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1DVBCWLL3 ;ALB/RLC LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 19 FEBRUARY 1999
2 ;;2.7;AMIE;**86**;July 22, 2004
3 ;
4 ;
5TXT ;
6 ;;
7 ;;A. Review of Medical Records: This may be of particular importance when
8 ;; hepatitis C or chronic liver disease is claimed as related to service.
9 ;;
10 ;;B. Medical History (Subjective Complaints):
11 ;;
12 ;; 1. For Gall Bladder Disease (Including Gall bladder removal): Episodes of
13 ;; colic or other abdominal pain, distention, nausea, and / or vomiting.
14 ;; Include a statement on frequency of attacks (number within past year).
15 ;; Provide statement as to what x-ray (or other) evidence supports diagnosis
16 ;; of chronic cholycystitis. Include current treatment - type (medication,
17 ;; diet, etc.), duration, response, side effects. For Gall Bladder injury,
18 ;; refer to Stomach, Duodenum and Peritoneal Adhesions worksheet.
19 ;;
20 ;; 2. For Pancreatic conditions: Does veteran have steatorrhea, malabsorption,
21 ;; or malnutrition? Comment on whether veteran has attacks of abdominal
22 ;; pain. Include frequency of attacks (per year). Comment on whether veteran
23 ;; has diarrhea, weight loss. Is there evidence of continuing pancreatic
24 ;; insufficiency between acute attacks? Provide evidence (lab or other
25 ;; clinical studies) that abdominal pain is a consequence of pancreatic
26 ;; disease. Has veteran had pancreatic surgery? If so, describe. Include
27 ;; current treatment - type (medication, diet, enzymes, etc.), duration,
28 ;; response, side effects.
29 ;;
30 ;; 3. For Chronic Liver disease (including hepatitis B, chronic active
31 ;; hepatitis, autoimmune hepatitis, hemochromatosis, drug-induced hepatitis,
32 ;; etc., but excluding bile duct disorders and Hepatitis C): (a) Does
33 ;; veteran have "incapacitating episodes" (defined as periods of acute signs
34 ;; and symptoms with symptoms such as fatigue, malaise, nausea, vomiting,
35 ;; anorexia, arthralgia, and right upper quadrant pain with symptoms severe
36 ;; enough to require bed rest and treatment by a physician)? If so, provide
37 ;; frequency of episodes and total duration of episodes over the past
38 ;; 12-month period. Please include comment on whether this is veteran
39 ;; reported, and / or documented in the available records. (b) Include
40 ;; current treatment - type (medication, diet, enzymes, etc.), duration,
41 ;; response, side effects. (c) Comment on presence and severity (e.g.
42 ;; near-constant, debilitating, daily or intermittent), as appropriate, of
43 ;; fatigue, malaise, anorexia and weight loss, right upper quadrant pain and
44 ;; hepatomegaly. (d) Include a history of risk factors for the liver
45 ;; condition which the veteran is claiming service connection. For instance
46 ;; (as appropriate) is there a history of occupational blood exposure? IV
47 ;; drug use? Taking medications that are associated with liver disease?
48 ;; Include a history of alcohol use / abuse, past and present. Note presence
49 ;; or absence of extrahepatic manifestations of veteran's liver disease (e.g.
50 ;; vasculitis, kidney disease, arthritis.) Refer to additional worksheets
51 ;; as necessary. See and address 4. Cirrhosis of the liver when cirrhosis
52 ;; is a sequelae. See and address 7 (below) where veteran is status post
53 ;; liver transplant.
54 ;;
55 ;; 4. For Cirrhosis of the Liver, primary biliary cirrhosis, cirrhotic phase of
56 ;; sclerosing cholangitis, or as a sequelae of hepatitis from any cause:
57 ;; (a)Fully describe the following, indicating, as appropriate, the number
58 ;; of episodes, periods of remission, or whether the condition is refractory
59 ;; to treatment: (i) ascites, (ii) hepatic encephalopathy, (iii) hemorrhage
60 ;; from varicies (include comment on episodes of hemetemesis and/or melana,
61 ;; (iv) portal gastropathy (v) portal hypertension, (vi) jaundice. (b)
62 ;; comment on: (i) current treatment (s) (medications, diet, response, side
63 ;; effects, duration) (ii) Discuss presence, frequency (e.g., daily,
64 ;; intermittent, etc.) and severity of each of the following: weakness,
65 ;; anorexia, malaise, abdominal pain, weight loss (include amount and time
66 ;; frame), weight gain, and weakness. Note presence or absence of
67 ;; extrahepatic manifestations of veteran's liver disease (e.g.
68 ;; vasculitis, kidney disease, arthritis.) Refer to additional worksheets
69 ;; as necessary. See and address 3 (above) where cirrhosis is a sequaele
70 ;; of Chronic Liver disease (including hepatitis B, chronic active
71 ;; hepatitis, autoimmune hepatitis, hemochromatosis, drug-induced
72 ;; hepatitis, etc., but excluding bile duct disorders and Hepatitis C).
73 ;; See and address 7 (below) where veteran is status post liver transplant.
74 ;;
75 ;; 5. For Hepatitis C: (a) Does veteran have "incapacitating episodes" (defined
76 ;; as periods of acute signs and symptoms with symptoms such as fatigue,
77 ;; malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant
78 ;; pain with symptoms severe enough to require bed rest and treatment by a
79 ;; physician)? If so, provide frequency of episodes and total duration of
80 ;; episodes over the past 12-month period. Please include comment on whether
81 ;; this is veteran reported, and/ or documented in the available records.
82 ;; (b) comment on: (i) current treatment (s) (medications, diet, response,
83 ;; side effects, duration) (ii) Discuss presence, frequency (e.g., daily,
84 ;; intermittent, etc.) and severity of each of the following: weakness,
85 ;; anorexia, malaise, abdominal pain, weight loss (include amount and time
86 ;; frame), weight gain, and weakness. (c) Include a history of risk factors
87 ;; for the liver condition for which the veteran is claiming service
88 ;; connection. For instance (as appropriate) is there a history of
89 ;; occupational blood exposure? IV drug use? See established risk factors
90 ;; for Hepatitis C, below. Note presence or absence of extrahepatic
91 ;; manifestations of veteran's liver disease (e.g. vasculitis, kidney
92 ;; disease, arthritis.) Refer to additional worksheets as necessary.
93 ;; See and address 7 (below) where veteran is status post liver transplant.
94 ;;
95 ;; 6. For Liver Malignancy: Address presence or absence of symptomatolgy, etc.,
96 ;; as outlined in both: 3. (For Chronic Liver disease (including hepatitis B,
97 ;; chronic active hepatitis, autoimmune hepatitis, hemochromatosis,
98 ;; drug-induced hepatitis, etc., but excluding bile duct disorders and
99 ;; Hepatitis C) and 4. (For Cirrhosis of the Liver, primary biliary
100 ;; cirrhosis, cirrhotic phase of sclerosing cholangitis, or as a sequelae
101 ;; of hepatitis from any cause) above.
102 ;;
103 ;; 7. For Liver Transplant: Provide date of transplant. Describe current
104 ;; treatment(s) (medications, diet, response, side effects, duration).
105 ;; Please refer to additional AMIE worksheets to address conditions veteran
106 ;; has as a consequence of the transplant, treatment for the transplant, and
107 ;; as a consequence of any underlying disease that prompted the transplant
108 ;; in the first place (e.g. extrahepatic complications / manifestations of
109 ;; hepatitis C).
110 ;;
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