[613] | 1 | DVBCWFI3 ;ALB/RLC FIBROMYALGIA WKS TEXT - 1 ; 12 FEB 2007
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| 2 | ;;2.7;AMIE;**121**;Apr 10, 1995;Build 9
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| 3 | ;
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| 4 | ;
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| 5 | TXT ;
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| 6 | ;;Narrative: For VA compensation purposes, the diagnosis of fibromyalgia
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| 7 | ;;(sometimes called fibrositis, primary fibromyalgia syndrome, or
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| 8 | ;;myofascial pain syndrome) requires the presence of widespread
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| 9 | ;;musculoskeletal pain and tender points. Additional findings may also
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| 10 | ;;be present: fatigue, sleep disturbance, stiffness, paresthesias,
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| 11 | ;;headache, irritable bowel symptoms, depression, anxiety, or Raynaud's
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| 12 | ;;-like symptoms. Widespread pain is defined as pain in both the left
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| 13 | ;;and right sides of the body, that is both above and below the waist,
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| 14 | ;;and that affects both the axial skeleton (i.e., cervical spine,
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| 15 | ;;anterior chest, thoracic spine, or low back) and the extremities.
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| 16 | ;;Rule out other diagnostic entities that may be responsible for the
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| 17 | ;;symptomatology presented.
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| 18 | ;;
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| 19 | ;;A. Review of Medical Records:
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| 20 | ;;
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| 21 | ;;B. Medical History (Subjective Complaints):
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| 22 | ;;
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| 23 | ;; Comment on:
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| 24 | ;;
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| 25 | ;; 1. Date of onset of symptoms, date of diagnosis (if known).
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| 26 | ;; 2. Are symptoms constant or nearly so? If episodic, how often are they
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| 27 | ;; present? What precipitates and alleviates symptoms? Are they
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| 28 | ;; refractory to therapy?
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| 29 | ;; 3. Location, severity, frequency of any musculoskeletal pain,
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| 30 | ;; stiffness, or muscle weakness.
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| 31 | ;; 4. Unexplained fatigue, sleep disturbances, headaches, paresthesias.
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| 32 | ;; 5. GI symptoms.
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| 33 | ;; 6. Treatment, (type, duration, response, side effects). Has treatment
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| 34 | ;; been continuous?
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| 35 | ;; 7. Is there depression or anxiety?
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| 36 | ;; 8. Effects of symptoms on daily activities.
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| 37 | ;; 9. Lost time from work?
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| 38 | ;; 10. History of hospitalizations, dates and location, if known, reason.
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| 39 | ;;
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| 40 | ;;C. Physical Examination (Objective Findings):
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| 41 | ;;
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| 42 | ;; Address each of the following and fully describe current findings:
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| 43 | ;; (Please incorporate all ancillary study results into the final
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| 44 | ;; diagnosis.)
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| 45 | ;;
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| 46 | ;; 1. Musculoskeletal areas involved.
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| 47 | ;; 2. Trigger or tender points.
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| 48 | ;; 3. Muscle strength in involved areas.
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| 49 | ;;
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| 50 | ;;D. Diagnostic and Clinical Tests:
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| 51 | ;;
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| 52 | ;; 1. Include results of all diagnostic and clinical tests conducted
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| 53 | ;; in the examination report.
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| 54 | ;;
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| 55 | ;;E. Diagnosis:
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| 56 | ;;
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| 57 | ;; 1. Is the condition currently active or in remission?
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| 58 | ;;
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| 59 | ;;
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| 60 | ;;
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| 61 | ;;Signature: Date:
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| 62 | ;;END
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