DVBCWPW1 ;ALB/CMM PULMONARY TB AND MYCO. DIS. WKS TEXT - 1 ; 6 MARCH 1997 ;;2.7;AMIE;**12**;Apr 10, 1995 ; ; TXT ; ;;A. Review of Medical Records: ;; ;; ;; ;;B. Medical History (Subjective Complaints): ;; ;; Comment on: ;; 1. Activity of pulmonary tuberculosis or other mycobacterial disease. ;; ;; ;; 2. Date of inactivity if it is not active. ;; ;; ;; 3. Identity of organism (if possible). ;; ;; ;;C. Physical examination (Objective Findings): ;; ;; Address each of the following and fully describe current findings: ;; 1. Extent of structural damage to lungs. ;; ;; ;; 2. If patient was hospitalized for 6 months or more, what is the ;; condition at the end of hospitalization? ;; ;; ;; 3. If patient was hospitalized for 12 months or more, what is the ;; condition at the end of hospitalization? ;; ;; ;;D. Diagnostic and Clinical Tests: ;; ;; Provide: ;; Pulmonary Function Tests, if indicated. When the results of ;; pre-bronchodilator pulmonary function tests are NORMAL, post- ;; bronchodilator studies are not required for VA evaluation purposes. ;; IN ALL OTHER CASES, post-bronchodilator studies shuld be conducted ;; unless contraindicated (because of allergy to medication, etc.) or ;; if the veteran was on bronchodilators before the test and had taken ;; his or her medication within a few hours of the study. An examiner ;; who determines that a post-bronchodilator study should not be ;; performed should provide an explanation of why not. If there is ;; a disparity between the results of different pulmonary function ;; tests (FEV-1, FVC, etc.), the examiner should indicate which test ;; result is the best indicator of the veteran's level of pulmonary ;; functioning. ;; ;; ;;E. Diagnosis: ;; ;; In reactivated cases, is this reactivation of the old disease or a ;; separate and distinct new infection. ;; ;; ;; ;;ADDITIONAL NOTE TO THE PHYSICIAN: ;;In all claims, if the disease is inactive and if the inactivity was ;;confirmed at a non-VA facility, obtain the name and mailing address of ;;the facility from the veteran so that the Regional Office may request ;;the report. ;; ;; ;;Signature: Date: ;;END