DVBCWAH1 ;ALB/CMM A&A OR HOUSEBOUND WKS TEXT - 1 ; 7 MARCH 1997
;;2.7;AMIE;**12**;Apr 10, 1995
;
;
TXT ;
;;NARRATAIVE: Once the existence of at least a single disability rated
;;at 100% has been established, additional benefits may be payable if
;;the veteran requires:
;;
;; 1. The regular assistance of another person in attending to the
;; ordinary hazards of daily living.
;; 2. Assistance of another in protecting himself or herself from
;; the ordinary hazards of his or her daily environment, and/or
;; 3. If the veteran is restricted to his or her home or the immediate
;; vicinity thereof, including the ward or immediate clinical
;; area, if hospitalized.
;;
;;
;;A. Review Of Medical Records:
;;
;;
;;B. Medical History (Subjective Complaints):
;;
;; 1. Indicate whether or not the veteran requires an attendant in
;; reporting for this exam, and if so, identify the nurse or attendant
;; and the mode of travel employed.
;;
;;
;; 2. Indicate whether or not the veteran is hospitalized, and if so,
;; state where and the date of admission.
;;
;;
;; 3. Indicate whether or not the veteran is permanently bedridden.
;;
;;
;; 4. Indicate whether of not the veteran's best corrected vision is
;; 5/200 or worse in both eyes.
;;
;;
;; 5. State whether the veteran is capable of managing benefit patments
;; in his or her own best interests without restriction. (A physical
;; disability which prevents the veteran from attending to financial
;; matters in person is not a proper basis for a finding of incompetency
;; unless he or she is, by reason of that disability, incapable or
;; directing someone else in handling financial affairs.)
;;
;;
;; 6. Capacity to protect oneself from the hazards/dangers of daily
;; environment:
;;
;; a. Describe briefly any pathological processes involving other
;; body parts and systems, including the effects of advancing
;; age, such as dizziness, bowel/bladder incontinence, loss of
;; memory, poor balance affecting ability to ambulate, performing
;; self-care, or travel beyond the premises of the home (or the
;; ward or clinical area if hospitalized).
;;
;;
;; b. Describe where the veteran goes and what he or she does
;; during a typical day.
;;
;;
;;C. Physical Examination (Objective Findings):
;;
;; Comment on:
;; 1. General Appearance.
;;
;;
;; 2. Height and weight (including maximum and minimum weight for past year.
;;
;;
;; 3. Build and posture.
;;
;;
;; 4. State of nutrition.
;;
;;
;; 5. Gait.
;;
;;
;; 6. Temperature, pulse, respiration.
;;
;;
;; 7. Blood Pressure.
;;
;;
;; 8. Upper extremities (reporting each upper extremity separately):
;;
;; a. Describe functional restrictions with reference to
;; strength and coordination and ability for self-feeding,
;; fastening clothing, bathing, shaving, and toileting.
;;
;;
;; b. If amputated, indicate level of amputation (or length of
;; stump and whether or not use of a prosthesis is feasible).
;;
;; 9. Lower extremities (reporting each lower extremity separately):
;;
;; a. Describe functional restrictions with reference to extent
;; of limitation of motion, muscle atrophy, contractures,
;; weakness, lack of coordination, or other interference.
;;
;;
;; b. Indicate any deficits of weight bearing, balance, and propulsion.
;;
;;
;; c. If amputated, indicate level of amputation (or length of
;; stump and whether use of a prosthesis is feasible).
;;
;;
;; 10. Spine, trunk and neck:
;; Describe any limitation of motion or deformity of lumbar,
;; thoracic, and cervical spine.
;;
;;
;; 11. Note if deformity of thoracic spine interferes with breathing.
;;
;;
;; 12. Ambulation:
;;
;; a. Indicate whether the veteran is able to walk without the
;; assistance of another person and give the maximum distance.
;;
;;
;; b. Indicate any mechanical aid used or recommended by the examiner.
;;
;;
;; c. Indicate the frequency, and under what circumstances, the
;; veteran is able to leave the home or immediate premises.
;;
;; 13. Except as to amputations and other anatomical losses, indicate
;; if any restrictions noted in the examination are permanent.
;;
;;
;;D. Diagnostic and Clinical Tests:
;;
;; 1. No specific diagnostic testing required unless required to evaluate
;; the veteran as required above.
;; 2. Include results of all diagnostic and clinical tests conducted
;; in the examination report.
;;
;;
;;E. Diagnosis:
;;
;;
;;Signature: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWAH1 5200 printed Apr 09, 2024@20:56:18 Page 2
DVBCWAH1 ;ALB/CMM A&A OR HOUSEBOUND WKS TEXT - 1 ; 7 MARCH 1997
+1 ;;2.7;AMIE;**12**;Apr 10, 1995
+2 ;
+3 ;
TXT ;
+1 ;;NARRATAIVE: Once the existence of at least a single disability rated
+2 ;;at 100% has been established, additional benefits may be payable if
+3 ;;the veteran requires:
+4 ;;
+5 ;; 1. The regular assistance of another person in attending to the
+6 ;; ordinary hazards of daily living.
