1 | DVBCWEA1 ;ALB/CMM EATING DISORDERS WKS TEXT - 1 ; 6 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 | ;;
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11 | ;;B. Medical History (Subjective Complaints):
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12 | ;;
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13 | ;; Comment on:
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14 | ;; 1. PAST MEDICAL HISTORY
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15 | ;;
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16 | ;; a. Previous hospitalizations and outpatient care for parenteral
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17 | ;; nutrition or tube feeding.
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18 | ;;
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19 | ;;
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20 | ;; b. Medical and occupational history from the time between the
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21 | ;; last such rating examination and the present needs to be
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22 | ;; accounted for, UNLESS the purpose of this examination is to
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23 | ;; ESTABLISH service connection, then a complete medical history
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24 | ;; since discharge from military service is required.
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25 | ;;
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26 | ;;
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27 | ;; c. Periods of incapacitation (during which bed rest and treatment
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28 | ;; by a physician are required due to the eating disorder).
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29 | ;; Describe the frequency and duration.
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30 | ;;
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31 | ;;
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32 | ;; d. Current treatment, response, side effects.
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33 | ;;
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34 | ;;
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35 | ;; 2. PRESENT MEDICAL, OCCUPATIONAL AND SOCIAL HISTORY - over the past
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36 | ;; one year.
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37 | ;;
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38 | ;; a. History of onset of eating disorder.
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39 | ;;
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40 | ;; b. Its course, treatment, and current status to include symptoms.
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41 | ;;
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42 | ;; c. Extent of time lost from work over the past 12 month period
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43 | ;; and social impairment. If employed, identify current occupation
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44 | ;; and length of time at this job.
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45 | ;;
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46 | ;;
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47 | ;; 3. SUBJECTIVE COMPLAINTS:
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48 | ;;
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49 | ;; a. Describe fully.
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50 | ;;
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51 | ;;
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52 | ;;C. Examination (Objective Findings):
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53 | ;;
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54 | ;; Address each of the following and fully describe:
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55 | ;; 1. Mental status exam to confirm or establish diagnosis in
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56 | ;; accordance with DSM-IV.
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57 | ;;
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58 | ;; 2. Additionally, please provide this specific information.
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59 | ;;
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60 | ;; a. Current weight.
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61 | ;;
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62 | ;;
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63 | ;; b. Expected minimum weight based on age, height, and body build.
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64 | ;;
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65 | ;;
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66 | ;; c. Obtain weight history.
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67 | ;;
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68 | ;;
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69 | ;; 3. Additionally, to allow evaluation by the rating specialist,
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70 | ;; describe and fully explain the existence, frequency, and extent
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71 | ;; of the following signs and symptoms and relate how they
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72 | ;; interfere with employment:
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73 | ;;
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74 | ;; a. Binge eating.
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75 | ;;
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76 | ;;
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77 | ;; b. Self-induced vomiting or other measure to prevent weight gain
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78 | ;; when weight is already below expected minimum normal weight.
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79 | ;;
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80 | ;;
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81 | ;;D. Diagnostic Tests (including psychological testing if deemed necessary):
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82 | ;;
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83 | ;; 1. Provide specific evaluation information required by the rating
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84 | ;; board or on a BVA Remand. Diagnostic Tests (See the examination
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85 | ;; request remarks for specifics.):
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86 | ;;
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87 | ;; a. COMPETENCY: State whether the veteran is capable of managing
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88 | ;; his or her benefit payments in the individual's own best
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89 | ;; interests. (A physical disability which prevents the veteran
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90 | ;; from attending to financial matters in person is not a proper
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91 | ;; basis for a finding of incompetency unless the veteran is,
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92 | ;; by reason of that disability, incapable of directing someone
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93 | ;; else in handling the individual's financial affairs.)
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94 | ;;
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95 | ;;TOF
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96 | ;; b. OTHER OPINION: Furnish any other specific opinion requested
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97 | ;; by the rating board or BVA Remand, furnishing the complete
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98 | ;; rationale and citation of medical texts or treatise supporting
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99 | ;; opinion, if medical literature review was undertaken. If the
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100 | ;; requested opinion is medically not ascertainable on exam or
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101 | ;; testing, please state WHY. If the requested opinion cannot
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102 | ;; be expressed without resorting to speculation or making
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103 | ;; improbable assumptions say so, and explain why. If the opinion
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104 | ;; asks "...is it at least as likely as not...", fully explain
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105 | ;; the clinical findings and rationale for the opinion.
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106 | ;;
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107 | ;;
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108 | ;; 2. Include results of all diagnostic and clinical tests conducted
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109 | ;; in the examination report.
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110 | ;;
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111 | ;;
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112 | ;;E. Diagnosis:
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113 | ;;
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114 | ;;
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115 | ;;Signature: Date:
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116 | ;;END
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