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1DVBCST1 ;ALB/JEH SOCIAL AND INDUSTRIAL SURVEY WKS TEXT - 1 ; 24 MAY 2004
2 ;;2.7;AMIE;**70**;Apr 10, 1995
3 ;
4 ;
5TXT ;
6 ;;A. Demographic & Information and Sources
7 ;; -------------------------------------
8 ;;
9 ;; 1. Note the location of the interview/exam.
10 ;;
11 ;; 2. List demographic data, including age, gender, marital status, and other
12 ;; relevant data.
13 ;;
14 ;; 3. List service connected disabilities.
15 ;;
16 ;; 4. Discuss capacity to manage financial affairs (if an issue).
17 ;;
18 ;; 5. Verify accuracy of veteran's name, address, phone number.
19 ;;
20 ;; 6. List informants or sources of information, such as claims folder,
21 ;; medical record, veteran, family members, employers, neighbors, friends,
22 ;; physician, or other persons.
23 ;;
24 ;; 7. If S&I Survey is done in the community, list the collaterals residing in
25 ;; the home, their ages and relationship to the veteran, a brief
26 ;; description at the household appearance and overall home environment.
27 ;;
28 ;;
29 ;;B. Appearance & Response to Interview
30 ;; ----------------------------------
31 ;;
32 ;; 1. Appearance - Describe the veteran's size, build, general physical
33 ;; appearance and dress, noting any distinguishing features or
34 ;; characteristics.
35 ;;
36 ;; 2. Indicate if s/he was alone or interviewed with others.
37 ;;
38 ;; 3. Make personal observations as to attitude, openness to interview,
39 ;; reality testing, physical or mental difficulties in communicating. Does
40 ;; s/he find the interview stressful or threatening? Is s/he cooperative
41 ;; and friendly or guarded and withdrawn? Observe eye contact, facial
42 ;; expressions, and attention span during interview.
43 ;;
44 ;;
45 ;;C. Disabilities
46 ;; ------------
47 ;;
48 ;; 1. Include disabilities listed on Form 2507 for which the exam is
49 ;; requested and any other complaints or conditions expressed by the
50 ;; veteran.
51 ;;
52 ;; 2. List of current medications.
53 ;;
54 ;;
55 ;;D. Brief Pre-Military Social History
56 ;; ---------------------------------
57 ;;
58 ;; Include where the veteran was born, his/her family configuration,
59 ;; education, etc.
60 ;;
61 ;;
62 ;;E. Military History
63 ;; ----------------
64 ;;
65 ;; 1. Date the veteran entered military service and branch of service.
66 ;;
67 ;; 2. Where s/he completed basic training.
68 ;;
69 ;; 3. Military occupation(s).
70 ;;
71 ;; 4. Primary assignments and where stationed.
72 ;;
73 ;; 5. Any special training received in military.
74 ;;
75 ;; 6. Combat experiences.
76 ;;
77 ;; 7. Sexual trauma while in military.
78 ;;
79 ;; 8. Injuries or illness incurred while in military.
80 ;;
81 ;; 9. If claim is for PTSD, include a detailed account of the traumatic
82 ;; experience(s).
83 ;;
84 ;; 10. Relationships with peers, superiors, subordinates, etc.
85 ;;
86 ;;
87 ;;F. Prisoner of War (POW) Data (if applicable)
88 ;; --------------------------
89 ;;
90 ;; 1. Capture Data
91 ;; ------------
92 ;;
93 ;; a. Injuries/wounds incurred when captured and any treatment received.
94 ;;
95 ;; b. Captors - Date and place captured.
96 ;;
97 ;; c. Internment - List names of camps where interred and dates of
98 ;; internment, psychological conditions, physical conditions, methods
99 ;; used to control prisoners.
100 ;;
101 ;; d. Work - Physical & psychological conditions of work.
102 ;;
103 ;; e. Diet - Daily meals, including types of food, quantities, regularity
104 ;; of meals.
105 ;;
106 ;; f. Illnesses or Injuries incurred when captured or while imprisoned
107 ;; and any treatment received.
108 ;;
109 ;; 2. Information from Veteran's Significant Other(s)
110 ;; -----------------------------------------------
111 ;;
112 ;; a. The significant other's relationship to the veteran.
113 ;;
114 ;; b. Whether s/he knew veteran before or after capture.
115 ;;
116 ;; c. Any changes observed.
117 ;;
118 ;; d. General comments on impact of POW experience.
119 ;;
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