+7 ;; 2. Assistance of another in protecting himself or herself from
+8 ;; the ordinary hazards of his or her daily environment, and/or
+9 ;; 3. If the veteran is restricted to his or her home or the immediate
+10 ;; vicinity thereof, including the ward or immediate clinical
+11 ;; area, if hospitalized.
+12 ;;
+13 ;;
+14 ;;A. Review Of Medical Records:
+15 ;;
+16 ;;
+17 ;;B. Medical History (Subjective Complaints):
+18 ;;
+19 ;; 1. Indicate whether or not the veteran requires an attendant in
+20 ;; reporting for this exam, and if so, identify the nurse or attendant
+21 ;; and the mode of travel employed.
+22 ;;
+23 ;;
+24 ;; 2. Indicate whether or not the veteran is hospitalized, and if so,
+25 ;; state where and the date of admission.
+26 ;;
+27 ;;
+28 ;; 3. Indicate whether or not the veteran is permanently bedridden.
+29 ;;
+30 ;;
+31 ;; 4. Indicate whether of not the veteran's best corrected vision is
+32 ;; 5/200 or worse in both eyes.
+33 ;;
+34 ;;
+35 ;; 5. State whether the veteran is capable of managing benefit patments
+36 ;; in his or her own best interests without restriction. (A physical
+37 ;; disability which prevents the veteran from attending to financial
+38 ;; matters in person is not a proper basis for a finding of incompetency
+39 ;; unless he or she is, by reason of that disability, incapable or
+40 ;; directing someone else in handling financial affairs.)
+41 ;;
+42 ;;
+43 ;; 6. Capacity to protect oneself from the hazards/dangers of daily
+44 ;; environment:
+45 ;;
+46 ;; a. Describe briefly any pathological processes involving other
+47 ;; body parts and systems, including the effects of advancing
+48 ;; age, such as dizziness, bowel/bladder incontinence, loss of
+49 ;; memory, poor balance affecting ability to ambulate, performing
+50 ;; self-care, or travel beyond the premises of the home (or the
+51 ;; ward or clinical area if hospitalized).
+52 ;;
+53 ;;
+54 ;; b. Describe where the veteran goes and what he or she does
+55 ;; during a typical day.
+56 ;;
+57 ;;
+58 ;;C. Physical Examination (Objective Findings):
+59 ;;
+60 ;; Comment on:
+61 ;; 1. General Appearance.
+62 ;;
+63 ;;
+64 ;; 2. Height and weight (including maximum and minimum weight for past year.
+65 ;;
+66 ;;
+67 ;; 3. Build and posture.
+68 ;;
+69 ;;
+70 ;; 4. State of nutrition.
+71 ;;
+72 ;;
+73 ;; 5. Gait.
+74 ;;
+75 ;;
+76 ;; 6. Temperature, pulse, respiration.
+77 ;;
+78 ;;
+79 ;; 7. Blood Pressure.
+80 ;;
+81 ;;
+82 ;; 8. Upper extremities (reporting each upper extremity separately):
+83 ;;
+84 ;; a. Describe functional restrictions with reference to
+85 ;; strength and coordination and ability for self-feeding,
+86 ;; fastening clothing, bathing, shaving, and toileting.
+87 ;;
+88 ;;
+89 ;; b. If amputated, indicate level of amputation (or length of
+90 ;; stump and whether or not use of a prosthesis is feasible).
+91 ;;
+92 ;; 9. Lower extremities (reporting each lower extremity separately):
+93 ;;
+94 ;; a. Describe functional restrictions with reference to extent
+95 ;; of limitation of motion, muscle atrophy, contractures,
+96 ;; weakness, lack of coordination, or other interference.
+97 ;;
+98 ;;
+99 ;; b. Indicate any deficits of weight bearing, balance, and propulsion.
+100 ;;
+101 ;;
+102 ;; c. If amputated, indicate level of amputation (or length of
+103 ;; stump and whether use of a prosthesis is feasible).
+104 ;;
+105 ;;
+106 ;; 10. Spine, trunk and neck:
+107 ;; Describe any limitation of motion or deformity of lumbar,
+108 ;; thoracic, and cervical spine.
+109 ;;
+110 ;;
+111 ;; 11. Note if deformity of thoracic spine interferes with breathing.
+112 ;;
+113 ;;
+114 ;; 12. Ambulation:
+115 ;;
+116 ;; a. Indicate whether the veteran is able to walk without the
+117 ;; assistance of another person and give the maximum distance.
+118 ;;
+119 ;;
+120 ;; b. Indicate any mechanical aid used or recommended by the examiner.
+121 ;;
+122 ;;
+123 ;; c. Indicate the frequency, and under what circumstances, the
+124 ;; veteran is able to leave the home or immediate premises.
+125 ;;
+126 ;; 13. Except as to amputations and other anatomical losses, indicate
+127 ;; if any restrictions noted in the examination are permanent.
+128 ;;
+129 ;;
+130 ;;D. Diagnostic and Clinical Tests:
+131 ;;
+132 ;; 1. No specific diagnostic testing required unless required to evaluate
+133 ;; the veteran as required above.
+134 ;; 2. Include results of all diagnostic and clinical tests conducted
+135 ;; in the examination report.
+136 ;;
+137 ;;
+138 ;;E. Diagnosis:
+139 ;;
+140 ;;
+141 ;;Signature: Date:
+142 ;;END
