DVBCTBI3	;ALB/RLC TRAUMATIC BRAIN INJURY (TBI) WKS TEXT - 2 ; 12 FEB 2007
	;;2.7;AMIE;**125**;Apr 10, 1995;Build 9
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	;;C. Physical Examination (Objective Findings): 
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	;;   Address each of the following and fully describe current findings:
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	;;     1. Motor function.  Report the motor strength of the affected muscles
	;;        of all areas of weakness or paralysis using the standard muscle
	;;        grading scale, for example, weakness of flexion of left elbow
	;;        (3/5 strength for flexors), complete paralysis of left lower
	;;        extremity (0/5 for all muscle groups).  To the extent possible,
	;;        identify the peripheral nerves that innervate the weakened or
	;;        paralyzed muscles.
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	;;          Standard muscle grading scale:
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	;;          0=Absent  No muscle movement felt.
	;;          1=Trace  Muscle can be felt to tighten, but no movement produced.
	;;          2=Poor  Muscle movement produced only with gravity eliminated.
	;;          3=Fair  Muscle movement produced against gravity, but cannot
	;;          overcome any resistance.
	;;          4=Good  Muscle movement produced against some resistance, but
	;;          not against "normal" resistance.
	;;          5=Normal  Muscle movement can overcome "normal" resistance.
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	;;     2. Muscle tone, reflexes.  Describe any muscle atrophy or loss of
	;;        muscle tone.  Examine and report deep tendon reflexes and any
	;;        pathological reflexes.
	;;     3. Sensory function.  Describe exact location of any area of abnormal
	;;        sensory function.  State which modalities of sensation were tested.
	;;     4. Gait, cerebellar signs.  Describe any gait abnormality, imbalance,
	;;        tremor or fasciculations, incoordination, or spasticity.  If there
	;;        is spasticity or rigidity, assess any limitation of motion of 
	;;        joint (including joint contracture) by following the Joints
	;;        examination protocol.  (A tandem gait assessment (walking in a
	;;        straight line with one foot directly in front of the other) is
	;;        recommended).
	;;     5. Autonomic nervous system.  Describe any other impairment of the
	;;        nervous system, such as orthostatic hypotension, hyperhidrosis.
	;;     6. Cranial nerves.  Conduct a screening exam for cranial nerve
	;;        impairment.  If positive, follow Cranial Nerves examination
	;;        protocol.
	;;     7. Cognitive impairment.  Conduct a screening examination (such as
	;;        Mini-mental State Examination) to assess cognitive impairment and
	;;        report results and their significance.  Does the screening show
	;;        problems with memory, concentration, attention, information
	;;        processing, aggressiveness, decreased spontaneity, etc.?  If yes,
	;;        have these been confirmed by prior special examinations, such as
	;;        neuropsychological testing?  If not, are these indicated?  If
	;;        cognitive abnormalities are found, claimed, or suspected, request
	;;        a Mental Disorder examination protocol by a mental disease
	;;        specialist.
	;;     8. Psychiatric manifestations.  Conduct a screening examination for
	;;        psychiatric manifestations, including emotional behavior.  If a
	;;        mental disorder is suggested, request a mental disorder exam or
	;;        PTSD exam, as appropriate, by a mental disease specialist.
	;;     9. Vision and hearing screening examinations (if abnormalities are
	;;        found, or there are symptoms or a claim of eye or ear impairment,
	;;        request an eye or audio exam by a specialist).
	;;    10. Skin.  Describe any areas of skin breakdown due to neurologic
	;;        problems.
	;;    11. Endocrine dysfunction.  Describe any evidence of endocrine
	;;        dysfunction due to TBI.
	;;    12. Oral and dental screening examination.  Describe jaw malalignment,
	;;        cracked or missing teeth, etc., and refer for special Dental and
	;;        Oral examination when indicated.
	;;    13. Other abnormal physical findings.
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	;;D. Diagnostic and Clinical Tests:
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	;;     1. Skull X-rays to measure bony defect, if any, due to surgery or
	;;        injury.
	;;     2. Include results of all diagnostic and clinical tests conducted in
	;;        the examination report.
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	;;E. Diagnosis:
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	;;     1. List each diagnosis.
	;;     2. Capacity to manage financial affairs.
	;;        Mental competency, for VA benefits purposes, refers only to the
	;;        ability of the veteran to manage VA benefit payments in his or her
	;;        own best interest, and not to any other subject.
	;;        Mental incompetency, for VA benefits purposes, means that the
	;;        veteran, because of injury or disease, is not capable of managing
	;;        benefit payments in his or her own best interest.  In order to
	;;        assist raters in making a legal determination as to competency,
	;;        please address the following:
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	;;        a. What is the impact of injury or disease on the veteran's ability
	;;           to manage his or her financial affairs, including consideration
	;;           of such things as knowing the amount of his or her VA benefit
	;;           payment, knowing the amounts and types of bills owed monthly,
	;;           and handling the payment prudently?  Does the veteran handle
	;;           the money and pay the bills himself or herself?
	;;        b. Based on your examination, do you believe that the veteran is
	;;           capable of managing his or her financial affairs?  Please
	;;           provide examples to support your conclusion.
	;;        c. If you believe a Social Work Service assessment is needed
	;;           before you can give your opinion on the veteran's ability to
	;;           manage his or her financial affairs, please explain why.
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	;;Signature:                                     Date:
	;;END