
completely integrated treatment and examination program.

\*[3]{.underline}. Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4]{.underline}. Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts, and equipment
expenditures), forecast resource and equipment needs, and administer the
allocated budget.

\*[5]{.underline}. Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

\(c\) **Certification.** Registration by Cardiovascular Credentialing
International (CCI) or by the American Registry of Diagnostic Medical
Sonographers (ARDMS) is highly desirable. Basic Cardiac Life Support
(BCLS) and Advanced Cardiac Life Support (ACLS) certifications are also
desirable.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Special Assignments.** There may be a rare
non-supervisory position supporting this grade level. Such a position
would typically include knowledge of standards of medical practice in
applicable medico-legal responsibilities in diagnostic ultrasound
procedures; developing protocols and clinical research projects;

developing and updating technical policy and procedure manuals; as well
as teaching the correct methodology of diagnostic ultrasound procedures,
theory of operations, and theory of interpretation of results to
trainees.

[2]{.underline}. **Supervisory Diagnostic Ultrasound Technician.**
Individuals at this level plan and direct programs at affiliated medical
centers and their satellite outpatient clinics and have full supervisory
responsibility for a large staff of non-supervisory personnel and at
least one subordinate team leader or supervisor. Typically these duties
include assigning and evaluating the work of subordinate staff resolving
problems which may interfere with patient examination or treatment;
providing diagnostic ultrasonography technician services in more complex
and non-standard cases; evaluating new products and equipment and making
recommendations concerning developments which would improve operations;
participating as an instructor in the facility's clinical training
program; making final decisions on selections based on recommendations
from subordinate supervisors or leads; evaluating performance; taking
disciplinary action when necessary; and identifying educational or
training needs.

**Appendix D -- Medical Instrument Technician (Echocardiography)**

\(1\) **GS-6**

\(a\) Experience. At least 1 year of experience comparable to the next
lower grade level which demonstrates the knowledge, skills, abilities,
and other characteristics related to the duties of the positions to be
filled. In addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of the anatomy and physiology of the heart
and great vessels.

[2]{.underline}. Knowledge of cardiac arrhythmias and their relationship
to hemodynamic conditions of the cardiac cycle.

[3]{.underline}. Knowledge of basic cardiac ultrasound physics and the
acoustic mechanisms by which high quality cardiac images are obtained.

[4]{.underline}. Ability to set up and adjust the ultrasound equipment
to meet the conditions of the examination and the patient and to operate
the equipment for standardized, routine procedures.

[5]{.underline}. Ability to interact with patients explaining procedures
and positioning the patient for the procedure.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) certification
is desirable.

\(d\) **Assignment.** Echocardiography technician assignments at this
level involve performing routine, standardized cardiac ultrasound
examinations under the supervision of a fully qualified cardiac
sonographer. The work involves generating adequate gray scale images to
define cardiac borders and learning to perform Doppler integration of
cardiac valves for determination of flow velocities.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided the
individual with the knowledge, skills, and abilities to independently
conduct difficult but standardized echocardiographic examinations. In
addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to scan transthoracic echocardiograms in all
views with colorflow and some Doppler.

[2]{.underline}. Ability to conduct cardiac testing to determine the
severity and variety of cardiac problems, i.e., valvular dysfunction,
myocardial wall kinesia, effusions, endocardial lesions, etc.

[3]{.underline}. Knowledge of the set-up for transesophageal
echocardiograms.

[4]{.underline}. Ability to set up and adjust the ultrasound equipment
to meet the conditions of the examination and the patient and to operate
the equipment for more complex, but standardized procedures.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are desirable.

\(d\) **Assignment.** At this level, medical instrument technicians
(echocardiography) perform a range of standard, but complex,
echocardiographic examinations with responsibility for calibrating all
instruments prior to the procedure. They are expected to keep an
accurate record of tests, daily logs, and videotapes. They maintain
cidex logs.

\(3\) **GS-8**

\(a\) Experience. At least 1 year of experience comparable to the next
lower grade level which demonstrates the knowledge, skills, abilities,
and other characteristics related to the duties of the positions to be
filled. This would be experience which provided the overall knowledge,
skills, and abilities to conduct diagnostic echocardiography
examinations in complex and unusual cases. In addition, the candidate
must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills and Abilities**

[1]{.underline}. Ability to produce diagnostic quality images and
Doppler frequency shift recordings using M-mode, two-dimensional, pulsed
and continuous wave Doppler spectral display, and colorflow Doppler
imaging.

[2]{.underline}. Knowledge of normal echocardiographic findings and
deviations produced by a wide variety of cardiovascular diseases.

[3]{.underline}. Ability to perform complex procedures such as cardiac
studies of the four chambers of the heart and valves using sector
scanning techniques to detect stenotic and incompetent valves, chamber
enlargement, and pericardial effusion and cardiovascular studies
deriving pressure gradients across obstructed valves, etc.

[4]{.underline}. Ability to perform complementary ultrasonic
examinations (including noninvasive) transthoracic, Bubble studies and
contrast echocardiography, (invasive) stress echocardiography, and
transesophageal echocardiography.

[5]{.underline}. Ability to adapt transducer positioning, instrument
controls, and examination techniques to the individual patient being
studied and the problem being evaluated including recognizing pertinent
abnormalities and documenting abnormal findings.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are desirable.

\(d\) **Assignment.** This represents the full performance level.
Echocardiography technicians at this level identify and record anomalies
indicative of disease, injury, or other medically significant condition
from ultrasound imaging and simultaneous recordings of the Doppler. They
incorporate the causes and results of a variety of symptoms and
conditions into a plan of ultrasonic diagnostic examination. They change
and develop sounding techniques to accommodate such variables as limited
patient mobility, variation in

physical condition or dimension of the patient, presence of prosthesis
or foreign objects, and ultrasonic response of different body parts.
They produce diagnostic quality images and Doppler frequency recordings
using M-mode, two-dimensional, and Doppler ultrasound.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
full performance level, positions at this grade may be lead,
supervisory, or non-supervisory with specialized advanced knowledge and
assignments.

\(a\) **Experience.** At least 1 year experience comparable to the next
lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be experience which demonstrates possession of the knowledge
required in order to provide all aspects of echocardiography services.
In addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Knowledge of the more complex examination and treatment
procedures and techniques in order to provide training and supervision
in these procedures, to evaluate and initiate performance improvement
projects, and to write policies, procedures, and protocols, that pertain
to Echocardiography.

\*[2]{.underline}. Knowledge of JCAHO and other regulatory requirements.

[3]{.underline}. Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[4]{.underline}. Ability to manage and supervise employees.

\*[5]{.underline}. Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** Registration by Cardiovascular Credentialing
International (CCI) as a Registered Cardiac Sonographer (RCS) or by the
American Registry of Diagnostic Medical Sonographers (ARDMS) as a
Registered Diagnostic Cardiac Sonographer (RDCS) is highly desirable.
Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support
(ACLS) certifications are also desirable.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Special Assignments**. Non-supervisory
echocardiography technicians may have assignments that because of their
nature substantially exceed the full performance level. The Professional
Standards Board will review proposed non-supervisory special assignments
for the GS-9 level and make a determination regarding their
appropriateness. These assignments are expected to be relatively few in
number and must represent substantial additional responsibility over the
full performance level.

[2]{.underline}. **Lead Echocardiography Technician.** In certain
programs, either because of their size and scope or because of a lack of
specific supervisory positions, lead positions may be appropriate.

[3]{.underline}. **Supervisory Echocardiography Technician.**
Individuals in this assignment assume full administrative and
professional responsibility for planning and directing the work of
subordinate technicians. Typically these duties include assigning and
evaluating the work of subordinate staff; providing Echocardiography
Technician services in more complex cases; reviewing and making
recommendations regarding new and emerging procedures; providing
instruction and training to new staff; interviewing candidates for
positions; recommending selections, advancements, promotions; evaluating
performance; taking disciplinary action when necessary; and identifying
educational or training needs.

\(5\) **GS-10.** In addition to the core competencies defined at the
GS-9 level, positions at this grade may be supervisory or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Advanced knowledge of complex and non-standard
treatment and examination procedures and techniques.

\*[2]{.underline}. Ability to plan and assist in the establishment of a
completely integrated treatment and examination program.

\*[3]{.underline}. Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4]{.underline}. Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts, and equipment
expenditures), forecast resource and equipment needs, and administer the
allocated budget.

\*[5]{.underline}. Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

\(c\) **Certification.** Registration by Cardiovascular Credentialing
International (CCI) as a Registered Cardiac Sonographer (RCS) or by the
American Registry of Diagnostic Medical Sonographers (ARDMS) as a
Registered Diagnostic Cardiac Sonographer (RDCS) is highly desirable.
Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support
(ACLS) certifications are also desirable.

\(d\) **Assignments**. For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Special Assignments.** There may be a rare
non-supervisory position supporting this grade level. Such a position
would typically include independently carrying out the most complex
laboratory procedures such

as real-time 3D cardiac ultrasounds utilizing on-line and off line
computer enhancement and reconstruction technology and 3D reconstruction
using off-line computers for rendering real-time 3D images to specified
parameters as well as teaching the correct methodology of
echocardiography procedures, theory of operations, and theory of
interpretation of results to trainees.

[2]{.underline}. **Supervisory Echocardiography Technician.**
Individuals at this level plan and direct programs at affiliated medical
centers and satellite outpatient clinics and have full supervisory
responsibility for a large staff of non-supervisory personnel and at
least one subordinate team leader or supervisor. Typically these duties
include assigning and evaluating the work of subordinate staff resolving
problems which may interfere with patient examination or treatment;
providing echocardiography technician services in more complex and
non-standard cases; evaluating new products and equipment and making
recommendations concerning developments which would improve operations;
participating as an instructor in the facility's clinical training
program; making final decisions on selections based on recommendations
from subordinate supervisors or leads; evaluating performance; taking
disciplinary action when necessary; and identifying educational or
training needs.

**Appendix E -- Electrocardiograph Technician (EKG)**

\(1\) **GS-6**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills and Abilities**

[1]{.underline}. Ability to recognize special patient needs such as
disabilities, impaired mobility, and complicating medical conditions in
order to prepare and position the patient for the prescribed procedure.

[2]{.underline}. Knowledge of the specialized equipment and accessories
appropriate to Holter monitoring and ability to perform such tests.

[3]{.underline}. Knowledge of universal precautions and sterilization
techniques and ability to follow CDC guidelines in cleaning equipment.

[4]{.underline}. Ability to monitor the patient for adverse reactions
and take appropriate action.

[5]{.underline}. Ability to operate the equipment to perform standard
and routine highly specialized procedures including exercise stress
testing.

\(c\) **Certification.** No certification is required; however, it is
desirable that employees at this level have BCLS (Basic Cardiac Life
Support) certification.

\(d\) **Assignment.** Medical instrument technicians (EKG) at this level
receive and interpret physician's requests for diagnostic procedures
and/or treatments; explain the procedure to the patient to secure the
patient's confidence and cooperation; document the patient's record;
independently perform standardized testing monitoring the patient for
adverse reactions; and operate, calibrate, and clean and/or sterilize
commonly used equipment. Assignments at this level require knowledge of
standard medical terminology as well as common diseases and their
specific affects.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided
knowledge of the equipment, standard tests and procedures, and typical
readings including arrhythmias and abnormalities. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Knowledge of typical patient reactions and signs of
distress including the ability to recognize, report and treat
potentially lethal arrhythmias.

[2]{.underline}. Knowledge of common equipment settings and standardized
procedures plus knowledge of common errors and corrective measures.

[3]{.underline}. Ability to modify procedures/positions to obtain the
correct results with patients with complicating conditions such as
amputations, Parkinson's disease, structural defects, and scar tissue.

[4]{.underline}. Ability to act as a mentor or preceptor to lower graded
technicians.

[5]{.underline}. Ability to conduct in-service training on the EKG
equipment and related instrumentation.

\(c\) **Certification.** No certification is required; however, it is
desirable that employees at this level have BCLS (Basic Cardiac Life
Support) and ACLS (Advanced Cardiac Life Support) certifications.

\(d\) **Assignment.** This represents the full performance level.
Medical instrument technicians (EKG) at this level operate and monitor
electrocardiographic equipment to perform specialized examinations and
studies involving exercise stress testing, ambulatory monitoring of
arrhythmias, and indirect carotid pulse tracings on chronic patients.
They monitor tracings to identify arrhythmias and when gross
abnormalities appear, when to repeat certain procedures, when to stop
test procedures, and when to get the immediate attention of a physician.
They evaluate test results to determine appropriate machine adjustments
and use alternative techniques and procedures when established
procedures do not accomplish acceptable results. This includes adapting
equipment and accessories to yield the best results during the
examination. They edit and select an appropriate sample portion of the
tracing for further interpretation by the physician.

\(3\) **GS-8.** In addition to the core competencies defined at the GS-7
full performance level, positions at this grade may be lead,
supervisory, or non-supervisory with specialized advanced knowledge and
assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be experience which provided knowledge of advanced specialized
procedures, the pharmacology related to this occupation, and knowledge
of related acute disorders and diseases and their effects on organs and
methods of treatment. In addition, the candidate must demonstrate the
following technical KSAs and the potential to acquire the assignment
specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, 3,
and 4 are appropriate for all positions at this level. KSAs 5 and 6 are
to be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Knowledge of pharmacology related to specialized
procedures.

[2]{.underline}. Ability to provide briefings and orientations to
hospital staff including physicians.

[3]{.underline}. Knowledge of a variety of related acute disorders and
diseases, their effects on organs, and methods of treatment.

[4]{.underline}. Ability to perform more complex procedures such as
SAECG (Signal Averaged ECG), Tilt table monitoring, electrophysiology
monitoring, and event monitoring.

\*[5]{.underline}. Ability to provide, or provide for, staff development
and training.

\*[6]{.underline}. Ability to manage and supervise employees.

\(c\) **Certification.** No certification is required; however, it is
desirable that employees at this level have BCLS (Basic Cardiac Life
Support) and ACLS (Advanced Cardiac Life Support) certifications.

\(d\) **Assignments.** Medical instrument technicians (EKG) at this
level perform complicated examinations or treatments for which there are
no standard instructions or procedures. They utilize knowledge of
anatomy and physiology including an in depth understanding of the
functioning of the major systems and internal organs to interpret
requests and to recognize the need for additional tests or a different
position. Knowledge of pharmacology including the classification and
administration of drugs, patient responses, and common dosages as
related to this specialty is required. The technician has the ability to
perform Signal Averaged ECG, Tilt table monitoring, electrophysiology
monitoring, and event monitoring. For all assignments above the full
performance level, the higher-level duties must consist of significant
scope, complexity (difficulty), and range of variety, and be performed
by the incumbent at least 25% of the time.

[1]{.underline}. **Special Assignments.** Non-supervisory medical
instrument technician (EKG) may have assignments that because of their
nature substantially exceed the full performance level. The Professional
Standards Board will review proposed non-supervisory special assignments
for the GS-8 level and make a determination regarding their
appropriateness. These assignments are expected to be relatively few in
number and must represent substantial additional responsibility over the
full performance level.

[2]{.underline}. **Lead Medical Instrument Technician (EKG).** In
certain programs, either because of their size and scope or because of a
lack of specific supervisory positions, lead positions may be
appropriate.

[3]{.underline}. **Supervisory Medical Instrument Technician (EKG).**
Individuals in this assignment assume full administrative and
professional responsibility for planning and directing the work of
subordinate technicians. Typically these duties include assigning and
evaluating the work of subordinate staff; providing medical instrument
technician (EKG) services in more complex cases; reviewing and making
recommendations regarding new and emerging procedures; providing
instruction and training to new staff; interviewing candidates for
positions; recommending selections, advancements, promotions; evaluating
performance; taking disciplinary action when necessary; and identifying
educational or training needs.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
level, positions at this grade may be lead, supervisory, or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Knowledge of the more complex examination and treatment
procedures and techniques such as SAECG, ETT, Tilt table monitoring,
electrophysiology monitoring, and event monitoring in order to

provide training and supervision in these procedures, to develop
analysis interpretation formats, and to receive inquiries concerning
results.

\*[2]{.underline}. Knowledge of JCAHO and other regulatory requirements.

[3]{.underline}. Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[4]{.underline}. Ability to provide, or provide for, staff development
and training.

\*[5]{.underline}. Ability to manage and supervise employees.

\(c\) **Certification.** Certification by Cardiovascular Credentialing
International (CCI) as a Certified Cardiographic Technician (CCT) is
highly desirable at this level. Basic Cardiac Life Support (BCLS) and
Advanced Cardiac Life Support (ACLS) certifications are also desirable
for employees at this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Special Assignments.** Non-supervisory medical
instrument technician (EKG) may have assignments that because of their
nature substantially exceed the GS-8 level. The Professional Standards
Board will review proposed non-supervisory special assignments for the
GS-9 level and make a determination regarding their appropriateness.
These assignments are expected to be few in number and must represent
substantial additional responsibility.

[2]{.underline}. **Lead Medical Instrument Technician (EKG).** In
certain programs, either because of their size and scope or because of a
lack of specific supervisory positions, lead positions may be
appropriate.

[3]{.underline}. **Supervisory Medical Instrument Technician (EKG).**
Individuals in this assignment assume full administrative and
professional responsibility for planning and directing the work of
subordinate technicians. Typically these duties include assigning and
evaluating the work of subordinate staff; providing medical instrument
technician (EKG) services in more complex cases; reviewing and making
recommendations regarding new and emerging procedures; providing
instruction and training to new staff; interviewing candidates for
positions; recommending selections, advancements, promotions; evaluating
performance; taking disciplinary action when necessary; and identifying
educational or training needs.

**Appendix F -- Medical Instrument Technician (Electroencephalography)**

\(1\) **GS-6**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of basic medical terminology, neuroanatomy,
neurophysiology, and EEG interpretation.

[2]{.underline}. Ability to position patients for the examination or
treatment including using standard alternate positions for patient with
common physical disabilities.

[3]{.underline}. Ability to operate the appropriate EEG equipment to
administer routine, standardized diagnostic or treatment procedures.

[4]{.underline}. Knowledge of normal and abnormal results to recognize
and report obvious abnormalities during procedures.

[5]{.underline}. Knowledge of universal precautions and basic
sterilization methods to clean instruments to prevent the spread of
infectious diseases.

[6]{.underline}. Knowledge of EEG and peripheral equipment to conduct
routine maintenance and adjustment checks.

\(c\) **Certification.** No certification or registration is required;
however, it is desirable that employees at this level have BCLS (Basic
Cardiac Life Support) certification.

\(d\) **Assignment.** Operates and monitors EEG equipment in the EEG
Lab, intensive care units, operating room, and the patient's bedside.
Performs a full range of standard, routine EEG examinations including
routine awake and sleep recordings, electrocerebral silence recordings,
multiple sleep latency recordings, intraoperative monitoring,
electrocorticography. Performs nerve conduction studies using
electromyography equipment. Prepares recordings for interpretation and
performs a preliminary review and interpretation of the recordings.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the positions to be
filled. This would be experience which provided the individual with the
knowledge, skills, and abilities to independently conduct difficult but
standardized electroencephalography examinations. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to perform more complex electroencephalography
studies such as evoked potential (visual, auditory, somatosensory) and
transcranial Doppler studies.

[2]{.underline}. Knowledge of medication effects related to
electroencephalography studies and clinical situations requiring
medication.

[3]{.underline}. Knowledge of life threatening or medically emergent
testing or patient situations.

[4]{.underline}. Ability to recognize artifacts (patient or
environmental) and document, eliminate, or take proper measures to
monitor the artifact.

\(c\) **Certification.** No certification or registration is required;
however, it is desirable that employees at this level have BCLS (Basic
Cardiac Life Support) and ACLS (Advanced Cardiac Life Support)
certifications.

\(d\) **Assignment.** At this level, the medical instrument technician
(EEG) independently performs routine but complex procedures and has
advanced knowledge in certain areas. They are able to deal with
difficult or more complex patients. They are able to identify and
correct most artifacts. Procedures are fully explained to the patient
and family members to set them at ease. Interpretative skills are
sufficient to allow identification of more serious conditions requiring
rapid intervention.

\(3\) **GS-8**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided
knowledge of the more complex procedures, the pharma-cology related to
this occupation, and knowledge of related acute disorders and diseases
and their effects on organs and methods of treatment. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to interpret testing data to evaluate critical
information for surgeons and other medical staff during testing
procedures.

[2]{.underline}. Knowledge of anatomy and physiology of the nervous
system and the ability to understand the relationship of EEG and evoked
potential testing in detecting states of disease and health.

[3]{.underline}. Knowledge of behavior assessment during seizure attacks
in order to insure adequacy of recordings during seizure discharges.

[4]{.underline}. Knowledge of a variety of advanced EEG equipment and
peripheral equipment such as equipment for brain mapping, video EEG
telemetry systems with seizure detection computers, and spike analysis
software.

[5]{.underline}. Knowledge of anticonvulsant medications and their
effects on the EEG as well as other frequently used pharmaceuticals.

[6]{.underline}. Ability to adapt neurodiagnostic devices, parameters,
and procedures to complex, unusual, and often critical situations.

\(c\) **Certification.** No certification or registration is required;
however, it is desirable that employees at this level have BCLS (Basic
Cardiac Life Support) and ACLS (Advanced Cardiac Life Support)
certifications.

\(d\) **Assignment**. This represents the full performance level.
Medical instrument technicians (EEG) at this level are expected to
provide independent performance of a full range of procedures. The
technician consistently delivers high quality studies for the most
complex and non-routine procedures in difficult or demanding
environments such as research, intraoperative monitoring, or intensive
care monitoring. Procedures are tailored to clinical questions to be
answered and may require additional monitors, electrodes, or other
devices as clinically indicated. The technician interprets study results
and brings to the attention of the physician or supervisor more subtle
abnormalities that may require intervention. The technician will
highlight portions of recordings of clinical importance for review by
the clinical neurophysiologist and will accurately describe the
concurrent behavior of the patient. Positive interaction with other
health care staff to inform them of the indications for testing; the
value, possible outcomes, and limitations of testing; and the policies
of the laboratory are expected.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
full performance level, positions at this grade may be lead,
supervisory, or non-supervisory with specialized advanced knowledge and
assignments.

\(a\) **Experience**. At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Knowledge of the more complex examination and treatment
procedures and techniques in order to provide training and supervision
in these procedures.

\*[2]{.underline}. Knowledge of JCAHO and other regulatory requirements.

[3]{.underline}. Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[4]{.underline}. Ability to manage and supervise employees.

\*[5]{.underline}. Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** Registration by the American Board of
Registration of EEG, CNIM &EP Technologists (ABRET) or the American
Association of Electrodiagnostic Technologists (AEET) is highly
desirable. Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life
Support (ACLS) certifications are also desirable for employees at this
level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1.]{.underline} **Special Assignments.** Non-supervisory
Electroencephalography Technicians may have assignments that because of
their nature substantially exceed the full performance level. The
Professional Standards Board will review proposed non-supervisory
special assignments for the GS-9 level and make a determination
regarding their appropriateness. These assignments are expected to be
relatively few in number and must represent substantial additional
responsibility over the full performance level.

[2.]{.underline} **Lead Electroencephalograpy Technicians.** In certain
programs, either because of their size and scope or because of a lack of
specific supervisory positions, lead positions may be appropriate.

[3.]{.underline} **Supervisory Electroencephalography Technician.**
Individuals in this assignment assume full administrative and
professional responsibility for planning and directing the work of
subordinate technicians. Typically these duties include assigning and
evaluating the work of subordinate staff; providing medical instrument
technician (EEG) services in more complex cases; reviewing and making
recommendations regarding new and emerging procedures; providing
instruction and training to new staff; interviewing candidates for
positions; recommending selections, advancements, promotions; evaluating
performance; taking disciplinary action when necessary; and identifying
educational or training needs.

\(5\) **GS-10.** In addition to the core competencies defined at the
GS-9 level, positions at this grade may be supervisory or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be experience which demonstrates possession of the knowledge
required to provide the most complex EEG Technician services and/or
supervisory knowledge, skills, and abilities. Participation in
recognized professional organizations as a Board examiner, in the
development of curricula for training, or testing for the Board is
evidence of competence. In addition, the candidate must demonstrate the
following technical KSAs and the potential to acquire the assignment
specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Advanced knowledge of the most complex and non-standard
treatment and examination procedures and techniques.

\*[2]{.underline}. Ability to plan and assist in the establishment of a
completely integrated treatment and examination program.

\*[3]{.underline}. Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4]{.underline}. Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts, and equipment
expenditures), forecast resource and equipment needs, and administer the
allocated budget.

\*[5]{.underline}. Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

\(c\) **Certification.** Registration by the American Board of
Registration of EEG, CNIM &EP Technologists (ABRET) or the American
Association of Electrodiagnostic Technologists (AEET) is highly
desirable. Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life
Support (ACLS) certifications are also desirable for employees at this
level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Special Assignments.** There may be a rare
non-supervisory position supporting this grade level. Such a position
would typically include carrying out laboratory procedures independently
in complex environments such as the operating room, monitoring suites,
and clinical research laboratories as well as teaching the correct
methodology of neurodiagnostic procedures, theory of operations, and
theory of interpretation of results to trainees.

[2]{.underline}. **Supervisory Electroencephalography Technician.**
Individuals at this level plan and direct programs at affiliated medical
centers and satellite outpatient clinics and have full supervisory
responsibility for a large staff of non-supervisory personnel and at
least one subordinate team leader or supervisor. Typically these duties
include assigning and evaluating the work of subordinate staff resolving
problems which may interfere with patient examination or treatment;
providing Medical Instrument Technician (EEG) services in more complex
and non-standard cases; evaluating new products and equipment and making
recommendations concerning developments which would improve operations;
participating as an instructor in the facility's clinical training
program; making final decisions on selections based on recommendations
from subordinate supervisors or leads; evaluating performance; taking
disciplinary action when necessary; and identifying educational or
training needs.

**Appendix G -- Medical Instrument Technician (Hemodialysis)**

\(1\) **GS-6**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Skill in setting up, operating, and performing
calibrations as required on a variety of dialysis equipment.

[2]{.underline}. Skill in performing and interpreting test results
(dialysate chemistries, water treatment testing for contaminates, etc.)
including the ability to analyze deviations from the expected norm and
responding appropriately.

[3]{.underline}. Knowledge of American Association of Medical
Instrumentation (AMMI) standards and unit policies as they relate to
water treatment.

[4]{.underline}. Knowledge of physiological and psychological changes
and conditions related to end stage renal disease.

[5]{.underline}. Ability to calculate dialysis baths according to the
physician's orders per patient by mixing critical concentrates, i.e.,
calcium, potassium, and bicarbonate.

[6]{.underline}. Knowledge of Basic Cardiac Life Support (BCLS).

\(c\) **Certification.** No certification is required; however, it is
desirable that employees at this level have BCLS (Basic Cardiac Life
Support) certification.

\(d\) **Assignment.** Hemodialysis Technicians at this level operate and
monitor dialysis systems for chronic patients; check patient condition
and determine the proper treatment procedures, technique, and machine
adjustments; understand medical treatment for patients with renal
failure; administer prescribed medication and observe the patient for
desired action or adverse reaction; and recognize and react to signs and
symptoms that signal the onset of complications of dialysis including
hypotension, disequilibrium, seizures, and arrhythmias.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided
knowledge the equipment, standard procedures, and typical machine
problems and/or patient reactions to treatment. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to assist the physician in more complex
procedures such as central venous catheter insertion.

[2]{.underline}. Ability to assist in training patients in
home/self-care by teaching components of machine operation including
water treatment and monitoring patients for compliance.

[3]{.underline}. Ability to act as a mentor or preceptor to lower graded
technicians.

[4]{.underline}. Ability to analyze deviations from the expected,
determine whether the deviations are machine or patient related, and
respond according to the findings.

\(c\) **Certification.** No certification is required; however, it is
desirable that employees at this level have BCLS (Basic Cardiac Life
Support) and ACLS (Advanced Cardiac Life Support) certifications.

\(d\) **Assignment.** At this level in addition to providing
hemodialysis for chronic patients, hemodialysis technicians assist the
physician during central venous catheter insertion, assist in the
training of patients for home dialysis/self-care, and act as a mentor or
preceptor to lower graded hemodialysis technicians. At this level, the
technician accepts responsibility and accountability for his/her own
actions.

\(3\) **GS-8**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided
knowledge of the more complex procedures, the pharmacology related to
this occupation, and knowledge of related acute disorders and diseases
and their effects on organs and methods of treatment. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of the hemodialysis process and equipment
needed for home/self care including knowledge of common machine problems
and repairs to such equipment.

[2]{.underline}. Knowledge of the equipment and procedures for
peritoneal dialysis.

[3]{.underline}. Ability to assist the physician with percutaneous renal
biopsies and peritoneal catheter insertion.

[4]{.underline}. Ability to provide instruction to dialysis patients in
home/self care and in the maintenance of the equipment.

[5]{.underline}. Ability to provide instruction for physicians, nurses,
and other personnel in dialysis procedures, equipment operation and
maintenance, etc.

\(c\) **Certification.** No certification is required; however, it is
desirable that employees at this level have BCLS (Basic Cardiac Life
Support) and ACLS (Advanced Cardiac Life Support) certifications.

\(d\) **Assignment.** This represents the full performance level. At
this level the hemodialysis technician serves as a member of a dialysis
team performing dialysis on acutely ill patients including those within
an intensive care setting. Assignments involve performing both
peritoneal and hemodialysis procedures. The dialysis technician may
participate in percutaneous renal biopsies, watching the patient during
the procedure and properly processing the specimen. Assists the
physician in peritoneal catheter insertions and observes the patient for
vital signs and provides post operative care. Provides instruction and
monitors patients for home dialysis. Performs training of physicians,
nurses, and technicians on hemodialysis and peritoneal dialysis
techniques.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
full performance level, positions at this grade may be lead,
supervisory, or non-supervisory with specialized advanced knowledge and
assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Knowledge of the more complex examination and treatment
procedures and techniques such as those provided for acutely ill
patients and peritoneal dialysis in order to provide training and
supervision in these procedures.

\*[2]{.underline}. Knowledge of JCAHO and other regulatory requirements.

[3]{.underline}. Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[4]{.underline}. Ability to manage and supervise employees.

\*[5]{.underline}. Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** Certification by one of the following
organizations is highly desirable at this level: Nephrology
Certification Commission (NNCC), Board of Nephrology Examiners, Inc.,
Nursing and Technology (BONENT), National Nephrology Certification
Organization (NNCO), and the International Certification Commission for
Clinical Engineering and Biomedical Technology (ICC) in conjunction with
the United States Certification Commission (USCC). Basic Cardiac Life
Support (BCLS) and Advanced Cardiac Life Support (ACLS) certifications
are also desirable for employees at this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Special Assignments**. Non-supervisory hemodialysis
technicians may have assignments that because of their nature
substantially exceed the full performance level. The Professional
Standards Board will review

proposed non-supervisory special assignments for the GS-9 level and make
a determination regarding their

appropriateness. These assignments are expected to be relatively few in
number and must represent substantial additional responsibility over the
full performance level.

[2]{.underline}. **Lead Hemodialysis Technician.** In certain programs,
either because of their size and scope or because of a lack of specific
supervisory positions, lead positions may be appropriate.

[3]{.underline}. **Supervisory Hemodialysis Technician.** Individuals in
this assignment assume full administrative and professional
responsibility for planning and directing the work of subordinate
technicians. Typically these duties include assigning and evaluating the
work of subordinate staff; providing dialysis technician services in
more complex cases; reviewing and making recommendations regarding new
and emerging procedures; providing instruction and training to new
staff; interviewing candidates for positions; recommending selections,
advancements, promotions; evaluating performance; taking disciplinary
action when necessary; and identifying educational or training needs.

\(5\) **GS-10.** In addition to the core competencies defined at the
GS-9 level, positions at this grade may be supervisory or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Advanced knowledge of the most complex and non-standard
treatment and examination procedures and techniques.

\*[2]{.underline}. Ability to plan and assist in the establishment of a
completely integrated treatment and examination program.

\*[3]{.underline}. Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4]{.underline}. Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts, and equipment
expenditures), forecast resource and equipment needs, and administer the
allocated budget.

\*[5]{.underline}. Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

\(c\) **Certification.** Certification by one of the following
organizations is highly desirable at this level: Nephrology
Certification Commission (NNCC), Board of Nephrology Examiners, Inc.,
Nursing and Technology (BONENT), National Nephrology Certification
Organization (NNCO), and the International Certification Commission for
Clinical Engineering and Biomedical Technology (ICC) in conjunction

with the United States Certification Commission (USCC). Basic Cardiac
Life Support (BCLS) and Advanced Cardiac Life Support (ACLS)
certifications are also desirable for employees at this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Special Assignments.** There may be a rare
non-supervisory position supporting this grade level. Such a position
would typically include advising physicians on the creation of dialysate
formulations not commercially available, determining contract
requirements for all dialysis equipment, and evaluating the home
environment and coordinating the modifications necessary for home
dialysis.

