DVBCMOCK ;ALB/GTS-557/THM-MENTAL, NOT ELSEWHERE CLASSIFIED ; 5/10/90 9:17 AM
;;2.7;AMIE;;Apr 10, 1995
EN S DVBAX="For MENTAL, NOT ELSEWHERE CLASSIFIED"
S PG=1 D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
W !?22,"Compensation and Pension Examination",!?33,"# 0905 Worksheet",!,?(IOM-$L(DVBAX)\2),DVBAX,!!
W "Name: ",NAME,?45,"SSN: ",SSN,!,?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: MENTAL, NOT ELSEWHERE CLASSIFIED",!!
W "Physician's Guide Reference: None",!!,"Narrative:",!!
F I=0:1 S LY=$T(TXT+I) Q:LY["END" W $P(LY,";;",2),! I $Y>55 D HD2
K I,LY,DVBAX Q
;
TXT ;;This exam is to handle the balance of currently recognized mental disorders
;;and to allow for new disorders not yet classified for V.A. compensation
;;evaluations. The severity of a condition is based upon the residual
;;disability. If there is a disease process that affects multiple systems or
;;extremeties, please evaluate each separately.
;;
;;
;;A. Medical history (W/P):
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;B. Subjective findings (W/P):
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;C. Objective findings (W/P):
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;D. Evaluation information for the rating board:
;;
;;
;;
;; 1) State how the residual disability affects the earning capacity of the
;; Veteran in job performance.
;;
;;
;;
;;
;;
;;
;;
;; 2) State how the residual disability affects normal everyday activities.
;;
;;
;;
;;
;;
;;
;;
;; 3) State if the disability has constant activity or give any periods
;; of remission during the year.
;;
;;
;;
;;
;;
;;
;;
;; 4) If there are acute exacerbations, state the effect on everyday
;; life.
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;E. Diagnosis (W/P):
;;
;;
;;
;;
;;
;;
;;
;;
;;F. Diagnostic tests (Lab,X-Ray, etc) (W/P):
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;
;;
;; Signature: ______________________________
;;
;; Date: _________________________
;;END
Q
;
HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for "_NAME,!
W "For MENTAL, NOT ELSEWHERE CLASSIFIED",!!!
Q
;
SETIOF ; ** Set device control var's
D HOME^%ZIS
Q
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCMOCK 2473 printed Nov 22, 2024@16:55:07 Page 2
DVBCMOCK ;ALB/GTS-557/THM-MENTAL, NOT ELSEWHERE CLASSIFIED ; 5/10/90 9:17 AM
+1 ;;2.7;AMIE;;Apr 10, 1995
EN SET DVBAX="For MENTAL, NOT ELSEWHERE CLASSIFIED"
+1 SET PG=1
if '$DATA(IOF)
DO SETIOF
if (IOST?1"C-".E)
WRITE @IOF
+2 WRITE !?22,"Compensation and Pension Examination",!?33,"# 0905 Worksheet",!,?(IOM-$LENGTH(DVBAX)\2),DVBAX,!!
+3 WRITE "Name: ",NAME,?45,"SSN: ",SSN,!,?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: MENTAL, NOT ELSEWHERE CLASSIFIED",!!
+4 WRITE "Physician's Guide Reference: None",!!,"Narrative:",!!
+5 FOR I=0:1
SET LY=$TEXT(TXT+I)
if LY["END"
QUIT
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 mental disorders
+1 ;;and to allow for new disorders not yet classified for V.A. compensation
+2 ;;evaluations. The severity of a condition is based upon the residual
+3 ;;disability. If there is a disease process that affects multiple systems or
+4 ;;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 ;;C. Objective findings (W/P):
+29 ;;
+30 ;;
+31 ;;
+32 ;;
+33 ;;
+34 ;;
+35 ;;
+36 ;;
+37 ;;
+38 ;;
+39 ;;
+40 ;;
+41 ;;
+42 ;;
+43 ;;
+44 ;;D. Evaluation information for the rating board:
+45 ;;
+46 ;;
+47 ;;
+48 ;; 1) State how the residual disability affects the earning capacity of the
+49 ;; Veteran in job performance.
+50 ;;
+51 ;;
+52 ;;
+53 ;;
+54 ;;
+55 ;;
+56 ;;
+57 ;; 2) State how the residual disability affects normal everyday activities.
+58 ;;
+59 ;;
+60 ;;
+61 ;;
+62 ;;
+63 ;;
+64 ;;
+65 ;; 3) State if the disability has constant activity or give any periods
+66 ;; of remission during the year.
+67 ;;
+68 ;;
+69 ;;
+70 ;;
+71 ;;
+72 ;;
+73 ;;
+74 ;; 4) If there are acute exacerbations, state the effect on everyday
+75 ;; life.
+76 ;;
+77 ;;
+78 ;;
+79 ;;
+80 ;;
+81 ;;
+82 ;;
+83 ;;
+84 ;;
+85 ;;
+86 ;;
+87 ;;
+88 ;;
+89 ;;
+90 ;;E. Diagnosis (W/P):
+91 ;;
+92 ;;
+93 ;;
+94 ;;
+95 ;;
+96 ;;
+97 ;;
+98 ;;
+99 ;;F. Diagnostic tests (Lab,X-Ray, etc) (W/P):
+100 ;;
+101 ;;
+102 ;;
+103 ;;
+104 ;;
+105 ;;
+106 ;;
+107 ;;
+108 ;;
+109 ;;
+110 ;;
+111 ;;
+112 ;; Signature: ______________________________
+113 ;;
+114 ;; Date: _________________________
+115 ;;END
+116 QUIT
+117 ;
HD2 SET PG=PG+1
WRITE @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for "_NAME,!
+1 WRITE "For MENTAL, NOT ELSEWHERE CLASSIFIED",!!!
+2 QUIT
+3 ;
SETIOF ; ** Set device control var's
+1 DO HOME^%ZIS
+2 QUIT
