DVBCQMR5 ;;ALB-CIOFO/ECF - MALE REPRODUCTIVE SYSTEM CONDITIONS QUESTIONNAIRE (V3); 6/15/2011
;;2.7;AMIE;**169**;Apr 10, 1995;Build 5
;
TXT ;
;;
;; Your patient is applying to the U. S. Department of Veterans Affairs (VA) for
;; disability benefits. VA will consider the information you provide on this
;; questionnaire as part of their evaluation in processing the Veteran's claim.
;;
;; 1. Diagnosis
;;
;; Does the Veteran now have or has he ever been diagnosed with any conditions
;; of the male reproductive system?
;; ___ Yes ___ No
;;
;; If yes, indicate diagnoses: (check all that apply)
;; ___ Erectile dysfunction ICD code: ______ Date of diagnosis: ____________
;; ___ Penis, deformity (e.g., Peyronie's)
;; ICD code: ______ Date of diagnosis: ____________
;; ___ Testis, atrophy, one or both
;; ICD code: ______ Date of diagnosis: ____________
;; ___ Testis, removal, one or both
;; ICD code: ______ Date of diagnosis: ____________
;; ___ Epididymitis, chronic ICD code: ______ Date of diagnosis: ____________
;; ___ Epididymo-orchitis, chronic
;; ICD code: ______ Date of diagnosis: ____________
;; ___ Prostate injury ICD code: ______ Date of diagnosis: ____________
;; ___ Prostate hypertrophy (BPH)
;; ICD code: ______ Date of diagnosis: ____________
;; ___ Prostatitis, chronic ICD code: ______ Date of diagnosis: ____________
;; ___ Prostate surgical residuals (as addressed in items 3-6)
;; ICD code: ______ Date of diagnosis: ____________
;; ___ Neoplasms of the male reproductive system
;; ICD code: ______ Date of diagnosis: ____________
;; ___ Other male reproductive system condition (specify diagnosis, providing
;; only diagnoses that pertain to male reproductive system.)
;; ICD code: ______ Date of diagnosis: ____________
;;
;; Other diagnosis #1: ____________________________
;; ICD code: ______________________________________
;; Date of diagnosis: _____________________________
;;^TOF^
;; Other diagnosis #2: ____________________________
;; ICD code: ______________________________________
;; Date of diagnosis: _____________________________
;;
;; If there are additional diagnoses that pertain to the male reproductive organ
;; conditions, list using above format: ________________________________________
;;
;; 2. Medical history
;;
;; a. Describe the history (including onset and course) of the Veteran's male
;; reproductive organ condition(s) (brief summary): ____________________________
;;
;; b. Does the Veteran's treatment plan include taking continuous medication
;; for the diagnosed condition?
;; ___ Yes ___ No
;; List medications taken for the diagnosed condition: _______________________
;;
;; c. Has the Veteran had an orchiectomy?
;; ___ Yes ___ No
;;
;; Indicate testicle removed: ___ Right ___ Left ___ Both
;;
;; Indicate reason for removal:
;; ___ Undescended
;; ___ Congenitally underdeveloped
;; ___ Other, provide reason for removal: ___________________________________
;;
;; 3. Voiding dysfunction
;;
;; Does the Veteran have a voiding dysfunction?
;; ___ Yes ___ No
;; If yes, complete the following section:
;;
;; a. Etiology of voiding dysfunction: ____________________________
;;
;; b. Does the voiding dysfunction cause urine leakage?
;; ___ Yes ___ No
;; Indicate severity (check one):
;;
;; ___ Does not require the wearing of absorbent material
;; ___ Requires absorbent material which must be changed less than 2 times
;; per day
;; ___ Requires absorbent material which must be changed 2 to 4 times per day
;; ___ Requires absorbent material which must be changed more than 4 times
;; per day
;; ___ Other, describe: ______________________________________________________
;;^TOF^
;; c. Does the voiding dysfunction require the use of an appliance?
;; ___ Yes ___ No
;;
;; If yes, describe the appliance: _____________________________________________
;;
;; d. Does the voiding dysfunction cause increased urinary frequency?