[2]{.underline}. **Supervisory Hemodialysis Technician.** Individuals at
this level plan and direct programs at affiliated medical centers and
their satellite outpatient clinics and have full supervisory
responsibility for a large staff of non-supervisory personnel and at
least one subordinate team leader or supervisor. Typically these duties
include assigning and evaluating the work of subordinate staff resolving
problems which may interfere with patient examination or treatment;
providing dialysis technician services in more complex and non-standard
cases; evaluating new products and equipment and making recommendations
concerning developments which would improve operations; participating as
an instructor in the facility's clinical training program; making final
decisions on selections based on recommendations from subordinate
supervisors or leads; evaluating performance; taking disciplinary action
when necessary; and identifying educational or training needs.

**Appendix H -- Medical Instrument Technician (Perfusion)**

\(1\) **GS-9**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This represents the entry level for medical
instrument technician (perfusion) positions. Applicants must demonstrate
experience, education, or training which provided the basic knowledge,
skills, and abilities to maintain extracorporeal circulation during
heart surgery. This may evidenced by certification by the American Board
of Cardiovascular Perfusion (ABCP) as a Certified Clinical Perfusionist.
In addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of the equipment and supplies needed for safe
conduct of cardiopulmonary by-pass.

[2]{.underline}. Knowledge of counter pulsation life support and
insertion, maintenance, and removal of the intraaortic balloon pump.

[3]{.underline}. Knowledge of blood sparing equipment (its uses,
indications, and contraindications), blood banking procedures, blood
storage and administration, and blood components (including platelet gel
and sequestration).

[4]{.underline}. Ability to operate ventricular assist devices (VAD) and
assist with implantation, transportation, and removal of the device.

[5]{.underline}. Knowledge of blood gases (using alpha stat or ph stat
measures) and ability to analyze and apply lab results to patients under
direct care on by-pass or VAD.

\(c\) **Certification.** Certification by the American Board of
Cardiovascular Perfusion (ABCP) as a Certified Cardiovascular
Perfusionist (CCP) is highly desirable.

\(d\) **Assignment.** Medical instrument technicians (perfusion) at this
level operate the heart-lung machine, intra-aortic balloon pump, cell
saver and blood salvaging equipment, and ventricular assist devices
during open heart and coronary by-pass surgery. They analyze blood
gasses and laboratory results in preparation for cardiopulmonary by-pass
or while conducting cardiopulmonary by-pass.

\(2\) **GS-10**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the positions being
filled. This would be experience as a clinical perfusionist which
provided the knowledge, skills, and abilities to function as a full
member of the surgical team on the most critical and complex cases. In
addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of occupation specific pharmacology and
ability to give drug therapy and medications as necessary to maintain
homeostasis.

[2]{.underline}. Ability to maintain intra-operative and initial
post-operative files of extracorporeal circulation data records and
patient response postoperatively.

[3]{.underline}. Ability to provide instruction for physicians, nurses,
residents, medical and nursing students, and other personnel in
perfusion procedures, equipment operation and maintenance, etc.

\(c\) **Certification.** Certification by the American Board of
Cardiovascular Perfusion (ABCP) as a Certified Cardiovascular
Perfusionist (CCP) is highly desirable.

\(d\) **Assignment.** This represents the full performance level.
Medical instrument technicians (perfusion) at this level operate the
heart-lung machine, intra-aortic balloon pump, cell saver and blood
salvaging equipment, and ventricular assist devices during open heart
and coronary by-pass surgery for patients representing the most complex
and critical cases. They analyze blood gasses and laboratory results in
preparation for cardiopulmonary by-pass or while conducting
cardiopulmonary by-pass. They may also operate the equipment during
heart transplantation. This could include participating as part of the
team for retrieval and transportation of the donor heart. They also
provide training to lower grade perfusion technicians, cardiac
catheterization technicians, and ICU staff regarding all aspects of
perfusion services.

\(3\) **GS-11**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the position to be
filled, and must fully meet the KSAs at that level. This would be
experience as a clinical perfusionist which provided the knowledge,
skills, and abilities to function as a chief technician and/or program
manager. In addition, the candidate must demonstrate the following
technical KSAs and the potential to acquire the assignment specific KSAs
designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

\*[1]{.underline}. Knowledge of quality assurance and performance
improvement measures for perfusion programs.

\*[2]{.underline}. Ability to identify training needs for lower graded
staff and provide, or provide for this training.

\(c\) **Certification.** Certification by the American Board of
Cardiovascular Perfusion (ABCP) as a Certified Cardiovascular
Perfusionist (CCP) is highly desirable.

\(d\) **Assignment.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Medical Instrument Technicians
(Perfusion) at this level function as Chief Technicians and/or program
directors for the perfusion program. They are responsible for evaluating
quality control and developing performance improvement programs for the
program. They provide administrative oversight for lower graded
Perfusion Technicians and for other personnel assigned to the program.

**Appendix I -- Medical Instrument Technician (Polysomnography)**

\(1\) **GS-6**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of standard, computerized polysomnographs for
recording continuous all night physiological data including EEG, EOG,
EKG, EMG and respiratory parameters.

[2]{.underline}. Knowledge of standard devices such as oximeters,
respiratory effort devices, nasal pressure devices, thermistors,
thermocouples, continuous positive airway pressure (CPAP) machines, and
laboratory computers including the ability to calibrate and operate the
equipment and recognize and eliminate recording artifacts.

[3]{.underline}. Knowledge of medical terminology and medical record
organization to review medical records, sleep study orders, consent
forms, medical charts, etc.

[4]{.underline}. Knowledge of polysmnographic procedural protocols
(including overnight sleep studies, MSLT, MWT, PAP, etc.).

[5]{.underline}. Knowledge of basic anatomy and physiology and the
international 10-20 electrode placement system in order to conduct the
sleep studies.

\(c\) **Certification.** No certification or registration is required at
this level. Basic Cardiac Life Support (BCLS) certification is
desirable.

\(d\) **Assignment.** Polysomnography (PSG) Technicians at this level
perform a full range of standard, routine examinations including
overnight sleep studies, MSLT (Multiple Sleep Latency Test), MWT
(Maintenance of Wakefulness Test), and PAP (Positive Airway Pressure
Titration).

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided the
individual with the knowledge, skills, and abilities to independently
conduct difficult but standardized polysomnography examinations. In
addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of CPAP function and operation to select and
fit appropriate PAP patient interface devices.

[2]{.underline}. Ability to independently titrate and document PAP level
to achieve therapeutic goals.

[3]{.underline}. Knowledge of indications, complications, and
contraindications of CPAP therapy.

[4]{.underline}. Knowledge of Bi-Level pressure titrations.

[5]{.underline}. Ability to recognize changes seen during the PSG
tracing and identify all stages of sleep. This includes the ability to
score and analyze sleep stages in clinical polysomnography recordings.

\(c\) **Certification.** No certification or registration is required.
Basic Cardiac Life Support (BCLS) certification is desirable.

\(d\) **Assignment.** At this level the Polysomnography Technician
performs a full range of standard, but complex, polysomnography
examinations with responsibility for properly and accurately calibrating
all instruments prior to the beginning of the PSG tracing and selection
of appropriate electrode montages and sensitivity and filter settings to
elicit the best possible tracings. They independently determine the need
for CPAP during all night sleep studies for sleep apnea. They may
administer nerve conduction velocity tests.

\(3\) **GS-8**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided a
knowledge of the more complex procedures as well as knowledge of the
uncommon and/or rare sleep disorders. In addition, the candidate must
demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1.]{.underline} Advanced knowledge or the International Classification
of Sleep Disorders and the ability to recognize uncommon and/or rare
sleep disorders.

[2.]{.underline} Ability to summarize and report polysomnographic data
in narrative form.

[3.]{.underline} Knowledge of event characteristics (e.g., respiratory,
cardiac, sleep stage, seizures, etc.) and ability to take appropriate
action.

[4.]{.underline} Ability to provide briefings and orientation to
hospital staff including physicians.

\(c\) **Certification.** No certification or registration is required.
Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support
(ACLS) certifications are also desirable for employees at this level.

\(d\) **Assignment.** This represents the full performance level. At
this level Polysomnographic Technicians are able to interact fully with
the patient and physician to diagnose sleep disorders including those
that are uncommon or rare. They are able to conduct full sleep studies
including overnight studies and evaluate the relationship of events,
sleep stages, and possible medical conditions which influence or result
from events occurring during sleep. They anticipate problems likely to
occur during the sleep study and prepare for such situations, make
changes in established procedures, or recommend alternative courses of
action. They are able to mentor lower graded technicians.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
level, positions at this grade may be lead, supervisory, or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be experience which demonstrates possession of the knowledge
required to provide all aspects of polysomnography services. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Knowledge of the more complex examination and treatment
procedures and techniques in order to provide training and supervision
in these procedures, to evaluate and initiate performance improvement
projects, and to write policies, procedures, and protocols, that pertain
to Polysomnography.

\*[2]{.underline}. Knowledge of JCAHO and other regulatory requirements.

[3]{.underline}. Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[4]{.underline}. Ability to manage and supervise employees.

\*[5]{.underline}. Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** Registration by the Board of Registered
Polysomnographic Technologists (BRPT) is highly desirable. Basic Cardiac
Life Support (BCLS) and Advanced Cardiac Life Support (ACLS)
certifications are also desirable for employees at this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

1\. **Special Assignments.** Non-supervisory polysomnography technicians
may have assignments that because of their nature substantially exceed
the full performance level. The Professional Standards Board will review
proposed non-supervisory special assignments for the GS-9 level and make
a determination regarding their appropriateness. These assignments are
expected to be relatively few in number and must represent substantial
additional responsibility over the full performance level.

[2.]{.underline} **Lead Polysomnography Technician.** In certain
programs, either because of their size and scope or because of a lack of
specific supervisory positions, lead positions may be appropriate.

[3]{.underline}. **Supervisory Polysomnography Technician.** Individuals
in this assignment assume full administrative and professional
responsibility for planning and directing the work of subordinate
technicians. Typically these duties include assigning and evaluating the
work of subordinate staff; providing polysomnography technician services
in more complex cases; reviewing and making recommendations regarding
new and emerging procedures; providing instruction and training to new

staff; interviewing candidates for positions; recommending selections,
advancements, promotions; evaluating performance; taking disciplinary
action when necessary; and identifying educational or training needs.

\(5\) **GS-10.** In addition to the core competencies defined at the
GS-9 level, positions at this grade may be supervisory or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be experience which demonstrates possession of the knowledge
required to provide the most complex polysomnography technician
services. In addition, the candidate must demonstrate the following
technical KSAs and the potential to acquire the assignment specific KSAs
designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Advanced knowledge of complex and non-standard
treatment and examination procedures and techniques.

\*[2]{.underline}. Ability to plan and assist in the establishment of a
completely integrated treatment and examination program.

\*[3]{.underline}. Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4]{.underline}. Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts, and equipment
expenditures), forecast resource and equipment needs, and administer the
allocated budget.

\*[5]{.underline}. Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

\(c\) **Certification**. Registration by the Board of Polysomnographic
Technologists (BRPT) is highly desirable. Basic Cardiac Life Support
(BCLS) and Advanced Cardiac Life Support (ACLS) certifications are also
desirable for employees at this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Special Assignments.** There may be a rare
non-supervisory position supporting this grade level. Such a position
would typically include producing preliminary polysomnographic
interpretations and recommendations for presentations at case
conferences as well as developing, updating, and annually reviewing all
sleep laboratory policies and procedures to assure that the laboratory
operates according to national standards of practice.

[2]{.underline}. **Supervisory Polysomnographic Technician.**
Individuals at this level plan and direct programs at affiliated medical
centers and satellite outpatient clinics and have full supervisory
responsibility for a large staff of non-supervisory personnel and at
least one subordinate team leader or supervisor. Typically these duties
include assigning and evaluating the work of subordinate staff resolving
problems which may interfere with patient examination or treatment;
providing polysomnography technician services in more complex and
non-standard cases; evaluating new products and equipment and making
recommendations concerning developments which would improve operations;
participating as an instructor in the facility's clinical training
program; making final decisions on selections based on recommendations
from subordinate supervisors or leads; evaluating performance; taking
disciplinary action when necessary; and identifying educational or
training needs.

**Appendix J -- Medical Instrument Technician (Pulmonary Function)**

\(1\) **GS-6**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. In addition, the candidate must demonstrate the
following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of proper administration of metered dose
inhalers and the various medications associated with bronchodilation
including understanding of the contraindications and dangers of such
pharmaceutical agents.

[2]{.underline}. Knowledge of the proper use and placement of pulse
oximetry equipment and sensors.

[3]{.underline}. Knowledge of universal precautions and aseptic
techniques for cleaning equipment to provide a safe environment for
performing tests.

[4]{.underline}. Ability to perform routine, standardized pulmonary
function tests.

[5]{.underline}. Ability to recognize adverse reactions to treatment
that may indicate the need to terminate procedures and to call the
physician's attention to unusual reactions to administered medications.

\(c\) **Certification.** No certification or registration is required;
however it is desirable that technicians at this level have Basic
Cardiac Life Support (BCLS) certification.

\(d\) **Assignment.** Technicians at this level perform routine
pulmonary function tests in a hospital or clinic. They administer
inhaled medications for the purpose of bronchodilator response. They
operate, calibrate, and maintain commonly used instruments such as blood
gas analyzers, oximeters, and gas nebulizers. They conduct standardized
tests such as forced and slow vital capacity, blood gas analysis, and
flow volume loops. They instruct patients when and how to perform
breathing exercises. They calculate and measure blood gas values. They
use aseptic methods to draw blood samples from patients and properly use
and clean equipment.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided
knowledge the equipment, standard tests and procedures, and typical
readings. In addition, the candidate must demonstrate the following
KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to perform arterial punctures, analyze blood
gases, and interpret blood gas measurements including the ability to
determine if the sample is accurate for reporting, assess for
inaccuracy, and correct inaccurate samples.

[2]{.underline}. Knowledge of lung mechanics and ability to perform a
variety of spiromety and complex pulmonary function tests on both
ambulatory and non-ambulatory patients.

[3]{.underline}. Ability to determine the order of priority for
administering multiple pulmonary function tests, choose the most
appropriate equipment and techniques for the type of ventilatory
problem, and determine the proper sequence of steps to complete the
testing.

[4]{.underline}. Ability to measure the pulmonary function of patients
for the purpose of diagnosing disease, determining responsiveness to
treatment, and assessing disability.

\(c\) **Certification.** No certification or registration is required;
however, Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life
Support (ACLS) certifications are desirable for employees at this level.

\(d\) **Assignment.** Assignments at this level require the technician
to have knowledge of the basic principles of pulmonary physiology
sufficient to understand impairment of lung function and to be able to
utilize that information in the design of individualized tests to help
solve specific problems. They perform complex but standardized tests and
procedures. They fully explain procedures to the patient and are aware
of possible complications and adverse reactions to the performance of
pulmonary function testing.

\(3\) **GS-8**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which provided
knowledge of the more complex procedures, the pharma-cology related to
this occupation, and knowledge of related acute disorders and diseases
and their effects on organs and methods of treatment. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to perform special procedures pulmonary
function testing which may include cardiopulmonary exercise testing,
exercise induced asthma testing, Shunt testing, and/or P-100 testing.

[2]{.underline}. Knowledge of airway management, pulmonary pharmacology,
CPR, and oxygen administration.

[3]{.underline}. Knowledge of bio-testing procedures, syringe quality
control procedures, and ability to analyze results for compliance.

[4]{.underline}. Ability to perform quality control on blood gas
analyzers as required by accrediting bodies.

[5]{.underline}. Ability to provide training to lower graded pulmonary
function technicians and students including teaching the correct
methodology of pulmonary function procedures and theory of
interpretation of results.

\(c\) **Certification.** No certification or registration is required;
however, Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life
Support (ACLS) certifications are desirable for employees at this level.

\(d\) **Assignment.** This represents the full performance level. At
this level assignments are characterized by performance of the complex,
non-routine Pulmonary Function tests and procedures. Technicians are

expected to provide emergency airway management when patients
deteriorate in the Laboratory including bronchodilator nebulization,
provision of supplemental oxygen, bag-and-mask ventilation,
cardio-pulmonary resuscitation and to assist with or perform airway
intubation and defibrillation.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
full performance level, positions at this grade may be lead,
supervisory, or non-supervisory with specialized advanced knowledge and
assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Knowledge of the more complex examination and treatment
procedures and techniques such as cardiopulmonary pulmonary exercise
testing, exercise induced asthma testing, Shunt testing, and/or P-100
testing in order to provide training and supervision in these
procedures, to develop analysis interpretation formats, and to receive
inquiries concerning results.

\*[2]{.underline}. Knowledge of JCAHO and other regulatory requirements.

[3]{.underline}. Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[4]{.underline}. Ability to manage and supervise employees.

\*[5]{.underline}. Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** Certification by the National Board of
Respiratory Care as a Certified Pulmonary Function Technologist (CPFT)
is highly desirable. Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are also desirable for
employees at this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Special Assignments.** Non-supervisory pulmonary
function technicians may have assignments that because of their nature
substantially exceed the full performance level. The Professional
Standards Board will review proposed non-supervisory special assignments
for the GS-9 level and make a determination regarding their
appropriateness. These assignments are expected to be relatively few in
number and must represent substantial additional responsibility over the
full performance level.

[2]{.underline}. **Lead Pulmonary Function Technician.** In certain
programs, either because of their size and scope or because of a lack of
specific supervisory positions, lead positions may be appropriate.

[3]{.underline}. **Supervisory Pulmonary Function Technician.**
Individuals in this assignment assume full administrative and
professional responsibility for planning and directing the work of
subordinate technicians. Typically these duties include assigning and
evaluating the work of subordinate staff; providing pulmonary function
technician services in more complex cases; reviewing and making
recommendations regarding new and emerging procedures; providing
instruction and training to new staff; interviewing candidates for
positions; recommending selections, advancements, promotions; evaluating
performance; taking disciplinary action when necessary; and identifying
educational or training needs.

\(5\) **GS-10.** In addition to the core competencies defined at the
GS-9 level, positions at this grade may be supervisory or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Advanced knowledge of complex and non-standard
treatment and examination procedures and techniques.

\*[2]{.underline}. Ability to plan and assist in the establishment of a
completely integrated treatment and examination program.

\*[3]{.underline}. Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4]{.underline}. Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts, and equipment
expenditures), forecast resource and equipment needs, and administer the
allocated budget.

\*[5]{.underline}. Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

\(c\) **Certification.** Certification by the National Board of
Respiratory Care as a Certified Pulmonary Function Technologist (CPFT)
is highly desirable. Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are also desirable for
employees at this level.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

Supervisory Pulmonary Function Technician. Individuals at this level
plan and direct programs at affiliated medical centers and satellite
outpatient clinics and have full supervisory responsibility for a

large staff of non-supervisory personnel and at least one subordinate
team leader or supervisor. Typically these duties include assigning and
evaluating the work of subordinate staff resolving problems which may
interfere with patient examination or treatment; providing pulmonary
function technician services in more complex and non-standard cases;
evaluating new products and equipment and making recommendations
concerning developments which would improve operations; participating as
an instructor in the facility's clinical training program; making final
decisions on selections based on recommendations from subordinate
supervisors or leads; evaluating performance; taking disciplinary action
when necessary; and identifying educational or training needs.

**Appendix K -- Medical Instrument Technician (Vascular)**

\(1\) **GS-6**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
position to be filled. This would be experience which demonstrates the
knowledge, skills, and abilities to perform routine, standardized
vascular ultrasound procedures where the technician is not expected to
deviate from established procedures. In addition, the candidate must
demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to perform standardized, routine vascular
ultrasound procedures and/or examinations of upper and lower extremity,
abdominal, and extra-cranial cerebrovascular vessels.

[2]{.underline}. Knowledge of anatomy and physiology including location
and function of major body organs and structures as they relate to
vascular ultrasonography.

[3]{.underline}. Ability to prepare preliminary reports from the
examination including documentation of procedural difficulties in the
medical record.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) certification
is desirable.

\(d\) **Assignment.** Assignments at this level are characterized by the
performance of routine, standardized vascular ultrasound procedures and
techniques in accordance with instructions.

\(2\) **GS-7**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
positions to be filled. This would be experience which demonstrates that
the technician has the knowledge, skills, and abilities to perform
complex procedures requiring the ability to select appropriate equipment
based on symptomology and the objective of the examination and the
ability to adapt procedures and techniques to enhance diagnostic
results. In addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to perform noninvasive vascular ultrasound
procedures or examinations of upper and lower extremity, abdominal, and
extra-cranial cerebrovascular vessels which require adaptation of
procedures or instruments.

[2]{.underline}. Knowledge of anatomy and physiology including location
and function of major body organs and structures as they relate to
vascular ultrasonography. This would also include knowledge of
physiological influences on the hemodynamics of blood flow.

[3]{.underline}. Knowledge of pharmacology and chemistry to understand
drug reactions, action, effects, and method of administration
specifically related to vascular ultrasonography.

[4]{.underline}. Knowledge of disease entities that impact the vascular
system and their influence on the test results to select the appropriate
procedures.

[5]{.underline}. Ability to obtain a patient history and perform and
appropriate physical assessment based on patient presentation and type
of exam to include observation, inspection, auscultation, and palpation.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are desirable.

\(d\) **Assignment.** At the GS-7 level the medical instrument
technician (vascular) is expected to perform complex noninvasive
vascular testing for diagnostic purposes. These procedures are performed
with a variety of testing equipment and modalities to include B mode
scanning, duplex imaging, Doppler spectral analysis,
photoplethysmography, and upper and lower extremity, digit, and pensile
blood pressures. The technician must be able to deviate from normal
technique when necessary.

\(3\) **GS-8**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level which demonstrates the knowledge, skills,
abilities, and other characteristics related to the duties of the
position to be filled. This would be experience which demonstrates the
knowledge, skills, and abilities to perform noninvasive vascular
ultrasound procedures as a senior technician. In addition, the candidate
must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of cross-sectional and longitudinal vascular
anatomy in normal and abnormal vessels, anatomical planes and tissue
structures, physiologic effects of disease entities that impact the
vascular system, signs and symptoms of acute and chronic vascular
disease, and the characteristic appearance of aneurysms,
pseudoaneurysms, thromboses, stenoses, occlusions, AV fistulae, and
morphology of atherosclerotic plaque formulation.

[2]{.underline}. Ability to provide Doppler information of peripheral
vessels; demonstrate characteristic differences related to the organs
they supply; accurately quantify carotid artery stenoses; and identify
and correlate specific waveform analysis, plethysmographic tracings,
velocity changes, and pressure gradients characteristic of normal,
obstructed, or occluded vessels or grafts.

[3]{.underline}. Ability to perform intracranial (transcranial) vascular
examinations.

[4]{.underline}. Ability to operate the instruments to extract the
highest quality image utilizing the appropriate transducer frequency,
Doppler angle, focal zones, gain, depth, color map, wall filter, and
sample volume.

[5]{.underline}. Ability to provide objective data to document
progression or regression of disease.

\(c\) **Certification.** Basic Cardiac Life Support (BCLS) and Advanced
Cardiac Life Support (ACLS) certifications are desirable.

\(d\) **Assignment.** This represents the full performance level. At the
GS-8 level the medical instrument technician (vascular) functions as a
senior technician. They are expected to perform the full range of

vascular ultrasound procedures including the most complex and
non-routine and to make appropriate adjustments in established
procedures and techniques to obtain the results required for clinical
diagnosis and documentation. At this level the technician would also
have the ability to perform intracranial (transcranial) vascular
examinations.

\(4\) **GS-9.** In addition to the core competencies defined at the GS-8
full performance level, positions at this grade may be lead,
supervisory, or non-supervisory with specialized advanced knowledge and
assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. This
would be experience which demonstrates the knowledge, skills, and
abilities to fully perform all vascular ultrasound tests and
examinations and to function as a technical director of the vascular
laboratory and provide oversight and/or guidance to other technicians.
In addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Knowledge of the more complex examination and treatment
procedures and techniques in order to provide training and supervision
in these procedures, to evaluate and initiate performance improvement
projects, and to write policies, procedures, and protocols, that pertain
to vascular ultrasonography.

\*[2]{.underline}. Knowledge of JCAHO and other regulatory requirements.

[3]{.underline}. Ability to communicate effectively and professionally
with employees at varying grade levels.

\*[4]{.underline}. Ability to manage and supervise employees.

\*[5]{.underline}. Ability to provide, or provide for, staff development
and training.

\(c\) **Certification.** Registration by Cardiovascular Credentialing
International (CCI) as a Registered Vascular Sonographer (RVS) or by the
American Registry of Diagnostic Medical Sonographers (ARDMS) as a
Registered Vascular Technologist (RVT) is highly desirable. Basic
Cardiac Life Support (BCLS) and Advanced Cardiac Life Support (ACLS)
certifications are also desirable.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Special Assignments.** Non-supervisory vascular
technicians may have assignments that because of their nature
substantially exceed the full performance level. The Professional
Standards Board will review proposed non-supervisory special assignments
for the GS-9 level and make a determination regarding their
appropriateness. These assignments are expected to be relatively few in
number and must represent substantial additional responsibility over the
full performance level.

[2]{.underline}. Lead Vascular Technician. In certain programs, either
because of their size and scope or because of a lack of specific
supervisory positions, lead positions may be appropriate.

[3]{.underline}. Supervisory Vascular Technician. Individuals in this
assignment assume full administrative and professional responsibility
for planning and directing the work of subordinate technicians.
Typically these duties include assigning and evaluating the work of
subordinate staff; providing Vascular Sonography services in more
complex cases; reviewing and making recommendations regarding new and
emerging procedures; providing instruction and training to new staff;
interviewing candidates for positions; recommending selections,
advancements, promotions; evaluating performance; taking disciplinary
action when necessary; and identifying educational or training needs.

\(5\) **GS-10.** In addition to the core competencies defined at the
GS-9 level, positions at this grade may be supervisory or
non-supervisory with specialized advanced knowledge and assignments.

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level, which is directly related to the duties of the
position to be filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities.** KSAs 1, 2, and
3 are appropriate for all positions at this level. KSAs 4 and 5 are to
be used in accordance with their appropriateness for the specific
assignment.

[1]{.underline}. Advanced knowledge of the most complex and non-standard
treatment and examination procedures and techniques.

\*[2]{.underline}. Ability to plan and assist in the establishment of a
completely integrated treatment and examination program.

\*[3]{.underline}. Ability to evaluate new products and equipment and
make recommendations concerning developments which would improve
operations.

\*[4]{.underline}. Ability to manage the fiscal matters of the functions
supervised (which would include fund controls, contracts, and equipment
expenditures), forecast resource and equipment needs, and administer the
allocated budget.

\*[5]{.underline}. Knowledge of and ability to provide the full range of
supervisory duties which would include responsibility for assignment of
work to be performed; performance evaluation; selection of staff; and
recommendation of awards, advancements, and, when appropriate,
disciplinary actions.

\(c\) **Certification.** Registration by Cardiovascular Credentialing
International (CCI) as a Registered Vascular Sonographer (RVS) or by the
American Registry of Diagnostic Medical Sonographers (ARDMS) as a
Registered Vascular Technologist (RVT) is highly desirable. Basic
Cardiac Life Support (BCLS) and Advanced Cardiac Life Support (ACLS)
certifications are desirable.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Special Assignments.** There may be a rare
non-supervisory position supporting this grade level. Such a position
would typically include knowledge of standards of medical practice in
applicable medico-legal responsibilities in vascular ultrasound
procedures as well as teaching the correct methodology of vascular
ultrasound procedures, theory of operations, and theory of
interpretation of results to trainees.

[2]{.underline}. **Supervisory Vascular Technician.** Individuals at
this level plan and direct programs at affiliated medical centers and
their satellite outpatient clinics and have full supervisory
responsibility for a large staff of non-supervisory personnel and at
least one subordinate team leader or supervisor. Typically these duties
include assigning and evaluating the work of subordinate staff resolving
problems which may interfere with patient examination or treatment;
providing vascular sonography services in more complex and non-standard
cases; evaluating new products and equipment and making recommendations
concerning developments which would improve operations; participating as
an instructor in the facility's clinical training program; making final
decisions on selections based on recommendations from subordinate
supervisors or leads; evaluating performance; taking disciplinary action
when necessary; and identifying educational or training needs.

**Authority: 38 U.S.C. §§ 7402, 7403.**

[]{#PartIIAppG28 .anchor}**APPENDIX G-28. PHARMACY TECHNICIAN
QUALIFICATION STANDARD**

**GS-661**

**Veterans Health Administration**

**1. COVERAGE.** This standard applies to all pharmacy technician
positions in the Veterans Health Administration (VHA). Under the
supervision of a pharmacist, pharmacy technicians perform routine
pharmacy functions including receiving prescriptions from patients in
writing or electronically from physicians. Pharmacy technicians prepare
prescriptions by counting, pouring, weighing, measuring, and mixing the
medication if necessary. Pharmacy technicians maintain patient profiles,
prepare insurance claim forms, stock, and take inventory of medications.
Pharmacy technicians prepare medications for inpatients in various
settings, including sterile product preparation.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizen of the United States. (Noncitizens may be
appointed when it is not possible to recruit qualified citizens in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Education or Experience.** A high school diploma or equivalent; or
at least 3 months experience.

c\. **Certification.** Certification by the National Pharmacy Technician
Certification Board (PTCB) is required at grades GS-6 and above.

d\. **Loss of Credential.** An employee in this occupation who fails to
obtain licensure/certification/

registration within the required time frame, or who fails to maintain
the required licensure/certification/

registration must be removed from the occupation, which may also result
in termination of employment.

For occupations which [require]{.underline} an active credential
(licensure/certification/registration) at all grade levels, at the
discretion of the appointing official, an employee may be reassigned to
another occupation for which he/she qualifies [if]{.underline} a
placement opportunity exists.  For occupations which require an active
credential (licensure/certification/registration) in assignments above
the full-performance level [only]{.underline}, at the discretion of the
appointing official, an employee may remain at an appropriate lower
grade level in the occupation when both of the following apply:  the
credential is not a requirement [and]{.underline} a placement
opportunity exists."

e\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 hybrid qualification standards.
Some of these provisions may not apply to this occupation.  Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but [may not]{.underline} be promoted beyond the journey
level or placed in supervisory or managerial positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

f\. **Physical Requirements.** See VA Directive and Handbook 5019.

g\. **English Language Proficiency.** Pharmacy technicians appointed to
direct patient care positions must be proficient in spoken and written
English in accordance with chapter 2, section D, paragraph 5a, this
part.

**3. GRADE REQUIREMENTS**

a\. **Definitions**

\(1\) **Creditable Experience.** To be creditable, the experience must
have required the use of knowledge, skills, abilities, and other
characteristics associated with the scope of pharmacy technician
practice.

\(2\) **Quality of Experience.** To be creditable, pharmacy technician
experience must be documented on the application and verified in an
employment reference, or through other independent means.

\(3\) **Part-time Experience.** Part-time experience as a pharmacy
technician is credited according to its relationship to the full-time
workweek. For example, a pharmacy technician would receive 1 week of
full-time credit for each 2 weeks of half-time work.

\(4\) **Grade Determinations.** In addition to the basic requirements
for employment, the following criteria must be met when determining the
grade of candidates:

\(1\) **GS-2**

\(a\) **Experience.** None beyond the basic requirement.

\(b\) **Assignment.** Employees at this grade level serve in a pharmacy
technician/aide-training level position.

\(2\) **GS-3**

\(a\) **Education or Experience.** Completion of 1 year of post-high
school coursework related to medicine (e.g. chemistry, biology, college
mathematics, etc.), or successful completion of a 1 year accredited
pharmacy technician training program, or 6 months of general experience,
that may have included experience in another medical field (licensed
practical nurse, laboratory technology, etc.). In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to maintain appropriate files.

[2]{.underline}. Ability to prepare sterile compounds under supervision.

[3]{.underline}. Ability to communicate with patients and other health
professions.

\(c\) **Assignments.** Employees at this grade level serve in a pharmacy
technician/aide training level position.

\(3\) **GS-4**

\(a\) **Education or Experience.** Successful completion of 2 years
above high school with courses related to pharmacy or pharmacy
technology, or 1 year of general experience that may have included
experience in another medical field (licensed practical nurse,
laboratory technology, etc.) Successful completion of a course for
medical technicians, hospital corpsmen, medical service specialists, or
hospital training obtained in a training program conducted by the Armed
Forces or the U.S. Maritime Service under close medical and professional
supervision is creditable on a month-for-month basis for general
experience. In addition, the candidate must demonstrate the following
KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to process and fill prescriptions under
supervision.

[2]{.underline}. Ability to operate and maintain dispensing equipment.

3\. Ability to operate pharmacy information systems.

[4]{.underline}. Ability to maintain appropriate files.

[5]{.underline}. Ability to prepare sterile compounds under supervision.

\(c\) **Assignments.** Pharmacy technicians at the GS-4 level perform
all duties expected of employees at the GS-3 level; however, they are
expected to exercise greater judgment, require less supervision, and to
operate in accordance with all established policies, procedures, and
techniques.

