DVBCST1 ;ALB/JEH SOCIAL AND INDUSTRIAL SURVEY WKS TEXT - 1 ; 24 MAY 2004 ;;2.7;AMIE;**70**;Apr 10, 1995 ; ; TXT ; ;;A. Demographic & Information and Sources ;; ------------------------------------- ;; ;; 1. Note the location of the interview/exam. ;; ;; 2. List demographic data, including age, gender, marital status, and other ;; relevant data. ;; ;; 3. List service connected disabilities. ;; ;; 4. Discuss capacity to manage financial affairs (if an issue). ;; ;; 5. Verify accuracy of veteran's name, address, phone number. ;; ;; 6. List informants or sources of information, such as claims folder, ;; medical record, veteran, family members, employers, neighbors, friends, ;; physician, or other persons. ;; ;; 7. If S&I Survey is done in the community, list the collaterals residing in ;; the home, their ages and relationship to the veteran, a brief ;; description at the household appearance and overall home environment. ;; ;; ;;B. Appearance & Response to Interview ;; ---------------------------------- ;; ;; 1. Appearance - Describe the veteran's size, build, general physical ;; appearance and dress, noting any distinguishing features or ;; characteristics. ;; ;; 2. Indicate if s/he was alone or interviewed with others. ;; ;; 3. Make personal observations as to attitude, openness to interview, ;; reality testing, physical or mental difficulties in communicating. Does ;; s/he find the interview stressful or threatening? Is s/he cooperative ;; and friendly or guarded and withdrawn? Observe eye contact, facial ;; expressions, and attention span during interview. ;; ;; ;;C. Disabilities ;; ------------ ;; ;; 1. Include disabilities listed on Form 2507 for which the exam is ;; requested and any other complaints or conditions expressed by the ;; veteran. ;; ;; 2. List of current medications. ;; ;; ;;D. Brief Pre-Military Social History ;; --------------------------------- ;; ;; Include where the veteran was born, his/her family configuration, ;; education, etc. ;; ;; ;;E. Military History ;; ---------------- ;; ;; 1. Date the veteran entered military service and branch of service. ;; ;; 2. Where s/he completed basic training. ;; ;; 3. Military occupation(s). ;; ;; 4. Primary assignments and where stationed. ;; ;; 5. Any special training received in military. ;; ;; 6. Combat experiences. ;; ;; 7. Sexual trauma while in military. ;; ;; 8. Injuries or illness incurred while in military. ;; ;; 9. If claim is for PTSD, include a detailed account of the traumatic ;; experience(s). ;; ;; 10. Relationships with peers, superiors, subordinates, etc. ;; ;; ;;F. Prisoner of War (POW) Data (if applicable) ;; -------------------------- ;; ;; 1. Capture Data ;; ------------ ;; ;; a. Injuries/wounds incurred when captured and any treatment received. ;; ;; b. Captors - Date and place captured. ;; ;; c. Internment - List names of camps where interred and dates of ;; internment, psychological conditions, physical conditions, methods ;; used to control prisoners. ;; ;; d. Work - Physical & psychological conditions of work. ;; ;; e. Diet - Daily meals, including types of food, quantities, regularity ;; of meals. ;; ;; f. Illnesses or Injuries incurred when captured or while imprisoned ;; and any treatment received. ;; ;; 2. Information from Veteran's Significant Other(s) ;; ----------------------------------------------- ;; ;; a. The significant other's relationship to the veteran. ;; ;; b. Whether s/he knew veteran before or after capture. ;; ;; c. Any changes observed. ;; ;; d. General comments on impact of POW experience. ;;