| 1 | DVBCWSW1 ;ALB/CMM SCARS 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 | ;;B.  Medical History (Subjective Complaints): | 
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| 11 | ;; | 
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| 12 | ;;    1.  Type of injury or infection causing the wound or scar, its | 
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| 13 | ;;        date, the treatment used and the response to such treatment. | 
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| 14 | ;; | 
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| 15 | ;; | 
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| 16 | ;;    2.  Current symptoms. | 
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| 17 | ;; | 
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| 18 | ;; | 
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| 19 | ;;C.  Physical Examination (Objective Findings): | 
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| 20 | ;; | 
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| 21 | ;;    Address each of the following and fully describe current findings | 
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| 22 | ;;    (for each scar): | 
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| 23 | ;;    1.  Location, measurements (cm. x cm.), and shape of each scar. | 
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| 24 | ;; | 
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| 25 | ;; | 
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| 26 | ;;    2.  Tenderness. | 
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| 27 | ;; | 
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| 28 | ;; | 
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| 29 | ;;    3.  Adherence. | 
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| 30 | ;; | 
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| 31 | ;; | 
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| 32 | ;;    4.  Texture. | 
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| 33 | ;; | 
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| 34 | ;; | 
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| 35 | ;;    5.  Ulceration or breakdown of skin. | 
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| 36 | ;; | 
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| 37 | ;; | 
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| 38 | ;;    6.  Elevation or depression of scar. | 
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| 39 | ;; | 
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| 40 | ;; | 
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| 41 | ;;    7.  Extent of underlying tissue loss. | 
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| 42 | ;; | 
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| 43 | ;; | 
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| 44 | ;;    8.  Inflammation, edema, or keloid formation. | 
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| 45 | ;; | 
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| 46 | ;; | 
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| 47 | ;;    9.  Color of scar compared to normal areas of skin. | 
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| 48 | ;; | 
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| 49 | ;; | 
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| 50 | ;;   10.  Disfigurement. | 
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| 51 | ;; | 
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| 52 | ;; | 
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| 53 | ;;   11.  For each burn scar, state if due to a 2nd or 3rd degree burn. | 
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| 54 | ;; | 
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| 55 | ;; | 
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| 56 | ;;   12.  Limitation of function by scar. | 
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| 57 | ;; | 
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| 58 | ;; | 
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| 59 | ;;   13.  An attachment is provided in the Handout of Instructions for | 
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| 60 | ;;        Compensation and Pension Examinations for plotting the | 
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| 61 | ;;        location of scars. | 
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| 62 | ;; | 
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| 63 | ;; | 
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| 64 | ;;D.  Diagnostic and Clinical Tests: | 
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| 65 | ;; | 
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| 66 | ;;    1.  With disfigurement or disfiguring scar of head, face, or neck, | 
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| 67 | ;;        submit COLOR PHOTOGRAPHS. | 
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| 68 | ;;    2.  Include results of all diagnostic and clinical tests conducted | 
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| 69 | ;;        in the examination report. | 
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| 70 | ;; | 
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| 71 | ;; | 
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| 72 | ;;E.  Diagnosis: | 
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| 73 | ;; | 
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| 74 | ;; | 
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| 75 | ;;Signature:                             Date: | 
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| 76 | ;;END | 
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