;; ___ Yes ___ No
;;
;; If yes, check all that apply:
;; ___ Daytime voiding interval between 2 and 3 hours
;; ___ Daytime voiding interval between 1 and 2 hours
;; ___ Daytime voiding interval less than 1 hour
;; ___ Nighttime awakening to void 2 times
;; ___ Nighttime awakening to void 3 to 4 times
;; ___ Nighttime awakening to void 5 or more times
;;
;; e. Does the voiding dysfunction cause signs or symptoms of obstructed
;; voiding?
;; ___ Yes ___ No
;;
;; If yes, check all that apply:
;; ___ Hesitancy
;; If checked, is hesitancy marked?
;; ___ Yes ___ No
;; ___ Slow or weak stream
;; If checked, is stream markedly slow or weak?
;; ___ Yes ___ No
;; ___ Decreased force of stream
;; If checked, is force of stream markedly decreased?
;; ___ Yes ___ No
;; ___ Stricture disease requiring dilatation 1 to 2 times per year
;; ___ Stricture disease requiring periodic dilatation every 2 to 3 months
;; ___ Recurrent urinary tract infections secondary to obstruction
;; ___ Uroflowmetry peak flow rate less than 10 cc/sec
;; ___ Post void residuals greater than 150 cc
;; ___ Urinary retention requiring intermittent catheterization
;; ___ Urinary retention requiring continuous catheterization
;; ___ Other, describe: _____________________________________________________
;;^TOF^
;; 4. Urinary tract/kidney infection
;;
;; Does the Veteran have a history of recurrent symptomatic urinary tract
;; or kidney infections?
;; ___ Yes ___ No
;; If yes, complete the following section:
;;
;; a. Etiology of recurrent urinary tract or kidney infections: ______________
;; ____________________________________________________________________________
;;
;; b. Indicate all treatment modalities used for recurrent urinary tract or
;; kidney infections (check all that apply):
;;
;; ___ No treatment
;; ___ Long-term drug therapy
;; If checked, list medications used and indicate dates for courses of
;; treatment over the past 12 months: ___________________________________
;; ___ Hospitalization
;; If checked, indicate frequency of hospitalization:
;; ___ 1 or 2 per year
;; ___ > 2 per year
;; ___ Drainage
;; If checked, indicate dates when drainage performed over past 12
;; months: ______________________
;; ___ Continuous intensive management
;; If checked, indicate types of treatment and medications used over past
;; 12 months: ___________________
;; ___ Intermittent intensive management
;; If checked, indicate types of treatment and medications used over past
;; 12 months: ___________________
;; ___ Other, describe: _____________________________________________________
;;
;; 5. Erectile dysfunction
;;
;; Does the Veteran have erectile dysfunction?
;; ___ Yes ___ No
;;
;; If yes, complete the following section:
;;
;; a. Etiology of erectile dysfunction: _______________________________________
;; ____________________________________________________________________________
;;
;; b. If the Veteran has erectile dysfunction, is it as likely as not (at least
;; a 50% probability) attributable to one of the diagnoses in Section 1,
;; including residuals of treatment for this diagnosis?
;; ___ Yes ___ No
;;
;; If yes, specify the diagnosis to which the erectile dysfunction is as likely
;; as not attributable: ________________________________________________________
;;^TOF^
;; c. If the Veteran has erectile dysfunction, is he able to achieve an erection
;; sufficient for penetration and ejaculation (without medication)?
;; ___ Yes ___ No
;;
;; If no, is the Veteran able to achieve an erection sufficient for penetration
;; and ejaculation (with medication)?
;; ___ Yes ___ No
;;
;; 6. Retrograde ejaculation
;;
;; Does the Veteran have retrograde ejaculation?
;; ___ Yes ___ No
;; If yes, complete the following section:
;;
;; a. Etiology of retrograde ejaculation: ______________________
;;
;; b. If the Veteran has retrograde ejaculation, is it as likely as not (at
;; least a 50% probability) attributable to one of the diagnoses in Section 1,
;; including residuals of treatment for this diagnosis?
;; ___ Yes ___ No
;;
;; If yes, specify the diagnosis to which the retrograde ejaculation is as
;; likely as not attributable: _________________________________________________
;;
;; 7. Male reproductive organ infections
;;
;; Does the Veteran have a history of chronic epididymitis, epididymo-orchitis
;; or prostatitis?
