source: FOIAVistA/tag/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCWFI1.m@ 628

DVBCWFI1 ;ALB/CMM FIBROMYALGIA WKS TEXT - 1 ; 6 MARCH 1997
 ;;2.7;AMIE;**12**;Apr 10, 1995
 ;
 ;
TXT ;
 ;;Narrative:  For VA compensation purposes, the diagnosis of fibromyalgia 
 ;;(sometimes called fibrositis, primary fibromyalgia syndrome, or 
 ;;myofascial pain syndrome) requires the presence of widespread 
 ;;musculoskeletal pain and tender points.  Additional findings may also
 ;;be present:  fatigue, sleep disturbance, stiffness, paresthesias, 
 ;;headache, irritable bowel symptoms, depression, anxiety, or Raynaud's
 ;;-like symptoms.  Widespread pain is defined as pain in both the left 
 ;;and right sides of the body, that is both above and below the waist, 
 ;;and that affects both the axial skeleton (i.e., cervical spine, 
 ;;anterior chest, thoracic spine, or low back) and the extremities.  
 ;;Rule out other diagnostic entities that may be responsible for the 
 ;;symptomatology presented.
 ;;
 ;;A.  Review of Medical Records:
 ;;
 ;;
 ;;
 ;;B.  Medical History (Subjective Complaints):
 ;;
 ;;    Comment on:
 ;;    1.  Date of onset of symptoms, date of diagnosis (if known).
 ;;
 ;;
 ;;    2.  What precipitates and alleviates symptoms?
 ;;
 ;;
 ;;    3.  Location, severity, frequency of any musculoskeletal pain, 
 ;;        stiffness, or muscle weakness, whether episodic or constant, 
 ;;        and what their effects are on daily activities.
 ;;
 ;;
 ;;    4.  Unexplained fatigue, sleep disturbances.
 ;;
 ;;
 ;;    5.  GI symptoms.
 ;;
 ;;
 ;;    6.  Treatment, (type, duration, response).  Has treatment been 
 ;;        continuous?  
 ;;
 ;;
 ;;    7.  Is there depression or anxiety?
 ;;
 ;;
 ;;    8.  Lost time from work?
 ;;
 ;;
 ;;
 ;;C.  Physical Examination (Objective Findings):
 ;;
 ;;    Address each of the following and fully describe current findings:
 ;;    (Please incorporate all ancillary study results into the final 
 ;;    diagnosis.)
 ;;
 ;;    1.  Is the condition currently active or in remission?
 ;;
 ;;
 ;;    2.  Musculoskeletal areas involved.
 ;;
 ;;
 ;;    3.  Trigger or tender points.
 ;;
 ;;
 ;;    4.  Muscle strength in involved areas.
 ;;
 ;;
 ;;D.  Diagnostic and Clinical Tests:
 ;;
 ;;    1.  Include results of all diagnostic and clinical tests conducted
 ;;        in the examination report.
 ;;
 ;;
 ;;
 ;;E.  Diagnosis:
 ;;
 ;;
 ;;
 ;;Signature:                             Date:
 ;;END