DVBCPRCK ;ALB/GTS-557/THM-THE PERIPHERAL NERVES EXAM ; 12/27/90 1:32 PM
;;2.7;AMIE;;Apr 10, 1995
;
S PG=1,HD91="Department of Veterans Affairs",HD9=$S($D(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet"
EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1230 Worksheet" S HD7="THE PERIPHERAL NERVES",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
W !!!!,"Narrative: None",!!
W !! I '$D(CMBN) W "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:" D HD2
W $S($D(CMBN):"A. ",1:"D. "),"Specific evaluation information required by the rating board",!?4,"(if the information requested is included elsewhere, do not",!?4,"repeat here):",!!!
S LX="TXT1" F I=1:1 S LY=$T(@LX+I) Q:LY["END" W $P(LY,";;",2),!
D:$D(CMBN) HD2 S LX="TXT2" F I=1:1 S LY=$T(@LX+I) Q:LY["END" W $P(LY,";;",2),!
D:'$D(CMBN) HD2 W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!!!
W $S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
K LN,LN1,LN2
Q
;
HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!,"for ",NAME,!!!
Q
;
SETIOF ; ** Set device control var's
D HOME^%ZIS
Q
;
TXT1 ;
;; 1. Where disability is the result of brain disease or injury, spinal cord
;; disease or injury, cervical disc disease, or trauma to the nerve roots
;; themselves, report sensory and motor impairment by reference to the
;; distribution of the affected groups as paralysis, neuritis or
;; neuralgia. Report each affected extremity separately -
;;
;;
;; a. In the upper extremities -
;;
;;
;;
;;
;;
;;
;;
;; b. In the lower extremities -
;;
;;
;;
;;
;;
;;
;;
;;
;;END
TXT2 ;
;; 2. Where disability is NOT from the above, identify the specific major
;; nerve involved, localize the lesion and describe specific impairment
;; of motor and sensory function, fine motor control, etc.. Again
;; characterization as paralysis, neuritis or neuralgia is necessary
;; Indicate whether any muscle wasting or atrophy represents direct
;; effect of nerve damage or merely disuse. Report each affected
;; extremity separately -
;;
;;
;; a. In the upper extremities -
;;
;;
;;
;;
;;
;;
;;
;;
;; b. In the lower extremities -
;;
;;
;;
;;
;;
;;
;;
;;
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCPRCK 2772 printed Sep 23, 2025@19:21:18 Page 2
DVBCPRCK ;ALB/GTS-557/THM-THE PERIPHERAL NERVES EXAM ; 12/27/90 1:32 PM
+1 ;;2.7;AMIE;;Apr 10, 1995
+2 ;
+3 SET PG=1
SET HD91="Department of Veterans Affairs"
SET HD9=$SELECT($DATA(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet"
EN if '$DATA(IOF)
DO SETIOF
if (IOST?1"C-".E)
WRITE @IOF
+1 WRITE !?25,HD91,!?22,"Compensation and Pension Examination",!
WRITE ?33,"# 1230 Worksheet"
SET HD7="THE PERIPHERAL NERVES"
SET HD8="For "_HD7
WRITE !?(40-($LENGTH(HD9)\2)),HD9,!?(40-($LENGTH(HD8)\2)),HD8,!!
+2 WRITE !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
+3 WRITE !!!!,"Narrative: None",!!
+4 WRITE !!
IF '$DATA(CMBN)
WRITE "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:"
DO HD2
+5 WRITE $SELECT($DATA(CMBN):"A. ",1:"D. "),"Specific evaluation information required by the rating board",!?4,"(if the information requested is included elsewhere, do not",!?4,"repeat here):",!!!
+6 SET LX="TXT1"
FOR I=1:1
SET LY=$TEXT(@LX+I)
if LY["END"
QUIT
WRITE $PIECE(LY,";;",2),!
+7 if $DATA(CMBN)
DO HD2
SET LX="TXT2"
FOR I=1:1
SET LY=$TEXT(@LX+I)
if LY["END"
QUIT
WRITE $PIECE(LY,";;",2),!
+8 if '$DATA(CMBN)
DO HD2
WRITE $SELECT($DATA(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!!!
+9 WRITE $SELECT($DATA(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
+10 KILL LN,LN1,LN2
+11 QUIT
+12 ;
HD2 SET PG=PG+1
WRITE @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!,"for ",NAME,!!!
+1 QUIT
+2 ;
SETIOF ; ** Set device control var's
+1 DO HOME^%ZIS
+2 QUIT
+3 ;
TXT1 ;
+1 ;; 1. Where disability is the result of brain disease or injury, spinal cord
+2 ;; disease or injury, cervical disc disease, or trauma to the nerve roots
+3 ;; themselves, report sensory and motor impairment by reference to the
+4 ;; distribution of the affected groups as paralysis, neuritis or
+5 ;; neuralgia. Report each affected extremity separately -
+6 ;;
+7 ;;
+8 ;; a. In the upper extremities -
+9 ;;
+10 ;;
+11 ;;
+12 ;;
+13 ;;
+14 ;;
+15 ;;
+16 ;; b. In the lower extremities -
+17 ;;
+18 ;;
+19 ;;
+20 ;;
+21 ;;
+22 ;;
+23 ;;
+24 ;;
+25 ;;END
TXT2 ;
+1 ;; 2. Where disability is NOT from the above, identify the specific major
+2 ;; nerve involved, localize the lesion and describe specific impairment
+3 ;; of motor and sensory function, fine motor control, etc.. Again
+4 ;; characterization as paralysis, neuritis or neuralgia is necessary
+5 ;; Indicate whether any muscle wasting or atrophy represents direct
+6 ;; effect of nerve damage or merely disuse. Report each affected
+7 ;; extremity separately -
+8 ;;
+9 ;;
+10 ;; a. In the upper extremities -
+11 ;;
+12 ;;
+13 ;;
+14 ;;
+15 ;;
+16 ;;
+17 ;;
+18 ;;
+19 ;; b. In the lower extremities -
+20 ;;
+21 ;;
+22 ;;
+23 ;;
+24 ;;
+25 ;;
+26 ;;
+27 ;;
+28 ;;END