;; ___ Yes ___ No
;;
;; If yes, indicate all treatment modalities used for chronic epididymitis,
;; epididymo-orchitis or prostatitis (check all that apply):
;; ___ No treatment
;; ___ Long-term drug therapy
;; If checked, list medications used and indicate dates for courses of
;; treatment over the past 12 months: ___________________________________
;; ___ Hospitalization
;; If checked, indicate frequency of hospitalization:
;; ___ 1 or 2 per year
;; ___ > 2 per year
;; ___ Continuous intensive management
;; If checked, indicate types of treatment and medications used over
;; past 12 months: ______________________________________________________
;; ___ Intermittent intensive management
;; If checked, indicate types of treatment and medications used over
;; past 12 months: ______________________________________________________
;; ___ Other, describe: _____________________________________________________
;;^TOF^
;; 8. Physical exam
;;
;; a. Penis
;; ___ Normal
;; ___ Not examined per Veteran's request
;; ___ Not examined per Veteran's request; Veteran reports normal anatomy
;; with no penile deformity or abnormality
;; ___ Not examined; penis exam not relevant to condition
;; ___ Abnormal
;; If abnormal, indicate severity:
;; ___ Loss/removal of half or more of penis
;; ___ Loss/removal of glans penis
;; ___ Penis deformity(such as Peyronie's disease)
;; If checked, describe: _________________________
;;
;; b. Testes
;; ___ Normal
;; ___ Not examined per Veteran's request
;; ___ Not examined per Veteran's request; Veteran reports normal anatomy
;; with no testicular deformity or abnormality
;; ___ Not examined; testicular exam not relevant to condition
;; ___ Abnormal
;;
;; If abnormal, check all that apply:
;; Right testicle
;; ___ Size 1/3 or less of normal
;; ___ Size 1/2 to 1/3 of normal
;; ___ Considerably harder than normal
;; ___ Considerably softer than normal
;; ___ Absent
;; ___ Other abnormality,
;; Describe: _____________________________________
;;
;; Left testicle
;; ___ Size 1/3 or less of normal
;; ___ Size 1/2 to 1/3 of normal
;; ___ Considerably harder than normal
;; ___ Considerably softer than normal
;; ___ Absent
;; ___ Other abnormality,
;; Describe: _____________________________________
;;^TOF^
;; c. Epididymis
;; ___ Normal
;; ___ Not examined per Veteran's request
;; ___ Not examined per Veteran's request; Veteran reports normal anatomy
;; of epididymis with no deformity or abnormality
;; ___ Not examined; epididymis exam not relevant to condition
;; ___ Abnormal
;;
;; If abnormal, check all that apply:
;; Right epididymis
;; ___ Tender to palpation
;; ___ Other, describe: ______________________________
;;
;; Left epididymis
;; ___ Tender to palpation
;; ___ Other, describe: ______________________________
;;
;; d. Prostate
;; ___ Normal
;; ___ Not examined per Veteran's request
;; ___ Not examined; prostate exam not relevant to condition
;; ___ Abnormal
;; If abnormal, describe: ___________________________
;;
Q
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCQMR5 12947 printed Apr 09, 2024@20:51:42 Page 2
DVBCQMR5 ;;ALB-CIOFO/ECF - MALE REPRODUCTIVE SYSTEM CONDITIONS QUESTIONNAIRE (V3); 6/15/2011
+1 ;;2.7;AMIE;**169**;Apr 10, 1995;Build 5
+2 ;
TXT ;
+1 ;;
+2 ;; Your patient is applying to the U. S. Department of Veterans Affairs (VA) for
+3 ;; disability benefits. VA will consider the information you provide on this
+4 ;; questionnaire as part of their evaluation in processing the Veteran's claim.
+5 ;;
+6 ;; 1. Diagnosis
+7 ;;
+8 ;; Does the Veteran now have or has he ever been diagnosed with any conditions
+9 ;; of the male reproductive system?
