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