[613] | 1 | DVBCWEA3 ;BPOIFO/ESW - EATING DISORDERS WKS TEXT - 1 ; 10/1/02 5:33pm
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| 2 | ;;2.7;AMIE;**46**;Apr 10, 1995
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| 3 | ;Per VHA Directive 10-92-142, this routine should not be modified
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| 4 | ;
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| 5 | TXT ;
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| 6 | ;;
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| 7 | ;;A. Review of Medical Records:
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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. PAST MEDICAL HISTORY
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| 14 | ;;
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| 15 | ;; a. Previous hospitalizations and outpatient care for parenteral
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| 16 | ;; nutrition or tube feeding.
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| 17 | ;; b. Medical and occupational history from the time between the
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| 18 | ;; last such rating examination and the present needs to be
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| 19 | ;; accounted for, UNLESS the purpose of this examination is to
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| 20 | ;; ESTABLISH service connection, then a complete medical history
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| 21 | ;; since discharge from military service is required.
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| 22 | ;; c. Periods of incapacitation (during which bed rest and treatment
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| 23 | ;; by a physician are required due to the eating disorder).
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| 24 | ;; Describe the frequency and duration.
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| 25 | ;; d. Current treatment, response, side effects.
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| 26 | ;;
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| 27 | ;;
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| 28 | ;; 2. PRESENT MEDICAL, OCCUPATIONAL AND SOCIAL HISTORY - over the past
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| 29 | ;; one year.
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| 30 | ;;
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| 31 | ;; a. History of onset of eating disorder.
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| 32 | ;; b. Its course, treatment, and current status to include symptoms.
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| 33 | ;; c. Extent of time lost from work over the past 12 month period
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| 34 | ;; and social impairment. If employed, identify current occupation
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| 35 | ;; and length of time at this job.
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| 36 | ;;
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| 37 | ;;
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| 38 | ;; 3. SUBJECTIVE COMPLAINTS:
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| 39 | ;;
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| 40 | ;; a. Describe fully.
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| 41 | ;;
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| 42 | ;;TOF
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| 43 | ;;C. Examination (Objective Findings):
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| 44 | ;;
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| 45 | ;; Address each of the following and fully describe:
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| 46 | ;;
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| 47 | ;; 1. Mental status exam to confirm or establish diagnosis in
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| 48 | ;; accordance with DSM-IV.
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| 49 | ;;
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| 50 | ;; 2. Additionally, please provide this specific information:
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| 51 | ;; a. Current weight.
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| 52 | ;; b. Expected minimum weight based on age, height, and body build.
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| 53 | ;; c. Obtain weight history.
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| 54 | ;;
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| 55 | ;; 3. Additionally, to allow evaluation by the rating specialist,
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| 56 | ;; describe and fully explain the existence, frequency, and extent
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| 57 | ;; of the following signs and symptoms and relate how they
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| 58 | ;; interfere with employment:
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| 59 | ;; a. Binge eating.
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| 60 | ;; b. Self-induced vomiting or other measure to prevent weight gain
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| 61 | ;; when weight is already below expected minimum normal weight.
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| 62 | ;;
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| 63 | ;;D. Diagnostic Tests (including psychological testing if deemed necessary):
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| 64 | ;;
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| 65 | ;; 1. Provide specific evaluation information required by the rating
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| 66 | ;; board or on a BVA Remand. Diagnostic Tests (See the examination
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| 67 | ;; request remarks for specifics.):
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| 68 | ;;
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| 69 | ;; a. CAPACITY TO MANAGE FINANCIAL AFFAIRS
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| 70 | ;;
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| 71 | ;; Mental competency, for VA benefits purposes, refers only to
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| 72 | ;; the ability of the veteran to manage VA benefit payments in his
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| 73 | ;; or her own best interest, and not to any other subject.
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| 74 | ;; Mental incompetency, for VA benefits purposes, means that
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| 75 | ;; the veteran, because of injury or disease, is not capable of
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| 76 | ;; managing benefit payments in his or her best interest.
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| 77 | ;; In order to assist raters in making a legal determination as to
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| 78 | ;; competency, please address the following:
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| 79 | ;; What is the impact of injury or disease on the veteran's ability
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| 80 | ;; to manage his or her financial affairs, including consideration
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| 81 | ;; of such things as knowing the amount of his or her VA benefit
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| 82 | ;; payment, knowing the amounts and types of bills owed monthly,
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| 83 | ;; and handling the payment prudently? Does the veteran handle
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| 84 | ;; the money and pay the bills himself or herself?
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| 85 | ;;
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| 86 | ;; Based on your examination, do you believe that the veteran is
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| 87 | ;; capable of managing his or her financial affairs?
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| 88 | ;; Please provide examples to support your conclusion.
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| 89 | ;;
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| 90 | ;; If you believe a Social Work Service assessment is needed before
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| 91 | ;; you can give your opinion on the veteran's ability to manage his
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| 92 | ;; or her financial affairs, please explain why.
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| 93 | ;;
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| 94 | ;; b. OTHER OPINION: Furnish any other specific opinion requested
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| 95 | ;; by the rating board or BVA Remand, furnishing the complete
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| 96 | ;; rationale and citation of medical texts or treatise supporting
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| 97 | ;; opinion, if medical literature review was undertaken. If the
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| 98 | ;; requested opinion is medically not ascertainable on exam or
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| 99 | ;; testing, please state WHY. If the requested opinion cannot
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| 100 | ;; be expressed without resorting to speculation or making
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| 101 | ;; improbable assumptions say so, and explain why. If the opinion
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| 102 | ;; asks "...is it at least as likely as not...", fully explain
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| 103 | ;; the clinical findings and rationale for the opinion.
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| 104 | ;;
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| 105 | ;;
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| 106 | ;; 2. Include results of all diagnostic and clinical tests conducted
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| 107 | ;; in the examination report.
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| 108 | ;;
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| 109 | ;;
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| 110 | ;;E. Diagnosis:
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| 111 | ;;
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| 112 | ;;
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| 113 | ;;Signature: Date:
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| 114 | ;;END
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