| 1 | DVBCWEA1 ;ALB/CMM EATING DISORDERS WKS TEXT - 1 ; 6 MARCH 1997 | 
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| 2 | ;;2.7;AMIE;**12**;Apr 10, 1995 | 
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| 3 | ; | 
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| 4 | ; | 
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| 5 | TXT ; | 
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| 6 | ;;A. Review of Medical Records: | 
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| 7 | ;; | 
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| 8 | ;; | 
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| 9 | ;; | 
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| 10 | ;; | 
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| 11 | ;;B. Medical History (Subjective Complaints): | 
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| 12 | ;; | 
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| 13 | ;;   Comment on: | 
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| 14 | ;;   1. PAST MEDICAL HISTORY | 
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| 15 | ;; | 
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| 16 | ;;      a. Previous hospitalizations and outpatient care for parenteral | 
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| 17 | ;;         nutrition or tube feeding. | 
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| 18 | ;; | 
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| 19 | ;; | 
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| 20 | ;;      b. Medical and occupational history from the time between the | 
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| 21 | ;;         last such rating examination and the present needs to be | 
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| 22 | ;;         accounted for, UNLESS the purpose of this examination is to | 
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| 23 | ;;         ESTABLISH service connection, then a complete medical history | 
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| 24 | ;;         since discharge from military service is required. | 
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| 25 | ;; | 
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| 26 | ;; | 
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| 27 | ;;      c. Periods of incapacitation (during which bed rest and treatment | 
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| 28 | ;;         by a physician are required due to the eating disorder). | 
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| 29 | ;;         Describe the frequency and duration. | 
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| 30 | ;; | 
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| 31 | ;; | 
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| 32 | ;;     d.  Current treatment, response, side effects. | 
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| 33 | ;; | 
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| 34 | ;; | 
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| 35 | ;;  2. PRESENT MEDICAL, OCCUPATIONAL AND SOCIAL HISTORY - over the past | 
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| 36 | ;;     one year. | 
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| 37 | ;; | 
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| 38 | ;;     a. History of onset of eating disorder. | 
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| 39 | ;; | 
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| 40 | ;;     b. Its course, treatment, and current status to include symptoms. | 
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| 41 | ;; | 
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| 42 | ;;     c. Extent of time lost from work over the past 12 month period | 
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| 43 | ;;        and social impairment. If employed, identify current occupation | 
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| 44 | ;;        and length of time at this job. | 
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| 45 | ;; | 
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| 46 | ;; | 
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| 47 | ;;  3. SUBJECTIVE COMPLAINTS: | 
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| 48 | ;; | 
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| 49 | ;;     a. Describe fully. | 
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| 50 | ;; | 
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| 51 | ;; | 
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| 52 | ;;C. Examination (Objective Findings): | 
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| 53 | ;; | 
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| 54 | ;;   Address each of the following and fully describe: | 
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| 55 | ;;   1. Mental status exam to confirm or establish diagnosis in | 
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| 56 | ;;      accordance with DSM-IV. | 
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| 57 | ;; | 
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| 58 | ;;   2. Additionally, please provide this specific information. | 
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| 59 | ;; | 
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| 60 | ;;      a. Current weight. | 
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| 61 | ;; | 
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| 62 | ;; | 
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| 63 | ;;      b. Expected minimum weight based on age, height, and body build. | 
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| 64 | ;; | 
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| 65 | ;; | 
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| 66 | ;;      c. Obtain weight history. | 
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| 67 | ;; | 
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| 68 | ;; | 
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| 69 | ;;   3. Additionally, to allow evaluation by the rating specialist, | 
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| 70 | ;;      describe and fully explain the existence, frequency, and extent | 
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| 71 | ;;      of the following signs and symptoms and relate how they | 
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| 72 | ;;      interfere with employment: | 
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| 73 | ;; | 
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| 74 | ;;      a. Binge eating. | 
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| 75 | ;; | 
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| 76 | ;; | 
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| 77 | ;;      b. Self-induced vomiting or other measure to prevent weight gain | 
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| 78 | ;;         when weight is already below expected minimum normal weight. | 
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| 79 | ;; | 
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| 80 | ;; | 
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| 81 | ;;D. Diagnostic Tests (including psychological testing if deemed necessary): | 
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| 82 | ;; | 
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| 83 | ;;   1. Provide specific evaluation information required by the rating | 
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| 84 | ;;      board or on a BVA Remand. Diagnostic Tests (See the examination | 
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| 85 | ;;      request remarks for specifics.): | 
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| 86 | ;; | 
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| 87 | ;;      a.  COMPETENCY: State whether the veteran is capable of managing | 
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| 88 | ;;          his or her benefit payments in the individual's own best | 
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| 89 | ;;          interests.  (A physical disability which prevents the veteran | 
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| 90 | ;;          from attending to financial matters in person is not a proper | 
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| 91 | ;;          basis for a finding of incompetency unless the veteran is, | 
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| 92 | ;;          by reason of that disability, incapable of directing someone | 
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| 93 | ;;          else in handling the individual's financial affairs.) | 
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| 94 | ;; | 
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| 95 | ;;TOF | 
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| 96 | ;;      b.  OTHER OPINION: Furnish any other specific opinion requested | 
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| 97 | ;;          by the rating board or BVA Remand, furnishing the complete | 
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| 98 | ;;          rationale and citation of medical texts or treatise supporting | 
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| 99 | ;;          opinion, if medical literature review was undertaken. If the | 
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| 100 | ;;          requested opinion is medically not ascertainable on exam or | 
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| 101 | ;;          testing, please state WHY. If the requested opinion cannot | 
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| 102 | ;;          be expressed without resorting to speculation or making | 
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| 103 | ;;          improbable assumptions say so, and explain why. If the opinion | 
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| 104 | ;;          asks "...is it at least as likely as not...", fully explain | 
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| 105 | ;;          the clinical findings and rationale for the opinion. | 
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| 106 | ;; | 
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| 107 | ;; | 
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| 108 | ;;  2.  Include results of all diagnostic and clinical tests conducted | 
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| 109 | ;;      in the examination report. | 
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| 110 | ;; | 
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| 111 | ;; | 
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| 112 | ;;E. Diagnosis: | 
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| 113 | ;; | 
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| 114 | ;; | 
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| 115 | ;;Signature:                              Date: | 
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| 116 | ;;END | 
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