VistA-WorldVistAEHR/r/AUTOMATED_MED_INFO_EXCHANGE.../DVBCWPT2.m

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DVBCWPT2 ;ALB/CMM PTSD WKS TEXT - 2 ; 6 MARCH 1997
;;2.7;AMIE;**12**;Apr 10, 1995
;
;
TXT ;
;;TOF
;;E. Diagnosis:
;;
;; Provide:
;; 1. The diangosis must conform to DSM-IV and be supported by the
;; findings on the examination report.
;; 2. If the diagnosis is changed, explain fully whether the new
;; diagnosis represents a progression of the prior diagnosis or
;; development of a new and separate condition.
;; 3. If there are multiple mental disorders, delineate, to the
;; extent possible, the symptoms associated with each and a
;; discussion of relationship.
;; 4. Evaluation is based on the effects of the signs and symptoms
;; on occupational and social functioning.
;;
;; NOTE: VA is prohibited by statute from paying compensation for a
;; disability that is a result of the veteran's own ALCOHOL OR DRUG
;; ABUSE, whether based on direct service connection, secondary service
;; connection, or aggravation by a service-connected condition.
;; Therefore, when alcohol or drug abuse accompanies or is associated
;; with another mental disorder, separate, to the extent possible, the
;; effects of the alcohol or drug abuse from the effects of the other
;; mental disorder(s). If it is not possible to separate the effects,
;; explain why.
;;
;;F. Global Assessment or Functioning (GAF):
;;
;; NOTE: The complete multi-axial format as specified by DSM-IV may
;; be required for REMAND or specifically requested by the rating
;; specialist. If so, include the GAF, whether it refers to current
;; functioning over the past year, etc.
;;
;; If multiple Axis I or Axis II diagnoses exist, attempt to the
;; extent possible, to provide a GAF score on service connected
;; conditions alone as well as a separate GAF score based on all
;; mental disorders present and explain and discuss your rationale.
;; (See the above note pertaining to alcohol or drug abuse, the
;; effects of which cannot be used to assess the effects of a
;; service-connected condition). If unable to separate
;; symptomatology, explain why.
;;
;; DSM-IV is only for application from 11/7/96 on. Therefore, when
;; applicable, note whether the diagnosis of PTSD was supportable under
;; DSM-III-R prior to that date. The prior criteria under DSM-III-R
;; are provided as an attachment.
;;
;;Signature: Date:
;;
;;TOF
;;Attachment A
;;
;;Historical DSM-III-R Diagnostic criteria for PTSD
;;
;;A. The veteran has experienced an event that is outside the range of
;; usual human experience and that would be markedly distressing to
;; almost anyone (e.g., serious threat to one's life or physical
;; integrity; serious threat to one's children, spouse, or other
;; close relatives and friends; sudden destruction of one's home or
;; community; seeing another person who has recently been seriously
;; injured or killed as the result of an accident or physical violence).
;;
;;B. The traumatic event is persistently re-experienced in at least one
;; of the following ways:
;;
;; 1. Recurrent and intrusive distressing recollections of the event.
;; 2. Recurrent distressing dreams of the event.
;; 3. Sudden acting or feeling as if the traumatic event were recurring
;; (includes a sense of reliving the experience, illusions,
;; hallucinations and dissociative [flashback] episodes, even
;; those that occur upon waking or when intoxicated).
;; 4. Intense psychological distress at exposure to events that
;; symbolize or resemble an aspect of the traumatic event, including
;; anniversaries of the trauma.
;;
;;C. Persistent avoidance of stimuli associated with the trauma or
;; numbing of general responsiveness (not present before the trauma),
;; as indicated by at least three of the following:
;;
;; 1. Efforts to avoid thoughts or feelings associated with the trauma.
;; 2. Efforts to avoid activities or situations that arouse
;; recollections of the trauma.
;; 3. Inability to recall an important aspect of the trauma
;; (psychogenic amnesia).
;; 4. Markedly diminished interest in significant activities.
;; 5. Feeling of detachment or estrangement from others.
;; 6. Restricted range of affect, e.g., unable to have love feelings.
;; 7. Sense of foreshortened future, e.g., does not expect to have a
;; career, marriage, children, or a long life.
;;
;;TOF
;;D. Persistent symptoms of increased arousal (not present before the
;; trauma), as indicated by at least two of the following:
;;
;; 1. Difficulty falling or staying asleep.
;; 2. Irritability or outbursts of anger.
;; 3. Difficulty concentrating.
;; 4. Hyper vigilance.
;; 5. Exaggerated startle response.
;; 6. Physiologic reactivity upon exposure to events that symbolize or
;; resemble an aspect of the traumatic event (e.g., a woman who was
;; raped in an elevator breaks out in a sweat when entering any
;; elevator).
;;END