DVBCWPA1 ;ALB/CMM POW, GENERAL WKS TEXT - 1 ; 7 MARCH 1997
 ;;2.7;AMIE;**79**;Apr 10, 1995
 ;
 ;
TXT ;
 ;;
 ;;Narrative: This is the protocol for conducting initial examinations on former 
 ;;POWs.  Approach these veterans with the greatest sensitivity because the 
 ;;POW experience likely resulted in a great deal of psychological and physical 
 ;;trauma.  Details about beatings, torture, forced marches, forced labor, diet, 
 ;;disease, brainwashing, extremes of hot and cold, and anxiety may be 
 ;;significant parts of the veteran's history; eliciting these details requires  
 ;;that one establish a trusting relationship with the veteran. Examine
 ;;veteran for each disability / disease / condition veteran is claiming 
 ;;as a consequence of the POW experience.  A former POW may be entitled 
 ;;to service connection for presumptive POW diseases; the worksheet contains
 ;;a list of these presumptive diseases.  Based on veteran's claim(s) and your
 ;;findings, please refer to and follow additional worksheets to assure
 ;;the examination  provides information adequate for rating purposes.
 ;;
 ;;
 ;;
 ;;PRESUMPTIVE POW DISABILITIES: 
 ;;
 ;;    o  Any of the anxiety states
 ;;    o  Any other nutritional deficiency
 ;;    o  Atherosclerotic heart disease, ischemic heart disease, coronary artery
 ;;       disease and beriberi heart disease to include complications (e.g.,
 ;;       myocardial infarction, congestive heart failure, arrhythmia).
 ;;    o  Avitaminosis
 ;;    o  Beriberi (including beriberi heart disease which includes ischemic
 ;;       heart disease in a former POW who experienced localized edema 
 ;;       during captivity)
 ;;    o  Chronic dysentery
 ;;    o  Cirrhosis of the liver
 ;;    o  Dysthymic disorder (or depressive neurosis)
 ;;    o  Helminthiasis
 ;;    o  Hypertension and hypertensive vascular disease to include complications
 ;;    o  Irritable bowel syndrome.
 ;;    o  Malnutrition (including optic atrophy associated with malnutrition)
 ;;    o  Organic residuals of frostbite
 ;;    o  Pellagra
 ;;    o  Peptic ulcer disease
 ;;    o  Peripheral neuropathy
 ;;    o  Post-traumatic arthritis
 ;;    o  Psychosis
 ;;    o  Stroke (ischemic stroke, hemorrhagic stroke and embolic stroke)
 ;;       to include complications
 ;;
 ;;
 ;;A.  Review of Medical Records:
 ;;
 ;;    1.  Include a review of VA form 10-0048, Former POW Medical 
 ;;        History, which the veteran should have completed, prior to 
 ;;        conducting the examination.
 ;;
 ;;
 ;;    2.  Review the Social Survey.
 ;;
 ;;B.  Medical History (Subjective Complaints):  NOTE:  If the veteran 
 ;;    has had a previous protocol examination, only an interval history
 ;;    is required.
 ;;
 ;;    Comment on:
 ;;    1.  Past medical history, including childhood and adult illnesses
 ;;        and surgery.
 ;;
 ;;
 ;;    2.  Family history.
 ;;
 ;;
 ;;    3.  Social history - state civilian and military occupations, 
 ;;        including dates and locations.  Describe use of alcohol, 
 ;;        tobacco, and drugs.
 ;;
 ;;
 ;;    4.  Complete system review, commenting on all positive symptoms.  
 ;;
 ;;        a.  Describe initial symptoms, time of onset, and current 
 ;;            symptoms of all presumptive POW disabilities found.  
 ;;
 ;;
 ;;        b.  Comment on amount of weight lost as a prisoner.  Record 
 ;;            initial and release weights.
 ;;
 ;;
 ;;    5.  Describe current treatment (specify type, frequency, duration, 
 ;;        response, side effects).
 ;;
 ;;
 ;;C.  Physical Examination (Objective Findings):
 ;;
 ;;    Address each of the following and fully describe current findings:
 ;;    The examiner should incorporate all ancillary study results into 
 ;;    the final diagnoses.
 ;;    1.  VS:  Heart rate, blood pressure (If the diagnosis of hypertension 
 ;;        has not been established, take 2 or more blood pressure readings 
 ;;        on at least 3 different days.  If hypertension has been 
 ;;        diagnosed, take 2 or more blood pressure readings.), respirations, 
 ;;        height, weight, maximum weight in past year, weight change in
 ;;        past year, body build, and state of nutrition.  
 ;;
 ;;
 ;;    2.  DOMINANT HAND:  Indicate the dominant hand and how determined
 ;;        (i.e., writes, eats, combs hair, etc.).
 ;;
 ;;
 ;;    3.  POSTURE AND GAIT:  (If abnormal, describe.)
 ;;
 ;;
 ;;    4.  SKIN, INCLUDING APPENDAGES:  (If abnormal, describe appearance, 
 ;;        location, extent of lesions, and limitations to daily activity.)  
 ;;        If there are laceration or burn scars, describe location, 
 ;;        measurements (cm. x cm.), depression, type of tissue loss, 
 ;;        adherence, disfigurement, and tenderness.  For each burn scar,
 ;;        state if due to a 2nd or 3rd degree burn.  (NOTE:  If skin 
 ;;        condition or scars are disfiguring, obtain COLOR PHOTOGRAPHS 
 ;;        of affected area(s).
 ;;
 ;;
 ;;    5.  HEMIC AND LYMPHATIC:  (Describe local or generalized adenopathy, 
 ;;        tenderness, suppuration, etc.)
 ;;
 ;;
 ;;    6.  HEAD AND FACE:  Describe scars, deformities, etc.
 ;;
 ;;
 ;;    7.  EYES:  Describe external eye, pupil reaction, movements, 
 ;;        field of vision, any uncorrectable refractive error or any 
 ;;        retinopathy.
 ;;
 ;;
 ;;    8.  EARS:  Describe canals, drums, perforations, discharge.
 ;;
 ;;
 ;;    9.  NOSE, SINUSES, MOUTH AND THROAT:  Include gross dental findings.
 ;;
 ;;
 ;;   10.  NECK:  Describe lymph nodes, thyroid, etc.
 ;;
 ;;
 ;;   11.  CHEST:  Inspection, palpation, percussion, auscultation.  If 
 ;;        abnormal, describe limitations of daily living (i.e., How far
 ;;        can veteran walk, how many flights of stairs can he or she 
 ;;        climb, etc.).
 ;;