| [613] | 1 | DVBCWAV1 ;ALB/CMM ARTERIES AND VEINS WKS TEXT - 1 ; 5 MARCH 1997
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 | 2 |  ;;2.7;AMIE;**12**;Apr 10, 1995
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 | 3 |  ;
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 | 4 |  ;
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 | 5 | TXT ;
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 | 6 |  ;;A.  Review of Medical Records:
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 | 7 |  ;;
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 | 8 |  ;;
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 | 9 |  ;;
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 | 10 |  ;;B.  Medical History (Subjective Complaints):
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 | 11 |  ;;
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 | 12 |  ;;    Comment on:
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 | 13 |  ;;    1.  Symptoms due to aortic aneurysm, other large or small artery 
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 | 14 |  ;;        aneurysm, or arteriovenous aneurysm.
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 | 15 |  ;;
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 | 16 |  ;;
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 | 17 |  ;;    2.  Current and past treatment, including surgery - e.g., aortic 
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 | 18 |  ;;        aneurysm grafting, varicose vein stripping, angioplasty of 
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 | 19 |  ;;        peripheral vessels, etc.  Date and response, side effects.
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 | 20 |  ;;
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 | 21 |  ;;
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 | 22 |  ;;    3.  Pain, cramping, claudication on exertion? standing? pain at 
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 | 23 |  ;;        rest?  Give frequency, severity, level of exercise that 
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 | 24 |  ;;        precipitates pain, duration.
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 | 25 |  ;;
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 | 26 |  ;;
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 | 27 |  ;;    4.  Paresthesias or other abnormal sensations.
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 | 28 |  ;;
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 | 29 |  ;;
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 | 30 |  ;;    5.  Attacks of angioneurotic edema - severity, location, frequency, 
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 | 31 |  ;;        duration?
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 | 32 |  ;;
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 | 33 |  ;;
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 | 34 |  ;;    6.  Cold sensitivity.
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 | 35 |  ;;
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 | 36 |  ;;
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 | 37 |  ;;    7.  If treated for malignancy, state type of treatment and dates,
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 | 38 |  ;;        including date of last treatment.  Describe any residual
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 | 39 |  ;;        or recurrent symptoms if treated has been completed.
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 | 40 |  ;;
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 | 41 |  ;;
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 | 42 |  ;;    8.  Is exercise and exertion precluded by the condition?
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 | 43 |  ;;
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 | 44 |  ;;
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 | 45 |  ;;    9.  Is veteran confined to house or bed because of the condition?
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 | 46 |  ;;
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 | 47 |  ;;
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 | 48 |  ;;   10.  Describe the effects of the condition(s) on the veteran's 
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 | 49 |  ;;        usual occupation and daily activities.
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 | 50 |  ;;
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 | 51 |  ;;
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 | 52 |  ;;C.  Physical Examination (Objective Findings):
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 | 53 |  ;;
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 | 54 |  ;;    Address each of the following and fully describe current findings:
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 | 55 |  ;;    1.  Nutrition, general state of health.
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 | 56 |  ;;
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 | 57 |  ;;
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 | 58 |  ;;    2.  Renal, cardiac, or cerebral arteriosclerotic foci.
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 | 59 |  ;;
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 | 60 |  ;;
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 | 61 |  ;;    3.  Cardiac status - size, function.
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 | 62 |  ;;
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 | 63 |  ;;
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 | 64 |  ;;    4.  Evidence and size of aneurysm.
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 | 65 |  ;;
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 | 66 |  ;;
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 | 67 |  ;;    5.  Extremities:
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 | 68 |  ;;        a.  Temperature.
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 | 69 |  ;;
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 | 70 |  ;;
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 | 71 |  ;;
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 | 72 |  ;;        b.  Evidence of superficial phlebitis.
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 | 73 |  ;;
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 | 74 |  ;;
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 | 75 |  ;;
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 | 76 |  ;;        c.  Ulceration or tissue loss.
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 | 77 |  ;;
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 | 78 |  ;;
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 | 79 |  ;;
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 | 80 |  ;;        d.  Edema (constant or intermittent, relieved by elevation?).
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 | 81 |  ;;
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 | 82 |  ;;
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 | 83 |  ;;        e.  Scar.
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 | 84 |  ;;
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 | 85 |  ;;
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 | 86 |  ;;
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 | 87 |  ;;        f.  Color.
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 | 88 |  ;;
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 | 89 |  ;;
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 | 90 |  ;;        g.  Eczema.
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 | 91 |  ;;
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 | 92 |  ;;
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 | 93 |  ;;        h.  Tenderness.
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 | 94 |  ;;
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 | 95 |  ;;
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 | 96 |  ;;    6.  If there are attacks of blanching or flushing, or blanching, 
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 | 97 |  ;;        rubor, and cyanosis, indicate their frequency and duration.
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 | 98 |  ;;
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 | 99 |  ;;
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 | 100 |  ;;    7.  If evidence or history of erythromelalgia - severity, frequency,
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 | 101 |  ;;        duration?
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 | 102 |  ;;
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 | 103 |  ;;
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 | 104 |  ;;    8.  If varicosities are present, indicate their size (diameter?),
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 | 105 |  ;;        location, appearance, and if deep circulation is involved.
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 | 106 |  ;;
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 | 107 |  ;;
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 | 108 |  ;;D.  Diagnostic and Clinical Tests:
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 | 109 |  ;;
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 | 110 |  ;;    1.  X-rays, Doppler vascular studies, angiogram, etc., as 
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 | 111 |  ;;        appropriate, and if indicated.
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 | 112 |  ;;    2.  Include results of all diagnostic and clinical tests conducted
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 | 113 |  ;;        in the examination report.
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 | 114 |  ;;
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 | 115 |  ;;
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 | 116 |  ;;E.  Diagnosis:
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 | 117 |  ;;
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 | 118 |  ;;
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 | 119 |  ;;Signature:                             Date:
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 | 120 |  ;;END
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