\(4\) **GS-5**

\(a\) **Education or Experience.** Successful completion of a 4-year
course of study above high school leading to a bachelor's degree that
included at least 24 semester hours of courses related to pharmacy or
pharmacy technology; successful completion of pertinent specialized
training courses in pharmaceutical and pharmacy services while serving
in the Armed Forces is creditable on a month-for-month basis up to the 1
year of experience required for the GS-5 level; or at least 1 year of
experience at the next lower level that demonstrates the core
competencies (KSAs) described at the GS-4 level. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated** **Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to operate and care for automated dispensing
devices and equipment.

2\. Knowledge of, and ability to perform, aseptic technique.

[3]{.underline}. Knowledge of basic inventory procedures.

[4]{.underline}. Knowledge of pharmacy information systems.

\(c\) **Assignments.** This is the full performance level for pharmacy
technicians. Employees at this grade level serve as staff pharmacy
technicians receiving little guidance from more experienced staff
members for more complex patients and procedures, and require minimal
supervision.

\(5\) **GS-6**

\(a\) **Experience.** One year experience at the next lower level, and
must fully meet the KSAs at the next lower level. In addition, the
candidate must demonstrate the following technical KSAs and the
potential to acquire the assignment specific KSAs designated by an
asterisk (\*):

\(b\) **Certification.** PTCB certification is required at this grade
level and above.

\(c\) **Demonstrated** **Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to solve problems and make recommendations,
e.g., troubleshoot operational problems and refer for appropriate
action.

[2]{.underline}. Knowledge of the operation and care of automated
equipment.

[3]{.underline}. Knowledge of, and ability to follow, written
instructions for compounding with aseptic technique for hazardous
materials such as oncology agents.

[4]{.underline}. Knowledge, and ability to perform, compounding with
aseptic technique for routine sterile products.

[5]{.underline}. Knowledge of policies and procedures for inventory
management in specialized areas such as emergency carts.

[6]{.underline}. Knowledge of the computerized prescription process
demonstrated by the ability to input prescriptions and medication
orders.

\(d\) **Assignments.** Pharmacy technicians may be assigned to any area
of the pharmacy including expanded distributive function assignments;
for example assignment as team leaders for specific process improvement
teams involving technical areas or performing more highly complex duties
including preparation of oncology agents for clinical pharmacy
specialists. For all assignments above the full performance level, the
higher-level duties must consist of significant scope, complexity
(difficulty), and range of variety, and be performed by the incumbent at
least 25% of the time.

\(6\) **GS-7**

\(a\) **Experience.** One year experience at the next lower level and
must fully meet the KSAs at the next lower level. In addition, the
candidate must demonstrate the following technical KSAs and the
potential to acquire the assignment specific KSAs designated by an
asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

\*[1]{.underline}. Ability to evaluate, analyze workflow, and coordinate
work activities.

[2]{.underline}. Ability to independently gather, evaluate, and analyze
data to generate reports and/or for other projects/statistical purposes.

[3]{.underline}. Knowledge of pharmacy policies and procedures
sufficient to train and orient new employees and other staff

[4]{.underline}. Comprehensive knowledge of the operation and care of
specialized pharmaceutical equipment.

[5]{.underline}. Comprehensive knowledge of the procurement and
formulary process.

[6]{.underline}. Comprehensive knowledge of investigational drug
policies and procedures.

[7]{.underline}. Comprehensive knowledge of controlled substance
policies and procedures, and the ability to identify and investigate
discrepancies in these policies and procedures.

[8.]{.underline} Comprehensive knowledge of, and ability to, analyze
data in VA information systems.

\(c\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Pharmacy technicians at this grade
level may be assigned as a supervisor; lead technician in a particular
area of the pharmacy; a controlled substance technician; an
investigational drug technician; a procurement/inventory management
technician; a clinical pharmacy technician; or similar assignment with
this level of complexity. The GS-7 level is for select, complex pharmacy
technician positions, as established by each health care facility. To be
advanced, employees must meet all of the following standards, provided
the standard is part of their assignment.

Determinations concerning placement of positions at this grade level
shall take into consideration the skill mix and the availability of
supervision in the work unit. Although these positions are under the
supervision of a pharmacist, employees in such settings successfully and
consistently demonstrate the exercise of independent technical judgment
(without the need for readily available supervision) as well as
comprehensive and thorough working knowledge of the most complex or
difficult practices and procedures. Such individuals may also serve as
leaders or co-leaders in a Pharmacy Service or for a specific unit or
section.

\(7\) **GS-8**

\(a\) **Experience.** One year experience at the next lower level and
must fully meet the KSAs at the next lower level. In addition, the
candidate must demonstrate the following technical KSAs and the
potential to acquire the assignment specific KSAs designated by an
asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

\*[1]{.underline}. Knowledge of human resource management policies and
procedures, and the ability to supervise various levels of pharmacy
technicians and other technical personnel (for supervisory assignments).

\*[2]{.underline}. Ability to apply management and leadership
principles.

[3]{.underline}. Ability to communicate orally and in writing.

[4]{.underline}. Extensive working knowledge of the pharmacy operation.

[5]{.underline}. Ability to assess staff needs and provide appropriate
training.

\(c\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Pharmacy technicians at this level
may be assigned supervisory positions or assignments as lead technicians
in a highly complex area of the pharmacy. The GS-8 level is for very
select, complex pharmacy technician positions as established by each
health care facility. To be advanced, employees must meet all of the
following standards, provided the standard is part of their assignment.

Determinations concerning placement of positions at this grade level
shall take into consideration the skill mix and availability of
supervision in the work unit. Although these positions are under the

supervision of a pharmacist, employees in such settings successfully and
consistently demonstrate the exercise of independent technical judgment
(without the need for readily available supervision) as well as
comprehensive and thorough working knowledge of the most complex or
difficult practices and procedures. Such individuals may also serve as
supervisors or in an equivalent assignment in a Pharmacy Service, or for
a specific unit or section.

**4. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for
pharmacy technicians in VHA whose composite record of accomplishments,
performance, and qualifications, as well as current assignments, warrant
such action based on demonstrated competence to meet the requirements on
the proposed grade.

b\. Under no circumstances will the certification requirements be
waived.

c\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**

**APPENDIX G-29. AUDIOLOGIST QUALIFICATION STANDARD**

**GS-665**

**Veterans Health Administration**

**1. COVERAGE.** The following are requirements for appointment as an
audiologist in the Veterans Health Administration (VHA). These
requirements apply to all VHA audiologists in the General Schedule
(GS)-665 series. VHA audiologists provide clinical service to veterans
and other beneficiaries in VHA medical centers, clinics, domiciliaries,
nursing care facilities, community care settings, Community-Based
Outpatient Clinics, Veterans Outreach Centers, Veterans Integrated
Service Network (VISN) offices, and VHA Central Office. In performing
these duties, VHA audiologists demonstrate professional knowledge of,
and skill in applying, a wide range of theories, principles, and
methodologies of the practice of audiology.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizen of the United States. (Non-citizens may be
appointed when it is not possible to recruit qualified citizens in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Education.** Master's degree or its equivalent in audiology or
hearing science from an accredited college or university is required.
"Accredited" means a college or university accredited by a regional
accreditation organization and an audiology program accredited by the
Council on Academic Accreditation of the American
Speech-Language-Hearing Association (ASHA).

**NOTE:** Beginning on January 1, 2007, the Council on Academic
Accreditation (CAA) in Audiology and Speech-Language Pathology of ASHA
will accredit only doctoral degree programs in audiology or hearing
science.

c\. **Licensure.** For those grades that require licensure (GS-12 and
above), within 2 years of initial appointment under this standard the
incumbent must hold a full, current, and unrestricted license in a
State, Territory, Commonwealth, or the District of Columbia. A staff
audiologist who fails to obtain licensure within 2 years of initial
appointment under this standard will be terminated.

**NOTE:** The audiologist must maintain full, current, and unrestricted
licensure/registration.

\(1\) Non-licensed audiologists who otherwise meet the eligibility
requirements for licensure may be given a temporary appointment as a
graduate audiologist under the authority of 38 U.S.C. § 7405 (a) (1)
(D). Failure to obtain licensure during appointment as a graduate
audiologist is justification for termination of the temporary
appointment. Individuals appointed as graduate audiologists may not be
promoted to the GS-12 level without being fully licensed. This may
result in termination of employment.

\(2\) **Loss of Credential.** An employee in this occupation who fails
to obtain licensure/certification/

registration within the required time frame, or who fails to maintain
the required licensure/certification/

registration must be removed from the occupation, which may also result
in termination of employment.

For occupations which [require]{.underline} an active credential
(licensure/certification/registration) at all grade levels, at the
discretion of the appointing official, an employee may be reassigned to
another occupation for which he/she qualifies [if]{.underline} a
placement opportunity exists.  For occupations which require an active
credential (licensure/certification/registration) in assignments above
the full-performance level [only]{.underline}, at the discretion of the
appointing official, an employee may remain at an appropriate lower
grade level in the occupation when both of the following apply:  the
credential is not a requirement [and]{.underline} a placement
opportunity exists.

\(3\) An audiologist who has, or has ever had, his/her audiology license
revoked, suspended, denied, restricted, limited, or issued/placed in a
probationary status may be appointed only in accordance with the
provisions in Chapter 3, section B, paragraph 16 of this part.

\(4\) **Exception.** The requirement for licensure may be waived by the
Under Secretary for Health or designee in VHA Central Office for
individuals engaged in research or academic assignments involving no
direct patient care duties, in accordance with current activities.

d\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 hybrid qualification standards.
Some of these provisions may not apply to this occupation.  Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but [may not]{.underline} be promoted beyond the journey
level or placed in supervisory or managerial positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

e\. **Physical Requirements.** See VA Directive and Handbook 5019

f\. **English Language Proficiency.** Audiologists must be proficient in
spoken and written English in accordance with chapter 2, section D,
paragraph 5a, this part.

**3. GRADE REQUIREMENTS**

a\. **Definitions**

\(1\) **Creditable Experience**

\(a\) **Knowledge of Contemporary Professional Audiology Practice.** To
be creditable, the experience must have required the use of knowledge,
skills, abilities, and other characteristics associated with
contemporary professional audiology practice. This knowledge may be
evidenced by one or more of the following:

[1]{.underline}. At least 1 year of active professional practice or its
equivalent. Active professional practice means paid or non-paid
employment as a professional audiologist engaged in the practice of
audiology as defined by the appropriate licensing board.

[2]{.underline}. Academic course work leading to a doctoral degree in
audiology or hearing science.

\(b\) **Quality of Experience.** Experience is only creditable if it is
both of the following:

[1]{.underline}. Work as a professional audiologist directly related to
the position to be filled; and

[2]{.underline}. At a level comparable to audiology experience at the
next lower grade level.

\(c\) **Part-Time Experience.** Part-time experience as a professional
audiologist is credited according to its relationship to the full-time
workweek. For example, an audiologist would receive 1 week of full-time
credit for each 2 weeks of half-tine work.

b\. **Grade Determinations.** In addition to the basic requirements for
employment, the following criteria must be met when determining grades.

\(1\) **GS-9**

\(a\) **Education and Experience.** None beyond the basic requirements.

\(b\) **Assignment.** Employees at this level serve in an audiologist
career development position.

\(2\) **GS-11**

\(a\) **Education and Experience.** Completion of 1 year of professional
experience as an audiologist equivalent to the next lower level; or 3
years of progressively higher level graduate education leading to a
doctoral degree; or doctoral degree in audiology, hearing science, or a
directly related field. For positions involved in research audiologist
assignments involving no direct patient care, no additional education or
professional experience is required beyond those identified at the GS-9
level. In addition, the candidate must demonstrate the following KSAs:

\(b\) **Assignments.** Audiologists at this grade level may be appointed
to one of the following assignments:

[1]{.underline}. **Staff Audiologist.** Staff audiologists at this grade
level perform audiology assessment and treatment intervention. If
unlicensed, the individual must function under the supervision of a
licensed audiologist.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of contemporary audiology practice;

([2]{.underline}) Ability to communicate orally and in writing;

([3]{.underline}) Knowledge of anatomy, physiology, acoustics, applied
acoustics, communication, psychoacoustics, and auditory/vestibular
pathophysiology;

([4]{.underline}) Knowledge of principles and techniques in the
assessment and treatment of auditory and balance disorders;

([5]{.underline}) Ability to perform functions associated with
contemporary audiology scope of practice; and

([6]{.underline}) Ability to interact with patients, families, and other
health care professionals.

[2]{.underline}. **Research Audiologist.** Research audiologists at this
grade level serve as research assistants. At this grade level, research
audiologists conduct research under the direct supervision of principal
investigators or co-principal investigators of higher grade level.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities.** In
addition to the KSAs required in 1.a. above, the following are required:

([1]{.underline}) Knowledge of, and ability to apply, appropriate basic
scientific methods, basic research design and statistics; and

([2]{.underline}) Project-specific knowledge of clinical and research
literature.

\(3\) **GS-12**

\(a\) **Licensure.** For those grades that require licensure (GS-12 and
above), within 2 years of initial appointment under this standard the
incumbent must hold a full, current, and unrestricted license in a
State, Territory, Commonwealth, or the District of Columbia. A staff
audiologist who fails to obtain licensure within 2 years of initial
appointment under this standard will be terminated.

\(b\) **Education and Experience.** In addition to the requirements at
the GS-11 level, completion of 1 year of professional experience
comparable to the next lower level and possession of a full, current and
unrestricted license to practice audiology. For positions involved in
research audiology assignments involving no direct patient care,
completion of a doctoral degree in audiology, hearing science, or a
related field is fully qualifying. In addition, the candidate must
demonstrate the following KSAs:

\(c\) **Assignments.** Audiologists at this grade level are independent
licensed practitioners and are considered to be at the full performance
level. Employees may be appointed to one of the following assignments:

[1]{.underline}. **Staff Audiologist.** Staff audiologists at this grade
level must demonstrate professional knowledge of, and skill in applying,
a wide range of theories, principles, and methodologies of the practice
of audiology to a wide range of populations. Individuals may perform
ancillary assignments, including program management duties on an
occasional basis, where the complexity and amount of work is not
substantial.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Ability to develop coherent treatment strategies;

([2]{.underline}) Knowledge of clinical services, and the ability to
perform them independently;

([3]{.underline}) Ability to conduct assessments and provide treatment
interventions;

([4]{.underline}) Ability to provide consultation to other health care
professionals;

([5]{.underline}) Knowledge of contemporary audiology practice; and

([6]{.underline}) Ability to perform functions associated with
contemporary audiology scope of practice.

[2]{.underline}. **Research Audiologist.** Research audiologists at this
grade level assist principal investigators or co-principal investigators
in peer reviewed VHA, National Institute of Health (NIH), or comparably
rigorous intramural or extramurally funded research programs, and may
serve as investigators on small or unfunded projects of limited
complexity or scope. At this grade level, research audiologists have
responsibility for conducting research under the general administrative
direction of principal investigators or co-principal investigators of
higher grade levels. Research audiologists at this grade level may have
authored one or more publications, or presented research findings at a
national meeting and may have earned an academic appointment at an
affiliated medical school or local university, usually at the rank of
instructor, lecturer, or equivalent.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities.** In
addition to the KSAs required in 1.a. above, the following are required:

([1]{.underline}) Ability to execute research independently; and

([2]{.underline}) Knowledge of clinical and research literature.

\(4\) **GS-13**

\(a\) **Licensure.** For those grades that require licensure (GS-12 and
above), within 2 years of initial appointment under this standard the
incumbent must hold a full, current, and unrestricted license in a
State, Territory, Commonwealth, or the District of Columbia. A staff
audiologist who fails to obtain licensure within 2 years of initial
appointment under this standard will be terminated.

\(b\) **Education and Experience.** Completion of 1 year of professional
experience equivalent to the next lower grade level directly related to
the position being filled, and must fully meet the KSAs at that level.
In addition, the candidate must demonstrate the following professional
KSAs and demonstrate the potential to acquire the assignment specific
KSAs as indicated by an asterisk (\*):

\(c\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Generally, non-supervisory
assignments at this grade level require the knowledge, skills, and
competencies normally acquired through a doctoral training program.
Audiologists at this grade may be appointed to one of the following
assignments:

[1]{.underline}. **Staff Audiologist (Advanced Practice Audiologist).**
Audiologists at this grade level are advanced practice independent
licensed practitioners and must demonstrate ability to apply advanced
audiologic knowledge, theories, and techniques to a full range of
complex patient populations. They apply advanced clinical skills such as
hearing conservation, advanced audiologic and electrophysiologic
assessment and interpretation, comprehensive tinnitus evaluation,
treatment, and retraining therapies, advanced central auditory function
assessment and treatment, assessment and treatment of patients with
surgically-implanted bio-electric or cochlear implants, intraoperative
(surgical) monitoring, advanced vestibular assessment and
rehabilitation, and analysis and fitting of advanced amplification
technology involving acoustic signal processing algorithms.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Advanced knowledge of anatomy, physiology, acoustics,
applied acoustics, communication, psychoacoustics, and auditory and
vestibular pathophysiology;

([2]{.underline}) Advanced skill to perform and interpret diagnostic and
electrophysiologic tests to a full range of patient populations;

([3]{.underline}) Advanced skill to provide treatment interventions
including analysis and fitting of advanced amplification technology and
signal processing algorithms to a full range of patient populations;

([4]{.underline}) Knowledge of embryology, genetics, pharmacology,
ethics, compliance, and biostatistics; and

\(5\) Advanced knowledge of, and ability to perform, functions
associated with contemporary audiology scope of practice.

[2]{.underline}. **Audiologist Program Manager.** Audiologist program
managers are responsible for providing comprehensive clinical services
as well as ensuring that the work assignments of the other members of

the clinical team are carried out by performing a range of duties such
as distributing and balancing workload among employees in accordance
with established work flow or job specialization; assuring timely
accomplishment of the assigned workload; assessing the status, quality,
and progress of work, making day-to-day adjustments in accordance with
established priorities; obtaining assistance from supervisors or
managers on problems that may arise. In the absence of a supervisory
audiologist, audiologist program managers oversee the professional
practice of peers.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of contemporary audiology practice;

([2]{.underline}) Ability to articulate and communicate the assignment,
project, problem to be solved, actionable events, and objectives; as
well as advise on work methods, practices and procedures;

([3]{.underline}) Ability to apply appropriate problem solving methods
and techniques;

\*([4]{.underline}) Ability to monitor and report on the status and
progress of work, evaluate program quality to ensure that methods,
deadlines and quality have been met; and make adjustments to accomplish
the workload in accordance with established priorities; and

([5]{.underline}) Ability to serve as facilitator and/or negotiator in
coordinating initiatives and consensus building activities among
clinical team members with widely divergent backgrounds, interests, and
points of view.

[]{.mark}

[3]{.underline}. **Supervisory Audiologist or Section Chief**.
Supervisory audiologists or section chiefs exercise supervision,
administrative management and direction of the audiology program in a
unified audiology and speech-language pathology service or equivalent
service-level department. They have responsibility for general or
technical supervision of key clinical or training programs and overall
technical and administrative oversight of audiologists depending on
grade level. Supervisory audiologists or section chiefs develop,
organize, direct, manage, supervise, control, and implement policies and
procedures in focused clinical programs. They plan, assess, and evaluate
programs to ensure proper coordination between care delivery within the
section and the overall delivery of health care. They make decisions
that affect staff and other resources associated with the section and
are made with wide latitude of control and independent judgment. They
exercise supervisory responsibilities such as planning and scheduling
work; assigning work to employees; accepting, amending or rejecting
completed work; assuring that production and accuracy requirements are
met; appraising performance and recommending performance standards and
ratings; assigning delineated clinical privileges; approving leave; and
effecting disciplinary measures.

a\. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Ability to balance responsibilities and to work with
great autonomy;

([2]{.underline}) Ability to set priorities and delegate tasks, meet
multiple deadlines, analyze organizational problems and develop and
implement effective solutions;

\*([3]{.underline}) Ability to analyze and use data effectively to
manage workload, quality, performance, and productivity within the
section;

([4]{.underline}) Skill in interpersonal relationships in dealing with
employees, team leaders, and managers;

([5]{.underline}) Knowledge of, and ability to utilize, evidence-based
practices and clinical practice guidelines in a professional area, and
to guide the section staff in applying these tools;

\*([6]{.underline}) Ability to analyze organizational and operational
problems and to develop and implement solutions that result in efficient
section operation;

([7]{.underline}) Skill in problem solving and conflict resolution; and

([8]{.underline}) Skill in the application and analysis of scientific
and clinical literature in a professional area.

[]{.mark}

[4]{.underline}. **Assistant Chief.** Assistant chiefs serve as full
assistants to service chiefs, department heads, or persons of similar
organizational rank in large, complex, or multi-division facilities and
share a full scope of delegated managerial responsibilities. Assistant
chiefs share full responsibility for all professional areas in a
service-level department with the service chief. Assistant chiefs
exercise supervision, administrative management, and direction of both
professional areas in a unified audiology and speech-language pathology
service or equivalent service-level department. Assistant chiefs have
responsibility for general or technical supervision of key clinical or
training programs within the service, and overall technical and
administrative oversight of audiologists.

[]{.mark}

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

\*([1]{.underline}) Ability to supervise, motivate, and manage
effectively a diverse clinical staff;

\*([2]{.underline}) Skill in assessing qualifications and abilities of
current and prospective employees;

([3]{.underline}) Ability to develop productivity standards applicable
to a service or equivalent organizational department;

\*([4]{.underline}) Ability to organize work, set priorities, delegate
tasks and responsibilities, and meet multiple deadlines for service; and

([5]{.underline}) Ability to accommodate new and changing work
conditions, staffing, and contingencies.

[]{.mark}

[5]{.underline}. **Service Chiefs.** Service chiefs at this grade level
have overall responsibility for a service-level department, or its
organizational equivalent in small and mid-sized facilities. These
individuals have responsibility for general supervision of clinical
and/or training programs, and overall technical and administrative
oversight for operations within the service, Service chiefs develop,
organize, direct, manage, supervise, control, and implement policies and
procedures for complex service-level departments. They have overall
responsibility for planning, assessing, and evaluating programs to
ensure proper coordination between care delivered by the service and the
overall delivery of health care within the facility. Service chiefs make
decisions that affect subordinate section or assistant chiefs (if
applicable), clinical, and clerical staff, and other resources
associated with the department and are made with great autonomy. Their
responsibilities may include full responsibility for developing and
directing educational and training programs; negotiating affiliation
agreements with academic partners; and responsibilities to subordinate

section or assistant chiefs (if applicable), planning, and scheduling
work; assigning work to employees; accepting, amending or rejecting
completed work; assuring that production and accuracy requirements are
met; appraising performance and recommending performance standards and
ratings; assigning delineated clinical privileges; approving leave; and
effecting all levels of disciplinary measures. Service chiefs exercise
supervision, administrative management and direction of both
professional areas in a unified audiology and speech-language pathology
service or equivalent service-level department, or administrative
management and program direction of other rehabilitation-related areas.

[]{.mark}

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

\*([1]{.underline}) Ability to supervise, motivate, and manage
effectively a diverse clinical staff applicable to service-level
departments in small or mid-sized facilities;

\*([2]{.underline}) Skill in assessing qualifications and abilities of
current and prospective employees;

([3]{.underline}) Ability to establish and monitor productivity
standards and production and performance priorities;

\*([4]{.underline}) Knowledge of, and ability to apply, administrative
and human resources policies effectively;

([5]{.underline}) Ability to organize work, set priorities, delegate
tasks, and manage and direct the work of others to accomplish program
goals and missions;

([6]{.underline}) Ability to accommodate to new and changing work
conditions and contingencies, and staffing;

([7]{.underline}) Ability to translate management goals and objectives
into well-coordinated and controlled work operations; and

\*(8) Knowledge of, and ability to manage, budgets for a service-level
department in a small or mid-sized facility.

[]{.mark}

[6]{.underline}. **Research Audiologist.** Research audiologists at this
grade level are actively involved as principal investigators or
co-principal investigators in peer reviewed VA, NIH, or comparably
rigorous intramural or extramurally funded research programs. At this
grade level, research audiologists have responsibility for formulating
or conducting research on problems of considerable scope and complexity.
Research audiologists at this grade level work with substantial freedom
in identifying, defining, and selecting problems for study. At this
grade level, research audiologists are mature, competent, and productive
workers. They have typically authored one or more publications of
considerable interest in the peer-reviewed literature; demonstrated a
consistent record of presentation of findings at national scientific
meetings; may have earned an academic appointment at the affiliated
medical school or local university, usually at the rank of assistant
professor or equivalent; and have responsibility for funded research
projects.

[]{.mark}

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of, and ability to apply, advanced
scientific methods in the design and execution of creative and
innovative research;

([2]{.underline}) Ability to convey scientific concepts and
methodological principles to individuals with diverse levels of
technical expertise;

([3]{.underline}) Ability to apply advanced theories and techniques; and

([4]{.underline}) Advanced knowledge of contemporary audiology practice
and related disciplines.

[7]{.underline}. **Special Clinical Program Responsibilities.**
Audiologists with special clinical program responsibilities, e.g.
inter-disciplinary teams or highly specialized clinical programs or
subunits such as hearing conservation program, tinnitus management,
program management of patients with bio-electric or cochlear implants,
intraoperative (surgical) monitoring, advanced vestibular assessment and
rehabilitation, or advanced analysis of acoustic signal processing
algorithms, in combination with professional accomplishments,
performance, and qualifications, may be appointed at the GS-13 grade
level. Examples of professional accomplishments may include authorship
of publications; presentations at national professional meetings; or
other scholarly works; or specialty or board certifications.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Advanced knowledge in a focused area of contemporary
audiology practice;

([2]{.underline}) Ability to articulate and communicate goals,
objectives, and focused initiatives to an inter-disciplinary team,
specialized clinical program, or subunit; as well as guiding the team
members on work methods, practices and procedures;

([3]{.underline}) Ability to monitor and evaluate the work of an
inter-disciplinary team, specialized clinical program, or subunit; and
to make adjustments in procedures or practices to accomplish the program
goals; and

([4]{.underline}) Ability to serve as coach and facilitator in
coordinating program or team initiatives and consensus building
activities among clinical team members with widely divergent
backgrounds, interests, and points of view.

\(5\) **GS-14**

\(a\) **Licensure.** For those grades that require licensure (GS-12 and
above), within 2 years of initial appointment under this standard the
incumbent must hold a full, current, and unrestricted license in a
State, Territory, Commonwealth, or the District of Columbia. A staff
audiologist who fails to obtain licensure within 2 years of initial
appointment under this standard will be terminated.

\(b\) **Education and Experience.** Completion of 1 year of professional
experience equivalent to the next lower grade level directly related to
the position being filled, and must fully meet the KSAs at that level.
In addition, the candidate must demonstrate the following professional
KSAs and demonstrate the potential to acquire the assignment specific
KSAs as indicated by an asterisk (\*):

\(c\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Audiologists in this grade level
demonstrate exceptional achievement, professional competence, and
leadership and may be appointed to one of the following assignments:

[1]{.underline}. **Service Chief.** Service chiefs have broad and
overall responsibility for a service-level department, or its
organizational equivalent in large, complex, or multi-division
facilities. They manage substantive parts of medical centers that
deliver specialized, complex, professional services, and significantly
impact the care provided to veterans. These individuals have
responsibility for general supervision of clinical and/or training
programs, and overall technical and administrative oversight for
operations within the service. Service chiefs develop, organize, direct,
manage, supervise, control, and implement policies and procedures for
complex service-level departments. They have overall responsibility for
planning, assessing, and evaluating programs to ensure proper
coordination between care delivered by the service and the overall
delivery of health care within the facility. Service chiefs make
decisions that affect subordinate section or assistant chiefs (if
applicable), clinical, and clerical staff, and other resources
associated with the department and are made with great autonomy. Their
responsibilities may include full responsibility for developing and
directing educational and training programs; negotiating affiliation
agreements with academic partners; and setting training objectives;
delegating responsibilities to subordinate section or assistant chiefs
(if applicable), planning, and scheduling work; assigning work to
employees; accepting, amending or rejecting completed work; assuring
that production and accuracy requirements are met; appraising
performance and recommending performance standards and ratings;
assigning delineated clinical privileges; approving leave; and effecting
all levels of disciplinary measures. Service chiefs exercise
supervision, administrative management and direction of both
professional areas in a unified audiology and speech-language pathology
service or equivalent service-level department, or administrative
management and program direction of other rehabilitation-related areas.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

\*(1) Ability to supervise, motivate, and manage effectively a diverse
clinical staff applicable to a service-level department in large,
complex, or multi-division facility;

\*([2]{.underline}) Skill in assessing qualifications and abilities of
current and prospective employees;

([3]{.underline}) Ability to establish and monitor productivity
standards and production and performance priorities;

([4]{.underline}) Ability to organize work, set priorities, delegate
tasks and responsibilities;

([5]{.underline}) Ability to manage and direct the work of others to
accomplish program goals and missions;

([6]{.underline}) Ability to accommodate to new and changing work
conditions and contingencies, and staffing; and

([7]{.underline}) Ability to translate management goals and objectives
into well-coordinated and controlled work operations.

[2]{.underline}. **Program Manager.** Program managers have overall
responsibility for management and direction of large,
geographically-separated, integrated health care facilities or a
Network; planning, coordinating, and evaluating complex
interdisciplinary services across the full continuum of care including
not only audiology but also other focused rehabilitation, ancillary, or
other health care services. In the absence of a supervisory audiologist,
this assignment is responsible for oversight of clinical competence and
performance of peers.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

\*([1]{.underline}) Skill in managing and directing diverse work to
include setting priorities and delegating tasks, meeting multiple
deadlines, analyzing complex organizational problems in order to develop
and implement effective solutions;

([2]{.underline}) Ability to balance responsibilities applicable to a
large service-level or multi-service, and multi-disciplinary,
organizational environment and to work with great autonomy;

([3]{.underline}) Skill in interpersonal relationships in dealing with a
diverse range of employees, team leaders, and managers;

([4]{.underline}) Advanced knowledge of, and ability to utilize,
evidence-based practices and clinical practice guidelines in multiple
professional areas, and to guide the program staff in applying these
tools; and

([5]{.underline}) Skill in problem solving and conflict resolution; and

\*(6) Knowledge of, and ability to manage, budgets for a large,
integrated services including not only audiology, but also other focused
rehabilitation, ancillary, or other health care services.

[3]{.underline}. **Research Audiologist.** At this grade level, they are
actively involved as principal investigators or co-principal
investigators in peer reviewed VA, NIH, or comparably rigorous
intramural or extramurally funded research programs. They are involved
in peer review activities for VHA and non-VHA research, e.g., grant
review for VHA or NIH proposals, local research service committees,
e.g., Research and Development (R&D), Health Services Research and
Development (HSR&D), Institutional Review Board (IRB), etc., or serve as
consulting editors for peer-reviewed journals. At this grade level,
research audiologists have responsibility for formulating and guiding
research on problems that are difficult to define or require
unconventional or novel approaches, or sophisticated research methods.
Research audiologists at this grade level have achieved significant
professional recognition by making scientific contributions to research
with potential for significant impact in audiology, hearing science, or
related disciplines. They have typically authored one or more
publications of considerable interest and value to the field in the
peer-reviewed professional literature; have a consistent record of
presentation of findings at national scientific meetings; may have
earned an academic appointment at an affiliated medical school or local
university, usually at the rank of associate professor or equivalent;
and have and responsibility for funded research projects.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of and ability to apply advanced scientific
methods in the design and execution of highly creative, innovative, or
complex research;

([2]{.underline}) Ability to lead and motivate a research team with
diverse backgrounds, research interests, and points of view;

\*([3]{.underline}) Ability to manage large research budgets;

([4]{.underline}) Knowledge of, and ability to evaluate critically, the
research of others in peer review or editorial settings;

([5]{.underline}) Ability to convey scientific concepts and
methodological principles to individuals with diverse levels of
technical expertise;

([6]{.underline}) Ability to apply advanced theories and techniques,
demonstrating exceptional depth of knowledge of clinical research
literature;

([7]{.underline}) Advanced knowledge of contemporary audiology practice
and related disciplines;

([8]{.underline}) Advanced knowledge of anatomy, physiology, acoustics,
applied acoustics, communication, neuroscience, psychoacoustics, and
auditory/vestibular pathophysiology; and

([9]{.underline}) Advanced knowledge of normal and abnormal auditory and
balance function.

