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Routine: DVBCWAH1

DVBCWAH1.m

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  1. DVBCWAH1 ;ALB/CMM A&A OR HOUSEBOUND WKS TEXT - 1 ; 7 MARCH 1997
  1.  ;;2.7;AMIE;**12**;Apr 10, 1995
  1.  ;
  1.  ;
  1. TXT ;
  1.  ;;NARRATAIVE:  Once the existence of at least a single disability rated
  1.  ;;at 100% has been established, additional benefits may be payable if 
  1.  ;;the veteran requires:
  1.  ;;
  1.  ;;      1.  The regular assistance of another person in attending to the
  1.  ;;          ordinary hazards of daily living.
  1.  ;;      2.  Assistance of another in protecting himself or herself from
  1.  ;;          the ordinary hazards of his or her daily environment, and/or
  1.  ;;      3.  If the veteran is restricted to his or her home or the immediate
  1.  ;;          vicinity thereof, including the ward or immediate clinical
  1.  ;;          area, if hospitalized.
  1.  ;;
  1.  ;;
  1.  ;;A.  Review Of Medical Records:
  1.  ;;
  1.  ;;
  1.  ;;B.  Medical History (Subjective Complaints):
  1.  ;;
  1.  ;;    1.  Indicate whether or not the veteran requires an attendant in
  1.  ;;        reporting for this exam, and if so, identify the nurse or attendant
  1.  ;;        and the mode of travel employed.
  1.  ;;
  1.  ;;
  1.  ;;    2.  Indicate whether or not the veteran is hospitalized, and if so, 
  1.  ;;        state where and the date of admission.
  1.  ;;
  1.  ;;
  1.  ;;    3.  Indicate whether or not the veteran is permanently bedridden.
  1.  ;;
  1.  ;;
  1.  ;;    4.  Indicate whether of not the veteran's best corrected vision is
  1.  ;;        5/200 or worse in both eyes.
  1.  ;;
  1.  ;;
  1.  ;;    5.  State whether the veteran is capable of managing benefit patments
  1.  ;;        in his or her own best interests without restriction.  (A physical 
  1.  ;;        disability which prevents the veteran from attending to financial 
  1.  ;;        matters in person is not a proper basis for a finding of incompetency 
  1.  ;;        unless he or she is, by reason of that disability, incapable or 
  1.  ;;        directing someone else in handling financial affairs.)
  1.  ;;
  1.  ;;
  1.  ;;    6.  Capacity to protect oneself from the hazards/dangers of daily
  1.  ;;        environment:
  1.  ;;
  1.  ;;        a.  Describe briefly any pathological processes involving other
  1.  ;;            body parts and systems, including the effects of advancing
  1.  ;;            age, such as dizziness, bowel/bladder incontinence, loss of 
  1.  ;;            memory, poor balance affecting ability to ambulate, performing
  1.  ;;            self-care, or travel beyond the premises of the home (or the 
  1.  ;;            ward or clinical area if hospitalized).
  1.  ;;
  1.  ;;
  1.  ;;        b.  Describe where the veteran goes and what he or she does 
  1.  ;;            during a typical day.
  1.  ;;
  1.  ;;
  1.  ;;C.  Physical Examination (Objective Findings): 
  1.  ;;
  1.  ;;    Comment on:
  1.  ;;    1.  General Appearance.
  1.  ;;
  1.  ;;
  1.  ;;    2.  Height and weight (including maximum and minimum weight for past year.
  1.  ;;
  1.  ;;
  1.  ;;    3.  Build and posture.
  1.  ;;
  1.  ;;
  1.  ;;    4.  State of nutrition.
  1.  ;;
  1.  ;;
  1.  ;;    5.  Gait.
  1.  ;;
  1.  ;;
  1.  ;;    6.  Temperature, pulse, respiration.
  1.  ;;
  1.  ;;
  1.  ;;    7.  Blood Pressure.
  1.  ;;
  1.  ;;
  1.  ;;    8.  Upper extremities (reporting each upper extremity separately):
  1.  ;;
  1.  ;;        a.  Describe functional restrictions with reference to 
  1.  ;;            strength and coordination and ability for self-feeding, 
  1.  ;;            fastening clothing, bathing, shaving, and toileting.  
  1.  ;;
  1.  ;;
  1.  ;;        b.  If amputated, indicate level of amputation (or length of 
  1.  ;;            stump and  whether or not use of a prosthesis is feasible).
  1.  ;;
  1.  ;;    9.  Lower extremities (reporting each lower extremity separately):
  1.  ;;
  1.  ;;        a.  Describe functional restrictions with reference to extent
  1.  ;;            of limitation of motion, muscle atrophy, contractures, 
  1.  ;;            weakness, lack of coordination, or other interference.
  1.  ;;
  1.  ;;
  1.  ;;        b.  Indicate any deficits of weight bearing, balance, and propulsion.
  1.  ;;
  1.  ;;
  1.  ;;        c.  If amputated, indicate level of amputation (or length of 
  1.  ;;            stump and whether use of a prosthesis is feasible).
  1.  ;;
  1.  ;;
  1.  ;;   10.  Spine, trunk and neck:
  1.  ;;        Describe any limitation of motion or deformity of lumbar, 
  1.  ;;        thoracic, and cervical spine.
  1.  ;;
  1.  ;;
  1.  ;;   11.  Note if deformity of thoracic spine interferes with breathing.
  1.  ;;
  1.  ;;
  1.  ;;   12.  Ambulation:
  1.  ;;
  1.  ;;        a.  Indicate whether the veteran is able to walk without the 
  1.  ;;            assistance of another person and give the maximum distance.
  1.  ;;
  1.  ;;
  1.  ;;        b.  Indicate any mechanical aid used or recommended by the examiner.
  1.  ;;
  1.  ;;
  1.  ;;        c.  Indicate the frequency, and under what circumstances, the
  1.  ;;            veteran is able to leave the home or immediate premises.
  1.  ;;
  1.  ;;   13.  Except as to amputations and other anatomical losses, indicate
  1.  ;;        if any restrictions noted in the examination are permanent.
  1.  ;;
  1.  ;;
  1.  ;;D.  Diagnostic and Clinical Tests:
  1.  ;;
  1.  ;;    1.  No specific diagnostic testing required unless required to evaluate
  1.  ;;        the veteran as required above.
  1.  ;;    2.  Include results of all diagnostic and clinical tests conducted
  1.  ;;        in the examination report.
  1.  ;;
  1.  ;;
  1.  ;;E.  Diagnosis:
  1.  ;;
  1.  ;;
  1.  ;;Signature:                             Date:
  1.  ;;END