source: FOIAVistA/tag/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCST2.m@ 628

DVBCST2 ;ALB/JEH SOCIAL AND INDUSTRIAL SURVEY WKS TEXT - 2 ; 24 MAY 2004
 ;;2.7;AMIE;**70**;Apr 10, 1995
 ;
 ;
TXT ;
 ;;G. Chronological History of Adjustment Prior to Service or Stressor
 ;;   ----------------------------------------------------------------    
 ;;
 ;;    1. Any evidence of disorder in infancy, childhood, or adolescence,
 ;;       especially antisocial behavior (reference DSM-IV).
 ;;
 ;;    2. Activity patterns Friendships and social relationships.
 ;;
 ;;    3. Family Describe relationships.
 ;;
 ;;    4. Significant issues in school, community, or work area.
 ;;
 ;;    5. Pre-military traumatic events Provide details, if possible.
 ;;
 ;;
 ;;H. Chronological History of Adjustment After Service or Stressor  
 ;;   -------------------------------------------------------------
 ;;
 ;;    1. Changes in personality or interpersonal relationships.
 ;;
 ;;    2. Work performance.
 ;;
 ;;    3. Emotional difficulties: Describe onset and details, including time,
 ;;       nature, and severity.
 ;;
 ;;    4. Onset of any other type of symptoms, such as physical.
 ;;
 ;;    5. Legal issues, such as involvement with authorities or courts. 
 ;;
 ;;    6. Substance abuse history Describe use of drugs, alcohol,
 ;;       prescription medications, and tobacco. 
 ;;
 ;;    7. Psychiatric treatment history.
 ;;
 ;;
 ;;I. Post-Military Social Adjustment  
 ;;   -------------------------------
 ;;
 ;;    1. Describe all marriages and divorces, loss of spouse or significant other
 ;;       through death, and birth (and death if applicable) of all children.
 ;;
 ;;    2. Describe nature of friendships and social relationships, including
 ;;       group memberships.
 ;;
 ;;    3. Describe the veteran's living situation.  
 ;;
 ;;    4. Note any significant post-military adjustment problems, including
 ;;       illness or injury.
 ;;
 ;;
 ;;J.  Industrial Adjustment  
 ;;    ---------------------
 ;;
 ;;    1. Veteran's occupation(s).
 ;;
 ;;    2. All education and training.
 ;;
 ;;    3. List all employers and positions, including: 
 ;;          a. Earnings
 ;;          b. Dates of change(s) in employment
 ;;          c. Length of time with specific employers
 ;;          d. Periods of unemployment
 ;;          e. Relationship with co-workers, supervisors, and subordinates
 ;;
 ;;    4. Highest paid position. 
 ;;
 ;;    5. Attitude toward employment. 
 ;;
 ;;    6. Is the veteran working at an occupation or position that is below
 ;;       his/her education and training level?
 ;;
 ;;    7. Is there evidence that the veteran's pre-traumatic level of
 ;;       performance was above his/her post-traumatic level of performance?
 ;;       What is the documentation of this?
 ;;
 ;;    8. Is there evidence service connected disability(ies) impacted the
 ;;       veteran's decision to retire? Discuss. (For example, did the
 ;;       veteran choose to take an early retirement with financial loss in
 ;;       order to reduce the stress experienced in the work environment
 ;;       because the stress was aggravating the service connected
 ;;       disability(ies)?)
 ;;
 ;;    9. Has an employer made official or unofficial  accommodations to handle
 ;;       veterans disabilities? Document any evidence of internal transfers,
 ;;       re-assignments, etc.
 ;;
 ;;K. Present Social Functioning 
 ;;   --------------------------
 ;;
 ;;    1. Identify Stressors in any of the following categories:
 ;;
 ;;        a. Primary support system or group
 ;;
 ;;        b. Social environment 
 ;;
 ;;        c. Educational problems 
 ;;
 ;;        d. Occupational problems
 ;;
 ;;        e. Housing problems 
 ;;
 ;;        f. Economic problems 
 ;;
 ;;        g. Problems accessing health care 
 ;;
 ;;        h. Legal system or criminal problems
 ;;
 ;;        i. Other
 ;;
 ;;    2. Appearance: Describe dress, speech, mannerisms, scars, facial
 ;;       expressions, and body movements (assessment based on observation
 ;;       listed above).
 ;;
 ;;    3. Relationships: Describe all relationships, including with whom
 ;;       and duration of relationship. Describe physical intimacy, including
 ;;       frequency, level of satisfaction, problems with intimacy, and any
 ;;       impact of medical or psychiatric conditions on performance.
 ;;
 ;;    4. Lifestyle: Describe how the veteran spends his/her time, including
 ;;       interests, hobbies, employment, typical day and week, and eating and
 ;;       sleeping patterns.
 ;;
 ;;    5. Mental Status: Describe, including evidence of confusion, memory
 ;;       problems, thought processes or disorders, and mood/affect.
 ;;       Describe the veteran's functioning in the areas of cognitive,
 ;;       emotional (mood) and judgment.
 ;;
 ;;    6. GAF Score (if available)
 ;;
 ;;L.  Capacity to manage financial affairs (if an issue)
 ;;    ------------------------------------
 ;;
 ;;NOTE:  Mental competency, for VA benefits purposes, refers only to the ability
 ;;       of the veteran to manage VA benefit payments in his or her own best
 ;;       interest, and not to any other subject. Mental incompetency, for VA
 ;;       benefits purposes, means that the veteran, because of injury or disease,
 ;;       is not capable of managing benefit payments in his or her best interest.
 ;;       In order to assist raters in making a legal determination as to
 ;;       competency, please address the following: 
 ;;
 ;;       1. What is the impact of injury or disease on the veteran's ability to
 ;;          manage his or her financial affairs, including consideration of
 ;;          such things as knowing the amount of his or her VA benefit payment,
 ;;          knowing the amounts and types of bills owed monthly, and handling the
 ;;          payment prudently?
 ;;
 ;;       2. Does the veteran handle the money and pay the bills himself or
 ;;          herself?
 ;;
 ;;       3. Based on your examination, do you believe that the veteran is capable
 ;;          of managing his or her financial affairs? Please provide examples to
 ;;          support your conclusion.
 ;;
 ;;M. Summary & Conclusions
 ;;   ---------------------
 ;;
 ;;       1.  Summarize the specific effect of disabilities and the impact on
 ;;           employment.
 ;;
 ;;       2.  Summarize the specific effect of disabilities and the impact on
 ;;           social functioning.
 ;;
 ;;
 ;;
 ;;NOTE:  Refer to medical, psychiatric and/or neuro-psychiatric report(s), as
 ;;       appropriate.
 ;;
 ;;
 ;;
 ;;__________________________                    ___________
 ;;SIGNATURE OF SOCIAL WORKER                    DATE
 ;;END