| 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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