**4. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for
audiologists in VHA whose composite record of accomplishments,
performance, and qualifications, as well as current assignments, warrant
such action based on demonstrated competence to meet the requirements of
the proposed grade.

b\. Under no circumstances will the educational or licensure
requirements be waived, except as provided in paragraph 2c above.

c\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**

[]{#PartIIAppG30 .anchor}**APPENDIX G30. SPEECH-LANGUAGE PATHOLOGIST
QUALIFICATION STANDARD**

**GS-665**

**Veterans Health Administration**

**1. COVERAGE.** The following are requirements for appointment as a
Speech-Language Pathologist

(S-LP) in the Veterans Health Administration (VHA). These requirements
apply to all VHA S-LPs in the General Schedule (GS)-665 series,
including those assigned to medical centers, clinics, domiciliaries,
nursing care facilities, community care settings, Community-Based
Outpatient Clinics, Veteran Outreach Centers, Veterans Integrated
Service Network (VISN) offices, and VHA Central Office. In performing
these duties, VHA S-LPs demonstrate professional knowledge of, and skill
in applying, a wide range of theories, principles, and methodology of
the practice of speech-language pathology.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizen of the United States. (Non-citizens may be
appointed when it is not possible to recruit qualified candidates in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Education.** A master's degree or its equivalent in
speech-language pathology, communication disorders, or a directly
related field from an accredited college or university. "Accredited"
means a college or university accredited by a regional accreditation
organization and a speech-language pathology academic program accredited
by the Council on Academic Accreditation of the American
Speech-Language-Hearing Association (ASHA).

c\. **Licensure.** For those grades that require licensure (GS-12 and
above), within 2 years of initial appointment under this standard the
incumbent must hold a full, current, and unrestricted license in a
State, Territory, Commonwealth, or the District of Columbia. A staff
S-LP who fails to obtain licensure within 2 years of initial appointment
under this standard will be terminated.

**NOTE:** The S-LP must maintain full, current, and unrestricted
licensure/registration.

\(1\) Non-licensed applicants who otherwise meet the eligibility
requirements for S-LP licensure may be given a temporary appointment as
a graduate S-LP under the authority of 38 U.S.C. **§** 7405 (a) (1) (D).
Failure to obtain licensure during that period is justification for
termination of the temporary appointment. This may result in termination
of employment.

d\. **Loss of Credential.** An employee in this occupation who fails to
obtain licensure/certification/

registration within the required time frame, or who fails to maintain
the required licensure/certification/

registration must be removed from the occupation, which may also result
in termination of employment.

For occupations which [require]{.underline} an active credential
(licensure/certification/registration) at all grade levels, at the
discretion of the appointing official, an employee may be reassigned to
another occupation for which he/she qualifies [if]{.underline} a
placement opportunity exists.  For occupations which require an active
credential (licensure/certification/registration) in assignments above
the full-performance level [only]{.underline}, at the discretion of the
appointing official, an employee may remain at an appropriate lower
grade level in the occupation when both of the following apply:  the
credential is not a requirement [and]{.underline} a placement
opportunity exists.

e\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 hybrid qualification standards.
Some of these provisions may not apply to this occupation.  Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but [may not]{.underline} be promoted beyond the journey
level or placed in supervisory or managerial positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

f\. **Physical Requirements.** See VA Directive and Handbook 5019.

g\. **English Language Proficiency.** Speech-language pathologists must
be proficient in spoken and written English in accordance with chapter
2, section D, paragraph 5a, this part.

**3. GRADE REQUIREMENTS**

a\. **Definitions**

\(1\) **Creditable Experience**

\(a\) **Knowledge of Contemporary Professional Speech-Language Pathology
Practice.** To be creditable, the experience must have required the use
of knowledge, skills, abilities, and other characteristics (also
referred to as "core competencies") associated with contemporary
professional speech-language pathology practice. This knowledge may be
evidenced by one or more of the following:

[1]{.underline}. At least 1 year of active professional practice or its
equivalent. Active professional practice means paid or non-paid
employment as a professional S-LP engaged in the practice of
speech-language pathology as defined by the appropriate licensing board.

[2]{.underline}. Academic course work leading to a doctoral degree in
speech-language pathology, communication disorders and sciences, or a
related field.

\(b\) **Quality of Experience.** Experience is only creditable if it is
both of the following:

[1]{.underline}. Work as a professional speech-language pathologist
related to the position to be filled; and

[2]{.underline}. The work is at a level comparable to speech-language
pathology experience at the next lower grade level.

\(c\) **Part-Time Experience.** Part-time experience as a professional
speech-language pathologist is credited according to its relationship to
the full-time work week. For example, a speech-language pathologist
employed 20 hours a week, or on a 1/2-time basis, would receive 1
full-time workweek of credit for each 2 weeks of service.

b\. **Grade Determinations.** In addition to the basic requirements, the
following criteria must be met when determining the grade of candidates.

\(1\) **GS-9**

\(a\) **Education and Experience**. None beyond the basic requirements.

\(b\) **Assignment.** Employees at this level serve in a speech-language
pathologist career development position.

\(2\) **GS-11**

\(a\) **Education and Experience.** Completion of 1 year of professional
experience as an S-LP equivalent to the next lower level, 3 years of
progressively higher level graduate education leading to a doctoral
degree, or doctoral degree in speech-language pathology, communication
disorders, or a directly related field. For positions involved in
research S-LP assignments involving no direct patient care, no
additional education or professional experience is required beyond those
identified at the GS-9 level. In addition, the candidate must
demonstrate the following KSAs:

\(b\) **Assignments.** Speech-language pathologists at this grade level
may be appointed to one of the following assignments:

[1]{.underline}. **Staff Speech-Language Pathologist.** Staff S-LPs at
this grade level provide assessment and treatment intervention. If
unlicensed, the individual must function under the supervision of a
licensed S-LP.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of principles and techniques used in speech
pathology;

([2]{.underline}) Ability to evaluate and interpret data;

([3]{.underline}) Ability to communicate information effectively to
patients and significant others;

([4]{.underline}) Ability to communicate effectively verbally and in
writing;

([5]{.underline}) Ability to function as a constructive member of a
team;

([6]{.underline}) Knowledge of principles and techniques in diagnosis
and treatment of dysphagia;

([7]{.underline}) Knowledge of, and ability to develop and implement,
comprehensive treatment plans.

[2]{.underline}. **Research Speech-Language Pathologist.** Research
S-LPs at this grade level serve as research assistants conducting
research under the direct supervision of principal investigators or
co-principal investigators of higher-grade levels.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities.** In
addition to the KSAs in 1.a. above, the following KSAs are required:

([1]{.underline}) Knowledge of, and ability to apply, appropriate basic
scientific methods, basic research design, and statistics;

([2]{.underline}) Project-specific knowledge of coinical and research
literature; and

([3]{.underline}) Knowledge of anatomy and physiology of speech,
language, voice, swallowing, applied acoustics, and project-specific
knowledge of clinical and research literature.

\(3\) **GS-12**

\(a\) **Licensure.** For those grades that require licensure (GS-12 and
above), within 2 years of initial appointment under this standard the
incumbent must hold a full, current, and unrestricted license in a
State, Territory, Commonwealth, or the District of Columbia. A staff
S-LP who fails to obtain licensure within 2 years of initial appointment
under this standard will be terminated.

\(b\) **Education and Experience.** In addition to the requirements at
the GS-11 level, completion of 1 year of professional experience
comparable to the next lower level and possession of a full, current,
and unrestricted license to practice speech-language pathology. For
positions engaged in research S-LP

assignments involving no direct patient care, completion of a doctoral
degree in speech-language pathology, communication disorders, or a
related field is fully qualifying. In addition, the candidate must
demonstrate the following KSAs:

\(c\) **Assignments.** Speech-language pathologists at this grade level
are considered to be at the full performance level and may be appointed
to one of the following assignments:

[1]{.underline}. **Staff Speech-Language Pathologist.** Staff S-LPs at
this grade level must demonstrate professional knowledge of, and skill
in applying, a wide range of theories, principles, and methodologies of
the practice of speech-language pathology to a wide range of
populations.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Ability to develop coherent treatment strategies;

([2]{.underline}) Ability to incorporate new clinical procedures
sufficient to perform clinical services independently;

([3]{.underline}) Ability to conduct assessments, provide treatment
interventions, and provide consultation to other health care
professionals;

([4]{.underline}) Knowledge of instrumentation used in speech-language
pathology;

([5]{.underline}) Knowledge of principles and techniques used in
alternative and augmentative communication (AAC) systems, diagnosis and
treatment of dysphagia, and cognitive-communication disorders;

([6]{.underline}) Knowledge of principles and techniques used in voice
disorders including alaryngeal and trach/ventilator-dependent patients;
and

([7]{.underline}) Ability to perform functions associated with
contemporary speech-language pathology practice.

[2]{.underline}. **Research Speech-Language Pathologist.** Research
S-LPs at this grade level assist principal investigators or co-principal
investigators in peer reviewed VHA, National Institutes of Health (NIH),
or comparably rigorous intramural or extramurally funded research
programs, and may serve as investigators on small or unfunded projects
of limited complexity or scope. At this grade level, research S-LPs have
responsibility for conducting research under the general supervision of
principal investigators or co-principal investigators of higher-grade
levels. Research S-LPs at this grade level may have authored one or more
publications or presented research findings at a national meeting and
may have earned academic appointment at an affiliated medical school or
local university, usually at the rank of instructor, lecturer, or
equivalent.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities.** In
addition to the KSAs in 1.a. above, the following KSAs are required:

([1]{.underline}) Ability to execute research independently; and

([2]{.underline}) Knowledge of clinical and research literature.

\(4\) **GS-13**

\(a\) **Licensure.** For those grades that require licensure (GS-12 and
above), within 2 years of initial appointment under this standard the
incumbent must hold a full, current, and unrestricted license in a
State, Territory, Commonwealth, or the District of Columbia. A staff
S-LP who fails to obtain licensure within 2 years of initial appointment
under this standard will be terminated.

\(b\) **Education and Experience.** Completion of 1 year of experience
equivalent to the next lower grade level directly related to the
position being filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following professional KSAs
and demonstrate the potential to acquire the assignment specific KSAs
designated by an asterisk (\*):

\(c\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Speech-language pathologists at this
grade level may be appointed to one of the following assignments:

[1]{.underline}. **Speech-Language Pathologist Program Manager.**
Speech-language pathologist program managers are responsible for
providing comprehensive clinical services as well as ensuring that the
work assignments of the other members of the clinical team are carried
out by performing a range of duties such as distributing and balancing
workload among employees in accordance with established work flow or job
specialization; assuring timely accomplishment of the assigned workload;
assessing the status, quality, and progress of work; making day-to-day
adjustments in accordance with established priorities; obtaining
assistance from supervisors or managers on problems that may arise. In
the absence of a supervisory speech-language pathologist, will oversee
the professional practice of peers.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of contemporary speech-language pathology
practice;

([2]{.underline}) Ability to articulate and communicate to the clinical
team the assignment, project, problem to be solved, actionable events,
and objectives, as well as advise on work methods, practices, and
procedures.

([3]{.underline}) Ability to coach the clinical team in the selection
and application of appropriate problem solving methods and techniques;

([4]{.underline}) Ability to monitor and report on the status and
progress of work, evaluate program quality to ensure that methods,
deadlines, and quality have been met; and make adjustments to accomplish
the workload in accordance with established priorities; and

([5]{.underline}) Ability to serve as coach, facilitator, and/or
negotiator in coordinating team initiatives and consensus building
activities among clinical team members with widely divergent
backgrounds, interests, and points of view.

[2]{.underline}. **Supervisory Speech-Language Pathologist or**
**Section Chief.** Supervisory S-LPs or section chiefs exercise
supervision, administrative management, and direction of the
speech-language pathology program

in a unified audiology and speech-language pathology service or
equivalent service-level department. They have responsibility for
general or technical supervision of key clinical or training programs
and overall technical and administrative oversight of S-LPs depending on
grade level. They develop, organize, direct, manage, supervise, control,
and implement policies and procedures in focused clinical programs and
plan, assess, and evaluate programs to ensure proper coordination
between care delivery within the section and the overall delivery of
health care. They make decisions that affect staff and other resources
associated with the section with wide latitude of control and
independent judgment. They exercise supervisory responsibilities such as
planning and scheduling work; assigning work to employees; accepting,
amending or rejecting completed work; ensuring that production and
accuracy requirements are met; appraising performance and recommending
performance standards and ratings; assigning delineated clinical
privileges; approving leave; and effecting disciplinary measures.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Ability to balance responsibilities and to work with
great autonomy;

\*([2]{.underline}) Ability to set priorities, delegate tasks, meet
multiple deadlines, analyze organizational problems, and develop and
implement effective solutions;

\*([3]{.underline}) Ability to analyze and use data effectively to
manage workload, quality, performance, and productivity within the
section;

([4]{.underline}) Skill in interpersonal relationships in dealing with
employees, team leaders, and managers;

([5]{.underline}) Knowledge of, and ability to utilize, evidence-based
practices and clinical practice guidelines in a professional area, and
to guide the section staff in applying these tools;

([6]{.underline}) Ability to analyze organizational and operational
problems and to develop and implement solutions that result in efficient
section operation;

([7]{.underline}) Skill in problem solving and conflict resolution; and

([8]{.underline}) Skill in the application and analysis of scientific
and clinical literature in a professional area.

[3]{.underline}. **Assistant Chief.** Assistant chiefs serve as full
assistants to service chiefs, department heads, or persons of similar
organizational rank, and share a full scope of delegated managerial
responsibilities. Assistant chiefs share full responsibility for all
professional areas in a service-level department with the service chief.
Assistant chiefs exercise supervision, administrative management, and
direction of both professional areas in a unified audiology and
speech-language pathology service or equivalent service-level
department. Assistant chiefs have responsibility for general or
technical supervision of key clinical or training programs within the
service, and overall technical and administrative oversight of S-LPs.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

\*([1]{.underline}) Ability to supervise, motivate, and manage
effectively a diverse clinical staff;

\*([2]{.underline}) Skill in assessing qualifications and abilities of
current and prospective employees;

([3]{.underline}) Ability to develop productivity standards applicable
to a service or equivalent organizational department;

([4]{.underline}) Ability to organize work, set priorities, delegate
tasks and responsibilities, and meet multiple deadlines for the service;
and

([5]{.underline}) Ability to adapt to new and changing work conditions,
staffing, and contingencies.

[4]{.underline}. **Service Chief.** Service chiefs at this grade level
have overall responsibility for a service-level department, or its
organizational equivalent in small or mid-sized facilities. These
individuals have responsibility for general supervision of clinical
and/or training programs, and overall technical and administrative
oversight for operations within the service. Service chiefs develop,
organize, direct, manage, supervise, control, and implement policies and
procedures for complex service-level departments. They have overall
responsibility for planning, assessing, and evaluating programs to
ensure proper coordination between care delivered by the service and the
overall delivery of health care within the facility. Service chiefs make
decisions that affect section or assistant chiefs (if applicable),
clinical and clerical staff, and other resources associated with the
department with great autonomy. Their responsibilities may include full
responsibility for developing and directing educational and training
programs; negotiating affiliation agreements with academic partners;
setting training objectives; delegating responsibilities to subordinate
section or assistant chiefs (if applicable); planning, and scheduling
work; assigning work to employees; accepting, amending, or rejecting
completed work; assuring that production and accuracy requirements are
met; appraising performance and recommending performance standards and
ratings; assigning delineated clinical privileges; approving leave; and
effecting all levels of disciplinary measures. Service chiefs exercise
supervision, administrative management, and direction of both
professional areas in a unified audiology and speech-language pathology
service or equivalent service-level department in other rehabilitation
areas.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

\*([1]{.underline}) Ability to supervise, motivate, and manage
effectively a diverse clinical staff applicable to a service-level
department in small or mid-sized facilities;

\*([2]{.underline}) Skill in assessing qualifications and abilities of
current and prospective employees;

([3]{.underline}) Ability to establish and monitor productivity
standards and production and performance priorities;

([4]{.underline}) Comprehensive knowledge of, and ability to, apply
administrative and human resources policies effectively;

([5]{.underline}) Demonstrated ability to organize work, set priorities,
delegate tasks and responsibilities, and manage and direct the work of
others to accomplish program goals and missions;

([6]{.underline}) Ability to adapt to new and changing work conditions,
contingencies, and staffing;

([7]{.underline}) Ability to translate management goals and objectives
into well-coordinated and controlled service operations; and

([8]{.underline}) Knowledge of, and ability to manage, budgets for a
service-level department in a small or mid-sized facility.

[5]{.underline}. **Research Speech-Language Pathologist.** Research
S-LPs at this grade level are actively involved as principal
investigators or co-principal investigators in peer reviewed VHA, NIH,
or comparably rigorous intramural or extramurally funded research
programs. Responsibilities may include peer review activities for VA and
non-VA research, e.g., grant review for VA or NIH proposals or local
research service committees, e.g., Research and Development (R&D),
Health Services Research and Development (HSR&D), Institutional Review
Board (IRB), etc. At this grade level, research S-LPs have
responsibility for formulating or conducting research on problems of
considerable scope and complexity. Researchers at this grade level work
with substantial freedom in identifying, defining, and selecting
problems for study. They typically will have authored one or more
publications in peer-reviewed literature; demonstrated a consistent
record of presentation of findings at national scientific meetings; may
have earned an academic appointment at an affiliated medical school or
local university, usually at the rank of Assistant Professor or
equivalent; and have responsibility for funded research projects.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of, and ability to apply, advanced
scientific methods in the design and execution of creative and
innovative research;

([2]{.underline}) Ability to convey scientific concepts and
methodological principles to individuals with diverse levels of
technical expertise;

([3]{.underline}) Ability to apply advanced theories and techniques; and

([4]{.underline}) Advanced knowledge of contemporary speech-language
pathology and related disciplines.

[6]{.underline}. **Special Clinical Program Responsibilities**.
Speech-language pathologists with special clinical program
responsibilities, e.g., inter-disciplinary teams or highly specialized
clinical programs or clinical subunits such as dysphagia, traumatic
brain injury, nursing home care, stroke management, spinal cord injury,
or head/neck cancer program, in combination with professional
accomplishments, performance, and qualifications*,* may be appointed to
the GS-13 grade level. Examples of professional accomplishments may
include attainment of advanced degrees, contributions resulting in
publications, presentations at national professional meetings, or other
scholarly works, or specialty or board certification, e.g., Board
Certification in neurologic communication disorders by the Academy of
Neurologic Communication Disorders and Sciences (BC-NCD), or ASHA
specialty certification. Typically, S-LPs with these responsibilities
apply advanced theories and techniques to special patient populations,
provide professional advice and counseling, and provide consultation in
specialized areas of speech-language pathology. They manage complex and
difficult patients with multiple physical, sensory, motor, cognitive, or
other issues that complicate communication or swallowing status, and
involve multiple clinical management options, difficult clinical
decision making, complex data, and high risk of complications,
morbidity, or mortality, e.g.,

tracheoesophageal voice prostheses and laryngectomy tubes,
ventilator-dependent and tracheostomized patients with speaking valves,
and those receiving poly-pharmacology impacting on communication.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Advanced knowledge in a focused area of contemporary
speech-language pathology practice;

([2]{.underline}) Ability to articulate and communicate goals,
objectives, and focused initiatives to an inter-disciplinary team,
specialized clinical program, or subunit; as well as guiding the team
members on work methods, practices, and procedures;

\*([3]{.underline}) Ability to monitor and evaluate the work of an
inter-disciplinary team, specialized clinical program, or subunit; and
to make adjustments in procedures or practices to accomplish the program
goals; and

([4]{.underline}) Ability to serve as coach and facilitator in
coordinating program or team initiatives and consensus building
activities among clinical team members with widely divergent
backgrounds, interests, and points of view.

\(5\) **GS-14**

\(a\) **Licensure.** For those grades that require licensure (GS-12 and
above), within 2 years of initial appointment under this standard the
incumbent must hold a full, current, and unrestricted license in a
State, Territory, Commonwealth, or the District of Columbia. A staff
S-LP who fails to obtain licensure within 2 years of initial appointment
under this standard will be terminated.

\(b\) **Education and Experience.** Completion of 1 year of experience
equivalent to the next lower grade level directly related to the
position being filled, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following professional KSAs
and demonstrate the potential to acquire the assignment specific KSAs
designated by an asterisk (\*):

\(c\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Speech-language pathologists at this
grade level demonstrate exceptional achievement, professional
competence, and leadership and may be appointed to one of the following
assignments:

[1]{.underline}. **Service Chief.** Service chiefs have broad and
overall responsibility for a service-level department, or its
organizational equivalent. They manage substantive parts of medical
centers that deliver specialized, complex, professional services, and
significantly impact the care provided to veterans. They have
responsibility for general supervision of clinical and/or training
programs, and overall technical and administrative oversight for
operations within the service. Service chiefs develop, organize, direct,
manage, supervise, control, and implement policies and procedures for
complex service-level departments. They have overall responsibility for
planning, assessing, and evaluating programs to ensure proper
coordination between care delivered by the service and the overall
delivery of health care within the facility. Service chiefs make
decisions that affect section or assistant chiefs (if applicable),
clinical and clerical staff, and other resources associated with the
department with great autonomy. Their responsibilities may include full

responsibility for developing and directing educational and training
programs; negotiating affiliation agreements with academic partners;
setting training objectives; delegating responsibilities to subordinate
section or assistant chiefs (if applicable); planning, and scheduling
work; assigning work to employees; accepting, amending, or rejecting
completed work; assuring that production and accuracy requirements are
met; appraising performance and recommending performance standards and
ratings; assigning delineated clinical privileges; approving leave; and
effecting all levels of disciplinary measures. Service chiefs exercise
supervision, administrative management, and direction of both
professional areas in a unified audiology and speech-language pathology
service or equivalent service-level department in other rehabilitation
areas.

[a.]{.underline} **Demonstrated Knowledge, Skills, and Abilities**

\*([1]{.underline}) Ability to supervise, motivate, and manage
effectively a diverse clinical staff applicable to a service-level
department in a large, complex, or multi-division facility;

\*([2]{.underline}) Skill in assessing qualifications and abilities of
current and prospective employees;

([3]{.underline}) Ability to establish and monitor productivity
standards and production and performance priorities;

([4]{.underline}) Ability to organize work, set priorities, delegate
tasks and responsibilities;

([5]{.underline}) Ability to manage and direct the work of others to
accomplish program goals and missions;

([6]{.underline}) Ability to accommodate to new and changing work
conditions and contingencies, staffing; and

([7]{.underline}) Ability to translate management goals and objectives
into well-coordinated and controlled service operations.

[2]{.underline}. **Assistant Program Manager.** Assistant program
managers have overall responsibility for management and direction of
large, geographically-separated, integrated health care facilities or a
Network; planning, coordinating, and evaluating complex
inter-disciplinary services across the full continuum of care including
not only speech-language pathology but also other focused
rehabilitation, ancillary, or other health care services. In the absence
of a supervisory speech-language pathologist, this assignment is
responsible for oversight of clinical competence and performance of
peers.

[a.]{.underline} **Demonstrated Knowledge, Skills, and Abilities**

\*([1]{.underline}) Skill in managing and directing work to include
setting priorities and delegating tasks, meeting multiple deadlines,
analyzing complex organizational problems in order to develop and
implement effective solutions;

([2]{.underline}) Ability to balance responsibilities applicable to a
large service-level or multi-service organizational environment and to
work with great autonomy;

([3]{.underline}) Skill in interpersonal relationships in dealing with
employees, team leaders, and managers;

([4]{.underline}) Advanced knowledge of and ability to utilize
evidence-based practices and clinical practice guidelines in multiple
professional areas, and to guide the program staff in applying these
tools; and

([5]{.underline}) Skill in problem solving and conflict resolution.

\(6\) Knowledge of, and ability to manage, budgets for a large,
integrated services including not only speech-language pathology but
also other focused rehabilitation, ancillary, or other health care
services.

[3]{.underline}. **Research Speech-Language Pathologist.** At this
level, research S-LPs are involved in peer review activities for VHA and
non-VHA research, e.g., grant review for VHA or NIH proposals, local
research service committees, e.g., R&D, HSR&D, IRB, etc., or serve as
consulting editors for peer-reviewed journals. At this grade level,
research S-LPs have responsibility for formulating and guiding research
on problems that are difficult to define or require unconventional,
novel approaches, or sophisticated research methods. Research S-LPs at
this grade level have achieved significant professional recognition by
making scientific contributions to research with potential for
significant impact in speech-language pathology and related disciplines.
They typically have authored one or more publications of considerable
interest and value to the field in peer-reviewed professional
literature; may have a consistent record of presentation of findings at
national scientific meetings; have earned an academic appointment at an
affiliated medical school or local university, usually at the rank of
associate professor or equivalent; and have responsibility for funded
research projects.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of, and ability to advance, scientific
methods in the design and execution of highly creative, innovative, or
complex research;

([2]{.underline}) Ability to lead and motivate a research team with
diverse backgrounds, research interests, and points of view;

([3]{.underline}) Ability to manage large research budgets;

([4]{.underline}) Knowledge of, and ability to, evaluate critically the
research of others in peer review or editorial settings;

([5]{.underline}) Ability to convey scientific concepts and
methodological principles to individuals with diverse levels of
technical expertise;

([6]{.underline}) Ability to apply advanced research theories and
techniques, demonstrating exceptional depth of knowledge of clinical
research literature;

([7]{.underline}) Advanced knowledge of contemporary speech-language
pathology, neuroscience, and related disciplines;

([8]{.underline}) Advanced knowledge of anatomy and physiology of
speech, language, voice, and swallowing, neuroanatomy, applied
acoustics; and

([9]{.underline}) Advanced knowledge of normal and abnormal
communication and swallowing function.

**4. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for S-LPs
in VHA whose composite record of accomplishments performance, and
qualifications, as well as current assignments, warrant such action
based on demonstrated competence to meet the requirements of the
proposed grade.

b\. Under no circumstances will the educational or licensure
requirements be waived.

c\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**

[]{#PartIIAppG31 .anchor}

**APPENDIX G31. AUDIOLOGIST/SPEECH-LANGUAGE PATHOLOGIST**

**QUALIFICATION STANDARD**

**GS-665**

**Veterans Health Administration**

**1. COVERAGE.** The following are requirements for appointment as an
audiologist/speech-language pathologist (A/S-LP) in the Veterans Health
Administration (VHA). These requirements apply to all VHA A/S-LPs in the
General Schedule (GS)-665 series. VHA A/S-LPs provide clinical service
to veterans and other VA beneficiaries in VA medical centers, clinics,
domiciliaries, nursing care facilities, community care settings,
Community-Based Outpatient Clinics, Veterans Outreach Centers, Veterans
Integrated Service Network (VISN) offices, and VHA Central Office. In
performing these duties, VHA A/S-LPs demonstrate professional knowledge
of, and skill in applying, a wide range of theories, principles, and
methodology in both the practice of audiology and speech-language
pathology.

**NOTE:** Only those individuals who hold an
"audiologist/speech-language pathologist" position title prior to the
effective date of this standard are subject to the provisions of this
standard. Initial appointments of new employees as an
"audiologist/speech-language pathologist" will not be permitted. In
unusual circumstances, A/S-LPs may be appointed or re-appointed under
this standard using waiver procedures. See Section 4, Paragraph 4
"Deviations," this part.

**NOTE:** Supervisory A/S-LPs will be appointed under either the
Audiologist Qualification Standard or Speech-Language Pathologist
Qualification Standard. The applicable qualification standard will
depend on the position and the nature of the work. In cases where a
supervisory A/S-LP has administrative or managerial responsibilities
over both audiology and speech-language pathology areas, the applicable
standard will be determined by (1) the qualifications of the person
applying for the position, (2) the predominance of work in each area,
and (3) the needs of the facility.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizen of the United States. (Non-citizens may be
appointed when it is not possible to recruit qualified citizens in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Education.** A master's degree or its equivalent in audiology or
hearing science from an accredited college or university; or, a master's
degree, or its equivalent, in speech-language pathology, communication
sciences and disorders, or a related field, from an accredited college
or university. "Accredited" means a college or university accredited by
a regional accreditation organization and an audiology or
speech-language pathology program accredited by the Council on Academic
Accreditation of the American Speech-Language-Hearing Association
(ASHA).

**NOTE:** Beginning on January 1, 2007, the Council on Academic
Accreditation (CAA) in Audiology and Speech-Language Pathology of the
ASHA will accredit only doctoral degree programs in audiology or hearing
science.

c\. **Licensure.** For those grades that require licensure (GS-12 and
above), within 2 years of initial appointment under this standard, the
incumbent must hold a full, current, and unrestricted license in both

areas in a State, Territory, Commonwealth, or the District of Columbia.
An A/S-LP who fails to achieve

licensure in one area within 2 years of initial appointment under this
qualification standard will be restricted to duties in the licensed
area.

\(1\) The A/S-LP must maintain full, current, and unrestricted
licensure/registration.

\(2\) An A/S-LP who has, or has ever had, his/her audiology and/or
speech pathology license revoked, suspended, denied, restricted,
limited, or issued/placed in a probationary status may be appointed only
in accordance with the provisions in Chapter 3, section B, paragraph 16
of this part.

\(3\) **Exception.** The requirement for licensure may be waived by the
Under Secretary for Health or designee in VHA Central Office for
individuals engaged in research or academic assignments involving no
direct patient care duties, in accordance with current activities.

\(4\) **Loss of Credential.** An employee in this occupation who fails
to obtain licensure/certification/

registration within the required time frame, or who fails to maintain
the required licensure/certification/

registration must be removed from the occupation, which may also result
in termination of employment.

For occupations which [require]{.underline} an active credential
(licensure/certification/registration) at all grade levels, at the
discretion of the appointing official, an employee may be reassigned to
another occupation for which he/she qualifies [if]{.underline} a
placement opportunity exists.  For occupations which require an active
credential (licensure/certification/registration) in assignments above
the full-performance level [only]{.underline}, at the discretion of the
appointing official, an employee may remain at an appropriate lower
grade level in the occupation when both of the following apply:  the
credential is not a requirement [and]{.underline} a placement
opportunity exists.

d\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 hybrid qualification standards.
Some of these provisions may not apply to this occupation.  Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but [may not]{.underline} be promoted beyond the journey
level or placed in supervisory or managerial positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to

those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

e\. **Physical Requirements.** See VA Directive and Handbook 5019.

f\. **English Language Proficiency.** A/S-LPs must be proficient in
spoken and written English in accordance with chapter 2, section D,
paragraph 5a, this part.

**3. GRADE REQUIREMENTS**

a\. **Definitions**

\(1\) **Creditable Experience**

\(a\) **Knowledge of Contemporary Professional Audiology and
Speech-Language Pathology Practices.** To be creditable, the experience
must have required the use of knowledge, skills, abilities and other
characteristics associated with contemporary professional audiology and
speech-language pathology practice. This knowledge may be evidenced by
one or more of the following:

[1]{.underline}. At least 1 year of active professional practice or its
equivalent. Active professional practice means paid or non-paid
employment as a professional audiologist and speech-language pathologist
engaged in the practice of audiology and speech-language pathology as
defined by the appropriate licensing boards.

[2]{.underline}. Academic course work leading to a doctoral degree in
audiology, speech-language pathology, or directly related fields.

\(b\) **Quality of Experience.** Experience is creditable if it is both
of the following:

[1]{.underline}. Work as a professional audiologist and speech-language
pathologist related to the position to be filled; and

[2]{.underline}. The work is at a level comparable to audiology and
speech-language pathology experience at the next lower grade level.

\(c\) **Part-Time Experience.** Part-time experience as a professional
A/S-LP is credited according to its relationship to the full-time
workweek. For example, an A/S-LP employed 20 hours a week, or on a
1/2-time basis, would receive 1 full-time work week of credit for each 2
weeks of service.

b\. **Grade Determinations.** In addition to the basic requirements for
employment, the following criteria must be met when determining grades.

\(1\) **GS-9**

\(a\) **Education and Experience.** None beyond the basic requirements.

\(b\) **Assignment.** Employees at this level serve in A/S-LP career
development positions.

\(2\) **GS-11**

\(a\) **Education and Experience.** Completion of 1 year of professional
experience as an A/S-LP equivalent to the next lower level; or 3 years
of progressively higher level graduate education leading to a doctoral
degree; or a doctoral degree in audiology or speech-language pathology,
communication sciences and disorders, or a related field. For positions
involved in research A/S-LP assignments involving no direct patient
care, no additional education or professional experience is required
beyond those identified at the GS-9 level. In addition, the candidate
must demonstrate the following KSAs:

\(b\) **Assignments.** A/S-LPs at this grade level may be appointed to
one of the following assignments:

[1]{.underline}. **Staff Audiologist/Speech Language Pathologist.**
Staff A/S-LPs at this grade level perform clinical assessment and
treatment intervention. If unlicensed in either field, the individual
must function under the supervision of a licensed A/S-LP, audiologist,
or speech-language pathologist. If licensed in one field only, the
A/S-LP must be supervised by a licensed A/S-LP or licensed audiologist
or speech-language pathologist depending on the unlicensed specialty.

[a]{.underline}. **Demonstrated** **Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of contemporary audiology and
speech-language pathology practice;

([2]{.underline}) Ability to communicate orally and in writing;

([3]{.underline}) Ability to communicate information effectively to
patients, families, and other health care professionals;

([4]{.underline}) Knowledge of the principles and techniques in the
assessment and treatment of auditory and balance disorders and the
diagnosis and treatment of dysphagia;

([5]{.underline}) Knowledge of, and ability to develop and implement,
comprehensive treatment plans; and

([6]{.underline}) Ability to function as a constructive member of a
team.

