DVBCWAH3 ;ALB/RLC A&A OR HOUSEBOUND WKS TEXT - 1 ; 7 MARCH 1997
;;2.7;AMIE;**183**;Apr 10, 1995;Build 8
;
;
TXT ;
;;NARRATIVE: Once the existence of at least one 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 activities 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. State whether the veteran is restricted to his or her home or its
;; immediate vicinity. If hospitalized, state whether the veteran is
;; restricted to the ward or immediate clinical area.
;; 2. Indicate whether or not the veteran required an attendant in reporting
;; for this exam, and if so, identify the nurse or attendant and the mode
;; of travel employed.
;; 3. Indicate whether or not the veteran is hospitalized, and if so, state
;; where and the date of admission.
;; 4. State whether or not the veteran is permanently bedridden.
;; 5. State whether or not the veteran uses an orthopedic or prosthetic
;; appliance. If yes, describe what, if any, assistance is required to
;; adjust it and how frequent the need is. (This does not include the
;; adjustment of appliances such as supports, belts, or lacing at the
;; back that anyone would have difficulty adjusting without aid).
;; 6. Capacity to protect oneself from the hazards/dangers of daily
;; environment:
;;
;; a. Describe briefly any dizziness, loss of memory, or poor balance
;; that affects the ability of the veteran to ambulate. Describe any
;; other pathological processes that lessen the ability of the veteran
;; to protect self from the hazards of the daily environment. State
;; the frequency of these effects.
;; 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 or paralysis, 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:
;;
;; a. Describe any limitation of motion or deformity of thoracolumbar
;; and cervical spine.
;;
;; 11. Note if deformity of thoracolumbar 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
;; for ambulation.
;; 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.
;; 14. Indicate whether or not the veteran's best corrected vision is 5/200
;; or worse in both eyes.
;; 15. Describe any self-care skills that that veteran is unable to perform
;; (self-feeding, dressing and undressing, bathing, grooming, toileting).
;;
;;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:
;;
;; 1. Diagnosis.
;; 2. Capacity to handle financial affairs. Mental competency, for VA
;; benefits purposes, refers only to the ability of the veteran to manage
;; VA benefit payments in his or her own best interest, and not to any
;; other subject. Mental incompetency, for VA benefit purposes, means
;; that the veteran, because of injury or disease, is not capable of
;; managing benefit payments in his or her best interest. In order to
;; assist raters in making a legal determination as to competency, please
;; address the following:
;;
;; What is the impact of injury or disease on the veteran's ability to
;; manage his or her financial affairs, including consideration of such
;; things as knowing the amount of his or her VA benefit payment, knowing
;; the amounts and types of bills owed monthly, and handling the payment
;; prudently? Does the veteran handle the money and pay the bills
;; himself or herself?
;;
;; Based on your examination, do you believe that the veteran is capable
;; of managing his or her financial affairs? Please provide examples to
;; support your conclusion.
;;
;; If you believe a Social Work Service assessment is needed before you
;; can give your opinion on the veteran's ability to manage his or her
;; financial affairs, please explain why.
;;
;;
;;Signature: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWAH3 6775 printed Apr 09, 2024@20:50:10 Page 2
DVBCWAH3 ;ALB/RLC A&A OR HOUSEBOUND WKS TEXT - 1 ; 7 MARCH 1997
+1 ;;2.7;AMIE;**183**;Apr 10, 1995;Build 8
+2 ;
+3 ;
TXT ;
+1 ;;NARRATIVE: Once the existence of at least one disability rated at 100% has
+2 ;;been established, additional benefits may be payable if the veteran requires:
+3 ;;
+4 ;; 1. The regular assistance of another person in attending to the
+5 ;; ordinary activities of daily living.
+6 ;; 2. Assistance of another in protecting himself or herself from
+7 ;; the ordinary hazards of his or her daily environment, and/or
+8 ;; 3. If the veteran is restricted to his or her home or the immediate
+9 ;; vicinity thereof, including the ward or immediate clinical
+10 ;; area, if hospitalized.
+11 ;;
+12 ;;A. Review Of Medical Records:
+13 ;;
+14 ;;B. Medical History (Subjective Complaints):
+15 ;;
+16 ;; 1. State whether the veteran is restricted to his or her home or its
+17 ;; immediate vicinity. If hospitalized, state whether the veteran is
+18 ;; restricted to the ward or immediate clinical area.
+19 ;; 2. Indicate whether or not the veteran required an attendant in reporting
+20 ;; for this exam, and if so, identify the nurse or attendant and the mode
+21 ;; of travel employed.
+22 ;; 3. Indicate whether or not the veteran is hospitalized, and if so, state
+23 ;; where and the date of admission.
+24 ;; 4. State whether or not the veteran is permanently bedridden.
+25 ;; 5. State whether or not the veteran uses an orthopedic or prosthetic
+26 ;; appliance. If yes, describe what, if any, assistance is required to
+27 ;; adjust it and how frequent the need is. (This does not include the
+28 ;; adjustment of appliances such as supports, belts, or lacing at the
+29 ;; back that anyone would have difficulty adjusting without aid).
