| 1 | DVBCWPM1 ;ALB/ESW PULMONARY TB AND MYCO. DIS. WKS TEXT - 1 ; 10 Oct 2000
 | 
|---|
| 2 |  ;;2.7;AMIE;**34**;Apr 10, 1995
 | 
|---|
| 3 |  ;
 | 
|---|
| 4 | TXT ;
 | 
|---|
| 5 |  ;;A. Review of Medical Records:
 | 
|---|
| 6 |  ;;
 | 
|---|
| 7 |  ;;B. Medical History (Subjective Complaints):
 | 
|---|
| 8 |  ;;    Comment on:
 | 
|---|
| 9 |  ;;
 | 
|---|
| 10 |  ;;    1. Activity of pulmonary tuberculosis or other mycobacterial disease. 
 | 
|---|
| 11 |  ;;    2. Date of inactivity if it is not active.
 | 
|---|
| 12 |  ;;    3. Identity of organism (if possible).
 | 
|---|
| 13 |  ;;
 | 
|---|
| 14 |  ;;C. Physical examination (Objective Findings):
 | 
|---|
| 15 |  ;;    Address each of the following and fully describe current findings:
 | 
|---|
| 16 |  ;;
 | 
|---|
| 17 |  ;;    1. Extent of structural damage to lungs.
 | 
|---|
| 18 |  ;;    2. If patient was hospitalized for 6 months or more, what is the
 | 
|---|
| 19 |  ;;       condition at the end of hospitalization?
 | 
|---|
| 20 |  ;;    3. If patient was hospitalized for 12 months or more, what is the
 | 
|---|
| 21 |  ;;        condition at the end of hospitalization?
 | 
|---|
| 22 |  ;;
 | 
|---|
| 23 |  ;;D. Diagnostic and Clinical Tests:
 | 
|---|
| 24 |  ;;Provide:
 | 
|---|
| 25 |  ;;
 | 
|---|
| 26 |  ;;1. Pulmonary Function Tests, if indicated. If performed, include the results
 | 
|---|
| 27 |  ;;   in the examination report, The FEV-1,FVC, and FEV-1/FVC should be included.
 | 
|---|
| 28 |  ;;   Both pre- and post-bronchodilatation pulmonary function test results should
 | 
|---|
| 29 |  ;;   be reported. If post-bronchodilatation test is not conducted in a particular
 | 
|---|
| 30 |  ;;   case, please provide an explanation of why not. A DLCO may or may not be
 | 
|---|
| 31 |  ;;   done routinely as part of pulmonary function testing at a particular
 | 
|---|
| 32 |  ;;   facility. If there is a disparity between the results of different tests,
 | 
|---|
| 33 |  ;;   please indicate which tests are more likely to accurately reflect
 | 
|---|
| 34 |  ;;   the severity of the condition.
 | 
|---|
| 35 |  ;;
 | 
|---|
| 36 |  ;;      DLCO note: If DLCO was not done as a routine part of pulmonary function
 | 
|---|
| 37 |  ;;      testing, the examiner should use his or her judgment, based on
 | 
|---|
| 38 |  ;;      the specific condition (.e.g., whether it is obstructive,
 | 
|---|
| 39 |  ;;      interstitial, etc.) and other available information about the condition,
 | 
|---|
| 40 |  ;;      as to whether a DLCO test is needed, since it is not useful in all
 | 
|---|
| 41 |  ;;      situations. If it may provide useful information about the severity
 | 
|---|
| 42 |  ;;      of the condition, it should be requested and reviewed before
 | 
|---|
| 43 |  ;;      the examination report is submitted. If the examiner determines that
 | 
|---|
| 44 |  ;;      the DLCO test is not needed, a statement as to why not (e.g., there are
 | 
|---|
| 45 |  ;;      decreased lung volumes that would not yield valid test results) should be
 | 
|---|
| 46 |  ;;      included in the report. Such a statement could avoid a remand from BVA
 | 
|---|
| 47 |  ;;      when the test is not done. However in the case of a BVA remand in which
 | 
|---|
| 48 |  ;;      the DLCO is requested, the DLCO MUST be done unless there is a medical
 | 
|---|
| 49 |  ;;      contraindication.
 | 
|---|
| 50 |  ;;
 | 
|---|
| 51 |  ;;E. Diagnosis:
 | 
|---|
| 52 |  ;;
 | 
|---|
| 53 |  ;;      1. In reactivated cases, is this reactivation of the old disease
 | 
|---|
| 54 |  ;;         or a separate and distinct new infection?
 | 
|---|
| 55 |  ;;
 | 
|---|
| 56 |  ;;ADDITIONAL NOTE TO THE EXAMINER:
 | 
|---|
| 57 |  ;;
 | 
|---|
| 58 |  ;;In all claims, if the disease is inactive and if the inactivity was confirmed
 | 
|---|
| 59 |  ;;at a non-VA facility, obtain the name and mailing address of the facility
 | 
|---|
| 60 |  ;;from the veteran so that the Regional Office may request the report.
 | 
|---|
| 61 |  ;;
 | 
|---|
| 62 |  ;;
 | 
|---|
| 63 |  ;;Signature:                             Date:
 | 
|---|
| 64 |  ;;END
 | 
|---|