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