[2.]{.underline} **Research Audiologist/Speech-Language Pathologist.**
Research A/S-LPs at this grade level serve as research assistants. At
this grade level, research A/S-LPs conduct research under the direct
supervision of principal investigators or co-principal investigators of
higher grade level.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of, and ability to apply, appropriate basic
scientific methods, basic research design, and statistics;

([2]{.underline}) Ability to communicate orally and in writing; and

([3]{.underline}) Knowledge of anatomy, physiology, acoustics, speech,
language, voice, swallowing, communication, psychoacoustics, and
auditory/vestibular pathophysiology, and project-specific knowledge of
clinical and research literature.

\(3\) **GS-12**

\(4\) **Licensure.**

\(a\) For those grades that require licensure (GS-12 and above), within
2 years of initial appointment under this standard, the incumbent must
hold a full, current, and unrestricted license in both areas in a State,
Territory, Commonwealth, or the District of Columbia. An A/S-LP who
fails to achieve licensure in one area within 2 years of initial
appointment under this qualification standard will be restricted to
duties in the licensed area.

\(b\) **Education and Experience.** In addition to the requirements at
the GS-11 level, completion of 1 year of professional experience
comparable to the next lower level and possession of a full, current,
and unrestricted license to practice both audiology and speech-language
pathology. For positions involved in research audiology/speech-language
pathology assignments involving no direct patient care, completion of a
doctoral degree in audiology, speech-language pathology, communication,
hearing science, or a related field is fully qualifying. In addition,
the candidate must demonstrate the following KSAs:

\(c\) **Assignments.** A/S-LPs at this grade level are considered to be
at the full performance level and may be appointed to one of the
following assignments:

[1]{.underline}. **Staff Audiologist/Speech-Language Pathologist.**
Staff A/S-LPs at this grade level must demonstrate professional
knowledge of, and skill in applying, a wide range of theories,
principles, and methodology of the practices of both audiology and
speech-language pathology to a wide range of populations.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Ability to develop coherent treatment strategies;

([2]{.underline}) Ability to incorporate new clinical procedures
sufficiently to perform clinical services independently;

([3]{.underline}) Ability to conduct assessments, provide treatment
interventions; and provide consultation to other health care
professionals;

([4]{.underline}) Knowledge of contemporary audiology and
speech-language pathology practices; and

([5]{.underline}) Ability to perform functions associated with
contemporary audiology and speech-language pathology scope of practice.

[2]{.underline}. **Research Audiologist/Speech-Language Pathologist.**
Research A/S-LPs at this grade level assist principal investigators or
co-principal investigators in peer reviewed VA, National Institutes of
Health (NIH), or comparably rigorous intramural or extramurally funded
research programs and may serve as investigators on small or unfunded
projects of limited complexity or scope. At this grade level, research
A/S-LPs have responsibility for conducting research under the general
administrative direction of principal investigators or co-principal
investigators of higher grade levels. Research A/S-LPs at this grade
level may have authored one or more publications, or presented research
findings at a national meeting; and may have earned an academic
appointment at an affiliated medical school or local university, usually
at the rank of instructor, lecturer, or equivalent.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Ability to execute research independently;

([2]{.underline}) Knowledge of clinical and research literature;

([3]{.underline}) Knowledge of the principles and techniques in the
assessment and treatment of auditory and balance disorders, and
communication and swallowing disorders; and

([4]{.underline}) Knowledge of anatomy, physiology, language, voice,
swallowing, acoustics, applied acoustics, communication, neuroscience
and auditory/vestibular pathophysiology.

([5]{.underline}) **Ancillary Assignments.** Individuals may perform
program management duties on an occasional basis, where the complexity
and amount of work is not substantial enough to qualify for the GS-13
level.

\(3\) **GS-13**

\(4\) **Licensure.**

\(a\) For those grades that require licensure (GS-12 and above), within
2 years of initial appointment under this standard, the incumbent must
hold a full, current, and unrestricted license in both areas in a State,
Territory, Commonwealth, or the District of Columbia. An A/S-LP who
fails to achieve licensure in one area within 2 years of initial
appointment under this qualification standard will be restricted to
duties in the licensed area.

\(b\) **Education and Experience.** Completion of 1 year of professional
experience equivalent to the next lower grade level directly related to
the position being filled, and must fully meet the KSAs at that level.
In addition, the candidate must demonstrate the following professional
KSAs and demonstrate the potential to acquire the assignment specific
KSAs designated by an asterisk (\*):

\(c\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. A/S-LPs at this grade level may be
appointed to one of the following assignments:

[1]{.underline}. **Audiologist/Speech-Language Pathologist Team
Leader.** A/S-LP clinical team leaders are responsible to program or
service managers for ensuring that the work assignments of the other
members

of the clinical team are carried out by performing a range of duties
such as distributing and balancing workload among employees in
accordance with established work flow or job specialization; assuring
timely accomplishment of the assigned workload; assessing the status,
quality, and progress of work; making day-to-day adjustments in
accordance with established priorities; obtaining assistance from
supervisors or managers on problems that arise. Team leaders exercise
authority that is routine or technical in nature but does not require
the consistent exercise of independent judgment.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of contemporary audiology and
speech-language pathology practice;

([2]{.underline}) Ability to articulate and communicate to the clinical
team the assignment, project, problem to be solved, actionable events,
and objectives, as well as advise on work methods, practices and
procedures;

([3]{.underline}) Ability to coach the clinical team in the selection
and application of appropriate problem solving methods and techniques;

\*([4]{.underline}) Ability to monitor and report on the status and
progress of work; evaluate program quality to ensure that methods,
deadlines and quality have been met; and make adjustments to accomplish
the workload in accordance with established priorities; and

\*([5]{.underline}) Ability to serve as coach, facilitator and/or
negotiator in coordinating team initiatives and consensus building
activities among clinical team members with widely divergent
backgrounds, interests, and points of view.

[2]{.underline}. **Research Audiologist/Speech-Language Pathologist.**
Research A/S-LPs at this grade level are actively involved as principal
investigators or co-principal investigators in peer reviewed VA, NIH, or
comparably rigorous intramural or extramurally funded research programs.
At this grade level, research A/S-LPs have responsibility for
formulating or conducting research on problems of considerable scope and
complexity. Research A/S-LPs at this grade level work with substantial
freedom in identifying, defining, and selecting problems for study. At
this grade level, research A/S-LPs are mature, competent, and productive
workers. They have typically authored one or more publications of
considerable interest in the peer-reviewed literature; demonstrated a
consistent record of presentation of findings at national scientific
meetings; may have earned an academic appointment at the affiliated
medical school or local university, usually at the rank of assistant
professor or equivalent; and have responsibility for funded research
projects.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of, and ability to apply, advanced
scientific methods in the design and execution of creative and
innovative research;

([2]{.underline}) Ability to convey scientific concepts and
methodological principles to individuals with diverse levels of
technical expertise;

([3]{.underline}) Ability to apply advanced theories and techniques; and

([4]{.underline}) Advanced knowledge of contemporary audiology and
speech-language pathology practice and related disciplines.

\(5\) **GS-14**

\(6\) **Licensure.**

\(a\) For those grades that require licensure (GS-12 and above), within
2 years of initial appointment under this standard, the incumbent must
hold a full, current, and unrestricted license in both areas in a State,
Territory, Commonwealth, or the District of Columbia. An A/S-LP who
fails to achieve licensure in one area within 2 years of initial
appointment under this qualification standard will be restricted to
duties in the licensed area.

\(b\) **Education and Experience.** Completion of 1 year of professional
experience equivalent to the next lower grade level directly related to
the position being filled, and must fully meet the KSAs at that level.
In addition, the candidate must demonstrate the following professional
KSAs and demonstrate the potential to acquire the assignment specific
KSAs designated by an asterisk (\*):

\(c\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. A/S-LPs at this grade level may only
be appointed to research assignments.

[1]{.underline}. **Research Audiologist/Speech-Language Pathologist.**
At this grade level, research A/S-LPs are actively involved as principal
investigators or co-principal investigators in peer reviewed VA, NIH, or
comparably rigorous intramural or extramurally funded research programs.
They are involved in peer review activities for VA and non-VA research,
e.g., grant review for VA or NIH proposals, local research service
committees, e.g., Research and Development (R&D), Health Services
Research and Development (HSR&D), Institutional Review Board (IRB),
etc.; or serve as consulting editors for peer-reviewed journals. At this
grade level, research A/S-LPs have responsibility for formulating and
guiding research on problems that are difficult to define or require
unconventional or novel approaches, or sophisticated research methods.
Research A/S-LPs at this grade level have achieved significant
professional recognition by making scientific contributions to research
with potential for significant impact in audiology, hearing science,
speech-language pathology, or related disciplines. They have typically
authored one or more publications of considerable interest and value to
the field in the peer-reviewed professional literature; have a
consistent record of presentation of findings at national scientific
meetings; may have earned an academic appointment at an affiliated
medical school or local university, usually at the rank of associate
professor or equivalent; and have responsibility for funded research
projects.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of, and ability to apply, advanced
scientific methods in the design and execution of highly creative,
innovative, or complex research;

([2]{.underline}) Ability to lead and motivate a research team with
diverse backgrounds, research interests, and points of view;

\*([3]{.underline}) Ability to manage large research budgets;

([4]{.underline}) Knowledge of, and ability to evaluate critically, the
research of others in peer review or editorial settings;

([5]{.underline}) Ability to convey scientific concepts and
methodological principles to individuals with diverse levels of
technical expertise;

([6]{.underline}) Ability to apply advanced theories and techniques,
demonstrating exceptional depth of knowledge of clinical research
literature;

([7]{.underline}) Advanced knowledge of contemporary audiology and
speech-language practice and related disciplines;

([8]{.underline}) Advanced knowledge of anatomy, physiology, physiology
of speech, acoustics, applied acoustics, communication, neuroscience,
psychoacoustics, auditory/vestibular pathophysiology, language, voice,
swallowing, and neuroanatomy;

([9]{.underline}) Advanced knowledge of normal and abnormal auditory and
balance function; and

([10]{.underline}) Advanced knowledge of normal and abnormal
communication and swallowing function.

**4. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for
A/S-LPs in VHA whose composite record of accomplishments, performance,
and qualifications, as well as current assignments, warrant such action
based on demonstrated competence to meet the requirements of the
proposed grade.

b\. Under no circumstances will the educational or licensure
requirements be waived, except as provided in paragraph 2c.

c\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**

[]{#PartIIAppG32 .anchor}**APPENDIX G32. ORTHOTIST/PROSTHETIST
QUALIFICATION STANDARD**

**GS-667**

**Veterans Health Administration**

**1. COVERAGE.** The following are requirements for appointment as an
orthotist, prosthetist, or orthotist/prosthetist in the Veterans Health
Administration (VHA). This General Schedule (GS)-667 series includes
positions the duties of which are to: administer, supervise, or perform
work involving designing, fabricating, or fitting orthotic or prosthetic
devices to preserve or restore function to patients with disabling
conditions of the limbs and spine, or with partial or total absence of
limbs.

a\. The work requires:

\(1\) Knowledge of anatomy, physiology, body mechanics, the application
and function of orthoses and/or prostheses, and of the materials and
technology available for use in, and fabrication of, such devices;

\(2\) Skill in the use of tools, materials, and specialized equipment;
and

\(3\) The ability to deal effectively with patients and their problems
and to work with other members of the medical team.

b\. Included in this series is such work as:

\(1\) Planning, developing, and directing an orthotics and prosthetics
program at the national, Veterans Integrated Service Network (VISN), or
local level;

\(2\) Serving as an integral member of the professional team providing
advice to physicians with regard to development of a treatment plan,
selection and prescription of devices, and furnishing information
concerning such matters as new developments in the fields of orthotics
and prosthetics; and

\(3\) Assisting in, or leading, research and investigative studies such
as those of experimental materials, microprocessor based components,
myoelectric components, and emerging technologies.

c\. The administrative aspects of the work require an understanding of
statistical information and principles, budget development and
management, vendor evaluation, human resources, inventory management,
the National Prosthetic Patient Database, a knowledge of the Prosthetic
National Software package, and knowledge of accreditation requirements
for orthotic and prosthetic laboratories.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizen of the United States. (Noncitizens may be
appointed when it is not possible to recruit qualified citizens in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Certification.** Certification is not required as a basic
requirement for this occupation; however, it is strongly desirable as
evidence of possession of the essential knowledge, skills, and
abilities. Certification is required for assignments at the GS-12 grade
level and higher.

c\. **Loss of Credential.** An employee in this occupation who fails to
obtain licensure/certification/registration within the required time
frame, or who fails to maintain the required
licensure/certification/registration must be removed from the
occupation, which may also result in termination of employment.

For occupations which [require]{.underline} an active credential
(licensure/certification/registration) at all grade levels, at the
discretion of the appointing official, an employee may be reassigned to
another occupation for which he/she qualifies [if]{.underline} a
placement opportunity exists.  For occupations which require an active
credential (licensure/certification/registration) in assignments above
the full-performance level [only]{.underline}, at the discretion of the
appointing official, an employee may remain at an appropriate lower
grade level in the occupation when both of the following apply:  the
credential is not a requirement [and]{.underline} a placement
opportunity exists.

[]{.mark}

d\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 hybrid qualification standards.
Some of these provisions may not apply to this occupation.  Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but [may not]{.underline} be promoted beyond the journey
level or placed in supervisory or managerial positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

e\. **Physical Requirements.** See VA Directive and Handbook 5019.

f\. **English Language Proficiency.** Orthotists, prosthetists, or
orthotist/prosthetists appointed to direct patient care positions must
be proficient in spoken and written English in accordance with chapter
2, section D, paragraph 5a, this part.

a\. **Definitions**

\(1\) **Titles.** For purposes of this qualification standard the
reference "orthotist/prosthetist" is intended to mean orthotist,
prosthetist, or orthotist-prosthetist. The professional standards board
will determine which is most appropriate based upon the function of the
position to be filled and the specific qualifications of individuals.

\(a\) **Orthotist.** An allied health professional specifically trained
to provide or manage the provision of a custom designed, fabricated,
modified, and fitted orthosis based upon independent or consultative
clinical assessment of the patient's unique needs and desires, as well
as their expectations pursuant to a physician's prescription.

\(b\) **Prosthetist.** An allied health professional specifically
trained to provide or manage the provision of a custom designed,
fabricated, modified, and fitted prosthesis based upon independent or
consultative clinical assessment of the patient's unique needs and
desires, as well as their expectations and pursuant to a physician's
prescription.

\(c\) **Orthotist/Prosthetist.** An allied health professional
specifically trained to provide or manage the provision of custom
designed, fabricated, modified and fitted orthoses [and]{.underline}
prostheses based upon the independent or consultative clinical
assessment of the patient's unique needs and desires, as well as their
expectations and pursuant to a physician's prescription.

**NOTE:** Orthotists, prosthetists, and orthotist/prosthetists are
sometimes referred to as "Practitioners", "Clinicians", and "Clinical
Practitioners".

\(2\) **Creditable Experience - Knowledge of Current Professional
Orthotic and/or Prosthetic Principles and Practices.** To be creditable,
the experience must have required the use of knowledge, skills, and
abilities associated with current professional orthotic and/or
prosthetic professional practice.

\(3\) **Quality of Experience.** Experience is only creditable if it is
equivalent to at least the next lower grade level and is directly
related to the position to be filled.

\(4\) **Part-Time Experience.** Part-time experience is creditable
according to its relationship to a full-time work week. For example, an
individual employed 20 hours per week, or on a ½ time basis, would
receive 1 work week credit for each 2 weeks of service.

b\. **Grade Determinations.** In addition to the basic requirements for
employment, the following criteria must be met when determining the
grade of candidates.

\(1\) **GS-5**

\(a\) **Education.** A full 4-year course of study at an accredited
college or university leading to a bachelor's degree.

**OR,**

\(b\) **Experience.** Three years of experience in a related field which
demonstrates the basic knowledge, skills, and abilities (core
competencies) listed below.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Basic knowledge of medical/scientific terminology.

[2]{.underline}. Basic knowledge of psychology.

[3]{.underline}. Basic knowledge of materials such as plastics,
composites, metals, and leather commonly used in fabrication.

[4]{.underline}. Ability to use hand and power tools.

[5]{.underline}. Ability to communicate orally and in writing.

\(d\) **Assignment.** Assignments at this grade level are entry level
trainee in nature where the individual receives developmental
assignments designed to build upon the base knowledge, skills, and
abilities. The orthotist/prosthetist at this level receives training and
instruction to develop proficiency in essential occupational tasks such
as taking measurements, patient communication, and fabrication and
fitting of simple appliances. The work is performed under close
supervision.

\(2\) **GS-7**

\(a\) **Advanced Entry Level Placement.** See VA Handbook 5005, Appendix
G.

**OR,**

\(b\) **Experience.** One year of basic experience as an
orthotist/prosthetist equivalent to the next lower level and must fully
meet the KSAs at that level. In addition, the candidate must demonstrate
the following KSAs:

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of medical terminology, anatomy, physiology,
biomechanics, kinesiology, physics, and etiology of diseases.

[2]{.underline}. Knowledge of psychology and age related competency.

[3]{.underline}. Knowledge of materials science including materials such
as plastics, composites, metals, and leather commonly used in
fabrication.

[4]{.underline}. Ability to use hand and power tools in the fabrication
of devices.

[5]{.underline}. Ability to communicate orally and in writing.

\(d\) **Assignment.** Assignments at this grade level represent an
advanced trainee level where the individual continues developing the
more complex knowledge, skills, and abilities to prepare for
substantially independent functioning at the GS-9 grade level. The work
includes consultation with the physician, therapist, and/or senior
orthotist/prosthetist staff members to obtain and understand the
prescription; taking measurements for fabrication and fitting for common
disability levels including orthoses for the trunk and cervical spine,
leg braces, and prostheses for short or long stumps; and fabrication and
fitting of those appliances. Supervision is close for developmental
assignments and more general in nature for assignments for which the
individual has demonstrated competency. The supervisor is present at
final fittings.

\(3\) **GS-9**

\(a\) **Education.** Education equivalent to 2 full years of
progressively higher level graduate education or master's or equivalent
graduate degree in orthotics and/or prosthetics, provided the
applicant's total background demonstrates the core competencies for GS-9
level assignment.

**OR,**

\(b\) **Experience.** Completion of 1 year of experience equivalent to
the next lower level which demonstrated possession of the knowledge,
skills, and abilities at that level needed to provide
orthotic/prosthetic services in a hospital setting. In addition, the
candidate must demonstrate the following KSAs:

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to attend clinics and participate as a member
of the treatment team. This includes knowledge of medical terminology,
anatomy, physiology, biomechanics, kinesiology, physics, and etiology of
diseases as well as knowledge of psychology and age related
competencies.

[2]{.underline}. Knowledge of the Healthcare Common Procedure Coding
System (HCPCS) coding.

[3]{.underline}. Ability to conduct clinical patient analyses such as
gait, range of motion, life style, etc., for patients with complex but
typical conditions.

[4]{.underline}. Ability to take necessary measurements, casts, or scans
to develop positive molds of the affected area of the body to create
orthoses and/or prostheses.

[5]{.underline}. Knowledge of materials science including materials such
as plastics, composites, metals, and leather commonly used in
fabrication in order to design and fabricate prescribed devices. This
would include ability to use hand and power tools in the fabrication of
the devices.

\(d\) **Assignments.** The orthotist/prosthetist performs a broad range
of orthotic and prosthetic services designing custom devices using
standard components to optimize patient performance for difficult and
complex but typical conditions. Assignments include clinic attendance to
provide information on standard and stock items which are readily
available. The work involves identification of the biomechanical
condition; explaining procedures to patients to reduce anxiety and gain
support and cooperation; detailed patient assessment including
conducting gait analysis, range of motion, coordination and balance, and
motor skills; interviewing patients for lifestyle assessments; taking
necessary measurements, casts, or scans to develop positive molds;
recognizing physical abnormalities, deviations, and complicating
conditions; fabricating, fitting, and evaluating these custom devices;
and maintenance of the patient's record. The work may include use of
Computer Assisted Design/Computer Assisted Manufacturing (CAD/CAM)
systems.

\(4\) **GS-11**

\(a\) **Experience.** Completion of 1 full year of experience as an
orthotist/prosthetist equivalent to the next lower level that
demonstrates possession of the knowledge, skills, and abilities at that
level needed to provide orthotic/prosthetic services in a hospital
setting. Certification at the practitioner level by the American Board
for Certification in Orthotics and Prosthetics (ABC) or the Board for
Orthotist/Prosthetist Certification (BOC) as an orthotist, prosthetist,
or orthotist/prosthetist is not required but is highly desirable at this
level. In addition, the candidate must demonstrate the following KSAs:

**OR,**

\(b\) **Education.** Three full years of progressively higher-level
graduate education or a Ph.D. or equivalent doctoral degree in orthotics
and/or prosthetics, provided the applicant's total background
demonstrates evidence of knowledge, skills, and abilities necessary to
perform the work of the position to be filled.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to attend clinics and participate as a fully
participating member of the treatment team with considerable influence
in the development of the treatment plan. This includes advanced
knowledge of medical terminology, anatomy, physiology, biomechanics,
kinesiology, physics, and etiology of diseases as well as knowledge of
psychology and age related competencies.

[2]{.underline}. Ability to conduct clinical patient analyses such as
gait, range of motion, life style, etc., for patients with a wide range
of complex medical conditions which include unusual problems or
complications, and to design unique or innovative devices to accommodate
those conditions.

[3]{.underline}. Knowledge of materials science including materials such
as plastics, composites, metals, and leather used in fabrication in
order to design and fabricate prescribed devices considering new and
emerging technologies. This would include ability to use hand and power
tools and CAD/CAM systems in the fabrication of the devices.

[4]{.underline}. Knowledge of materials science in order to design and
fabricate prescribed devices considering new and emerging technologies.
This would include the ability to use CAD/CAM systems in the fabrication
of the devices.

[5]{.underline}. Ability to recognize physical abnormalities,
deviations, and complicating conditions with potentially life
threatening implications.

\(d\) **Assignments.** This is considered to be the full performance
level. The orthotist/prosthetist communicates and interacts with
physicians, allied health professionals, patients, and caregivers in
various interdisciplinary clinical settings, rehabilitation medicine,
orthopedics, neurosurgery, vascular care, podiatry, oncology, etc., as a
subject matter expert to develop the orthotic and/or prosthetic
treatment plan. The work includes complex patient analyses in accordance
with established procedures for patients with unusual conditions,
multiple complex conditions, interrelated conditions, etc.; assessment
of the patient for indications/contra-indications and discussion the
assessment with the physician/requesting provider for the purpose of
developing the overall treatment plan with considerable influence in the
development of that plan; consideration of new and emerging technologies
in designing unique or innovative devices to accommodate or treat a wide
range of complex medical conditions which include unusual problems or
complications. The orthotist/prosthetist at this level is expected to
recognize physical abnormalities, deviations, and complicating
conditions with potentially life threatening implications.

\(5\) **GS-12**

\(a\) **Experience.** Completion of 1 year of experience equivalent to
the next lower level as an orthotist/prosthetist functioning as a full
member of the clinical team which includes significant involvement in
treatment plan development for the most complex types of conditions.
Certification is required at the practitioner level by the American
Board for Certification in Orthotics and Prosthetics (ABC) or the Board
for Orthotist/Prosthetist Certification (BOC) as an orthotist,
prosthetist, or orthotist/prosthetist. Certification as a technician or
fitter does not meet this requirement. Candidates must fully meet the
KSAs at that level. In addition, the candidate must demonstrate the
professional KSAs and demonstrate the potential to acquire the
assignment specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of regulatory requirements established by the
ABC, BOC, the National Committee for Orthotic/Prosthetic Education
(NCOPE), the International Association of Orthotists and Prosthetists
(IAOP), the American Academy of Orthotists and Prosthetists (AAOP),
Joint Commission on Accreditation of Healthcare Organizations (JCAHO),
etc.

\*[2]{.underline}. Knowledge of administrative functions including
budget development and management, inventory management, space and
workload planning as well as knowledge of the National Prosthetic
Patient Database, a knowledge of the Prosthetic National Software
package, and knowledge of accreditation requirements for orthotic and
prosthetic laboratories.

\*[3]{.underline}. Ability to analyze data and provide reports using
HCPCS codes and other patient database information.

\*[4]{.underline}. Ability to provide training to
orthotists/prosthetists in new technologies and innovations in devices.

\*5. Ability to manage and supervise employees. (To be used if the
assignment is supervisory in nature.)

\(c\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Supervisory Orthotist/Prosthetist**. The
orthotist/prosthetist at this level serves as supervisor of an
orthotics/prosthetics laboratory assessing, planning, and evaluating the
orthotic/prosthetic program at the facility level to ensure proper
coordination between the delivery of orthotic/prosthetic services and
the overall delivery of health care. Responsibilities include assuring
the accreditation of the laboratory, regulatory compliance, and a
variety of administrative duties such as developing a budget, managing
inventory and resources, overseeing contract employees, supervising
assigned staff, etc. The assignment includes performance of the full
range of supervisory duties. This includes responsibility for assignment
of duties; development of performance standards and performance
evaluations; and recommendations for appointment, awards, advancement,
and when appropriate, disciplinary action; etc. At this level, the
orthotist/prosthetist serves as a consultant within orthotic and
prosthetic treatment service and with other facility health care staff
in evaluating health care delivery to patients.

[2]{.underline}. **Advanced Practitioner.** The orthotist/prosthetist
assignment at this level is intended for smaller, independent
laboratories not large enough to support a supervisory position. In
addition to functions typical of the GS-11 grade level, the assignment
involves responsibility for assuring the accreditation of the
laboratory, regulation compliance, and a variety of administrative
duties such as developing a budget; managing inventory and resources;
overseeing contract employees; planning the orthotics and prosthetics
clinical schedule; conducting site surveys of commercial vendors;
devising short and long range goals in accordance with local, VISN, and
VHA Central Office direction; and conducting quality assurance
activities; etc.

\(6\) **GS-13**

\(a\) **Experience.** Completion of 1 year of experience equivalent to
the next lower level, [and]{.underline} certification at the
practitioner level in both orthotics and prosthetics by the American
Board for Certification in Orthotics and Prosthetics (ABC) or the Board
for Orthotist/Prosthetist Certification (BOC). Certification as a
technician or fitter does not meet this requirement. Candidates must
fully meet the KSAs at that level. In addition, the candidate must
demonstrate the professional KSAs and demonstrate the potential to
acquire the assignment specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of regulatory requirements established by
ABC, BOC, NCOPE, IAOP, AAOP, JCAHO, Centers for Medicare and Medicaid
Services (CMMS), Occupational Safety and Health Administration (OSHA),
etc., in order to provide advice to VISN management of the
implementation of those requirements.

\*[2]{.underline}. Knowledge of administrative functions including
budget development and management, inventory management, space and
workload planning as well as knowledge of the National Prosthetic
Patient

Database, a knowledge of the Prosthetic National Software package, and
knowledge of accreditation requirements for orthotic and prosthetic
laboratories in order to develop VISN guidelines and policies, allocate
resources within the VISN, and project future workload for the VISN.

\*[3]{.underline}. Ability to analyze data and provide reports using
HCPC codes and other patient database information from VISN orthotic and
prosthetic laboratories within the VISN and to provide such reports to
VISN management.

\*[4]{.underline}. Ability to serve as a consultant to
orthotists/prosthetists within the VISN on emerging technologies, the
most difficult and complex cases, changes in policy, etc.

\*[5]{.underline}. Ability to supervise. (To be used if the assignment
is supervisory in nature.)

\(c\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Supervisory Orthotist/Prosthetist**. The
orthotist/prosthetist at this level serves as the supervisor and
laboratory manager for large laboratories or multiple satellite
laboratories. In addition to the responsibilities described in paragraph
3.b.(5)(c)[1.]{.underline}, this assignment includes serving as a VISN
resource/consultant for orthotics and prosthetics; performing or
overseeing testing and evaluation of design concepts; overseeing and
evaluating contract orthotics and prosthetics vendors.

[2]{.underline}. **Advanced Practitioner.** Non-supervisory
orthotists/prosthetists at this level would be rare; however, in some
cases may be justified. The professional standards board will evaluate
the overall assignment and qualifications of the individual to determine
if the assignment warrants this level. The assignment must represent a
substantial increase in responsibility over assignments at the GS-12
grade level. An example of an assignment that may possibly warrant this
grade level is functioning as a VISN resource/consultant for orthotics
and prosthetics [and]{.underline} manager of a clinical fabrication
facility. The orthotist/prosthetist would serve as a referral source for
questions from satellite facilities. This assignment also incorporates
those responsibilities described at the GS-12 grade level.

\(7\) **GS-14 VHA Central Office Orthotist/Prosthetist Clinical
Manager**

\(a\) **Experience.** Completion of 1 year of experience equivalent to
the next lower level, [and]{.underline} certification at the
practitioner level in both orthotics and prosthetics by the American
Board for Certification in Orthotics and Prosthetics (ABC) or the Board
for Orthotist/Prosthetist Certification (BOC) as an orthotist,
prosthetist, or orthotist/prosthetist. Certification as a technician or
fitter does not meet this requirement. Candidates must fully meet the
KSAs at that level. In addition, the candidate must demonstrate the
following professional KSAs and demonstrate the potential to acquire the
assignment specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

\*[1]{.underline}. Ability to manage and supervise prosthetic and
orthotic laboratories, conduct site visits, and review the functional
level of each lab.

[2]{.underline}. Knowledge of ABC, BOC, OSHA, and JCAHO standards and
Prosthetic and Sensory Aids Service policies and ability to apply these
in the daily operations of orthotic and prosthetic laboratories.

\*[3]{.underline}. Ability to provide training in new technologies
involving CAD/CAM systems and devices such as computerized foot
orthoses, myoelectric prostheses, and energy storing components.

[4]{.underline}. Ability to apply knowledge of the theories and
principles used in orthotics and prosthetics to teach custom design and
fabrication of devices that are innovative, complex, and/or unusual in
nature.

[5]{.underline}. Ability to communicate effectively, both orally and in
writing, with individuals at all organizational levels including
professional staff and administrative staff.

\*[6]{.underline}. Ability to function as a team member or leader with
orthotists, prosthetists, and other professionals on committees to
review local and national agenda items and to make recommendations based
on the review.

\(c\) **Assignment.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. The clinical manager is responsible
for the planning, developing, and implementation of a VHA nationwide
delivery system for orthotic/prosthetic appliances; and related
services. The assignment involves establishing performance standards for
VA orthotic and prosthetic laboratories; assessment of VA
orthotist/prosthetist certification; accreditation of VA
orthotic/prosthetic laboratories; establishing and implementing an
educational plan for clinical and technical orthotic and prosthetic
laboratories staff; representing the VA as a liaison to CMMS;
establishing uniform competency assessment procedures for VA orthotic
and prosthetic laboratories; developing and monitoring
orthotic/prosthetic resident NCOPE accreditation and university
preceptorship programs; establishing and implementing a communication
system for clinical staff; and acting as a VA orthotic and prosthetic
laboratory representative on prosthetic clinical management workgroups.

**4. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for
orthotists/prosthetists in VHA whose composite record of
accomplishments, performance, and qualifications, as well as current
assignments, warrant such action based on demonstrated competence to
meet the requirements of the proposed grade.

b\. Under no circumstances will the certification requirements be
waived.

c\. Placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**

[]{#PartIIAppG33 .anchor}**APPENDIX G33. MEDICAL RECORD ADMINISTRATOR**

**QUALIFICATION STANDARD**

**GS-669**

**Veterans Health Administration**

**1. COVERAGE.** The following are the requirements for appointment as a
Medical Record Administrator (MRA) in the Veterans Health Administration
(VHA). These requirements apply to all VHA MRAs in the General Schedule
(GS)-669 series.

MRAs in VHA perform or supervise work concerned with the management of a
medical record program or the provision of services related to medical
record administration/health information services. Medical Record
Administrators manage, preserve, analyze, and supervise the use of
diagnostic and therapeutic medical records/health information
management. They develop policies and procedures, and provide advice on
the use of medical records and health information management. Also
included are positions assigned responsibility for a section of a
medical record department as well as those assigned quality assurance,
risk management, compliance, privacy, decision support, financial, or
technology focused health information management responsibilities. In
the health care community, MRAs are generally referred to as "health
information managers," and this term is considered to be synonymous
where stated in this qualification standard.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizen of the United States. (Non-citizens may be
appointed when it is not possible to recruit qualified candidates in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Education or Experience**

\(1\) **Experience**

\(a\) Three years of experience in the field of medical records that
included the preparation, maintenance, and management of medical records
and health information systems. At least 1 year of this experience must
be comparable to a GS-4 level position.

An associate's degree in the health information field plus 1 year of
experience that included the

preparation, maintenance, and management of medical records and health
information systems.

