| 1 | DVBCWEA3 ;BPOIFO/ESW - EATING DISORDERS WKS TEXT - 1 ; 10/1/02 5:33pm
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| 2 |  ;;2.7;AMIE;**46**;Apr 10, 1995
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| 3 |  ;Per VHA Directive 10-92-142, this routine should not be modified
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| 4 |  ;
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| 5 | TXT ;
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| 6 |  ;;
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| 7 |  ;;A. Review of Medical Records:
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| 8 |  ;;
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| 9 |  ;;
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| 10 |  ;;B. Medical History (Subjective Complaints):
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| 11 |  ;;
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| 12 |  ;;   Comment on:
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| 13 |  ;;   1. PAST MEDICAL HISTORY
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| 14 |  ;;
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| 15 |  ;;      a. Previous hospitalizations and outpatient care for parenteral
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| 16 |  ;;         nutrition or tube feeding.
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| 17 |  ;;      b. Medical and occupational history from the time between the
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| 18 |  ;;         last such rating examination and the present needs to be 
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| 19 |  ;;         accounted for, UNLESS the purpose of this examination is to
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| 20 |  ;;         ESTABLISH service connection, then a complete medical history
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| 21 |  ;;         since discharge from military service is required.
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| 22 |  ;;      c. Periods of incapacitation (during which bed rest and treatment 
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| 23 |  ;;         by a physician are required due to the eating disorder). 
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| 24 |  ;;         Describe the frequency and duration.
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| 25 |  ;;      d. Current treatment, response, side effects.
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| 26 |  ;;
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| 27 |  ;;
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| 28 |  ;;   2. PRESENT MEDICAL, OCCUPATIONAL AND SOCIAL HISTORY - over the past
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| 29 |  ;;      one year.
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| 30 |  ;;
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| 31 |  ;;      a. History of onset of eating disorder.
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| 32 |  ;;      b. Its course, treatment, and current status to include symptoms.
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| 33 |  ;;      c. Extent of time lost from work over the past 12 month period 
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| 34 |  ;;        and social impairment. If employed, identify current occupation
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| 35 |  ;;        and length of time at this job.
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| 36 |  ;;
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| 37 |  ;;
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| 38 |  ;;   3. SUBJECTIVE COMPLAINTS:
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| 39 |  ;;
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| 40 |  ;;      a. Describe fully.
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| 41 |  ;;
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| 42 |  ;;TOF
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| 43 |  ;;C. Examination (Objective Findings):
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| 44 |  ;;
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| 45 |  ;;   Address each of the following and fully describe:
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| 46 |  ;;
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| 47 |  ;;   1. Mental status exam to confirm or establish diagnosis in 
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| 48 |  ;;      accordance with DSM-IV.
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| 49 |  ;; 
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| 50 |  ;;   2. Additionally, please provide this specific information:
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| 51 |  ;;      a. Current weight.
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| 52 |  ;;      b. Expected minimum weight based on age, height, and body build.
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| 53 |  ;;      c. Obtain weight history.
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| 54 |  ;;
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| 55 |  ;;   3. Additionally, to allow evaluation by the rating specialist, 
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| 56 |  ;;      describe and fully explain the existence, frequency, and extent
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| 57 |  ;;      of the following signs and symptoms and relate how they 
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| 58 |  ;;      interfere with employment:
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| 59 |  ;;      a. Binge eating.
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| 60 |  ;;      b. Self-induced vomiting or other measure to prevent weight gain
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| 61 |  ;;         when weight is already below expected minimum normal weight.
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| 62 |  ;; 
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| 63 |  ;;D. Diagnostic Tests (including psychological testing if deemed necessary):
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| 64 |  ;; 
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| 65 |  ;;   1. Provide specific evaluation information required by the rating 
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| 66 |  ;;      board or on a BVA Remand. Diagnostic Tests (See the examination
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| 67 |  ;;      request remarks for specifics.):
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| 68 |  ;; 
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| 69 |  ;;           a. CAPACITY TO MANAGE FINANCIAL AFFAIRS
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| 70 |  ;;
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| 71 |  ;;           Mental competency, for VA benefits purposes, refers only to
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| 72 |  ;;           the ability of the veteran to manage VA benefit payments in his
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| 73 |  ;;           or her own best interest, and not to any other subject.
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| 74 |  ;;           Mental incompetency, for VA benefits purposes, means that
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| 75 |  ;;           the veteran, because of injury or disease, is not capable of
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| 76 |  ;;           managing benefit payments in his or her best interest.
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| 77 |  ;;           In order to assist raters in making a legal determination as to
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| 78 |  ;;           competency, please address the following:
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| 79 |  ;;                What is the impact of injury or disease on the veteran's ability
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| 80 |  ;;                to manage his or her financial affairs, including consideration
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| 81 |  ;;                of such things as knowing the amount of his or her VA benefit
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| 82 |  ;;                payment, knowing the amounts and types of bills owed monthly,
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| 83 |  ;;                and handling the payment prudently? Does the veteran handle
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| 84 |  ;;                the money and pay the bills himself or herself?
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| 85 |  ;;
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| 86 |  ;;                Based on your examination, do you believe that the veteran is
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| 87 |  ;;                capable of managing his or her financial affairs?
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| 88 |  ;;                Please provide examples to support your conclusion.
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| 89 |  ;;
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| 90 |  ;;                If you believe a Social Work Service assessment is needed before
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| 91 |  ;;                you can give your opinion on the veteran's ability to manage his
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| 92 |  ;;                or her financial affairs, please explain why.
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| 93 |  ;;
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| 94 |  ;;      b.  OTHER OPINION: Furnish any other specific opinion requested
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| 95 |  ;;          by the rating board or BVA Remand, furnishing the complete 
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| 96 |  ;;          rationale and citation of medical texts or treatise supporting 
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| 97 |  ;;          opinion, if medical literature review was undertaken. If the
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| 98 |  ;;          requested opinion is medically not ascertainable on exam or
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| 99 |  ;;          testing, please state WHY. If the requested opinion cannot 
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| 100 |  ;;          be expressed without resorting to speculation or making 
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| 101 |  ;;          improbable assumptions say so, and explain why. If the opinion 
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| 102 |  ;;          asks "...is it at least as likely as not...", fully explain
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| 103 |  ;;          the clinical findings and rationale for the opinion.
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| 104 |  ;;
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| 105 |  ;;
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| 106 |  ;;  2.  Include results of all diagnostic and clinical tests conducted 
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| 107 |  ;;      in the examination report.
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| 108 |  ;;
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| 109 |  ;;
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| 110 |  ;;E. Diagnosis:
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| 111 |  ;;
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| 112 |  ;;
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| 113 |  ;;Signature:                              Date:
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| 114 |  ;;END
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