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1DVBCST2 ;ALB/JEH SOCIAL AND INDUSTRIAL SURVEY WKS TEXT - 2 ; 24 MAY 2004
2 ;;2.7;AMIE;**70**;Apr 10, 1995
3 ;
4 ;
5TXT ;
6 ;;G. Chronological History of Adjustment Prior to Service or Stressor
7 ;; ----------------------------------------------------------------
8 ;;
9 ;; 1. Any evidence of disorder in infancy, childhood, or adolescence,
10 ;; especially antisocial behavior (reference DSM-IV).
11 ;;
12 ;; 2. Activity patterns Friendships and social relationships.
13 ;;
14 ;; 3. Family Describe relationships.
15 ;;
16 ;; 4. Significant issues in school, community, or work area.
17 ;;
18 ;; 5. Pre-military traumatic events Provide details, if possible.
19 ;;
20 ;;
21 ;;H. Chronological History of Adjustment After Service or Stressor
22 ;; -------------------------------------------------------------
23 ;;
24 ;; 1. Changes in personality or interpersonal relationships.
25 ;;
26 ;; 2. Work performance.
27 ;;
28 ;; 3. Emotional difficulties: Describe onset and details, including time,
29 ;; nature, and severity.
30 ;;
31 ;; 4. Onset of any other type of symptoms, such as physical.
32 ;;
33 ;; 5. Legal issues, such as involvement with authorities or courts.
34 ;;
35 ;; 6. Substance abuse history Describe use of drugs, alcohol,
36 ;; prescription medications, and tobacco.
37 ;;
38 ;; 7. Psychiatric treatment history.
39 ;;
40 ;;
41 ;;I. Post-Military Social Adjustment
42 ;; -------------------------------
43 ;;
44 ;; 1. Describe all marriages and divorces, loss of spouse or significant other
45 ;; through death, and birth (and death if applicable) of all children.
46 ;;
47 ;; 2. Describe nature of friendships and social relationships, including
48 ;; group memberships.
49 ;;
50 ;; 3. Describe the veteran's living situation.
51 ;;
52 ;; 4. Note any significant post-military adjustment problems, including
53 ;; illness or injury.
54 ;;
55 ;;
56 ;;J. Industrial Adjustment
57 ;; ---------------------
58 ;;
59 ;; 1. Veteran's occupation(s).
60 ;;
61 ;; 2. All education and training.
62 ;;
63 ;; 3. List all employers and positions, including:
64 ;; a. Earnings
65 ;; b. Dates of change(s) in employment
66 ;; c. Length of time with specific employers
67 ;; d. Periods of unemployment
68 ;; e. Relationship with co-workers, supervisors, and subordinates
69 ;;
70 ;; 4. Highest paid position.
71 ;;
72 ;; 5. Attitude toward employment.
73 ;;
74 ;; 6. Is the veteran working at an occupation or position that is below
75 ;; his/her education and training level?
76 ;;
77 ;; 7. Is there evidence that the veteran's pre-traumatic level of
78 ;; performance was above his/her post-traumatic level of performance?
79 ;; What is the documentation of this?
80 ;;
81 ;; 8. Is there evidence service connected disability(ies) impacted the
82 ;; veteran's decision to retire? Discuss. (For example, did the
83 ;; veteran choose to take an early retirement with financial loss in
84 ;; order to reduce the stress experienced in the work environment
85 ;; because the stress was aggravating the service connected
86 ;; disability(ies)?)
87 ;;
88 ;; 9. Has an employer made official or unofficial accommodations to handle
89 ;; veterans disabilities? Document any evidence of internal transfers,
90 ;; re-assignments, etc.
91 ;;
92 ;;K. Present Social Functioning
93 ;; --------------------------
94 ;;
95 ;; 1. Identify Stressors in any of the following categories:
96 ;;
97 ;; a. Primary support system or group
98 ;;
99 ;; b. Social environment
100 ;;
101 ;; c. Educational problems
102 ;;
103 ;; d. Occupational problems
104 ;;
105 ;; e. Housing problems
106 ;;
107 ;; f. Economic problems
108 ;;
109 ;; g. Problems accessing health care
110 ;;
111 ;; h. Legal system or criminal problems
112 ;;
113 ;; i. Other
114 ;;
115 ;; 2. Appearance: Describe dress, speech, mannerisms, scars, facial
116 ;; expressions, and body movements (assessment based on observation
117 ;; listed above).
118 ;;
119 ;; 3. Relationships: Describe all relationships, including with whom
120 ;; and duration of relationship. Describe physical intimacy, including
121 ;; frequency, level of satisfaction, problems with intimacy, and any
122 ;; impact of medical or psychiatric conditions on performance.
123 ;;
124 ;; 4. Lifestyle: Describe how the veteran spends his/her time, including
125 ;; interests, hobbies, employment, typical day and week, and eating and
126 ;; sleeping patterns.
127 ;;
128 ;; 5. Mental Status: Describe, including evidence of confusion, memory
129 ;; problems, thought processes or disorders, and mood/affect.
130 ;; Describe the veteran's functioning in the areas of cognitive,
131 ;; emotional (mood) and judgment.
132 ;;
133 ;; 6. GAF Score (if available)
134 ;;
135 ;;L. Capacity to manage financial affairs (if an issue)
136 ;; ------------------------------------
137 ;;
138 ;;NOTE: Mental competency, for VA benefits purposes, refers only to the ability
139 ;; of the veteran to manage VA benefit payments in his or her own best
140 ;; interest, and not to any other subject. Mental incompetency, for VA
141 ;; benefits purposes, means that the veteran, because of injury or disease,
142 ;; is not capable of managing benefit payments in his or her best interest.
143 ;; In order to assist raters in making a legal determination as to
144 ;; competency, please address the following:
145 ;;
146 ;; 1. What is the impact of injury or disease on the veteran's ability to
147 ;; manage his or her financial affairs, including consideration of
148 ;; such things as knowing the amount of his or her VA benefit payment,
149 ;; knowing the amounts and types of bills owed monthly, and handling the
150 ;; payment prudently?
151 ;;
152 ;; 2. Does the veteran handle the money and pay the bills himself or
153 ;; herself?
154 ;;
155 ;; 3. Based on your examination, do you believe that the veteran is capable
156 ;; of managing his or her financial affairs? Please provide examples to
157 ;; support your conclusion.
158 ;;
159 ;;M. Summary & Conclusions
160 ;; ---------------------
161 ;;
162 ;; 1. Summarize the specific effect of disabilities and the impact on
163 ;; employment.
164 ;;
165 ;; 2. Summarize the specific effect of disabilities and the impact on
166 ;; social functioning.
167 ;;
168 ;;
169 ;;
170 ;;NOTE: Refer to medical, psychiatric and/or neuro-psychiatric report(s), as
171 ;; appropriate.
172 ;;
173 ;;
174 ;;
175 ;;__________________________ ___________
176 ;;SIGNATURE OF SOCIAL WORKER DATE
177 ;;END
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