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1DVBCWPD2 ;ALB/ESW PTSD WKS TEXT - 2 ; 10 Oct 2000
2 ;;2.7;AMIE;**34**;Apr 10, 1995
3 ;
4 ;
5TXT ;
6 ;;
7 ;;F. Assessment of PTSD
8 ;;
9 ;; * state whether or not the veteran meets the DSM-IV stressor criterion
10 ;; * identify behavioral, cognitive, social, affective, or somatic change
11 ;; veteran attributes to stress exposure
12 ;; * describe specific PTSD symptoms present (symptoms of trauma
13 ;; re-experiencing, avoidance/numbing, heightened physiological arousal,
14 ;; and associated features [e.g., disillusionment and demoralization])
15 ;; * specify onset, duration, typical frequency, and severity of symptoms
16 ;;
17 ;;G. Psychometric Testing Results
18 ;;
19 ;; * provide psychological testing if deemed necessary.
20 ;; * provide specific evaluation information required by the rating board or
21 ;; on a BVA Remand.
22 ;; * comment on validity of psychological test results
23 ;; * provide scores for PTSD psychometric assessments administered
24 ;; * state whether PTSD psychometric measures are consistent or inconsistent
25 ;; with a diagnosis of PTSD, based on normative data and established
26 ;; "cutting scores" (cutting scores that are consistent with or supportive
27 ;; of a PTSD diagnosis are as follows: PCL - not less than 50;
28 ;; Mississippi Scale - not less than 107; MMPI PTSD subscale a score
29 ;; greater than 28; MMPI code type: 2-8 or 2-7-8)
30 ;; * state degree of severity of PTSD symptoms based on psychometric data
31 ;; (mild, moderate, or severe)
32 ;; * describe findings from psychological tests measuring other than
33 ;; PTSD (MMPI, etc.)
34 ;;
35 ;;H. Diagnosis:
36 ;;
37 ;; 1. The Diagnosis must conform to DSM-IV and be supported by the findings
38 ;; on the examination report.
39 ;; 2. If there are multiple mental disorders, delineate to the extent possible
40 ;; the symptoms associated with each and a discussion of relationship.
41 ;; 3. Evaluation is based on the effects of the signs and symptoms on
42 ;; occupational and social functioning.
43 ;;
44 ;; NOTE: VA is prohibited by statute from paying compensation for a disability
45 ;; that is a result of the veteran's own ALCOHOL OR DRUG ABUSE, whether based
46 ;; on direct service connection, secondary service connection, or aggravation
47 ;; by a service-connected condition. Therefore, when alcohol or drug abuse
48 ;; accompanies or is associated with another mental disorder, separate,
49 ;; to the extent possible, the effects of the alcohol or drug abuse from
50 ;; the effects of the other mental disorder(s). If it is not possible
51 ;; to separate the effects, explain why.
52 ;;
53 ;;I. Diagnostic Status
54 ;;
55 ;; Axis I disorders
56 ;; Axis II disorders
57 ;; Axis III disorders
58 ;; Axis IV (psychosocial and environmental problems)
59 ;; Axis V (GAF score - current)
60 ;;
61 ;;J. Global Assessment or Functioning (GAF):
62 ;;
63 ;; NOTE: The complete multi-axial format as specified by DSM-IV may be required
64 ;; by BVA REMAND or specifically requested by the rating specialist. If so,
65 ;; include the GAF score and note whether it refers to current functioning.
66 ;; A BVA REMAND may also request, in addition to an overall GAF score,
67 ;; that a separate GAF score be provided for each mental disorder present when
68 ;; there are multiple Axis I or Axis II diagnoses and not all are service-
69 ;; connected. If separate GAF scores can be given, an explanation and
70 ;; discussion of the rationale is needed. If it is not possible, an explanation
71 ;; as to why not is needed. (See the above note pertaining to alcohol or drug
72 ;; abuse, the effects of which cannot be used to assess the effects of
73 ;; a service-connected condition.)
74 ;;
75 ;; DSM-IV is only for application from 11/7/96 on. Therefore, when applicable
76 ;; note whether the diagnosis of PTSD was supportable under DSM-III-R prior
77 ;; to that date.
78 ;;
79 ;;K. Competency:
80 ;;
81 ;; Competency, for benefits purposes, has a special meaning,
82 ;; and refers ONLY to veterans' ability to manage benefit payments in their own
83 ;; best interests without restriction, and not to any other subject. State
84 ;; whether the veteran is capable of managing his/her or her benefit payments
85 ;; in the individual's own best interests (a physical disability which prevents
86 ;; the veteran from attending to financial matters in person is not a proper
87 ;; basis for a finding of incompetency unless the veteran is, by reason of that
88 ;; disability, incapable of directing someone else in handling the individual's
89 ;; financial affairs).
90 ;;
91 ;;L. Other Opinion:
92 ;;
93 ;; Furnish any other specific opinion requested by the rating
94 ;; board or BVA remand (furnish the complete rationale and citation of medical
95 ;; texts or treatise supporting opinion, if medical literature review was
96 ;; undertaken). If the requested opinion is medically not ascertainable
97 ;; on exam or testing please state WHY. If the requested opinion can not be
98 ;; expressed without resorting to speculation or making improbable assumptions
99 ;; say so, and explain why. If the opinion asks "... is it at least as likely
100 ;; as not..", fully explain the clinical findings and rationale for the opinion.
101 ;;
102 ;;M. Integrated Summary and Conclusions
103 ;;
104 ;;- Describe changes in PSYCHOSOCIAL FUNCTIONAL STATUS and QUALITY of LIFE
105 ;; following trauma exposure (performance in employment or schooling, routine
106 ;; responsibilities of self care, family role functioning, physical health,
107 ;; social/interpersonal relationships, recreation/leisure pursuits)
108 ;;- Describe linkage between PTSD symptoms and aforementioned changes in
109 ;; impairment in functional status and quality of life.
110 ;; Particularly in cases where a veteran is unemployed, specific details about
111 ;; the effects of PTSD and its symptoms on employment are especially
112 ;; important.
113 ;;- If possible, describe extent to which disorders other than PTSD
114 ;; (e.g., substance use disorders) are independently responsible for impairment
115 ;; in psychosocial adjustment and quality of life. If this is not possible,
116 ;; explain why (e.g., substance use had onset after PTSD and clearly is a means
117 ;; of coping with PTSD symptoms).
118 ;;- If possible, describe pre-trauma risk factors or characteristics that may
119 ;; have rendered the veteran vulnerable to developing PTSD subsequent to trauma
120 ;; exposure.
121 ;;- If possible, state prognosis for improvement of psychiatric condition
122 ;; and impairments in functional status.
123 ;;- Comment on whether veteran should be rated as competent for VA purposes
124 ;; in terms of being capable of managing his/her benefit payments in his/her
125 ;; own best interest.
126 ;;
127 ;;
128 ;;Signature: Date:
129 ;;END
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