+30 ;; 6. Capacity to protect oneself from the hazards/dangers of daily
+31 ;; environment:
+32 ;;
+33 ;; a. Describe briefly any dizziness, loss of memory, or poor balance
+34 ;; that affects the ability of the veteran to ambulate. Describe any
+35 ;; other pathological processes that lessen the ability of the veteran
+36 ;; to protect self from the hazards of the daily environment. State
+37 ;; the frequency of these effects.
+38 ;; b. Describe where the veteran goes and what he or she does during a
+39 ;; typical day.
+40 ;;
+41 ;;C. Physical Examination (Objective Findings):
+42 ;;
+43 ;; Comment on:
+44 ;;
+45 ;; 1. General Appearance.
+46 ;; 2. Height and weight (including maximum and minimum weight for past
+47 ;; year.
+48 ;; 3. Build and posture.
+49 ;; 4. State of nutrition.
+50 ;; 5. Gait.
+51 ;; 6. Temperature, pulse, respiration.
+52 ;; 7. Blood Pressure.
+53 ;; 8. Upper extremities (reporting each upper extremity separately):
+54 ;;
+55 ;; a. Describe functional restrictions with reference to
+56 ;; strength and coordination and ability for self-feeding,
+57 ;; fastening clothing, bathing, shaving, and toileting.
+58 ;; b. If amputated, indicate level of amputation (or length of
+59 ;; stump and whether or not use of a prosthesis is feasible).
+60 ;;
+61 ;; 9. Lower extremities (reporting each lower extremity separately):
+62 ;;
+63 ;; a. Describe functional restrictions with reference to extent
+64 ;; of limitation of motion, muscle atrophy, contractures,
+65 ;; weakness or paralysis, lack of coordination, or other interference.
+66 ;; b. Indicate any deficits of weight bearing, balance, and propulsion.
+67 ;; c. If amputated, indicate level of amputation (or length of
+68 ;; stump and whether use of a prosthesis is feasible).
+69 ;;
+70 ;; 10. Spine, trunk and neck:
+71 ;;
+72 ;; a. Describe any limitation of motion or deformity of thoracolumbar
+73 ;; and cervical spine.
+74 ;;
+75 ;; 11. Note if deformity of thoracolumbar spine interferes with breathing.
+76 ;;
+77 ;; 12. Ambulation:
+78 ;;
+79 ;; a. Indicate whether the veteran is able to walk without the
+80 ;; assistance of another person and give the maximum distance.
+81 ;; b. Indicate any mechanical aid used or recommended by the examiner
+82 ;; for ambulation.
+83 ;; c. Indicate the frequency, and under what circumstances, the
+84 ;; veteran is able to leave the home or immediate premises.
+85 ;;
+86 ;; 13. Except as to amputations and other anatomical losses, indicate
+87 ;; if any restrictions noted in the examination are permanent.
+88 ;; 14. Indicate whether or not the veteran's best corrected vision is 5/200
+89 ;; or worse in both eyes.
+90 ;; 15. Describe any self-care skills that that veteran is unable to perform
+91 ;; (self-feeding, dressing and undressing, bathing, grooming, toileting).
+92 ;;
+93 ;;D. Diagnostic and Clinical Tests:
+94 ;;
+95 ;; 1. No specific diagnostic testing required unless required to evaluate
+96 ;; the veteran as required above.
+97 ;; 2. Include results of all diagnostic and clinical tests conducted
+98 ;; in the examination report.
+99 ;;
+100 ;;E. Diagnosis:
+101 ;;
+102 ;; 1. Diagnosis.
+103 ;; 2. Capacity to handle financial affairs. Mental competency, for VA
+104 ;; benefits purposes, refers only to the ability of the veteran to manage
+105 ;; VA benefit payments in his or her own best interest, and not to any
+106 ;; other subject. Mental incompetency, for VA benefit purposes, means
+107 ;; that the veteran, because of injury or disease, is not capable of
+108 ;; managing benefit payments in his or her best interest. In order to
+109 ;; assist raters in making a legal determination as to competency, please
+110 ;; address the following:
+111 ;;
+112 ;; What is the impact of injury or disease on the veteran's ability to
+113 ;; manage his or her financial affairs, including consideration of such
+114 ;; things as knowing the amount of his or her VA benefit payment, knowing
+115 ;; the amounts and types of bills owed monthly, and handling the payment
+116 ;; prudently? Does the veteran handle the money and pay the bills
+117 ;; himself or herself?
+118 ;;
+119 ;; Based on your examination, do you believe that the veteran is capable
+120 ;; of managing his or her financial affairs? Please provide examples to
+121 ;; support your conclusion.
+122 ;;
+123 ;; If you believe a Social Work Service assessment is needed before you
+124 ;; can give your opinion on the veteran's ability to manage his or her
+125 ;; financial affairs, please explain why.
+126 ;;
+127 ;;
+128 ;;Signature: Date:
+129 ;;END