+10 ;; ___ Yes ___ No
+11 ;;
+12 ;; If yes, indicate diagnoses: (check all that apply)
+13 ;; ___ Erectile dysfunction ICD code: ______ Date of diagnosis: ____________
+14 ;; ___ Penis, deformity (e.g., Peyronie's)
+15 ;; ICD code: ______ Date of diagnosis: ____________
+16 ;; ___ Testis, atrophy, one or both
+17 ;; ICD code: ______ Date of diagnosis: ____________
+18 ;; ___ Testis, removal, one or both
+19 ;; ICD code: ______ Date of diagnosis: ____________
+20 ;; ___ Epididymitis, chronic ICD code: ______ Date of diagnosis: ____________
+21 ;; ___ Epididymo-orchitis, chronic
+22 ;; ICD code: ______ Date of diagnosis: ____________
+23 ;; ___ Prostate injury ICD code: ______ Date of diagnosis: ____________
+24 ;; ___ Prostate hypertrophy (BPH)
+25 ;; ICD code: ______ Date of diagnosis: ____________
+26 ;; ___ Prostatitis, chronic ICD code: ______ Date of diagnosis: ____________
+27 ;; ___ Prostate surgical residuals (as addressed in items 3-6)
+28 ;; ICD code: ______ Date of diagnosis: ____________
+29 ;; ___ Neoplasms of the male reproductive system
+30 ;; ICD code: ______ Date of diagnosis: ____________
+31 ;; ___ Other male reproductive system condition (specify diagnosis, providing
+32 ;; only diagnoses that pertain to male reproductive system.)
+33 ;; ICD code: ______ Date of diagnosis: ____________
+34 ;;
+35 ;; Other diagnosis #1: ____________________________
+36 ;; ICD code: ______________________________________
+37 ;; Date of diagnosis: _____________________________
+38 ;;^TOF^
+39 ;; Other diagnosis #2: ____________________________
+40 ;; ICD code: ______________________________________
+41 ;; Date of diagnosis: _____________________________
+42 ;;
+43 ;; If there are additional diagnoses that pertain to the male reproductive organ
+44 ;; conditions, list using above format: ________________________________________
+45 ;;
+46 ;; 2. Medical history
+47 ;;
+48 ;; a. Describe the history (including onset and course) of the Veteran's male
+49 ;; reproductive organ condition(s) (brief summary): ____________________________
+50 ;;
+51 ;; b. Does the Veteran's treatment plan include taking continuous medication
+52 ;; for the diagnosed condition?
+53 ;; ___ Yes ___ No
+54 ;; List medications taken for the diagnosed condition: _______________________
+55 ;;
+56 ;; c. Has the Veteran had an orchiectomy?
+57 ;; ___ Yes ___ No
+58 ;;
+59 ;; Indicate testicle removed: ___ Right ___ Left ___ Both
+60 ;;
+61 ;; Indicate reason for removal:
+62 ;; ___ Undescended
+63 ;; ___ Congenitally underdeveloped
+64 ;; ___ Other, provide reason for removal: ___________________________________
+65 ;;
+66 ;; 3. Voiding dysfunction
+67 ;;
+68 ;; Does the Veteran have a voiding dysfunction?
+69 ;; ___ Yes ___ No
+70 ;; If yes, complete the following section:
+71 ;;
+72 ;; a. Etiology of voiding dysfunction: ____________________________
+73 ;;
+74 ;; b. Does the voiding dysfunction cause urine leakage?
+75 ;; ___ Yes ___ No
+76 ;; Indicate severity (check one):
+77 ;;
+78 ;; ___ Does not require the wearing of absorbent material
+79 ;; ___ Requires absorbent material which must be changed less than 2 times
+80 ;; per day
+81 ;; ___ Requires absorbent material which must be changed 2 to 4 times per day
+82 ;; ___ Requires absorbent material which must be changed more than 4 times
+83 ;; per day
+84 ;; ___ Other, describe: ______________________________________________________
+85 ;;^TOF^
+86 ;; c. Does the voiding dysfunction require the use of an appliance?
+87 ;; ___ Yes ___ No
+88 ;;
+89 ;; If yes, describe the appliance: _____________________________________________
+90 ;;
+91 ;; d. Does the voiding dysfunction cause increased urinary frequency?
+92 ;; ___ Yes ___ No
+93 ;;
+94 ;; If yes, check all that apply:
+95 ;; ___ Daytime voiding interval between 2 and 3 hours
+96 ;; ___ Daytime voiding interval between 1 and 2 hours
+97 ;; ___ Daytime voiding interval less than 1 hour
+98 ;; ___ Nighttime awakening to void 2 times
+99 ;; ___ Nighttime awakening to void 3 to 4 times
+100 ;; ___ Nighttime awakening to void 5 or more times
+101 ;;
+102 ;; e. Does the voiding dysfunction cause signs or symptoms of obstructed
+103 ;; voiding?
+104 ;; ___ Yes ___ No
+105 ;;
+106 ;; If yes, check all that apply:
+107 ;; ___ Hesitancy
+108 ;; If checked, is hesitancy marked?