**NOTE:** Successfully completed training for health information
technicians in a school accredited by the American Health Information
Management Association (AHIMA) at the time the program was completed may
be substituted for 1 year of experience. No credit may be given for
partial completion of such training.

**OR,**

\(2\) **Education.** Education equivalent to a baccalaureate degree from
an accredited university or college.

**OR,**

\(3\) **Experience/Education Combination.** Equivalent combinations of
experience and education may be used to meet basic requirements.

c\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 hybrid qualification standards.
Some of these provisions may not apply to this occupation.  Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but [may not]{.underline} be promoted beyond the journey
level or placed in supervisory or managerial positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

d\. **Physical Requirements**. See VA Directive and Handbook 5019.

e\. **English Language Proficiency.** MRAs must be proficient in spoken
and written English in accordance with chapter 2, section D, paragraph
5a, this part.

**3. GRADE REQUIREMENTS**

a\. **Definitions**

\(1\) **Creditable Experience**

\(a\) **Knowledge of Current Medical Record Administration Practices.**
To be creditable, experience must have required the use of knowledge,
skills, abilities, and other characteristics (also referred to as "core
competencies") associated with current health information practice. This
knowledge may be evidenced by one or more of the following:

[1]{.underline}. The equivalent of 1 year of active practice in the
health information management field that included knowledge of the
content and uses of health records, computerized information systems,
and disease and procedural indices; ability to apply the concepts,
principles and practices of health information administration; ability
to apply knowledge of anatomy, pathophysiology, and medical terminology
to health information management functions.

**OR,**

[2]{.underline}. Maintenance/possession of an active credential from
AHIMA as a Registered Health Information Administrator (RHIA) or
Registered Health Information Technician (RHIT);

**OR,**

[3]{.underline}. Successful completion of academic course work leading
to an advanced degree in health information management or a related
field.

\(2\) **Quality of Experience.** Experience is only creditable if it is
in health information management and is directly related to the position
to be filled or in a related field, such as quality assurance, Health
Insurance Portability & Accountability Act (HIPAA) privacy, or
electronic medical record implementation. Qualifying experience must
also be at a level and complexity comparable to medical record
management experience at the next lower grade level. Registration is
offered by AHIMA as a Registered Health Information Administrator (RHIA)
or Registered Health Information Technician (RHIT) and is highly
desirable.

\(3\) **Part-Time Experience.** Part-time experience as a medical record
administrator is creditable according to its relationship to full-time
workweek. For example, an MRA would receive 1 week of full-time credit
for each 2 weeks of half-time work.

b\. **Grade Determinations.** In addition to the basic requirements for
employment, the following criteria must be met when determining the
grade of candidates.

\(1\) **GS-5.** None beyond basic requirements.

\(a\) **Assignment.** Employees at this grade level serve in an MRA
career development position under close supervision.

\(2\) **GS-7**

\(a\) Experience. In addition to the basic requirements, at least 1 year
of experience comparable to the next lower grade level. In addition, the
candidate must demonstrate the following KSAs:

**OR,**

\(b\) **Advanced Entry Level Placement.** See VA Handbook 5005, Appendix
G.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Comprehensive understanding of clinical classification
systems and nomenclatures.

[2]{.underline}. Ability to provide advisory and technical expertise on
a range of health information management/medical record issues to staff,
management, and the general public.

[3]{.underline}. Ability to use data collection and analytical
techniques for purposes of review, quality control, studies and
analysis.

[4]{.underline}. Knowledge of and ability to use and evaluate software
programs and information systems relative to health information
services.

[5]{.underline}. Knowledge of anatomy, pathophysiology, and medical
terminology.

\(d\) **Assignment.** Employees at this level typically serve in an MRA
career development position under the supervision of higher level MRAs
and are provided ongoing guidance in day-to-day assignments.

\(3\) **GS-9**

\(a\) **Experience.** At least 1 year of experience at the next lower
grade level that demonstrates the knowledge, skills, abilities, and
other characteristics described at that level. In addition, the
candidate must demonstrate the following KSAs:

**OR,**

\(b\) **Education.** Education equivalent to 2 full years of
progressively higher level graduate education or master's or equivalent
graduate degree from an accredited college or university in a field
directly related to health information.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to interpret and apply knowledge of clinical
classification systems such as International Classification of Diseases
(ICD), Current Procedural Technology (CPT), the Systematized
Nomenclature of Medicine (SNOMED), and the Healthcare Common Procedure
Coding System (HCPCS);

[2]{.underline}. Ability to determine and evaluate compliance with the
standards of regulatory and accrediting bodies such as the Joint
Commission on the Accreditation of Healthcare Organizations (JCAHO), the
Centers for Medicare and Medicaid Services, etc.;

[3]{.underline}. Ability to provide technical advice and/or provide
oversight on health information issues. This includes skill in
interpreting and adapting health information management guidelines that
are not completely applicable to the work or have gaps in specificity;

[4]{.underline}. Ability to extract information, generate reports from
various databases (e.g. clinical, financial), and analyze data including
a consideration of such issues as applicability, validity, reliability,
and the quality and characteristics of the data source, etc.;

[5]{.underline}. If the position is supervisory in nature, ability to
successfully apply principles and techniques of sound human resource
management;

[6]{.underline}. If the position is supervisory in nature, skill in
administrative management, i.e., budgeting, contracting, procurement,
property management; and

[7]{.underline}. If the position is supervisory in nature, ability to
delegate authority, evaluate and oversee people and programs, accomplish
program goals, and adapt to changing priorities.

\(d\) **Assignments.** At the GS-9 grade level, individuals may be
assigned to advisory, consultative, supervisory, or non-supervisory
positions in a health information department or other organizational
entity requiring health information management competencies.

\(3\) **GS-11**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level that demonstrates the KSAs described at that
level. In addition, the candidate must demonstrate the following KSAs:

**OR,**

\(b\) **Education.** Education equivalent to 3 full years of
progressively higher level graduate education or a Ph.D. or equivalent
doctoral degree from an accredited university or college in the field of
health information.

\(c\) **Demonstrated Knowledges, Skills, and Abilities**

[1]{.underline}. Skill in project management and process improvement,
which includes the ability to develop new or improved solutions to
complex technical problems in health information management;

[2]{.underline}. Ability to advise management and staff about adequate
medical record documentation, health information services, and/or
computerized patient records based on current statutes and standards;

[3]{.underline}. Ability to plan for, justify, test, assess, and/or
advise about the use of current and future software programs or
information systems, implement and integrate such products into current
health information management processes, and recommend changes in
policies or procedures;

[4]{.underline}. Ability to interpret, implement, and apply knowledge of
privacy and confidentiality requirements affecting individual
patient/protected health information;

[5]{.underline}. Demonstrated comprehensive knowledge of medical and
legal requirements related to both paper and electronic medical records;

[6]{.underline}. Ability to communicate and negotiate with professionals
in higher level positions;

[7]{.underline}. If the position is supervisory in nature, ability to
plan, develop, direct, and evaluate health information or related
functions;

[8]{.underline}. If the position is supervisory in nature, ability to
successfully apply principles and techniques of sound human resources
management; and

[9]{.underline}. If the position is supervisory in nature, skill in
administrative management, i.e., budgeting, contracting, procurement,
and property management.

\(d\) **Assignments.** This is considered the full performance level for
non-supervisory positions. Individuals at the GS-11 level may be
assigned supervisory and program management responsibilities at smaller
medical centers where the clinical program does not include a wide range
of acute care activities and where the medical records unit staff is
predominately Medical Record Technicians. Employees may also be assigned
supervisory and program responsibilities for a portion of the medical
records program at medium to complex medical centers that provide a wide
range of acute care activities but where a higher graded Medical Record
Administrator has overall program responsibilities.

\(5\) **GS-12**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level that demonstrates the KSAs described at that
level. In addition, the candidate must demonstrate the following
professional KSAs and demonstrate the potential to acquire the
assignment specific KSAs indicated by an asterisk (\*):

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to identify, define, and resolve managerial,
administrative, and computerized medical record problems associated with
unique, underdeveloped, and controversial aspects of medical record
management;

\*[2]{.underline}. Skill in developing new policies and procedures for
administering electronic medical record programs in order to improve
program effectiveness and/or apply newly developed programs or theories
to problems that require new approaches;

[3]{.underline}. Ability to understand computerized patient record data
systems that are meaningful to the medical center as a whole;

\*[4]{.underline}. Ability to teach new and continuing users in
electronic health record and health data systems as appropriate to the
current assignment;

\*[5]{.underline}. If supervisory, ability to manage assigned resources;

\*[6]{.underline}. If the position is supervisory in nature, the ability
to provide the full range of supervisory duties which would include
assignment of work; completing performance evaluations; selection of
staff; and recommendation of awards, advancements, and, when
appropriate, disciplinary actions.

\(d\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Individuals at the GS-12 level are
assigned to one of the following assignments:

[1]{.underline}. **Supervisory Medical Record Administrators (Chief
HIMS)** are delegated full program management and supervisory
responsibility to direct professional (MRA), technical (MRT), and other
support staff in medical health information work. This is considered the
typical managerial and supervisory level at most VA Medical Centers.
MRAs in this assignment provide technical advice, planning, and
evaluation about health information management issues impacting the
overall program on a regular and recurring basis. The MRA is the highest
level professional position at the facility with responsibility for the
management and direction of the health information management program
and services. Multi-division, integrated health care systems under the
leadership of a single director are considered to be a single facility.
An individual who has program responsibility for less than the single
health care system do not have full program responsibility for the
medical records program.

[2]{.underline}. **Supervisory Medical Record Administrators** in those
VA Medical Centers that are in the highest complexity level category for
VHA facilities which are complex, highly affiliated, tertiary care
facility/health care system with comprehensive research programs and
thus warrant an expanded senior leadership team may be assigned to
Assistant Chief HIMS duties where the number of employees within the
HIMS unit justifies the existence of such a position.

[3]{.underline}. **Medical Record Administrators** serving at the
Network level who have oversight responsibilities for a portion of the
overall medical records program (e.g. coding compliance across the
Network).

\(6\) **GS-13**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level that demonstrates the KSAs described at that
level. In addition, the candidate must demonstrate the following
professional KSAs and demonstrate the potential to acquire the
assignment specific KSAs designated with an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of the legal, ethical, and professional
standards as they apply to health information management;

[2]{.underline}. Ability to provide sound, technical guidance to the
professional and medical center staff about major program, legal, or
procedural changes related to health information management;

\*[3]{.underline}. Ability to revise medical center procedures to
improve health information management services and to evaluate, modify,
and/or adapt new methods to meet regulatory requirements;

\*[4]{.underline}. Skill in conducting studies and analyzing data; and

\*[5]{.underline}. Knowledge and skill in management/administration,
which includes program planning, coordination, interpretation,
supervision, consultation, negotiation, problem solving, and monitoring.

\(c\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. At this grade level, positions may
be non-supervisory, supervisory, or managerial as follows.

**Supervisory Medical Record Administrators** at this grade level are
Chiefs of HIMS in

VA Medical Centers that are the highest complexity level category for
VHA facilities, and which are affiliated, tertiary care facility/health
care system with comprehensive research programs and thus warrant an
expanded senior leadership team. MRAs in this assignment provide
technical advice, planning, and evaluation about health information
management issues impacting the overall program on a regular and
recurring basis. The MRA is the highest level professional position at
the facility with responsibility for the management and direction of the
health information management program and services.

**Supervisory Medical Record Administrators** at this grade level are
Chiefs of HIMS for

more than one VA Medical Center when each facility is not individually
within the grouping of most complex VA Medical Centers, BUT when taken
together the medical records program is equivalent to those at the most
complex VA Medical Centers. MRAs in this assignment provide technical
advice, planning, and evaluation about health information management
issues impacting the overall program on a regular and recurring basis.
The MRA is the highest level professional position for those facilities
with responsibility for the management and direction of the health
information management program and services across the facilities.
Multi-division, integrated health care systems under the leadership of a
single director are considered to be a single facility.

**Supervisory Medical Record Administrators** at this grade level are
Chiefs of HIMS for an

entire Network. MRAs in this assignment provide technical advice,
planning, and evaluation about health information management issues
impacting the overall program on a regular and recurring basis. The MRA
is the highest level professional position for those facilities with
responsibility for the management and direction of the health
information management program and services across the facilities in the
Network.

In some cases, placement of individuals in non-supervisory medical
record administrator

positions may be appropriate at the GS-13 level. Establishment of
non-supervisory GS-13 level MRA positions must be approved by the Under
Secretary for Health, or designee in VHA Central Office.

Typical examples include: medical record administrators who perform
national level consultative services at least 25% of the time; Clinical
Application Coordinators when the professional knowledge and skill of a
Medical Record Administrator is required in order to perform the duties
or would enhance the quality of the facility's overall clinical program;
Medical Record Administrators who perform duties within field based
central office components established to enhance VHA's Computerized
Patient Record System.

\(7\) **GS-14**

\(a\) **Experience.** At least 1 year of experience comparable to the
next lower grade level that demonstrates the KSAs described at that
level. In addition, the candidate must demonstrate the following
professional KSAs and demonstrate the potential to acquire the
assignment specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledges, Skills, and Abilities**

\*[1]{.underline}. Ability to develop, maintain, and evaluate health
information management policy and program needs at the national level
and serve as a national technical expert in the medical record
administration/health information management program area.

\*[2]{.underline}. Ability to provide formal clinical, research, and /or
educational consultation on a wide range of health information
management issues such as HIPAA, electronic medical record
implementation and/or quality assurance, for use by the field MRAs and
VHA Central Office program officials.

\*[3]{.underline}. Ability to determine methodologies for achieving
compliance with new and changing regulations governing health
information at the national level to improve program effectiveness,
implement new legislation and/or resolve persistent program problem
areas.

\(c\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. GS-14 MRA placements are limited to
positions which have national level program assignments as a primary
responsibility, function as a national technical expert in the field of
medical record administration/health information management, provide
leadership and guidance at the national level, and have final and
independent technical authority. Establishment of a GS-14 level position
must be approved by the Under Secretary for Health, or designee in VHA
Central Office.

**4. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for
medical record administrators in VHA whose composite record of
accomplishments, performance, and qualifications, as well as current
assignments, warrant such action based on demonstrated competence to
meet the requirements on the proposed grade.

b\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**

[]{#PartIIAppG34 .anchor}**APPENDIX G34. PROSTHETIC REPRESENTATIVE
QUALIFICATION STANDARD**

**GS-672**

**Veterans Health Administration**

**1. COVERAGE.** This standard applies to all prosthetic representative
positions in the Veterans Health Administration (VHA). The occupation
performs, supervises or administers the work of rendering prosthetic and
sensory aids services to disabled patients. The work may include:
planning, developing, and directing a prosthetic and sensory aids
program at local, Veterans Integrated Service Network (VISN), or
national levels; advising clinicians on selecting, prescribing, and
acquiring prosthetic devices; advising on new prosthetics field
developments and supply sources; interpreting clinician prescriptions to
ensure proper device selection; authorizing their purchase, fabrication,
or repair; maintaining liaison with prosthetic supply manufacturers and
dealers, inspecting their facilities and services, and participating in
awarding prosthetic appliance contracts; participating in investigative/
research studies by selecting pilot wearers of newly developed
prosthetic items, and evaluating and compiling data on item usefulness;
and providing multiple facilities with prosthetic and sensory aids
technical/administrative advice and assistance.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizen of the United States. (Non-citizens may be
appointed when it is not possible to recruit qualified citizens in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Experience and Education**

\(1\) **Experience.** Three years of experience that demonstrates:
knowledge of accounting methods; ability to analyze, comprehend, and
apply decisions; basic knowledge of inventory management procedures;
ability to use computer software packages for word processing,
spreadsheet development, and database management; ability to compile,
research, analyze, comprehend, and apply information or data; and
ability to work as a team member in a group setting.

**OR,**

\(2\) **Education.** Education equivalent to a bachelor's degree from an
accredited university or college.

**OR,**

\(3\) **Experience/Education Combination.** Equivalent combinations of
experience and education are qualifying.

c\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 Hybrid qualification standards.
Some of these provisions may not apply to this occupation. Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including

positive education and licensure/certification/registration that are
part of the basic requirements of the occupation. For employees who do
not meet all the basic requirements required in this standard, but who
met the qualifications applicable to the position at the time they were
appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but [may not]{.underline} be promoted beyond the journey
level or placed in supervisory or managerial positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

d\. **Physical Requirements.** See VA Directive and Handbook 5019.

e\. **English Language Proficiency.** Prosthetic representatives must be
proficient in spoken and written English in accordance with chapter 2,
section D, paragraph 5a, this part.

**3. GRADE REQUIREMENTS**

a\. **Definitions**

\(1\) **Creditable Experience.** Experience is only creditable if
documented in the application and verifiable through employment
references and/or other means.

\(2\) **Quality of Experience.** Experience is only creditable if it is
equivalent to at least the next lower grade level and is directly
related to the position to be filled.

\(3\) **Part-time Experience.** Part-time experience as a prosthetic
representative is credited according to its relationship to the
full-time workweek. For example, a prosthetic representative would
receive 1 week of full-time credit for each 2 weeks of half-time work.

\(4\) **Specialty Services.** Services that are unique to more complex
facilities. These include, but are not limited to:

Spinal Cord Injury Unit (SCIU)

Blind Rehabilitation Center (BRC)

Traumatic Brain Injury (TBI)

Home Based Primary Care (HBPC)

Driver Rehabilitation Training

Orthotic and Prosthetic Laboratories

Optical Laboratories

Prosthetic Implants

b\. **Grade Determination.** In addition to the basic requirements for
employment, the following criteria must be met when determining the
grade of candidates:

\(1\) **GS-5**

\(a\) **Experience.** None beyond the basic requirements.

\(b\) **Assignment.** Employees at this grade level serve in a
prosthetic representative career development position.

\(2\) **GS-7**

\(a\) **Experience.** In addition to the basic requirements, 1 year of
experience equivalent to the next lower level. In addition, the
candidate must demonstrate the following KSAs:

**OR,**

\(b\) **Advanced Entry Level Placement.** See VA Handbook 5005, Appendix
G. Appropriate bachelor's degrees include business; those in a medical
field, e.g., kinesiotherapy, occupational therapy, physical therapy,
orthotics, prosthetics, nursing, etc.; public administration; health
administration; or those in related courses of study.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to understand and apply procedures,
regulations, and laws.

[2]{.underline}. Knowledge of procurement practices.

[3]{.underline}. Knowledge of appropriations and obligations relating to
accounts.

[4]{.underline}. Knowledge of general anatomy and medical terminology.

[5]{.underline}. Knowledge of principles and practices of budget
formulation and execution.

\(d\) **Assignment.** Employees at this grade level typically serve in a
prosthetic representative career development position, or as a
prosthetic representative who does not have signatory authority.

\(3\) **GS-9**

\(a\) **Experience.** At least 1 year of experience equivalent to the
next lower level. In addition, the candidate must demonstrate the
following KSAs:

**OR,**

\(b\) **Education.** Education equivalent to 2 full years of
progressively higher level graduate education or master's or equivalent
graduate degree from an accredited university or college in the field of
business; a medical field, e.g., kinesiotherapy, occupational therapy,
physical therapy, nursing, etc.; public administration; health
administration; or those in related courses of study.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to maintain and control an inventory system.

[2]{.underline}. Knowledge of methods to identify trends and causation
factors sufficient to analyze prepared data and gather information to
inform and advise management.

\(d\) **Assignment.** Employees at this grade level typically serve in a
prosthetic representative career development position as a prosthetic
representative serving as a technical advisor to a facility with one
specialty service such as those indicated in paragraph 3a(4) or as a
prosthetic representative with signatory authority but with no specialty
service.

\(4\) **GS-11**

\(a\) **Experience.** At least 1 year of experience equivalent to the
next lower level. In addition, the candidate must demonstrate the
following KSAs:

**OR,**

\(b\) **Education.** Education equivalent to 3 full years of
progressively higher level graduate education or a Ph.D. or equivalent
doctoral degree from an accredited university or college in the field of
business; a medical field, e.g., kinesiotherapy, occupational therapy,
physical therapy, nursing, etc.; public administration; health
administration; or those in related courses of study.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of prosthetic programs related to at least 2
specialty programs as identified in 3a(4).

[2]{.underline}. Ability to advise clinicians on the selection,
prescription, and acquisition of a full range of prosthetic devices.

[3]{.underline}. Ability to maintain liaison with prosthetic supply
manufacturers and dealers by inspecting their facilities and services,
and participating in the award of prosthetic appliance contracts by
providing advisory services to contract specialists.

[4]{.underline}. Knowledge of investigative/research studies for newly
developed prosthetic items in order to select pilot wearers, and compile
data on item usefulness.

\(d\) **Assignment.** This is considered to be the full performance
level. Typical assignments include serving as a prosthetic
representative with signatory authority providing technical advice to a
facility with 2 or more specialty services such as those in paragraph
3a(4) or as a Supervisory Prosthetic Representative who is not in a
service chief or assistant service chief position.

**4. SERVICE CHIEFS, ASSISTANT SERVICE CHIEFS, AND OTHER PROGRAM
MANAGEMENT POSITIONS**

a\. **Service Chief.** Assignment as a Service Chief is restricted to
those serving with full line authority as Chief of a Prosthetic and
Sensory Aids Service. These individuals are fully responsible for
managing and supervising all phases of Prosthetic and Sensory Aids
Service operations.

b\. **Assistant Service Chief.** Assignment as an Assistant Chief is
restricted to those serving as a full assistant to a Chief, Prosthetic
and Sensory Aids Service. These individuals are to share, with a Chief,
Prosthetic and Sensory Aids Service, full responsibility for managing
and supervising all phases of Prosthetic and Sensory Aids Service
operations.

c\. **Other Program Management Positions.** Assignment in a program
management capacity is restricted to a Supervisory Prosthetic
Representative who serves as a VISN Service Line Manager, a VISN-level
senior-level practitioner, or as a staff senior-level practitioner who
serves at the VHA program office level in Central Office.

d\. **Grade Levels**

\(1\) **GS-11**

\(a\) **Experience.** At least 1 year of experience equivalent to the
next lower level, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

**OR,**

\(b\) **Education.** Education equivalent to 3 full years of
progressively higher level graduate education or a Ph.D. or equivalent
doctoral degree from an accredited university or college in the field of
business; a medical field, e.g., kinesiotherapy, occupational therapy,
physical therapy, nursing, etc.; public administration; health
administration; or those in related courses of study.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

\*[1]{.underline}. Ability to manage and supervise.

[2]{.underline}. Ability to initiate new ideas and approaches and
demonstrate resourcefulness.

\*[3]{.underline}. Ability to manage resources, e.g., space, equipment,
supplies, etc., and personnel at the local level.

\*[4]{.underline}. Ability to draft and/or recommend local policies
and/or directives.

[5]{.underline}. Skill in managing a prosthetic program at the local
level.

\(c\) **Assignments.** Employees at this grade level typically serve as
a Supervisory Prosthetic Representative in either a Chief of a
Prosthetic and Sensory Aids Service position at a facility that does not
have specialty services such as those in paragraph 3a(4), in an
Assistant Chief position at a facility that has one specialty service
such as those in paragraph 3a(4); or in a developmental capacity in
Supervisory Prosthetic Representative positions with known promotion
potential to a higher grade.

\(2\) **GS-12**

\(a\) **Experience.** At least 1 year of experience equivalent to the
next lower level, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to understand the unique characteristics of
sites for which responsible.

\*[2]{.underline}. Skill in participating in VISN/facility initiatives,
workgroups, and/or committees.

\*[3]{.underline}. Ability to draft and/or recommend VISN/facility
policies and/or directives.

\(b\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Employees at this level typically
serve as a Supervisory Prosthetic Representative in a Service Chief
position at a facility that has one specialty service such as those in
paragraph 3a(4), in an Assistant Chief position at a facility that has 2
or more specialty services such as those in paragraph 3a(4), or in a
developmental capacity in Supervisory Prosthetic Representative
positions with known promotion potential to a higher grade.

\(3\) **GS-13**

\(a\) **Experience.** At least 1 year of experience equivalent to the
next lower level, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of national initiatives and/or intra-agency
workgroups or committees.

\*[2]{.underline}. Ability to implement national policies over multiple
facilities.

\(c\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Employees at this level typically
serve as a Supervisory Prosthetic Representative in a Service Chief
position at a facility that has 2 or more specialty services such as
those in paragraph 3a(4) or in a developmental capacity in Supervisory
Prosthetic Representative positions with known promotion potential to a
higher grade.

\(4\) **GS-14**

\(a\) **Experience.** At least 1 year of experience equivalent to the
next lower level, and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and the potential to acquire the assignment specific KSAs designated by
an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

\*[1]{.underline}. Ability to draft, recommend, and/or implement
national policies and/or directives.

[2]{.underline}. Knowledge of VISN and/or national initiatives and/or
inter/intra-agency workgroups or committees.

\*[3]{.underline}. Skill in managing a prosthetic program at the VISN
level.

[4]{.underline}. Skill in managing resources, i.e., space, equipment,
supplies, staff, at the VISN level.

\(c\) **Assignment.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Employees at this level will
typically serve as a Supervisory Prosthetic Representative serving as
the VISN subject matter expert for the Prosthetic Program, as a VISN
Service line Manager, or as a VACO national program manager.

**5. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for
prosthetic representatives whose composite record of accomplishments,
performance, and qualifications, as well as current assignments, warrant
such action based on demonstrated competence to meet the requirements of
the proposed grade.

b\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**

[]{#PartIIAppG35 .anchor}**APPENDIX G35. MEDICAL RECORD TECHNICIAN
QUALIFICATION STANDARD**

**GS-675**

**Veterans Health Administration**

**1. COVERAGE.** The following are the requirements for appointment of
Medical Record Technicians (MRTs) in the Veterans Health Administration
(VHA). These requirements apply to all MRTs in the General Schedule
(GS)-675 series. Medical record technicians organize, process, and
maintain medical records and health information. They assemble, review,
analyze, code, abstract, maintain, compile, and extract medical record
and health data. MRTs check medical records for completeness, accuracy,
and compliance with requirements of regulatory and accrediting agencies.
Some MRTs maintain clinical registries and work to meet the standards of
regulatory and accrediting agencies. Typically MRTs work under the
guidance of the Medical Record Administrator. In the health care
community MRTs are known by a number of titles depending on job
function. Terms may include health information technician, coder, tumor
registrar, or registry technician. These types of functions are
incorporated in the MRT occupational qualification standard.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizen of the United States. (Non-citizens may be
appointed when it is not possible to recruit qualified candidates in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Experience and Education**

\(1\) **Experience.** Two years of experience that demonstrates the
applicant's ability to perform the work, or provides familiarity with
the work. Six months of the required 2 years of experience must have
provided the knowledge, skills, abilities, and other characteristics
(KSAs) needed to perform MRT work.

**OR,**

\(2\) **Education.** Successful completion of an associate's degree with
a major field of study in medical record technology/health information
technology which was accredited by the American Health Information
Management Association (AHIMA) at the time the program was completed.

**OR,**

\(3\) **Experience/Education Combination.** Equivalent combinations of
experience and education are qualifying. The following
educational/training substitutions are appropriate in this provision for
combining education and experience:

\(a\) Successful completion of an associate's degree in a field of study
other than medical records/health information will substitute for 18
months of the required experience.

\(b\) Successful completion of a course for medical technicians,
hospital corpsmen, medical service specialists, or hospital training,
obtained in a training program given by the Armed Forces or the U.S.
Maritime Service under close medical and professional supervision, may
be substituted on a month-for-month basis for up to 1 year of
experience.

\(c\) Successful completion of a post-high school course of study in
medical record technology, which includes courses in anatomy,
physiology, and medical record techniques and procedures, may substitute
on a month-for-month basis for up to 1 year of experience.

\(d\) Successful completion of post-high school courses for medical
administrative personnel, obtained in a closely supervised training
program given by the Armed Forces, may be substituted for experience on
a month-for-month basis for up to 6 months provided the training program
included courses in anatomy, physiology, and medical record techniques
and procedures.

c\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 hybrid qualification standards.
Some of these provisions may not apply to this occupation.  Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but [may not]{.underline} be promoted beyond the journey
level or placed in supervisory or managerial positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

d\. **Physical Requirements.** See VA Directive and Handbook 5019.

e\. **English Language Proficiency.** MRTs must be proficient in spoken
and written English in accordance with chapter 2, section D, paragraph
5a, this part.

**3. GRADE REQUIREMENTS**

a\. **Definitions**

\(1\) **Creditable Experience**

\(a\) **Knowledge of Current Medical Record Technology.** To be
creditable, the experience must have required the use of knowledge,
skills, abilities, and other characteristics (also referred to as "core
competencies") associated with current health information or medical
record technology and/or cancer registry practice.

\(b\) **Quality of Experience.** Experience is only creditable if it is
either directly related to the position to be filled or in a related
field. Qualifying experience must also be at a level comparable to
medical record technology experience at the next lower grade level.

\(c\) **Part-Time Experience.** Part-time experience as a professional
medical record technician is credited according to its relationship to a
full-time workweek. For example, a medical record technician would
receive 1 week of full-time credit for each 2 weeks of half-time work.

\(d\) **Specialized Areas for Medical Record Technicians**

[1]{.underline}. **Tumor (or Cancer) Registry** positions maintain
clinical registries and work to meet the standards of regulatory and
accrediting agencies related to approved cancer and/or other programs
requiring registries. Certification is offered by the National Cancer
Registrars Association as a Certified Tumor Registrar (CTR).
Certification is highly desired.

[2]{.underline}. **Medical Coders** analyze and abstract medical record
data and assign codes using clinical classification systems. Medical
coding requires independent judgment based on medical record
documentation and personal coding knowledge and skill. Certification is
offered by AHIMA as a Certified Coding Associate (CCA), Certified Coding
Specialist (CCS), Certified Coding Specialist-Physician-based (CCS-P),
or Registered Health Information Technician (RHIT). Certification is
offered by the American Academy of Professional Coders (AAPC) as a
Certified Professional Coder Apprentice (CPC-A), Certified Professional
Coder-Hospital Apprentice (CPC-H-A), Certified Professional Coder (CPC)
or Certified Professional Coder-Hospital (CPC-H) and is highly desired
at the higher grade levels.

[3]{.underline}. **Medical Record Technicians** perform medical record
technician work but are not working in specialized registry or medical
coding assignments. This assignment includes lead and supervisory
positions.

b\. **Grade Determinations.** In addition to the basic requirements for
employment, the following criteria must be met when determining the
grade of candidates.

\(1\) **GS-4**

\(a\) **Experience or Education.** None beyond basic requirements.

\(b\) **Demonstrated Knowledge, Skills, and Abilitie**s

[1.]{.underline} Basic knowledge of medical terminology;

[2.]{.underline} Basic knowledge of disease processes and human anatomy;

[3.]{.underline} Basic knowledge of medical record/health information
guidelines, techniques, and procedures;

[4.]{.underline} Knowledge of the medical and legal significance of
medical records.

\(c\) **Assignment.** Employees at this level serve in entry level MRT
career development positions in any area of medical records. It is
expected that they receive guidance from more experienced staff members
for more complex issues, and require daily direct supervision.

\(3\) **GS-5**

\(a\) **Experience.** In addition to the basic requirements, at least 1
year of experience at the next lower grade level and must fully meet the
KSAs at that level. In addition, the candidate must demonstrate the
following KSAs:

**OR,**

\(b\) **Education.** Successful completion of a baccalaureate degree
from an accredited college or university with a major field of study in
medical record technology/health information technology or a related
degree with courses related to medical record technology sufficient to
evidence the core competencies identified.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to apply knowledge of medical terminology,
human anatomy/pathophysiology, and disease processes sufficient to
appropriately file, locate, and disclose health information;

[2.]{.underline} Ability to correctly apply a practical knowledge of
laws and regulations related to the confidentiality of health
information and the release of information from medical records;

[3.]{.underline} Knowledge of the internal organization of medical
records and medical record references and procedures as appropriate to
the position.

[4.]{.underline} Ability to use health information software appropriate
to the position, such as the electronic patient record, record tracking
systems, chart deficiency systems, coding and abstracting systems,
release of information systems, document scanning technology, electronic
spreadsheets, transcription systems, encoder products, electronic
encounter forms, database software, etc.

\(d\) **Assignments.** Employees at this grade level serve in
developmental positions as MRTs in any of the identified specialized
areas and receive guidance from more experienced staff members for more
complex medical records and/or coding procedures.

