| 1 | DVBCPRCK ;ALB/GTS-557/THM-THE PERIPHERAL NERVES EXAM ; 12/27/90  1:32 PM
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| 2 |  ;;2.7;AMIE;;Apr 10, 1995
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| 3 |  ;
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| 4 |  S PG=1,HD91="Department of Veterans Affairs",HD9=$S($D(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet"
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| 5 | EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
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| 6 |  W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1230 Worksheet" S HD7="THE PERIPHERAL NERVES",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
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| 7 |  W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
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| 8 |  W !!!!,"Narrative:  None",!!
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| 9 |  W !! I '$D(CMBN) W "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:" D HD2
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| 10 |  W $S($D(CMBN):"A. ",1:"D. "),"Specific evaluation information required by the rating board",!?4,"(if the information requested is included elsewhere, do not",!?4,"repeat here):",!!!
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| 11 |  S LX="TXT1" F I=1:1 S LY=$T(@LX+I) Q:LY["END"  W $P(LY,";;",2),!
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| 12 |  D:$D(CMBN) HD2 S LX="TXT2" F I=1:1 S LY=$T(@LX+I) Q:LY["END"  W $P(LY,";;",2),!
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| 13 |  D:'$D(CMBN) HD2 W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!!!
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| 14 |  W $S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
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| 15 |  K LN,LN1,LN2
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| 16 |  Q
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| 17 |  ;
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| 18 | HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!,"for ",NAME,!!!
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| 19 |  Q
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| 20 |  ;
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| 21 | SETIOF ;  ** Set device control var's
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| 22 |  D HOME^%ZIS
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| 23 |  Q
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| 24 |  ;
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| 25 | TXT1 ;
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| 26 |  ;;   1.  Where disability is the result of brain disease or injury, spinal cord
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| 27 |  ;;       disease or injury, cervical disc disease, or trauma to the nerve roots
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| 28 |  ;;       themselves, report sensory and motor impairment by reference to the
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| 29 |  ;;       distribution of the affected groups as paralysis, neuritis or
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| 30 |  ;;       neuralgia.  Report each affected extremity separately -
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| 31 |  ;;
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| 32 |  ;;
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| 33 |  ;;       a.  In the upper extremities -
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| 34 |  ;;
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| 35 |  ;;
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| 36 |  ;;
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| 37 |  ;;
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| 38 |  ;;
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| 39 |  ;;
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| 40 |  ;;
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| 41 |  ;;       b.  In the lower extremities -
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| 42 |  ;;
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| 43 |  ;;
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| 44 |  ;;
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| 45 |  ;;
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| 46 |  ;;
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| 47 |  ;;
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| 48 |  ;;
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| 49 |  ;;
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| 50 |  ;;END
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| 51 | TXT2 ;
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| 52 |  ;;   2.  Where disability is NOT from the above, identify the specific major
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| 53 |  ;;       nerve involved, localize the lesion and describe specific impairment
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| 54 |  ;;       of motor and sensory function, fine motor control, etc..  Again
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| 55 |  ;;       characterization as paralysis, neuritis or neuralgia is necessary
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| 56 |  ;;       Indicate whether any muscle wasting or atrophy represents direct
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| 57 |  ;;       effect of nerve damage or merely disuse.  Report each affected
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| 58 |  ;;       extremity separately -
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| 59 |  ;;
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| 60 |  ;;
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| 61 |  ;;       a.  In the upper extremities -
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| 62 |  ;;
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| 63 |  ;;
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| 64 |  ;;
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| 65 |  ;;
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| 66 |  ;;
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| 67 |  ;;
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| 68 |  ;;
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| 69 |  ;;
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| 70 |  ;;       b.  In the lower extremities -
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| 71 |  ;;
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| 72 |  ;;
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| 73 |  ;;
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| 74 |  ;;
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| 75 |  ;;
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| 76 |  ;;
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| 77 |  ;;
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| 78 |  ;;
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| 79 |  ;;END
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