+109 ;; ___ Yes ___ No
+110 ;; ___ Slow or weak stream
+111 ;; If checked, is stream markedly slow or weak?
+112 ;; ___ Yes ___ No
+113 ;; ___ Decreased force of stream
+114 ;; If checked, is force of stream markedly decreased?
+115 ;; ___ Yes ___ No
+116 ;; ___ Stricture disease requiring dilatation 1 to 2 times per year
+117 ;; ___ Stricture disease requiring periodic dilatation every 2 to 3 months
+118 ;; ___ Recurrent urinary tract infections secondary to obstruction
+119 ;; ___ Uroflowmetry peak flow rate less than 10 cc/sec
+120 ;; ___ Post void residuals greater than 150 cc
+121 ;; ___ Urinary retention requiring intermittent catheterization
+122 ;; ___ Urinary retention requiring continuous catheterization
+123 ;; ___ Other, describe: _____________________________________________________
+124 ;;^TOF^
+125 ;; 4. Urinary tract/kidney infection
+126 ;;
+127 ;; Does the Veteran have a history of recurrent symptomatic urinary tract
+128 ;; or kidney infections?
+129 ;; ___ Yes ___ No
+130 ;; If yes, complete the following section:
+131 ;;
+132 ;; a. Etiology of recurrent urinary tract or kidney infections: ______________
+133 ;; ____________________________________________________________________________
+134 ;;
+135 ;; b. Indicate all treatment modalities used for recurrent urinary tract or
+136 ;; kidney infections (check all that apply):
+137 ;;
+138 ;; ___ No treatment
+139 ;; ___ Long-term drug therapy
+140 ;; If checked, list medications used and indicate dates for courses of
+141 ;; treatment over the past 12 months: ___________________________________
+142 ;; ___ Hospitalization
+143 ;; If checked, indicate frequency of hospitalization:
+144 ;; ___ 1 or 2 per year
+145 ;; ___ > 2 per year
+146 ;; ___ Drainage
+147 ;; If checked, indicate dates when drainage performed over past 12
+148 ;; months: ______________________
+149 ;; ___ Continuous intensive management
+150 ;; If checked, indicate types of treatment and medications used over past
+151 ;; 12 months: ___________________
+152 ;; ___ Intermittent intensive management
+153 ;; If checked, indicate types of treatment and medications used over past
+154 ;; 12 months: ___________________
+155 ;; ___ Other, describe: _____________________________________________________
+156 ;;
+157 ;; 5. Erectile dysfunction
+158 ;;
+159 ;; Does the Veteran have erectile dysfunction?
+160 ;; ___ Yes ___ No
+161 ;;
+162 ;; If yes, complete the following section:
+163 ;;
+164 ;; a. Etiology of erectile dysfunction: _______________________________________
+165 ;; ____________________________________________________________________________
+166 ;;
+167 ;; b. If the Veteran has erectile dysfunction, is it as likely as not (at least
+168 ;; a 50% probability) attributable to one of the diagnoses in Section 1,
+169 ;; including residuals of treatment for this diagnosis?
+170 ;; ___ Yes ___ No
+171 ;;
+172 ;; If yes, specify the diagnosis to which the erectile dysfunction is as likely
+173 ;; as not attributable: ________________________________________________________
+174 ;;^TOF^
+175 ;; c. If the Veteran has erectile dysfunction, is he able to achieve an erection
+176 ;; sufficient for penetration and ejaculation (without medication)?
+177 ;; ___ Yes ___ No
+178 ;;
+179 ;; If no, is the Veteran able to achieve an erection sufficient for penetration
+180 ;; and ejaculation (with medication)?
+181 ;; ___ Yes ___ No
+182 ;;
+183 ;; 6. Retrograde ejaculation
+184 ;;
+185 ;; Does the Veteran have retrograde ejaculation?
+186 ;; ___ Yes ___ No
+187 ;; If yes, complete the following section:
+188 ;;
+189 ;; a. Etiology of retrograde ejaculation: ______________________
+190 ;;
+191 ;; b. If the Veteran has retrograde ejaculation, is it as likely as not (at
+192 ;; least a 50% probability) attributable to one of the diagnoses in Section 1,
+193 ;; including residuals of treatment for this diagnosis?