\(4\) **GS-6**

\(a\) **Experience.** One year of experience comparable to the next
lower level and must fully meet the KSAs at that level. In addition, the
candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills and Abilities**

[1.]{.underline} Ability to apply knowledge of medical terminology,
human anatomy/pathophysiology, and disease processes to fully understand
the content of a patient record;

[2]{.underline}. Ability to navigate efficiently through the paper and
electronic medical record to find needed information;

[3]{.underline}. Skill in interpreting and adapting health information
guidelines that are not completely applicable to the work or have gaps
in specificity and ability to use judgment in completing assignments
with incomplete or inadequate guidelines;

[4]{.underline}**.** If assigned to medical record analysis, ability to
judge whether medical records contain sufficient information for
regulatory requirements; are acceptable as legal documents; are adequate
for continuity of patient care; and support education and research
needs. This includes the ability to take appropriate actions if medical
record contents are not adequate; accurate, timely, and/or reliable;

[5]{.underline}. Ability to apply laws and regulations on the
confidentiality of health information (e.g., Privacy Act, Freedom of
Information Act, Health Insurance Portability and Accountability Act
(HIPAA);

[6]{.underline}. If assigned to a tumor registry position, ability to
apply guidelines and standards for the maintenance of an approved tumor
registry; and

[7]{.underline}. If assigned to a medical coding position, comprehensive
knowledge of classification systems, such as current versions of
International Classification of Diseases (ICD), Current Procedural
Technology (CPT), the Systematized Nomenclature of Medicine (SNOMED) or
Healthcare Common Procedure Coding System (HCPCS), and skill in applying
coding knowledge.

\(c\) **Assignments.** Employees at this level typically work in any
specialty area of medical record/health information. In some instances,
they may be assigned lead or supervisory positions when the highest
level of non-supervisory MRT work is at a lower level. They receive
little guidance from more experienced staff members.

**NOTE:** In order to be considered a leader, the employee must be
responsible to his/her supervisor for ensuring that the work assignments
of the other employees of the team are carried out by successfully
performing a range of duties which include such duties as distributing
and balancing workload,

monitoring the status and progress of work, instructing and answering
employee questions, checking employee work, amending or rejecting work
not meeting standards, approving leave for a few hours or for
emergencies, resolving simple, informal complaints, etc.

\(5\) **GS-7**

\(a\) **Experience.** One year of experience comparable to the next
lower grade level and must fully meet the KSAs at that level including
those for tumor registry or coder assignments if applicable. In
addition, the candidate must demonstrate the following KSAs:

\(b\) **Assignments.** Employees at this level will be assigned to a
specific area of medical record/health information (tumor registry,
medical coding, or medical records). They may be in lead or supervisory
positions, as appropriate to the assignment. Core competencies are
described for each type of assignment as follows.

[1]{.underline}. **Tumor Registry Positions.** Tumor registry
assignments at this level represent the advanced developmental level
leading to the full performance level. At this level, MRTs in tumor
registry assignments perform a substantially full range of duties but
will receive more guidance and direction regarding unfamiliar or unusual
situations.

[a]{.underline}. **Demonstrated Knowledge, Skills and Abilities**

([1]{.underline}) In-depth knowledge of professional registry practices;

([2]{.underline}) In-depth knowledge of fundamental tumor registry
operations;

([3]{.underline}) Ability to analyze data using comparative statistical
methods and present the data in graphic format;

([4]{.underline}) Experience in meeting the standards of external
approving bodies;

([5]{.underline}) Ability to communicate with, and advise, clinical
staff about registry operations, statistical reports, and the standards
of approving bodies; and

([6]{.underline}) Ability to manage priorities and coordinate work in
order to complete duties at the assigned grade level in an accurate and
timely fashion; ability to follow-up on pending issues; and demonstrated
understanding of the impact of incomplete work.

[2]{.underline}. **Medical Record Technician Coding Positions.** Medical
coding assignments at this grade level represent the advanced
developmental level leading to the full performance level. It is
expected that the medical coder will do more than validate code
assignments made by clinical staff, but will have the skill to make
independent judgment in selection of codes based on medical
documentation and personal coding knowledge and skill. Reviewing codes
selected by physicians/ health care providers or reviewing entries on an
encounter form or superbill is not considered comprehensive coding and,
without the demonstration of additional skills, is not acceptable to
achieve this level. Since coding rules are specific to individual
classification systems, knowledge of coding systems other than the one
utilized in the position for which the individual is being boarded does
not automatically meet the requirements of the position. Generally, to

receive credit for experience, the coder should have performed the type
of coding specified as a significant portion of duties on a regular and
recurring basis, and provide evidence of the core competencies
identified.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Knowledge of classification systems, such as current
versions of ICD, CPT, SNOMED or HCPCS, and skill in applying coding
knowledge to a wide range of specialty areas;

([2]{.underline}) Knowledge of Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) as well as Medicare/Centers for
Medicare & Medicaid Services (CMS) and/or VHA medical record
documentation requirements;

([3]{.underline}) Ability to communicate with clinical staff on coding
and documentation issues such as recording inpatient and outpatient
diagnoses and procedures, the use of encounter forms, the correct
sequencing of diagnoses/ procedures, and/or the relationship between
health care documentation and code assignment;

([4]{.underline}) Ability to research and solve complex questions
related to coding and documentation, such as adequate health information
documentation, coding, billing, resident supervision, etc.; and

([5]{.underline}) Skill in reviewing and correcting system or processing
errors, reviewing transmission reports, and ensuring all assigned
episodes are complete and accurate as appropriate to the duties
assigned,

[3]{.underline}. **Medical Record Technician.** This is considered the
full performance level for MRTs who are not assigned to coding or
registry positions. Medical Record Technicians at the GS-7 level may be
assigned to assemble or review documentation as well as review, analyze,
abstract, compile, maintain, and/or extract health data. They may
organize medical records and check for completeness, accuracy, and
compliance, and/or may be assigned to scanning, privacy, research,
education, revenue, or similar functions. Such assignments do not
automatically qualify for this grade level unless core competencies are
met.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Skill in applying a comprehensive knowledge of health
information technology principles, concepts, and methodology in carrying
out assignments, operations, or procedures;

([2]{.underline}) Ability to perform work involving different and
unrelated processes and methods which includes the ability to analyze
the subject, phase, or issues involved in each assignment;

([3]{.underline}) Skill in communicating with individuals or groups who
may be uncooperative, fearful, or skeptical, in order to obtain the
desired effect, such as gaining compliance with established policies and
regulations by persuasion or negotiation, or gaining information by
establishing rapport; and

([4]{.underline}) Ability to manage priorities and coordinate work in
order to complete duties in an accurate and timely fashion. This
includes the ability to follow-up on pending issues and demonstrates an
understanding of the impact of incomplete work.

[4]{.underline}. **Lead or Supervisory Medical Record Technician
Positions.** An MRT may qualify at the GS-7 grade level by assignment as
a work leader or supervisor. The employee must serve as a work leader as
a regular and recurring part of assignments, or supervise medical record
technicians, where the highest level of non-supervisory work is at the
GS-6 grade level. In order to be considered a leader, the employee must
be responsible to his/her supervisor for ensuring that the work
assignments of the other employees of the team are carried out by
successfully performing duties which include distributing and balancing
workload, monitoring the status and progress of work, instructing and
answering employee questions, checking employee work, amending or
rejecting work not meeting standards, approving leave for a few hours or
for emergencies, resolving simple, informal complaints, etc.

([a]{.underline}) **Demonstrated Knowledge, Skills and Abilities**

([1]{.underline}) Ability to manage priorities and coordinate work in
order to complete duties in an accurate and timely fashion;

([2]{.underline}) Ability to follow-up on pending issues and
demonstrates an understanding of the impact of incomplete work;

([3]{.underline}) Ability to demonstrate appropriate human resources
management skills;

([4]{.underline}) Ability to communicate orally and in writing to meet
program objectives;

([5]{.underline}) If the position is supervisory in nature, ability to
provide or coordinate staff development and training; and

([6]{.underline}) If the position is supervisory in nature, ability to
manage and supervise employees.

\(6\) **GS-8**

\(a\) **Experience.** One year of experience comparable to the next
lower grade level for the appropriate assignment area and must fully
meet the KSAs at that level.

\(b\) **Assignments.** Employees at this grade level will be assigned to
a specific area of medical record/health information, e.g., tumor
registry, medical coding, or medical records. They may be in lead or
supervisory positions, as appropriate to the assignment. Core
competencies for the different assignments are listed with the
assignment.

[1]{.underline}. **Tumor Registry Positions.** This is considered to be
the full performance level for tumor registry assignments. Certification
at this grade level is highly desired. In addition, the candidate must
demonstrate the following KSAs:

[a]{.underline}. **Demonstrated Knowledge, Skills, Abilities**

([1]{.underline}) Knowledge of chronic disease registration/data basing
and specific cancer registration;

([2]{.underline}) Advanced knowledge of medical terminology, staging of
cancer, and requirements of external approving organizations;

([3]{.underline}) Knowledge of the design, conduct, and interpretation
of case ascertainment, re-abstracting, and quality assurance studies;

([4]{.underline}) Knowledge of cancer committee processes and procedures
in order to improve patient care and to verify compliance;

([5]{.underline}) Ability to serve as subject matter expert on cancer
program issues for the medical center and Veterans Integrated Service
Network (VISN) administration as tasked; and

([6]{.underline}) Ability to manage priorities and coordinate work in
order to complete duties in an accurate and timely fashion.

[2]{.underline}. **Medical Record Technician (Medical Coder)
Positions.** This is considered to be the full performance level for
this assignment. Certification at this grade level is highly desired. In
addition, the candidate must demonstrate the following KSAs:

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Ability to analyze the medical record to identify all
pertinent diagnoses and procedures for coding, and to evaluate the
adequacy of the documentation. This includes the ability to read and
understand the content of the medical record, the terminology, the
significance of the comments, and the disease process/pathophysiology of
the patient;

([2]{.underline}) Skill in reviewing medical record documentation and
assigning current versions of the classification systems required in the
current position, such as ICD and CPT; and

([3]{.underline}) Advanced knowledge of the full scope of coding and
abstracting including inpatient discharges, surgical cases, diagnostic
studies and procedures, outpatient encounters, and inpatient
professional fees for a highly diversified range of specialties and
subspecialties, such as orthopedics, neurosurgery, cardiology,
gastroenterology, plastic surgery, spinal cord injury, blind
rehabilitation, anesthesia, acute and long term psychiatry including
addiction treatment, hospice, ambulatory surgery, and other types of
care.

[3]{.underline}. **Lead or Supervisory Medical Record Technicians.** For
all assignments above the full performance level, the higher-level
duties must consist of significant scope, complexity (difficulty), and
range of variety, and be performed by the incumbent at least 25% of the
time. An MRT who is not in a tumor registry or coder position may, as a
regular and recurring aspect of the position, be assigned work leader or
supervisory duties for a unit of medical record technicians where the
highest level of non-supervisory work is at lower grade levels up to and
including the full performance level. In addition, the candidate must
demonstrate the following technical KSAs and demonstrate the potential
to acquire the assignment specific KSAs indicated by an asterisk (\*):

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

\*([1]{.underline}) Ability to manage priorities and coordinate work in
order to complete duties in an accurate and timely fashion;

\*([2]{.underline}) Ability to follow-up on pending issues and
demonstrate an understanding of the impact of incomplete work;

([3]{.underline}) Ability to demonstrate appropriate human resources
management skills;

([4]{.underline}) Ability to delegate authority, evaluate, and oversee
staff and programs;

\*([5]{.underline}) Ability to accomplish program goals and adapt to
changing priorities;

([6]{.underline}) If the position is supervisory in nature, knowledge
of, and ability to provide, the full range of supervisory duties which
would include responsibility for assignment of work to be performed,
performance evaluation, selection of staff, and recommendations of
awards, advancements, and, when appropriate, disciplinary actions.

[4]{.underline}. **Medical Record Technician.** For all assignments
above the full performance level, the higher-level duties must consist
of significant scope, complexity (difficulty), and range of variety, and
be performed by the incumbent at least 25% of the time. There may be
some instances of MRTs at the GS-8 grade level who are not assigned to
tumor registry, medical coder, lead, or supervisory positions. Such
assignments may have varying assignments related to medical records and
health data, including review, analysis, extraction, compilation, or
abstraction. They may be assigned to record completion, scanning,
privacy, revenue, quality assurance, or other areas requiring medical
record technician competencies which substantially exceed the full
performance level. Regardless of the nature of the specific assignment,
the work must be of sufficient scope and complexity to meet the
knowledge, skills, and abilities to perform at this grade level.

\(7\) **GS-9**

\(a\) **Experience.** One year of experience comparable to the next
lower grade level and must fully meet the KSAs at that level. In
addition, the candidate must demonstrate the following technical KSAs
and demonstrate the potential to acquire the assignment specific KSAs
indicated by an asterisk (\*):

\(b\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Employees at this level will be
assigned to a specific area of medical record/health information
(medical records, medical coding or tumor registry). They may be in lead
or supervisory positions, as appropriate to the assignment. Core
competencies may differ depending on assignment as follows.

[1]{.underline}. **Tumor Registry Positions.** The MRT (Tumor Registry)
at this level is responsible for the professional and administrative
management of a registry in a relatively large and complex medical
center and research program affiliated with a medical school. The
complexity of the program and duties of the position must substantially
exceed that of positions at the full performance level. Such individuals
typically

have responsibility for supervising 3 or more professional full time
registrars. In addition to the experience required at the GS-8 grade
level, active credentials as a Certified Tumor Registrar are highly
desirable. The following knowledge, skills, and abilities are required
in addition to the successful demonstration of required KSAs at lower
grades.

[a]{.underline}. **Demonstrated Knowledge, Skills and Abilities**

([1]{.underline}) Ability to perform the full range of supervisory
duties, including the responsibility for assignment of duties;
development of performance standards and performance evaluation;
recommendations for appointment, awards, advancement, and when
appropriate, disciplinary actions; identification of continuing
education and training needs; etc.;

([2]{.underline}) Skill serving as a consultant within the medical
center and with other medical center health care staff in evaluating
health care delivery to patients, disease incidence, and stratification;

\*([3]{.underline}) Ability to assess, plan, and evaluate the registry
program to ensure proper coordination between the interdisciplinary and
collaborative cancer care team on the overall delivery of health care;

\*([4]{.underline}) Ability to independently prepare comprehensive
survey applications; and

\*([5]{.underline}) Ability to ensure that regulatory requirements are
met.

[2]{.underline}. **Lead Medical Record Technician.** Lead MRTs may
qualify at the GS-9 grade level by experience, assignment,
[and]{.underline} demonstrated knowledge, skills and abilities. An MRT
at the GS-9 grade level functions as a work leader, as a regular and
recurring part of assignments, of medical record technicians, where the
highest level of non-supervisory work is at lower grade levels.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

\*([1]{.underline}) Ability to work with a team to provide technical
guidance, plan, organize, and coordinate activities of a medical record
function in order to effectively complete job duties of assignment such
as distributing workload, monitoring the status and progress of work,
monitoring accuracy of work, approving leave, etc.;

\*([2]{.underline}) Comprehensive knowledge of medical record technology
theories, methods, procedures, and techniques for assigned areas; and

\*([3]{.underline}) Ability to communicate tactfully and effectively,
both orally and in writing, in order to meet program objectives. This
may include preparing reports in various formats and presenting data to
various organizational levels.

[3]{.underline}. **Supervisory Medical Record Technician.** Assignment
as a supervisor where a significant number of the staff supervised is
either at the full performance level of GS-8 or MRTs in career
development positions or supervises lower level staff, mixed grade level
staff, multiple series staff, mixed shifts, physically dispersed or
other issues that add to the complexity of supervision.. The following
core competencies are required.

[a]{.underline}. **Demonstrated Knowledge, Skills, and Abilities**

([1]{.underline}) Ability to apply principles and procedures of sound
human resources management;

([2]{.underline}) Ability to provide technical and administrative
supervision to subordinates in order to meet organizational goals;

\*([3]{.underline}) Comprehensive knowledge of medical record technology
theories, methods, procedures and techniques for assigned areas;

[4]{.underline}. **Medical Record Technicians** at the GS-9 level who
are not supervisors or leads may be assigned varying duties related to
medical records and health data, including review, analysis, extraction,
compilation, or abstraction. They may be assigned to record completion,
scanning, privacy, revenue, quality assurance, or other areas requiring
such skills. At this grade level, it is expected such assignments would
be unique perhaps with great specialization in complex areas such as
privacy, coding compliance, medical staff assistance, health information
systems, clinical research, and technical education to a broad range of
individuals on various complex topics.

[a]{.underline}. **Demonstrated Knowledge, Skills and Abilities**

([1]{.underline}) Ability to collaborate and coordinate tasks with
individuals outside the work area and at higher organizational levels
who require persuasion and negotiation;

([2]{.underline}) Ability to work independently to accomplish a variety
of responsibilities including setting priorities, organizing and
adjusting workflows, utilizing problem-solving techniques in the
accomplishment of work;

\*([3]{.underline}) Ability to apply expert technical knowledge and
skills in medical records/health information, HIPAA, or a related area
in a complex work environment;

\*([4]{.underline}) Comprehensive knowledge of the most complex and
difficult medical record technician areas; and

\*([5]{.underline}) Knowledge of qualitative and/or quantitative methods
for assessment and improvement of medical record functions.

**4. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for
medical record technicians in VHA whose composite record of
accomplishments, performance, and qualifications, as well as current
assignments, warrant such action based on demonstrated competence to
meet the requirements of the proposed grade.

b\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**

[]{#PartIIAppG36 .anchor}**APPENDIX G36. DENTAL ASSISTANT QUALIFICATION
STANDARD**

**GS-681**

**Veterans Health Administration**

**1. COVERAGE.** Following are requirements for appointment as a Dental
Assistant in the Veterans Health Administration (VHA). These
requirements apply to all VHA dental assistants in the General Schedule
(GS)-681 series.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizen of the United States. (Non-citizens may be
appointed when it is not possible to recruit qualified candidates in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Experience and Education**

\(1\) **Experience.** Six months experience that demonstrates the
applicant's ability to perform the work, or provides familiarity with
the work.

**OR,**

\(2\) **Education.** Successful completion of a 1-year dental assistant
program accredited by the American Dental Association's Commission on
Accreditation that included a course in radiation physics; radiation
biology; radiation health, safety, and protection; X-ray films and
radiographic film quality; radiographic techniques; darkroom and
processing techniques; and film mounting; [or]{.underline} practical
nurse training approved by the appropriate State, territory, or District
of Columbia accrediting body.

\(3\) **Experience/Education Combination.** Equivalent combinations of
experience and education are qualifying.

c\. **Certification.** Public Law 97-35 requires that persons who
administer radiologic procedures meet the credentialing standards in 42
CFR Part 75. Essentially, they must have successfully completed an
educational program that meets or exceeds the standards described in
that regulation, and is accredited by an organization recognized by the
Department of Education, and be certified as radiographers in their
field.

\(1\) **Alternative Provisions for Certification of Radiologic
Competence**

\(a\) Successful completion of the Dental Radiation Health and Safety
Examination administered by the Dental Assisting National Board, Inc.;

**OR,**

\(b\) Successful completion of the education and training, including
coursework in radiation health and safety, described by the Office of
Personnel Management (OPM) as fully qualifying for any grade level
(copies of certificates of successful completion, plus transcripts or
course descriptions of the required subjects must be filed in the
employee's official personnel folder);

**OR,**

\(c\) Successful completion of the Principles and Practice of Dental
Radiology and Radiographic Safety courses and examinations developed by
the Assistant Under Secretary for Health for Dentistry. The chief,
dental service, will certify competency based on documentation of
successful completion of this training, a copy of which will be filed in
the personnel folder.

\(2\) Non-certified applicants who otherwise meet the eligibility
requirements for certification of radiologic competence may be given a
temporary appointment as a graduate dental assistant under the authority
of 38 U.S.C. § 7405 (a) (1) (D). Failure to obtain certification during
that period is justification for termination of the temporary
appointment. This may result in termination of employment.

\(3\) Certification in basic life support methods is highly desirable.

\(4\) **Loss of Credential.** An employee in this occupation who fails
to obtain licensure/certification/

registration within the required time frame, or who fails to maintain
the required licensure/certification/

registration must be removed from the occupation, which may also result
in termination of employment.

For occupations which [require]{.underline} an active credential
(licensure/certification/registration) at all grade levels, at the
discretion of the appointing official, an employee may be reassigned to
another occupation for which he/she qualifies [if]{.underline} a
placement opportunity exists.  For occupations which require an active
credential (licensure/certification/registration) in assignments above
the full-performance level [only]{.underline}, at the discretion of the
appointing official, an employee may remain at an appropriate lower
grade level in the occupation when both of the following apply:  the
credential is not a requirement [and]{.underline} a placement
opportunity exists.

d\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 hybrid qualification standards.
Some of these provisions may not apply to this occupation.  Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but [may not]{.underline} be promoted beyond the journey
level or placed in supervisory or managerial positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

e\. **Physical Requirements.** See VA Directive and Handbook 5019.

f\. **English Language Proficiency.** Dental assistants must be
proficient in spoken and written English in accordance with chapter 2,
section D, paragraph 5a, this part.

**3. GRADE REQUIREMENTS**

a\. **Definitions**

\(1\) **Creditable Experience**

\(a\) **Knowledge of Current Professional Dental Assistant Practices.**
To be creditable, the experience must have required the use of
knowledge, skills, abilities, and other characteristics (also referred
to as "core competencies") associated with current professional dental
assisting practice. Evidence of such experience includes graduation from
a certified dental assisting training program, experience in private
practice, VHA, Department of Defense (DoD), or other federal health care
agency.

\(b\) **Quality of Experience.** Experience is only creditable after the
training program certifies that the individual has completed all
required courses, an internship if it is part of the program, and
graduated with passing grades.

\(c\) **Part-Time Experience.** Part-time experience as a dental
assistant is credited according to its relationship to full-time
workweek. For example, a dental assistant would receive 1 week of
full-time credit for each 2 weeks of half-time work.

\(2\) **Internships.** Although not required, dental assistants are
encouraged to seek additional experience in an internship program,
especially when they may be providing chair side assistance in oral
surgery or other specialty care. An internship may qualify a dental
assistant for a higher grade as outlined below, but is not required for
initial appointment.

b\. **Grade Determinations.** In addition to the basic requirements for
employment, the following criteria must be met when determining the
grade of candidates.

\(1\) **GS-3**

\(a\) **Experience or Education.** None beyond the basic requirements.

\(b\) **Assignment.** Employees at this level serve in dental assistant
career development positions. It is expected that they receive guidance
from more experienced staff members for more complex patient issues, and
require daily close supervision.

\(2\) **GS-4**

\(a\) **Experience or Education.** In addition to the basic
requirements, 1 year of experience at the next lower level, OR 2 years
of education above high school that included completion of a dental
assistant program accredited by the American Dental Association's
Commission on Accreditation. In addition, the candidate must demonstrate
the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of the use, care, and storage of dental
instruments and materials.

[2]{.underline}. Basic knowledge of dental procedures and what the
patient requires during the procedure.

[3]{.underline}. Knowledge of basic oral care.

\(c\) **Assignment.** Employees at this level serve as staff dental
assistants. It is expected that they receive guidance from more
experienced staff members for more complex patient issues and require
daily and direct contact at the site of work from the assigned
supervisor.

\(3\) **GS-5**

\(a\) **Experience or Education**

\(1\) At least 1 year of experience at the next lower grade level that
demonstrates the core competencies described at that level. In addition,
the candidate must demonstrate the following KSAs:

**OR,**

\(2\) Successful completion of a full 4-year course of study that
included or was supplemented by completion of a dental assistant program
by the American Dental Association's Commission on Accreditation.

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of anatomy and radiological techniques,
including safety procedures.

[2]{.underline}. Skills in operating dental radiographic machinery.

[3]{.underline}. Knowledge of instruments, materials and standardized
dental procedures used in all phases of restorative, surgical,
endodontics, and periodontic care.

[4]{.underline}. Basic knowledge of preventive dentistry measures to
instruct patients in proper oral hygiene techniques.

[5]{.underline}. Knowledge of dental laboratory procedures to begin the
laboratory phase.

[6]{.underline}. Basic knowledge of the computerized dental record and
privacy requirements related to the maintenance and restriction of
release of information from the record.

[7]{.underline}. Basic knowledge of Occupational Safety & Health
Administration (OSHA) standards for clinical and laboratory operations.

\(c\) **Assignment.** Employees at this level serve as staff dental
assistants at the full performance level for more route patient care and
perform some complex patient procedures under general supervision of
more experienced dental assistants or dental supervisor.

\(4\) **GS-6**

\(a\) **Experience.** At least 1 year of experience at the next lower
grade level that demonstrates the core competencies described at that
level. In addition, the candidate must demonstrate the technical KSAs
and demonstrate the potential to acquire the assignment specific KSAs
designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of instruments, materials and standardized
dental procedures used in the specialty of oral and maxillofacial
surgery.

[2]{.underline}. Knowledge of anatomy of the oral structures and an
understanding of the surgical procedures performed.

\*[3]{.underline}. Advanced knowledge Occupational Safety & Health
Administration (OSHA) standards for clinical and laboratory operations.

\*[4]{.underline}. For supervisory positions, ability to lead and/or
supervise less experienced dental assistants.

\(c\) **Assignment.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Employees at this level serve in
staff dental assistant positions independently performing more complex
work in assigned specialties while receiving general administrative
supervision, or in lead, or supervisory dental assistant positions.

\(5\) **GS-7**

\(a\) **Experience.** At least 1 year of experience at the next lower
grade level that demonstrates the core competencies described at that
level. In addition, the candidate must demonstrate the technical KSAs
and demonstrate the potential to acquire the assignment specific KSAs
designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of instruments, materials, and procedures
used in all specialties of dentistry.

[2]{.underline}. Knowledge of impression materials and procedures for
impressions.

[3]{.underline}. Knowledge of laboratory procedures, materials, and
methods, including safety and proper handling.

[4]{.underline}. Knowledge of computerized dental patient records
systems, and their application to dental patients, to include approved
abbreviations and the format for completion of progress notes.

\*[5]{.underline}. For supervisory positions, ability to manage
resources, e.g., space, equipment, supplies, personnel, etc.

\(c\) **Assignment.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Employees at this level serve in
lead or supervisory dental assistant assignments. Dental assistants must
be extremely familiar with all specialty procedures including operating
room dental assisting, laboratory procedures, pouring models, making
trays, and provisional restorations. Assignments include advance use of
the computerized dental patient records system to include initiating
patient consults, storing and viewing images, entry of diagnostic data,
setting up for treatment planning and presentation to the patient, and
providing training to staff dental assistants to effectively use the
computerized record system.

**4. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for dental
assistants in VHA whose composite record of accomplishments,
performance, and qualifications, as well as current assignments, warrant
such action based on demonstrated competence to meet the requirements on
the proposed grade.

b\. Under no circumstances will the certification requirements of
radiologic competence be waived.

c\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402; 7403.**

[]{#PartIIAppG37 .anchor}**APPENDIX G37. DENTAL HYGIENIST QUALIFICATION
STANDARD**

**GS-682**

**Veterans Health Administration**

**1. COVERAGE.** The following are requirements for appointment as a
Dental Hygienist in the Veterans Health Administration (VHA). These
requirements apply to all VHA dental hygienists in the General Schedule
(GS)-682 series.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizen of the United States. (Non-citizens may be
appointed when it is not possible to recruit qualified candidates in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Licensure.** Applicants must be currently licensed to practice as
a dental hygienist with a full, current, and unrestricted license in a
State, Territory, or Commonwealth, or the District of Columbia.

c\. **Certification**

\(1\) Public Law 97-35 requires that persons who administer radiologic
procedures meet the credentialing standards in 42 CFR Part 75.
Essentially, they must have successfully completed an educational
program that meets or exceeds the standards described in that
regulation, and is accredited by an organization recognized by the
Department of Education, and be certified as radiographers in their
field.

\(2\) Non-certified applicants who otherwise meet the eligibility
requirements for licensure may be given a temporary appointment as a
graduate Dental Hygienist under the authority of 38 U.S.C. § 7405 (a)
(1) (D). Failure to obtain licensure during that period is justification
for termination of the temporary appointment. This may result in
termination of employment.

\(3\) Certification in basic life support methods is highly desirable.

\(4\) **Loss of Credential.** An employee in this occupation who fails
to obtain licensure/certification/

registration within the required time frame, or who fails to maintain
the required licensure/certification/

registration must be removed from the occupation, which may also result
in termination of employment.

For occupations which [require]{.underline} an active credential
(licensure/certification/registration) at all grade levels, at the
discretion of the appointing official, an employee may be reassigned to
another occupation for which he/she qualifies [if]{.underline} a
placement opportunity exists.  For occupations which require an active
credential (licensure/certification/registration) in assignments above
the full-performance level [only]{.underline}, at the discretion of the
appointing official, an employee may remain at an appropriate lower
grade level in the occupation when both of the following apply:  the
credential is not a requirement [and]{.underline} a placement
opportunity exists.

d\. **Grandfathering Provision.** The following is the standard
grandfathering policy for all Title 38 hybrid qualification standards.
Some of these provisions may not apply to this occupation.  Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but [may not]{.underline} be promoted beyond the journey
level or placed in supervisory or managerial positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

e\. **Physical Requirements.** See VA Directive and Handbook 5019.

f\. **English Language Proficiency.** Dental hygienists must be
proficient in spoken and written English in accordance with chapter 2,
section D, paragraph 5a, this part.

**3. GRADE REQUIREMENTS**

a\. **Definitions**

\(1\) **Creditable Experience**

\(a\) **Knowledge of Current Professional Dental Hygienist Practices.**
To be creditable, the experience must have required the use of
knowledge, skills, abilities, and other characteristics (also referred
to as "core competencies") associated with current professional dental
hygiene practice. Evidence of such experience includes experience in
private practice, or local/state/federal health care facilities.

\(b\) **Quality of Experience.** Experience in private practice and with
local/state/federal health care facilities must be verified with the
practitioner or the supervising officers.

\(c\) **Part-Time Experience.** Part-time experience as a dental
hygienist is credited according to its relationship to full-time
workweek. For example, a dental hygienist would receive 1 week of
full-time credit for each 2 weeks of half-time work.

b\. **Grade Determinations.** In addition to the basic requirements for
employment, the following criteria must be met when determining the
grade of candidates.

\(1\) **GS-4**

\(a\) **Experience.** None beyond the basic requirements.

\(b\) **Assignment.** Employees at this level serve in a dental
hygienist career development position. It is expected that they receive
guidance from more experienced staff members for patient issues, and
require daily close supervision.

\(2\) **GS-5**

\(a\) **Experience or Education.** In addition to the basic
requirements, 1 year of experience at the next lower level,
[OR]{.underline} completion of a 4-year course of study leading to a
bachelor's degree in dental hygiene or in a directly related field of
study. In addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to communicate orally and in writing with a
variety of people from diverse backgrounds.

[2]{.underline}. Knowledge of oral anatomy, physiology, histology,
periodontology, nutrition, pharmacology, microbiology, principles and
techniques of dental hygiene, oral disease etiology, preventive
dentistry, diet counseling, dental instruments, and dental materials.

[3]{.underline}. Knowledge of radiation protection standards devices and
techniques including concepts of accumulated dosage and genetic changes,
effects of radiation on living organisms, and the effects of X-ray
techniques on patient and operator exposure in order to assure that
adequate safeguards are maintained.

\(c\) **Assignment.** Employees at this level serve in a career
development position as staff dental hygienists. It is expected that
they receive relatively less guidance from more experienced staff
members and require daily supervision at the site of work.

\(3\) **GS-6**

\(a\) **Experience.** At least 1 year of experience at the next lower
grade level that demonstrates the core competencies described at that
level. In addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of advanced oral prophylactic, therapeutic,
and preventive procedures in cases or periodontal diseases, or
inflammation, or on patients with other medical and/or dental problems;

[2]{.underline}. Ability to use communication techniques to persuade and
inform individuals and groups; and

[3]{.underline}. Knowledge of dental methods and techniques used in
performing intra and extra oral procedures.

\(c\) **Assignment.** Employees at this level serve as staff dental
hygienists. It is expected that they receive guidance from more
experienced staff members for more complex patient issues and require
daily and direct contact at the site of work from the assigned
supervisor.

\(4\) **GS-7**

\(a\) **Experience.** At least 1 year of experience at the next lower
grade level that demonstrates the core competencies described at that
level. In addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of oral pathology to include disease of the
hard and soft tissues, disorders of tooth structure, developmental and
congenital anomalies, salivary gland disorders, symptoms of infectious
disorders, and appropriate protocols;

[2]{.underline}. Practical knowledge of medical diseases and conditions
such as cancer, HIV, radiation therapy, diabetes, cardiovascular
diseases, bulimia, anorexia, pregnancy, and chronic and degenerative
diseases as they relate to dental health and treatment; and

[3]{.underline}. Knowledge of radiographic exposure techniques in order
to produce radiographs of high diagnostic quality with a minimum of
retakes.

\(c\) **Assignment.** Employees at this level serve as staff dental
hygienists. It is expected that they perform more complex work while
receiving less frequent supervision than at the GS-6 level.

