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