148 lines
4.9 KiB
Mathematica
148 lines
4.9 KiB
Mathematica
DVBCWAH1 ;ALB/CMM A&A OR HOUSEBOUND WKS TEXT - 1 ; 7 MARCH 1997
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;;2.7;AMIE;**12**;Apr 10, 1995
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;
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;
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TXT ;
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;;NARRATAIVE: Once the existence of at least a single disability rated
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;;at 100% has been established, additional benefits may be payable if
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;;the veteran requires:
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;;
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;; 1. The regular assistance of another person in attending to the
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;; ordinary hazards of daily living.
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;; 2. Assistance of another in protecting himself or herself from
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;; the ordinary hazards of his or her daily environment, and/or
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;; 3. If the veteran is restricted to his or her home or the immediate
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;; vicinity thereof, including the ward or immediate clinical
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;; area, if hospitalized.
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;;
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;;
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;;A. Review Of Medical Records:
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;;
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;;
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;;B. Medical History (Subjective Complaints):
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;;
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;; 1. Indicate whether or not the veteran requires an attendant in
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;; reporting for this exam, and if so, identify the nurse or attendant
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;; and the mode of travel employed.
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;;
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;;
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;; 2. Indicate whether or not the veteran is hospitalized, and if so,
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;; state where and the date of admission.
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;;
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;;
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;; 3. Indicate whether or not the veteran is permanently bedridden.
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;;
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;;
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;; 4. Indicate whether of not the veteran's best corrected vision is
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;; 5/200 or worse in both eyes.
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;;
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;;
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;; 5. State whether the veteran is capable of managing benefit patments
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;; in his or her own best interests without restriction. (A physical
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;; disability which prevents the veteran from attending to financial
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;; matters in person is not a proper basis for a finding of incompetency
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;; unless he or she is, by reason of that disability, incapable or
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;; directing someone else in handling financial affairs.)
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;;
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;;
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;; 6. Capacity to protect oneself from the hazards/dangers of daily
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;; environment:
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;;
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;; a. Describe briefly any pathological processes involving other
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;; body parts and systems, including the effects of advancing
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;; age, such as dizziness, bowel/bladder incontinence, loss of
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;; memory, poor balance affecting ability to ambulate, performing
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;; self-care, or travel beyond the premises of the home (or the
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;; ward or clinical area if hospitalized).
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;;
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;;
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;; b. Describe where the veteran goes and what he or she does
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;; during a typical day.
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;;
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;;
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;;C. Physical Examination (Objective Findings):
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;;
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;; Comment on:
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;; 1. General Appearance.
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;;
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;;
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;; 2. Height and weight (including maximum and minimum weight for past year.
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;;
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;;
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;; 3. Build and posture.
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;;
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;;
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;; 4. State of nutrition.
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;;
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;;
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;; 5. Gait.
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;;
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;;
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;; 6. Temperature, pulse, respiration.
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;;
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;;
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;; 7. Blood Pressure.
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;;
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;;
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;; 8. Upper extremities (reporting each upper extremity separately):
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;;
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;; a. Describe functional restrictions with reference to
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;; strength and coordination and ability for self-feeding,
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;; fastening clothing, bathing, shaving, and toileting.
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;;
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;;
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;; b. If amputated, indicate level of amputation (or length of
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;; stump and whether or not use of a prosthesis is feasible).
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;;
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;; 9. Lower extremities (reporting each lower extremity separately):
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;;
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;; a. Describe functional restrictions with reference to extent
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;; of limitation of motion, muscle atrophy, contractures,
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;; weakness, lack of coordination, or other interference.
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;;
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;;
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;; b. Indicate any deficits of weight bearing, balance, and propulsion.
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;;
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;;
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;; c. If amputated, indicate level of amputation (or length of
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;; stump and whether use of a prosthesis is feasible).
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;;
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;;
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;; 10. Spine, trunk and neck:
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;; Describe any limitation of motion or deformity of lumbar,
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;; thoracic, and cervical spine.
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;;
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;;
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;; 11. Note if deformity of thoracic spine interferes with breathing.
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;;
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;;
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;; 12. Ambulation:
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;;
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;; a. Indicate whether the veteran is able to walk without the
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;; assistance of another person and give the maximum distance.
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;;
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;;
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;; b. Indicate any mechanical aid used or recommended by the examiner.
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;;
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;;
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;; c. Indicate the frequency, and under what circumstances, the
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;; veteran is able to leave the home or immediate premises.
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;;
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;; 13. Except as to amputations and other anatomical losses, indicate
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;; if any restrictions noted in the examination are permanent.
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;;
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;;
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;;D. Diagnostic and Clinical Tests:
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;;
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;; 1. No specific diagnostic testing required unless required to evaluate
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;; the veteran as required above.
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;; 2. Include results of all diagnostic and clinical tests conducted
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;; in the examination report.
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;;
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;;
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;;E. Diagnosis:
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;;
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;;
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;;Signature: Date:
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;;END
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