\(5\) **GS-8**

\(a\) **Experience.** At least 1 year of experience at the next lower
grade level that demonstrates the core competencies described at that
level. In addition, the candidate must demonstrate the following KSAs:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of state of the art preventive dentistry
measures for patient instruction and training;

[2]{.underline}. Knowledge of anatomy and physiology in order to
interpret the examination request accurately; to understand the
functioning and interrelationship of the various organs appearing on the
film and the various stages of the examination to judge the
acceptability of the radiograph for diagnostic use; and to correctly
mount them for viewing;

[3]{.underline}. Skill in providing individual and group oral health
care instructions to inpatients, outpatients, Nursing Home Care Unit
patients, etc.; and

[4]{.underline}. Knowledge of VA, Joint Commission on Accreditation of
Healthcare Organizations (JCAHO), Occupational Safety and Health
Administration (OSHA), and related regulations and guidelines pertaining
to dental matters.

\(c\) **Assignment.** Employees at this level serve as staff dental
hygienists at the full performance level, receiving little to no
guidance from more experienced staff members for more complex patient
issues, and require general supervision.

\(6\) **GS-9**

\(a\) **Experience.** At least 1 year of experience at the next lower
grade level that demonstrates the core competencies described at that
level. In addition, the candidate must demonstrate the following
technical KSAs and demonstrate the potential to acquire the assignment
specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Skill in performing specialized prophylactic and
preventive dental hygiene procedures;

[2]{.underline}. Ability to independently perform expanded dental
functions under the technical guidance of a professional dentist;

\*[3]{.underline}. Skill in providing individual and group oral health
care instructions to patients and other staff regarding the practice of
effective oral hygiene techniques; and

\*[4]{.underline}. Skill in presenting oral hygiene lectures and
demonstrations, and developing training materials.

\(c\) **Assignments.** For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time. Candidates at this grade level serve
as (1) staff dental hygienists performing advanced clinical techniques,
or serve as instructors for a dental hygiene program, or (2) in a lead
or supervisory capacity for lower graded dental hygienist and/or dental
assistants. Employees plan, coordinate, and conduct preventive oral
health programs for various patient groups; develop and modify
instructional methods; and develop methods for evaluating the
effectiveness of the preventive dentistry program. Employees work
closely with, and under the general direction of, a dentist or
periodontist.

**4. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for dental
hygienists in VHA whose composite record of accomplishments,
performance, and qualifications, as well as current assignments, warrant
such action based on demonstrated competence to meet the requirements on
the proposed grade.

b\. Under no circumstances will the licensure or certification
requirements of radiologic competence be waived.

c\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**

[]{#PartIIAppG38 .anchor}**APPENDIX G38. BIOMEDICAL ENGINEER
QUALIFICATION STANDARD**

**GS-858**

**Veterans Health Administration**

**1. COVERAGE.** This standard applies to all biomedical engineer
positions in the Veterans Health Administration (VHA). The work requires
the application of engineering concepts and methodology to investigate
problems and phenomena of living systems to advance the understanding of
these systems and improve medical practices; to develop materials,
instruments, diagnostic and therapeutic devices, and other equipment
applicable in the study of life systems and the practice of medicine;
and to improve health service delivery systems for communities and
within individual VA facilities (medical centers, outpatient clinics,
domiciliaries). Biomedical engineering work requires, in addition to
knowledge and skill in engineering disciplines, a background in
physiology and anatomy, and a practical facility in specialized subject
matter areas such as computer applications, electronics, or mathematics.

**2. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizen of the United States. (Non-citizens may be
appointed when it is not possible to recruit qualified citizens in
accordance with chapter 3, section A, paragraph 3g, this part.)

b\. **Education and/or Experience**

\(1\) **Bachelor's degree: Professional engineering.** To be acceptable,
the curriculum must: (a) Be in a school of engineering with at least 1
curriculum accredited by the Accreditation Board for Engineering and
Technology (ABET) as a professional engineering curriculum; or, (b)
Include differential and integral calculus, and courses (more advanced
than first-year physics and chemistry) in 5 of the following 7 areas of
engineering science or physics: (1) statics and/or dynamics; (2)
strength of materials (stress-strain relationships); (3) fluid mechanics
and/or hydraulics; (4) thermodynamics; (5) electrical fields and
circuits; (6) nature and properties of materials (relating particle and
aggregate structure to properties); or (7) any other comparable area of
fundamental engineering science or physics, such as optics, heat
transfer, soil mechanics, or electronics.

**OR,**

\(2\) **Combination of education and experience:** College-level
education, training, and/or technical experience that furnished: \[a\] a
thorough knowledge of the physical and mathematical sciences underlying
professional engineering; and \[b\] a good understanding, both
theoretical and practical, of the engineering sciences and techniques
and their applications to 1 of the branches of engineering. The adequacy
of such background must be demonstrated by 1 of the following:

[1]{.underline}. **Professional registration:** Current registration as
a professional engineer by any State, Territory, Commonwealth of the
United States (e.g., Puerto Rico), or the District of Columbia. Absent
other means of qualifying under this standard, those applicants who
achieved such registration by means other than a written test (e.g.,
State grandfather or eminence provisions) are eligible only for
positions that are within or closely related to the specialty field of
their registration. For example, an applicant who attains registration
through a State board\'s eminence provision as a manufacturing engineer
typically would not be rated eligible for biomedical engineering
positions.

[2]{.underline}. **Written Test:** Evidence of having successfully
passed the Engineer-in-Training (EIT) examination, or the written test
required for professional registration, which is administered by the
Boards of Engineering Examiners of a State, Territory, Commonwealth of
the United States (e.g., Puerto Rico), or the District of Columbia.

Applicants who have passed the EIT examination and have completed all
the requirements for either \[a\] a bachelor\'s degree in engineering
technology (BET) from an accredited college of university that included
60 semester hours of courses in the physical, mathematical, and
engineering sciences, OR, \[b\] a BET from a program accredited by the
Accreditation Board for Engineering and Technology (ABET) may be rated
eligible for certain engineering positions at GS-5. Eligibility is
limited to positions that are within, or closely related to, the
specialty field of the engineering technology program. Applicants for
positions that involve highly technical research, development, or
similar functions requiring an advanced level of competence in basic
science must meet the basic requirements in paragraph 2.b.(1).

Because of the diversity in kind and quality of BET programs, graduates
of other BET programs are required to complete at least 1 year of
additional education or highly technical work experience of such nature
as to provide reasonable assurance of the possession of the knowledge,
skills, and abilities required for professional engineering competence.
The adequacy of this background must be demonstrated by passing the EIT
examination.

[3]{.underline}. **Specified academic courses:** Successful completion
of at least 60 semester hours of courses in the physical, mathematical,
and engineering sciences and in engineering that included the courses
specified in the basic requirements. The courses must be fully
acceptable toward meeting the requirements of a professional engineering
curriculum as described in paragraph 2.b(1).

[4]{.underline}. **Related curriculum.** Successful completion of a
curriculum leading to a bachelor\'s degree in engineering technology or
in an appropriate professional field, e.g., physics, chemistry,
architecture, computer science, mathematics, hydrology, or geology, may
be accepted in lieu of a degree in engineering, provided the applicant
has had at least 1 year of professional engineering experience acquired
under professional engineering supervision and guidance. Ordinarily,
there should be either an established plan of intensive training to
develop professional engineering competence, or several years of prior
professional engineering-type experience, e.g., in interdisciplinary
positions. (The above examples of related curricula are not
all-inclusive.)

c\. **Grandfathering Provision**. The following is the standard
grandfathering policy for all Title 38 hybrid qualification standards.
Some of these provisions may not apply to this occupation. Please
carefully review the qualification standard to determine the specific
education and/or licensure/certification/ registration requirements that
apply to this occupation.

[]{.mark}

All persons employed in VHA in this occupation on the effective date of
this qualification standard are considered to have met all qualification
requirements [for the title, series and grade held]{.underline},
including positive education and licensure/certification/registration
that are part of the basic requirements of the occupation. For employees
who do not meet all the basic requirements required in this standard,
but who met the qualifications applicable to the position at the time
they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a
licensure/certification/registration, may be reassigned, promoted, or
demoted within the occupation.

Such employees in an occupation that [requires]{.underline} a
licensure/certification/registration, may be reassigned, promoted up to
and including the full performance (journey) level, or demoted within
the occupation, but [may not]{.underline} be promoted beyond the journey
level or placed in supervisory or managerial positions.

Such employees in an occupation that requires a
licensure/certification/registration only at higher grade levels must
meet the licensure/certification/registration requirement before they
can be promoted to those higher grade levels.

Employees who are appointed on a temporary basis prior to the effective
date of the qualification standard may not have their temporary
appointment extended or be reappointed, on a temporary or permanent
basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently
obtain additional education and/or licensure/certification/registration
that meet all the basic requirements of this qualification standard must
maintain the required credentials as a condition of employment in the
occupation.

If an employee who was retained in an occupation listed in 38 U.S.C. §
7401(3) under this provision leaves that occupation, the employee loses
protected status and must meet the full VA qualification standard
requirements in effect at the time of reentry to the occupation.

d\. **Physical Requirements.** See VA Directive and Handbook 5019.

e\. **English Language Proficiency.** Biomedical engineers must be
proficient in spoken and written English in accordance with chapter 2,
section D, paragraph 5a, this part.

**3. GRADE REQUIREMENTS**

a\. **Definitions**

\(1\) **Professional Engineering Experience**

\(a\) Professional knowledge of engineering is defined as the
comprehensive, in depth, knowledge of mathematical, physical, and
engineering sciences applicable to a specialty field of engineering that
characterizes a full 4-year professional engineering curriculum leading
to a bachelor\'s degree, or the equivalent.

\(b\) Professional ability to apply engineering knowledge is defined as
the ability to:

[1]{.underline}. Apply fundamental and diversified professional
engineering concepts, theories, and practices to achieve engineering
objectives with versatility, judgment, and perception;

[2]{.underline}. Adapt and apply methods and techniques of related
scientific disciplines; and

[3]{.underline}. Organize, analyze, interpret, and evaluate scientific
data in the solution of engineering problems.

\(2\) **Part-time Experience.** Part-time experience as a professional
biomedical engineer is credited according to its relationship to a
full-time workweek. For example, a biomedical engineer would receive 1
week of full-time credit for each 2 weeks of half-time work.

b\. **Grade Determinations.** In addition to the basic requirements for
employment, the following criteria must be met when determining the
grade of candidates.

\(1\) **GS-5**

\(a\) **Experience.** None beyond the basic requirements. Meeting these
requirements should demonstrate the following:

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of, and ability to apply, the principles,
theories, concepts, and practices of the engineering profession.

[2]{.underline}. Skill to effectively communicate both orally and in
writing with a wide variety of individuals, including communicating
highly technical information.

[3]{.underline}. Knowledge of, and ability to interpret and apply,
relevant codes, regulations, guidelines, and standards associated with
engineering.

[4]{.underline}. Ability to analyze organizational and operational
problems and develop timely and economical solutions.

[5]{.underline}. Ability to keep abreast of changes in technology and to
utilize information gained in the solution of engineering problems.

\(c\) **Assignment.** Employees at this grade level serve in career
development positions.

\(2\) **GS-7**

\(a\) **Experience.** In addition to the basic requirements, 1 year of
experience equivalent to the next lower level. In addition, the
candidate must demonstrate the following KSAs:

**OR,**

\(b\) **Advanced Entry Level Placement.** See VA Handbook 5005, Appendix
G.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Ability to prepare written and graphic presentations
for other technical staff including technicians and other junior
engineers.

[2]{.underline}. Knowledge of relevant codes, regulations, guidelines,
and standards.

[3]{.underline}. Ability to learn organizational concepts to meet
operational needs.

[4]{.underline}. Ability to learn new technology and identify changes
and trends for presentation to other technical staff.

\(d\) **Assignment.** Employees at this level are in career development
positions with the close supervision of higher-level biomedical
engineers.

\(3\) **GS-9**

\(a\) **Experience.** At least 1 year of specialized experience
equivalent to the next lower level. In addition, the candidate must
demonstrate the following KSAs:

**OR,**

\(b\) **Education.** Education equivalent to 2 full years of
progressively higher level graduate education or master's or equivalent
graduate degree in a field of engineering , e.g., biomedical
engineering, general engineering, mechanical engineering, etc., provided
the applicant's total background demonstrates the core competencies for
GS-9 level assignment.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of the principles, theories, concepts, and
practices of the biomedical engineering profession.

[2]{.underline}. Knowledge of relevant codes, regulations, guidelines,
and standards, and the ability to make recommendations to assure
compliance with medical center programs.

[3]{.underline}. Knowledge of organizational concepts and an
understanding of the operational needs of other administrative hospital
services.

[4]{.underline}. Ability to prepare material on current technical topics
and trends for presentation to other technical staff and mid-level
hospital management, and the ability to keep abreast of changes in
technology.

\(d\) **Assignment.** Employees at this level complete technical
assignments in the engineering field as assigned by senior engineers,
and will be required to rotate through, and participate in, the
operations of other administrative hospital services. At the GS-9 level,
employees will function at a more independent level with oversight by a
supervisor for more complex assignments.

\(4\) **GS-11**

\(a\) **Experience.** At least 1 year of experience equivalent to the
next lower level. In addition, the candidate must demonstrate the
following KSAs:

**OR,**

\(b\) **Education.** Three full years of progressively higher-level
graduate education or a Ph.D. or equivalent doctoral degree in
biomedical engineering or a related engineering field, provided the
applicant's total background demonstrates evidence of knowledge, skills,
and abilities necessary to perform the work of the position to be
filled.

\(c\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of an equipment management program that meets
current Joint Commission on the Accreditation of Health Care
Organizations (JCAHO) and National Fire Protection Association (NFPA)
requirements.

[2]{.underline}. Ability to develop material for a continuing education
program for clinical staff that addresses the principles and application
of medical instrumentation used in the delivery of healthcare.

[3]{.underline}. Ability to advise clinical and administrative staff on
emerging medical engineering technology, while keeping abreast of
changes in such technology, and utilizing the information to solve
biomedical engineering problems.

\(d\) **Assignment.** At this level, employees will function on an
independent basis at the full performance level; will participate in
medical device hazard investigations to assure compliance with patient
safety goals, the Safe Medical Devices Act (SMDA), and JCAHO
requirements; and will assist in the development of an equipment
management program at the medical center. At this level, employees may
assist in clinical research projects in the biomedical engineering
field.

\(5\) **GS-12**

\(a\) **Experience.** Completion of at least 1 year of specialized
experience equivalent to the next lower level; or completion of a
post-doctoral research fellowship in the field of biomedical
engineering, and must fully meet the KSAs at that level. In addition,
the candidate must demonstrate the following professional KSAs and
demonstrate the potential to acquire the assignment specific KSAs
designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

\*1. Ability to conduct an equipment management program that meets
current JCAHO and NFPA requirements.

\*[2]{.underline}. Ability to develop a curriculum for a continuing
education program that addresses the safe and effective use of medical
equipment and/or technology.

\*[3]{.underline}. Ability to manage a recall and safety alert program
for medical devices including medical device hazard investigations to
assure compliance with patient safety goals, SMDA, and JCAHO
requirements.

[4]{.underline}. Skill in advising clinical and administrative staff on
medical engineering technology, including existing and emerging
technology and which addresses viability, long-term suitability,
compatibility, and/or safety.

\*[5]{.underline}. Ability to analyze organizational and operational
problems and recommend timely and economical solutions involving medical
equipment spanning initial concept, installation, and effective
implementation of complex medical equipment.

\(d\) **Assignment.** At this level, employees may be in non-supervisory
or supervisory positions. For all assignments above the full performance
level, the higher-level duties must consist of significant scope,
complexity (difficulty), and range of variety, and be performed by the
incumbent at least 25% of the time.

[1]{.underline}. **Biomedical Engineer (Clinical).** Non-supervisory
employees support and advance patient care by applying engineering and
managerial skills to healthcare technology as demonstrated by at least 3
of the following major responsibilities:

[a]{.underline}. Conducting an equipment management program that meets
current JCAHO and NFPA requirements. The breadth of technology is less
than is typically present at a tertiary care and/or
university-affiliated institution.

[b]{.underline}. Assuring the provision of a continuing education
program for clinical staff addressing the principles and application of
medical instrumentation used in the delivery of healthcare. This
requires skill to effectively communicate, both orally and in writing,
with a wide variety of individuals, including technical and professional
clinical staff, to communicate technical information.

[c]{.underline}. Managing a recall and safety alert program for medical
devices, including medical device incident investigations to assure
compliance with patient safety goals, SMDA, and JCAHO requirements.

[d]{.underline}. Advising clinical and administrative staff on medical
engineering technology including existing and emerging technology
addressing viability, long-term suitability, compatibility, and/or
safety while keeping abreast of changes in technology and utilizing
information gained in the solution of biomedical engineering problems.

[e]{.underline}. Assisting with capital asset and infrastructure
planning for medical equipment spanning initial concept, installation,
and effective implementation of complex medical equipment.

[f]{.underline}. Functioning as the subject matter expert in the field
of biomedical engineering who directly supports specialized clinical
technology including service, system administration, training, and
quality assurance at a medical center.

[2]{.underline}. **Supervisory Biomedical Engineer.** The supervisory
biomedical engineer is responsible for the professional and
administrative management of a biomedical engineering section in a
facility with complexity equal to a secondary care facility. Such
individuals typically have responsibility for supervising technical
staff including lower level engineers, biomedical engineering
technicians, and other staff. The range of supervisory responsibility
includes development of performance standards and performance
evaluations; recommendations for appointments, awards, advancements, and
when appropriate, disciplinary

actions; and identification of continuing training needs; etc. The
supervisory biomedical engineer is responsible for financial management
of budget resources allocated to support quality assurance, and
maintenance activities necessary to assure the facility medical
equipment inventory is available for patient care activities. In
addition to the core competencies for GS-12 level positions, the
candidate must demonstrate the following professional KSAs and
demonstrate the potential to acquire the assignment specific KSAs
designated by an asterisk (\*):

[a]{.underline}. Ability to organize work, set priorities, delegate
tasks, and meet multiple deadlines.

[b]{.underline}. Skill in managing and directing the work of others to
accomplish programs goals and objectives.

\*[c]{.underline}. Ability to translate management goals and objectives
into well-coordinated and controlled biomedical work operations.

[d]{.underline}. Ability to deal effectively with individuals or groups
representing widely divergent backgrounds, interests, and points of
view.

\(6\) **GS-13**

\(a\) **Experience.** Completion of at least 1 year of experience
equivalent to the next lower level, and must fully meet the KSAs at that
level. In addition, the candidate must demonstrate the following
professional KSAs and potential to acquire the assignment specific KSAs
designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

\*[1]{.underline}. Ability to conduct capital asset and infrastructure
planning for medical equipment spanning initial concept, installation,
and effective implementation of complex medical equipment.

\*[2]{.underline}. Knowledge of the most complex and specialized
clinical technology including service, system administration, training,
and quality assurance.

[3]{.underline}. Expert knowledge of, and the ability to interpret and
apply, complex codes, regulations, guidelines, and standards associated
with the biomedical engineering field.

\(c\) **Assignment.** At this level, employees may be in
non-supervisory, supervisory, or research positions. For all assignments
above the full performance level, the higher-level duties must consist
of significant scope, complexity (difficulty), and range of variety, and
be performed by the incumbent at least 25% of the time.

[1]{.underline}. **Biomedical Engineer (Clinical):** Supports and
advances patient care by applying engineering and managerial skills to
healthcare technology as demonstrated by at least 4 of the following
major responsibilities:

[a]{.underline}. Responsibility for an equipment management program that
meets current JCAHO and NFPA requirements. The breadth of technology is
typical of a tertiary care and/or university-affiliated institution.

[b]{.underline}. Assures provision of a continuing education program for
clinical staff addressing the principles and application of medical
instrumentation used in the delivery of health care. This includes a
curriculum that addresses the safe and effective use of medical
equipment and/or technology.

[c]{.underline}. Manages a recall and safety alert program for medical
devices, including medical device incident investigations to assure
compliance with patient safety goals, SMDA, and JCAHO requirements.

[d]{.underline}. Serves as advisor to senior clinical and leadership
staff on medical engineering technology (including existing and emerging
technology) addressing viability, long-term suitability, compatibility,
and/or safety.

[e]{.underline}. Conducts capital asset and infrastructure planning for
medical equipment spanning initial concept, installation, and effective
implementation of complex medical equipment.

[f]{.underline}. Serves as institutional expert who directly supports
the most complex and specialized clinical technology including service,
system administration, training, and quality assurance.

[2]{.underline}. **Supervisory Biomedical Engineer (Clinical).** The
supervisory biomedical engineer (clinical) is responsible for the
professional and administrative management of a biomedical engineering
section in a tertiary care and/or university-affiliated facility. Such
individuals typically have responsibility supervising technical staff
including lower level engineers, biomedical engineering technicians, and
other staff. The range of supervisory responsibility includes
development of performance standards and performance evaluations;
recommendations for appointments, awards, advancements, and when
appropriate, disciplinary actions; and identification of continuing
training needs; etc. The supervisory biomedical engineer (clinical) is
responsible for financial management of budget resources allocated to
support quality assurance, and maintenance activities necessary to
assure the facility medical equipment inventory is available for patient
care activities. In addition to the core competencies for GS-13 level
positions, the supervisory biomedical engineer (clinical) must
demonstrate the following professional KSAs and potential to acquire the
assignment specific KSAs designated by an asterisk (\*):

[a]{.underline}. Ability to initiate new ideas and approaches, and
demonstrate resourcefulness.

\*[b]{.underline}. Ability to manage resources, i.e., space, equipment,
supplies, staff, at the local level.

\*[c]{.underline}. Ability to draft and/or recommend local policies
and/or directives.

[d]{.underline}. Skill in managing a biomedical engineering program at
the local level.

[3]{.underline}. **Biomedical Engineer (Research).** The biomedical
engineer (research) is responsible for conducting biomedical research
involving significant engineering concepts and applications as an
investigator; serving as senior author in the preparation of manuscripts
published in peer-reviewed archival journals; serving as principal
investigator on competitive research proposals for funding by Federal
and non-Federal peer reviewed sources; and disseminating research
findings at the local facility, and interacting with clinicians and
clinical biomedical engineers. In addition to the core competencies for
the GS-13 level, the biomedical engineer (research) must demonstrate the
following professional KSAs and potential to acquire the assignment
specific KSAs designated by an asterisk (\*):

[a]{.underline}. Knowledge of, and ability to apply, appropriate
scientific methods in the design and execution of basic and applied
research in the field of biomedical engineering.

[b]{.underline}. Ability to coordinate work across multiple settings,
e.g., medical centers, universities.

[c]{.underline}. Ability to convey scientific biomedical engineering
concepts and methodology to individuals with diverse levels of technical
expertise.

\(7\) **GS-14**

\(a\) **Experience.** Completion of at least 1 year of experience
equivalent to the next lower level, and must fully meet the KSAs at that
level. In addition, the candidate must demonstrate the following
professional KSAs and demonstrate the potential to acquire the
assignment specific KSAs designated by an asterisk (\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Advanced knowledge of, and ability to interpret and
apply, relevant codes, regulations, guidelines, and standards associated
with biomedical engineering to support the needs of 1 or more facility.

[2]{.underline}. Ability to effectively communicate both orally and in
writing with a wide variety of individuals, including technical and
professional clinical staff, to convey highly technical information.

\*[3]{.underline}. Ability to manage a recall and safety alert program
for medical devices, medical device incident investigations to assure
compliance with patient safety goals, SMDA, and JCAHO requirements.

\*[4]{.underline}. Advanced knowledge of, and ability to apply, the
principles, theories, concepts, and practices of biomedical engineering.
This would include the ability to keep abreast of changes in technology
and utilize the information gained in the solution of biomedical
engineering problems to meet operational needs.

\*[5]{.underline}. Ability to directly support the most complex and
specialized clinical technology including service, system
administration, training, and quality assurance.

\(c\) **Assignment.** At this level, employees may be in
non-supervisory, supervisory, or research positions. For all assignments
above the full performance level, the higher-level duties must consist
of significant scope, complexity (difficulty), and range of variety, and
be performed by the incumbent at least 25% of the time.

[1]{.underline}. **Biomedical Engineer (Clinical).** Supports and
advances patient care by applying engineering and managerial skills to
healthcare technology as demonstrated by at least 4 of the following
major responsibilities:

[a]{.underline}. Conducts an equipment management program that meets
current JCAHO and NFPA requirements. The breadth of technology is
typical of a tertiary care and/or university-affiliated institution.
Evaluates other programs in the Veterans Integrated Service Network
(VISN), or for the national program office.

[b]{.underline}. Assures provision of a continuing education program for
professional staff addressing the principles and application of medical
instrumentation used in the delivery of healthcare. This includes a
curriculum that addresses the safe and effective use of medical
equipment and/or technology. Provides continuing education beyond the
facility including the VISN and/or the national program office, or
teaches at a higher learning institution.

[c]{.underline}. Manages a recall and safety alert program for medical
devices, including medical device incident investigations to assure
compliance with patient safety goals, SMDA, and JCAHO requirements.
Analyzes recall and safety alert programs for other medical centers
and/or conducts medical equipment investigations for the VISN or
national program office.

[d]{.underline}. Serves as advisor to senior clinical and leadership
staff on medical technology, including existing and emerging technology,
addressing viability, long-term suitability, compatibility, and/or
safety. Serves as technology advisor to assist VISN with technology
management and assessment.

[e]{.underline}. Conducts capital asset and infrastructure planning for
medical equipment spanning initial concept, installation, and effective
implementation of complex medical equipment. Participates at the VISN
and/or national level with capital asset planning. Analyzes
organizational and operational problems and develops timely and
economical solutions to meet facility, VISN, and/or national needs.

[f]{.underline}. Serves as institutional expert who directly supports
the most complex and specialized clinical technology including service,
system administration, training, and quality assurance for multiple
sites.

[2]{.underline}. **Supervisory Biomedical Engineer (Clinical).** The
supervisory biomedical engineer (clinical) is responsible for the
professional and administrative management of a biomedical engineering
section in a facility with complexity equal to a tertiary care and/or
university-affiliated facility. Such individuals typically have
responsibility for supervising technical staff including engineers,
biomedical engineering technicians, and other technical staff. The range
of supervisory responsibility includes development of performance
standards and performance evaluations; recommendations for appointment,
awards, advancements, and when appropriate, disciplinary actions; and
identification of continuing training needs; etc. At this level, the
supervisor is responsible for financial management of budget resources
allocated to support quality assurance and maintenance activities
necessary to assure the facility medical equipment inventory is
available for patient care activities.

At this level the supervisory biomedical engineer (clinical), is
assigned oversight responsibility to establish operating policy for
other professional engineers at the facility and/or other professional
engineers in the VISN. In addition to the core competencies for the
GS-14 level, the supervisory biomedical engineer (clinical) must
demonstrate the following professional KSAs and potential to acquire the
assignment specific KSAs designated by an asterisk (\*):

[a]{.underline}. Skill in interpersonal relationships including conflict
resolution.

\*[b]{.underline}. Ability to work collaboratively with other
disciplines, upper management, VHA Central Office, and/or VISN level
staff.

\*[c]{.underline}. Ability to implement national policies.

[d]{.underline}. Ability to develop and recommend new or revised
policies that are consistent with organizational goals and objectives.

[3]{.underline}. **Biomedical Engineer (Research).** At this level, the
biomedical engineer (research) designs and supervises biomedical
research projects including the assembly and supervision of an
investigative team; has a record of publication as senior author on
manuscripts published in peer-reviewed archival journals; participates
in the peer-review of manuscripts in archival journals; has a record of
funded competitive research proposals by Federal or non-Federal
peer-reviewed sources; disseminates research findings at the VISN,
national, and international level; and participates in the mentorship
and training of junior researchers and investigators. In addition to the
core competencies for the GS-14 level, the biomedical engineer
(research) must demonstrate the following professional KSAs and
potential to acquire the assignment specific KSAs designated by an
asterisk (\*):

[a]{.underline}. Ability to provide formal clinical, research, and/or
educational consultation to multidisciplinary staff.

[b]{.underline}. Knowledge of the legal, ethical, and professional
standards applicable to clinical research in the field of biomedical
engineering.

\*[c]{.underline}. Knowledge of budget control procedures that including
funding from multiple sources and may vary annually.

\(8\) **GS-15.** The Under Secretary for Health, or designee, may
approve the assignment of a biomedical engineer at the GS-15 level when
the composite record of qualifications, scope, and complexity of the
assignment justify such action.

\(a\) **Experience.** Completion of at least 1 year of experience
equivalent to the next lower level, and must fully meet the KSAs at that
level. In addition, the candidate must demonstrate the following
professional KSAs and potential to acquire the assignment specific KSAs
designated by an asterisk(\*):

\(b\) **Demonstrated Knowledge, Skills, and Abilities**

[1]{.underline}. Knowledge of, and ability to interpret and apply,
relevant codes, regulations, guidelines, and standards associated with
biomedical engineering to establish criteria on a national basis for
biomedical engineering programs.

[2]{.underline}. Ability to effectively communicate, both orally and in
writing, on technical information with a wide variety of individuals
including senior VHA managers.

\*[3]{.underline}. Knowledge of, and ability to apply, the principles,
theories, concepts, and practices of the biomedical engineering
profession to establish a national recall and safety alert program,
and/or conduct medical equipment investigations for the national program
office.

\(c\) **Assignment.** At this level, employees may be in
non-supervisory, supervisory, or research positions. For all assignments
above the full performance level, the higher-level duties must consist
of significant scope, complexity (difficulty), and range of variety, and
be performed by the incumbent at least 25% of the time.

[1]{.underline}. **Biomedical Engineer (Clinical).** The biomedical
engineer (clinical) supports and advances patient care by applying
engineering and managerial skills to healthcare technology as
demonstrated by the following major responsibilities:

[a]{.underline}. Establishes national criteria for conduct of an
equipment management program that meets current JCAHO and NFPA
requirements; manages a national center for engineering programs that
provides solutions to medical technology and biomedical engineering
issues; or conducts a multi-medical center equipment management program
and serves as a national expert in biomedical engineering and evaluates
other programs in the VISN or for the national program office.

[b]{.underline}. Assures provision of a continuing education program for
professional staff addressing the principles and application of medical
instrumentation used in the delivery of healthcare. This includes a
curriculum that addresses the safe and effective use of medical
equipment and/or technology. Develops and organizes training for the
VISN and national level for professional engineering, and other medical
center staff as appropriate on engineering topics.

[c]{.underline}. Establishes a national recall and safety alert program
for medical devices, including medical device incident investigations,
consistent with patient safety goals and compliant with SMDA and JCAHO
requirements; or analyzes recall and safety alert programs for multiple
medical centers and conducts medical equipment investigations for the
VISN as well as high profile medical equipment investigations for the
national program office.

[d]{.underline}. Works with clinical programs at the national level to
identify medical equipment needs and priorities, and determine
maintenance and quality assurance requirements. Participates in
technology assessment activities for the Under Secretary for Health; or
serves as advisor to senior clinical and leadership staff on medical
engineering technology (including existing and emerging technology) for
multiple sites addressing viability, long-term suitability,
compatibility, and/or safety. Participates in technology assessment to
support national program office requirements.

[e]{.underline}. Represents VHA capital asset and infrastructure
planning for medical equipment at the national level. Reviews all
requests for major medical equipment systems to assure they meet
economic and workload requirements established by VA and good clinical
practice; or reviews VISN requests for major medical equipment systems
to assure they meet VISN economic and workload requirements, and assists
with capital asset review at the national level.

[2]{.underline}. **Biomedical Engineer (Research).** At this level the
biomedical engineer (research) assembles, maintains, and guides
broad-based research efforts involving multiple independently funded
investigators; maintains a competitive publication record achieving
national and/or international recognition for research accomplishments;
serves as a principal investigator on multiple research projects funded
by Federal and/or non-Federal sources; serves as a principal
investigator on programs or center research proposals for funding by
Federal or non-Federal peer-reviewed sources; designs and supervises a
mentoring and career develop-ment program for junior researchers and
investigators; and participates in editorial decisions or serves on the
editorial board of an archival journal, and/or is involved in research
grant proposal peer-review and/or in regional or national research
policy development. An employee achieving the academic rank at the full
professor level at an affiliated university's promotion and tenure
committee may demonstrate this

recognition. In addition to the core competencies for the GS-15 level,
the biomedical engineer (research)

must demonstrate the following professional KSAs and potential to
acquire the assignment specific KSAs designated by an asterisk (\*):

[a]{.underline}. Ability to balance responsibilities in an extremely
complex environment and to work with great autonomy.

\*[b]{.underline}. Ability to independently create, organize, manage,
and maintain high-quality research programs.

\*[c]{.underline}. Knowledge of budget control procedures that include
funding from multiple sources which may vary annually.

**4. DEVIATIONS**

a\. The appointing official may, under unusual circumstances, approve
reasonable deviations to the grade determination requirements for
biomedical engineers in VHA whose composite record of accomplishments,
performance, and qualifications, as well as current assignments, warrant
such action based on demonstrated competence to meet the requirements of
the proposed grade.

b\. The placement of individuals in grade levels not described in this
standard must be approved by the Under Secretary for Health, or
designee, in VHA Central Office.

**Authority: 38 U.S.C. §§ 7402, 7403.**\]