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1DVBCWPE2 ;ESW/ PTSD WKS TEXT - 2 ; 10 Oct 2000
2 ;;2.7;AMIE;**34**;Apr 10, 1995
3 ;
4 ;
5TXT ;
6 ;;E. Assessment of PTSD
7 ;;
8 ;; * state whether or not the veteran meets the DSM-IV stressor criterion
9 ;; * identify behavioral, cognitive, social, affective, or somatic symptoms
10 ;; veteran attributes to PTSD
11 ;; * describe specific PTSD symptoms present (symptoms of trauma
12 ;; re-experiencing, avoidance/numbing, heightened physiological arousal,
13 ;; and associated features [e.g., disillusionment and demoralization])
14 ;; * specify typical frequency, and severity of symptoms
15 ;;TOF
16 ;;F. Psychometric Testing Results
17 ;;
18 ;; * provide psychological testing if deemed necessary.
19 ;; * provide specific evaluation information required by the rating board or
20 ;; on a BVA Remand.
21 ;; * comment on validity of psychological test results
22 ;; * provide scores for PTSD psychometric assessments administered
23 ;; * state whether PTSD psychometric measures are consistent or inconsistent
24 ;; with a diagnosis of PTSD, based on normative data and established
25 ;; "cutting scores" (cutting scores that are consistent with or supportive
26 ;; of a PTSD diagnosis are as follows: PCL - not less than 50;
27 ;; Mississippi Scale - not less than 107; MMPI PTSD subscale a score
28 ;; greater than 28; MMPI code type: 2-8 or 2-7-8)
29 ;; * state degree of severity of PTSD symptoms based on psychometric data
30 ;; (mild, moderate, or severe)
31 ;; * describe findings from psychological tests measuring other than
32 ;; PTSD (MMPI, etc.)
33 ;;
34 ;;G. Diagnosis:
35 ;;
36 ;; 1. The Diagnosis must conform to DSM-IV and be supported by the findings
37 ;; on the examination report.
38 ;; 2. If there are multiple mental disorders, delineate to the extent possible
39 ;; the symptoms associated with each and a discussion of relationship.
40 ;; 3. Evaluation is based on the effects of the signs and symptoms on
41 ;; occupational and social functioning.
42 ;;
43 ;; NOTE: VA is prohibited by statute from paying compensation for a disability
44 ;; that is a result of the veteran's own ALCOHOL OR DRUG ABUSE, whether based
45 ;; on direct service connection, secondary service connection, or aggravation
46 ;; by a service-connected condition. Therefore, when alcohol or drug abuse
47 ;; accompanies or is associated with another mental disorder, separate,
48 ;; to the extent possible, the effects of the alcohol or drug abuse from
49 ;; the effects of the other mental disorder(s). If it is not possible
50 ;; to separate the effects, explain why.
51 ;;
52 ;;H. Diagnostic Status
53 ;;
54 ;; Axis I disorders
55 ;; Axis II disorders
56 ;; Axis III disorders
57 ;; Axis IV (psychosocial and environmental problems)
58 ;; Axis V (GAF score - current)
59 ;;
60 ;;I. Global Assessment or Functioning (GAF):
61 ;;
62 ;; NOTE: The complete multi-axial format as specified by DSM-IV may be required
63 ;; by BVA REMAND or specifically requested by the rating specialist. If so,
64 ;; include the GAF score and note whether it refers to current functioning.
65 ;; A BVA REMAND may also request, in addition to an overall GAF score,
66 ;; that a separate GAF score be provided for each mental disorder present when
67 ;; there are multiple Axis I or Axis II diagnoses and not all are service-
68 ;; connected. If separate GAF scores can be given, an explanation and
69 ;; discussion of the rationale is needed. If it is not possible, an explanation
70 ;; as to why not is needed. (See the above note pertaining to alcohol or drug
71 ;; abuse, the effects of which cannot be used to assess the effects of
72 ;; a service-connected condition.)
73 ;;
74 ;;J. Competency:
75 ;;
76 ;; Competency, for benefits purposes, has a special meaning,
77 ;; and refers ONLY to veterans' ability to manage benefit payments in their own
78 ;; best interests without restriction, and not to any other subject. State
79 ;; whether the veteran is capable of managing his/her or her benefit payments
80 ;; in the individual's own best interests (a physical disability which prevents
81 ;; the veteran from attending to financial matters in person is not a proper
82 ;; basis for a finding of incompetency unless the veteran is, by reason of that
83 ;; disability, incapable of directing someone else in handling the individual's
84 ;; financial affairs).
85 ;;
86 ;;K. Other Opinion:
87 ;;
88 ;; Furnish any other specific opinion requested by the rating
89 ;; board or BVA remand (i.e.,furnish the complete rationale and citation of
90 ;; medical texts or treatise supporting opinion, if medical literature review
91 ;; was undertaken). If the requested opinion is medically not ascertainable
92 ;; on exam or testing please state WHY. If the requested opinion can not be
93 ;; expressed without resorting to speculation or making improbable assumptions
94 ;; say so, and explain why. If the Opinion asks "... is it at least as likely
95 ;; as not..", fully explain the clinical findings and rationale for the opinion.
96 ;;
97 ;;L. Integrated Summary and Conclusions
98 ;;
99 ;; 1. Describe changes in PSYCHOSOCIAL FUNCTIONAL STATUS and QUALITY of LIFE
100 ;; since the last exam (performance in employment or schooling, routine
101 ;; responsibilities of self care, family role functioning, physical health,
102 ;; social/interpersonal relationships, recreation/leisure pursuits)
103 ;; 2. Describe linkage between PTSD symptoms and aforementioned changes in
104 ;; impairment in functional status and quality of life.
105 ;; Particularly in cases where a veteran is unemployed, specific details
106 ;; about the effects of PTSD and its symptoms on employment are especially
107 ;; important.
108 ;; 3. If possible, describe extent to which disorders other than PTSD
109 ;; (e.g., substance use disorders) are independently responsible for
110 ;; impairment in psychosocial adjustment and quality of life. If this is not
111 ;; possible, explain why (e.g., substance use had onset after PTSD
112 ;; and clearly is a means of coping with PTSD symptoms).
113 ;;TOF
114 ;; 4. If possible, state prognosis for improvement of psychiatric condition
115 ;; and impairments in functional status.
116 ;; 5. Comment on whether veteran should be rated as competent for VA purposes
117 ;; in terms of being capable of managing his/her benefit payments in his/her
118 ;; own best interest.
119 ;;
120 ;;
121 ;;Signature: Date:
122 ;;END
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