[613] | 1 | DVBCARC1 ;ALB ISC/THM-TEXT FOR A&A/HOUSEBOUND EXAM ; 5/17/91 9:16 AM
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| 2 | ;;2.7;AMIE;;Apr 10, 1995
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| 3 | ;
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| 4 | PTXT F AW=0:1 S AX=$T(@TXT+AW) S AY=$P(AX,";;",2) D:AY["|TOP|" HD2^DVBCARCK W:AY="END" !! Q:AY="END" I AY'["|TOP|" W AY,!
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| 5 | G:TXT="TXT3" ^DVBCARC2 Q
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| 6 | ;
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| 7 | TXT2 ;;A. Indicate whether or not the veteran REQUIRES an attendant in reporting
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| 8 | ;; for this exam, and if so, identify the nurse or attendant and the
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| 9 | ;; mode of travel employed:
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| 10 | ;;
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| 11 | ;;
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| 12 | ;;
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| 13 | ;;
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| 14 | ;;
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| 15 | ;;
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| 16 | ;;B. Indicate whether or not the veteran is hospitalized, and if so, state
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| 17 | ;; where and the date of admission:
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| 18 | ;;
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| 19 | ;;
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| 20 | ;;
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| 21 | ;;
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| 22 | ;;
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| 23 | ;;
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| 24 | ;;C. Indicate whether or not the veteran is blind (best corrected vision
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| 25 | ;; is 5/200 or worse in both eyes, or central vision field is five degrees
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| 26 | ;; or less) or is permanently bedridden (if either skip items "D" through
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| 27 | ;; "I" and go directly to "J"):
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| 28 | ;;END
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| 29 | TXT3 ;;
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| 30 | ;;
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| 31 | ;;
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| 32 | ;;F. Extremeties and spine:
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| 33 | ;;
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| 34 | ;; 1. Upper extremities (reporting each upper extremity separately) -
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| 35 | ;;
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| 36 | ;; a. Describe functional restrictions with reference to strength
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| 37 | ;;and coordination and ability for self-feeding, fastening clothing, bathing,
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| 38 | ;;shaving, and attending to the needs of nature -
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| 39 | ;;
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| 40 | ;;
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| 41 | ;;
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| 42 | ;;
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| 43 | ;;
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| 44 | ;;
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| 45 | ;;
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| 46 | ;; b. Indicate level of amputation or length of stump and state
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| 47 | ;;whether or not use of prothesis is feasible -
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| 48 | ;;|TOP|
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| 49 | ;;
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| 50 | ;;
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| 51 | ;; 2. Lower extremities (reporting each lower extremity separately) -
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| 52 | ;;
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| 53 | ;; a. Describe functional restrictions with reference to extent
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| 54 | ;;of limitation of motion, muscle atrophy, contractures, weakness, lack
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| 55 | ;;of coordination, or other interference -
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| 56 | ;;
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| 57 | ;;
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| 58 | ;;
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| 59 | ;; b. Indicate any deficits of weight bearing, balance and propulsion -
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| 60 | ;;
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| 61 | ;;
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| 62 | ;;
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| 63 | ;;
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| 64 | ;;
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| 65 | ;; c. If amputated, give level or length of stump and whether use
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| 66 | ;;of prosthesis is feasible -
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| 67 | ;;
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| 68 | ;;
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| 69 | ;;
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| 70 | ;;
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| 71 | ;;
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| 72 | ;; 3. Spine, trunk, and neck -
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| 73 | ;;
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| 74 | ;; a. Describe any limitation of motion or deformity of lumbar,
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| 75 | ;;thoracic, and cervical spine -
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| 76 | ;;
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| 77 | ;;
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| 78 | ;;
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| 79 | ;;
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| 80 | ;;
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| 81 | ;; b. Note if deformity of thoracic spine interferes with breathing -
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| 82 | ;;
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| 83 | ;;
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| 84 | ;;
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| 85 | ;;
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| 86 | ;;
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| 87 | ;;
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| 88 | ;;G. Capacity to protect oneself from the hazards/dangers of daily environment:
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| 89 | ;;
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| 90 | ;; 1. Describe briefly any pathological processes involving other body
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| 91 | ;;parts and systems, including the effects of advancing age, such as dizziness,
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| 92 | ;;loss of memory, poor balance affecting ability to ambulate, perform self-
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| 93 | ;;care, or travel beyond the premises of the home or the ward or clinical
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| 94 | ;;area if hospitalized -
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| 95 | ;;|TOP|
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| 96 | ;; 2. Describe where the veteran goes and what he/she does during a
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| 97 | ;;typical day -
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| 98 | ;;
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| 99 | ;;
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| 100 | ;;
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| 101 | ;;
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| 102 | ;;
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| 103 | ;;
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| 104 | ;;END
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| 105 | ;
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| 106 | TXT10 ;;Once the existence of at least one permanent disability
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| 107 | ;; rated as being 100% disabling has been established, additional
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| 108 | ;; benefits are payable if the veteran is so helpless as to require
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| 109 | ;; the regular aid and attendance of another person in attending to
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| 110 | ;; the ordinary activities of daily living, or in protecting
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| 111 | ;; himself/herself from the ordinary hazards of his/her daily
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| 112 | ;; environment, or is restricted to his/her home or the immediate
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| 113 | ;; vicinity thereof, including the ward or immediate clinical area,
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| 114 | ;; if hospitalized.
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| 115 | ;;
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| 116 | ;; If a general medical examination is included as a part of this
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| 117 | ;; request specific findings as to the individual body systems and
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| 118 | ;; extremeties already noted in that examination need not be repeated.
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| 119 | ;; Items "G" through "L", as the examiner deems appropriate, must be
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| 120 | ;; completed in all cases unless the veteran is blind or permanently
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| 121 | ;; bedridden (see item "C").
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| 122 | ;;
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| 123 | ;;END
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