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1DVBCDBCK ;ALB/GTS-557/THM-DISEASES/INJURIES OF THE BRAIN ; 12/28/90 9:26 AM
2 ;;2.7;AMIE;;Apr 10, 1995
3 ;
4 S PG=1,HD91="Department of Veterans Affairs"
5 S HD9=$S($D(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet"
6EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
7 W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1210 Worksheet" S HD7="DISEASES/INJURIES OF THE BRAIN",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
8 W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
9 W !!!!,"Narrative:"
10 S LX="TXT" F I=1:1 S LY=$T(@LX+I) Q:LY["END" W ?13,$P(LY,";;",2),!
11 W !! I '$D(CMBN) W "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:" D HD2
12 W $S($D(CMBN):"A. ",1:"D. "),"Specific evaluation information required by the rating board",!?4,"(if the information requested is included elsewhere, do not",!?4,"repeat here):",!!!
13 W ?5,"1. State if a tumor is present. If so, note type and whether ",!?9,"malignant -",!!!!!!!!
14 W ?5,"2. If a malignancy is present but is now cured or in remission,",!?9,"report the date of last surgery, radiation therapy, chemotherapy",!?9,"or other treatment -",!!!!!!!!
15 W ?5,"3. Describe in detail the motor and sensory impairment of the affected",!?9,"cranial nerves -",!!!!!!!!
16 D:$D(CMBN) HD2 W ?5,"4. Describe in detail any functional impairment of the peripheral",!?9,"and autonomic systems -",!!!!!!!!
17 D:'$D(CMBN) HD2 W ?5,"5. Describe any psychiatric manifestations in detail -",!!!!!!?5,"6. "
18 S LX="TXT1" F I=1:1 S LY=$T(@LX+I) Q:LY["END" W:$X'=5 ?5,$P(LY,";;",2),!
19 W !!!!!!!!!,$S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!!! D:$D(CMBN) HD2
20 W $S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
21 K LN,LN1,LN2
22 Q
23 ;
24HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!,"for ",NAME,!!!
25 Q
26 ;
27SETIOF ; ** Set device control var's
28 D HOME^%ZIS
29 Q
30 ;
31TXT ;
32 ;;Since disorders of the brain are likely to produce psychiatric
33 ;;manifestations as well as neurological, special psychiatric
34 ;;examinations will often be necessary. If special senses are
35 ;;impaired, the examiner should order additional testing as
36 ;;appropriate.
37 ;;END
38TXT1 ;
39 ;;State if the veteran is capable of managing his/her benefit payments
40 ;; in the individual's own best interest without restriction (a physical
41 ;; disability which prevents the veteran from attending to financial
42 ;; matters in person is not a proper basis for a finding of incompetency
43 ;; unless the veteran is, by reason of that disability, incapable of
44 ;; directing someone else in handling the individual's financial
45 ;; affairs) -
46 ;;END
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