+194 ;; ___ Yes ___ No
+195 ;;
+196 ;; If yes, specify the diagnosis to which the retrograde ejaculation is as
+197 ;; likely as not attributable: _________________________________________________
+198 ;;
+199 ;; 7. Male reproductive organ infections
+200 ;;
+201 ;; Does the Veteran have a history of chronic epididymitis, epididymo-orchitis
+202 ;; or prostatitis?
+203 ;; ___ Yes ___ No
+204 ;;
+205 ;; If yes, indicate all treatment modalities used for chronic epididymitis,
+206 ;; epididymo-orchitis or prostatitis (check all that apply):
+207 ;; ___ No treatment
+208 ;; ___ Long-term drug therapy
+209 ;; If checked, list medications used and indicate dates for courses of
+210 ;; treatment over the past 12 months: ___________________________________
+211 ;; ___ Hospitalization
+212 ;; If checked, indicate frequency of hospitalization:
+213 ;; ___ 1 or 2 per year
+214 ;; ___ > 2 per year
+215 ;; ___ Continuous intensive management
+216 ;; If checked, indicate types of treatment and medications used over
+217 ;; past 12 months: ______________________________________________________
+218 ;; ___ Intermittent intensive management
+219 ;; If checked, indicate types of treatment and medications used over
+220 ;; past 12 months: ______________________________________________________
+221 ;; ___ Other, describe: _____________________________________________________
+222 ;;^TOF^
+223 ;; 8. Physical exam
+224 ;;
+225 ;; a. Penis
+226 ;; ___ Normal
+227 ;; ___ Not examined per Veteran's request
+228 ;; ___ Not examined per Veteran's request; Veteran reports normal anatomy
+229 ;; with no penile deformity or abnormality
+230 ;; ___ Not examined; penis exam not relevant to condition
+231 ;; ___ Abnormal
+232 ;; If abnormal, indicate severity:
+233 ;; ___ Loss/removal of half or more of penis
+234 ;; ___ Loss/removal of glans penis
+235 ;; ___ Penis deformity(such as Peyronie's disease)
+236 ;; If checked, describe: _________________________
+237 ;;
+238 ;; b. Testes
+239 ;; ___ Normal
+240 ;; ___ Not examined per Veteran's request
+241 ;; ___ Not examined per Veteran's request; Veteran reports normal anatomy
+242 ;; with no testicular deformity or abnormality
+243 ;; ___ Not examined; testicular exam not relevant to condition
+244 ;; ___ Abnormal
+245 ;;
+246 ;; If abnormal, check all that apply:
+247 ;; Right testicle
+248 ;; ___ Size 1/3 or less of normal
+249 ;; ___ Size 1/2 to 1/3 of normal
+250 ;; ___ Considerably harder than normal
+251 ;; ___ Considerably softer than normal
+252 ;; ___ Absent
+253 ;; ___ Other abnormality,
+254 ;; Describe: _____________________________________
+255 ;;
+256 ;; Left testicle
+257 ;; ___ Size 1/3 or less of normal
+258 ;; ___ Size 1/2 to 1/3 of normal
+259 ;; ___ Considerably harder than normal
+260 ;; ___ Considerably softer than normal
+261 ;; ___ Absent
+262 ;; ___ Other abnormality,
+263 ;; Describe: _____________________________________
+264 ;;^TOF^
+265 ;; c. Epididymis
+266 ;; ___ Normal
+267 ;; ___ Not examined per Veteran's request
+268 ;; ___ Not examined per Veteran's request; Veteran reports normal anatomy
+269 ;; of epididymis with no deformity or abnormality
+270 ;; ___ Not examined; epididymis exam not relevant to condition
+271 ;; ___ Abnormal
+272 ;;
+273 ;; If abnormal, check all that apply:
+274 ;; Right epididymis
+275 ;; ___ Tender to palpation
+276 ;; ___ Other, describe: ______________________________
+277 ;;
+278 ;; Left epididymis
+279 ;; ___ Tender to palpation
+280 ;; ___ Other, describe: ______________________________
+281 ;;
+282 ;; d. Prostate
+283 ;; ___ Normal
+284 ;; ___ Not examined per Veteran's request
+285 ;; ___ Not examined; prostate exam not relevant to condition
+286 ;; ___ Abnormal
+287 ;; If abnormal, describe: ___________________________
+288 ;;
+289 QUIT
