DVBCMECK ;ALB/GTS-557/THM-MUSCULOSKELETAL, NOT ELSEWHERE CLASSIFIED ; 6/18/90 8:45 AM
;;2.7;AMIE;;Apr 10, 1995
EN S DVBAX="For MUSCULOSKELETAL, NOT ELSEWHERE CLASSIFIED"
S PG=1 D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
W !?22,"Compensation and Pension Examination",!?33,"# 1455 Worksheet",!,?(IOM-$L(DVBAX)\2),DVBAX,!!
W "Name: ",NAME,?45,"SSN: ",SSN,!,?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: MUSCULOSKELETAL, NOT ELSEWHERE CLASSIFIED",!!
W "Physician's Guide Reference: None",!!,"Narrative:",!!
F I=0:1 S LY=$T(TXT+I) D:LY["TOF" HD2 Q:LY["END" W:LY'["TOF" $P(LY,";;",2),! I $Y>55 D HD2
K I,LY,DVBAX Q
;
TXT ;;This exam is to handle the balance of currently recognized musculoskeletal
;;disorders and to allow for new disorders not yet classified for V.A.
;;compensation evaluations. The severity of a condition is based upon the
;;residual disability. If there is a disease process that affects multiple
;;systems or extremeties, please evaluate each separately.
;;
;;
;;A. Medical history (W/P):
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;B. Subjective findings (W/P):
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;C. Objective findings (W/P):
;;TOF
;;
;;
;;D. Evaluation Information for the Rating Board:
;;
;;
;; Residual disability effect on:
;;
;;
;; 1) earning capacity/job performance (F/T):
;;
;;
;;
;;
;;
;;
;; 2) everyday activities (F/T):
;;
;;
;;
;;
;;
;;
;;
;; 3) Is disability constant? (YES/NO):
;;
;;
;;
;;
;;
;;
;;
;; 4) If NO, give frequency, length of remissions (F/T):
;;
;;
;;
;;
;;
;;
;; 5) Acute exacerbations effect on everyday life. (F/T)
;;TOF
;;
;;
;;E. Diagnosis (W/P):
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;F. Diagnostic tests (Lab,X-Ray, etc) (W/P):
;;
;;
;;
;;
;;
;;
;;
;;
;;
;; Signature: ______________________________
;;
;; Date: _________________________
;;END
Q
;
HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for "_NAME,!
W "For MUSCULOSKELETAL, NOT ELSEWHERE CLASSIFIED",!!!
Q
;
SETIOF ; ** Set device control var's
D HOME^%ZIS
Q
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCMECK 2341 printed Dec 13, 2024@01:44:49 Page 2
DVBCMECK ;ALB/GTS-557/THM-MUSCULOSKELETAL, NOT ELSEWHERE CLASSIFIED ; 6/18/90 8:45 AM
+1 ;;2.7;AMIE;;Apr 10, 1995
EN SET DVBAX="For MUSCULOSKELETAL, NOT ELSEWHERE CLASSIFIED"
+1 SET PG=1
if '$DATA(IOF)
DO SETIOF
if (IOST?1"C-".E)
WRITE @IOF
+2 WRITE !?22,"Compensation and Pension Examination",!?33,"# 1455 Worksheet",!,?(IOM-$LENGTH(DVBAX)\2),DVBAX,!!
+3 WRITE "Name: ",NAME,?45,"SSN: ",SSN,!,?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: MUSCULOSKELETAL, NOT ELSEWHERE CLASSIFIED",!!
+4 WRITE "Physician's Guide Reference: None",!!,"Narrative:",!!
+5 FOR I=0:1
SET LY=$TEXT(TXT+I)
if LY["TOF"
DO HD2
if LY["END"
QUIT
if LY'["TOF"
WRITE $PIECE(LY,";;",2),!
IF $Y>55
DO HD2
+6 KILL I,LY,DVBAX
QUIT
+7 ;
TXT ;;This exam is to handle the balance of currently recognized musculoskeletal
+1 ;;disorders and to allow for new disorders not yet classified for V.A.
+2 ;;compensation evaluations. The severity of a condition is based upon the
+3 ;;residual disability. If there is a disease process that affects multiple
+4 ;;systems or extremeties, please evaluate each separately.
+5 ;;
+6 ;;
+7 ;;A. Medical history (W/P):
+8 ;;
+9 ;;
+10 ;;
+11 ;;
+12 ;;
+13 ;;
+14 ;;
+15 ;;
+16 ;;
+17 ;;
+18 ;;B. Subjective findings (W/P):
+19 ;;
+20 ;;
+21 ;;
+22 ;;
+23 ;;
+24 ;;
+25 ;;
+26 ;;
+27 ;;
+28 ;;
+29 ;;C. Objective findings (W/P):
+30 ;;TOF
+31 ;;
+32 ;;
+33 ;;D. Evaluation Information for the Rating Board:
+34 ;;
+35 ;;
+36 ;; Residual disability effect on:
+37 ;;
+38 ;;
+39 ;; 1) earning capacity/job performance (F/T):
+40 ;;
+41 ;;
+42 ;;
+43 ;;
+44 ;;
+45 ;;
+46 ;; 2) everyday activities (F/T):
+47 ;;
+48 ;;
+49 ;;
+50 ;;
+51 ;;
+52 ;;
+53 ;;
+54 ;; 3) Is disability constant? (YES/NO):
+55 ;;
+56 ;;
+57 ;;
+58 ;;
+59 ;;
+60 ;;
+61 ;;
+62 ;; 4) If NO, give frequency, length of remissions (F/T):
+63 ;;
+64 ;;
+65 ;;
+66 ;;
+67 ;;
+68 ;;
+69 ;; 5) Acute exacerbations effect on everyday life. (F/T)
+70 ;;TOF
+71 ;;
+72 ;;
+73 ;;E. Diagnosis (W/P):
+74 ;;
+75 ;;
+76 ;;
+77 ;;
+78 ;;
+79 ;;
+80 ;;
+81 ;;
+82 ;;
+83 ;;F. Diagnostic tests (Lab,X-Ray, etc) (W/P):
+84 ;;
+85 ;;
+86 ;;
+87 ;;
+88 ;;
+89 ;;
+90 ;;
+91 ;;
+92 ;;
+93 ;; Signature: ______________________________
+94 ;;
+95 ;; Date: _________________________
+96 ;;END
+97 QUIT
+98 ;
HD2 SET PG=PG+1
WRITE @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for "_NAME,!
+1 WRITE "For MUSCULOSKELETAL, NOT ELSEWHERE CLASSIFIED",!!!
+2 QUIT
+3 ;
SETIOF ; ** Set device control var's
+1 DO HOME^%ZIS
+2 QUIT
