DVBCWDI2 ;ALB/JEH DIABETES MELLITUS WKS TEXT - 1 ; 24 MAY 2004
;;2.7;AMIE;**69**;Apr 10, 1995
;
;
TXT ;
;;When a Diabetes Mellitus examination is requested, begin with this
;;worksheet. For each diabetic complication manifested by the veteran,
;;complete appropriate additional worksheets.
;;
;;Chronic complications from diabetes include vascular and nonvascular
;;complications. Vascular complications include microvascular
;;(eye disease, neuropathy, nephropathy) and macrovascular complications
;;(coronary artery disease, peripheral vascular disease, cerebrovascular
;;disease). Nonvascular complications include gastroparesis, sexual
;;dysfunction, and skin changes.
;;
;;Reference: Harrison's Principles of Internal Medicine, 2001, page 2119.
;;
;;
;;A. Review of Medical Records:
;;
;;
;;B. Medical History (Subjective Complaints):
;; As pertains to Diabetes Mellitus or its complications, comment on:
;;
;; 1. Age of onset.
;;
;; 2. Frequency of ketoacidosis or hypoglycemic reactions.
;;
;; 3. Hospitalizations per year for ketoacidosis or hypoglycemic
;; reactions.
;;
;; 4. Restricted diet.
;;
;; 5. Weight loss or gain since last exam.
;;
;; 6. Describe any restriction of activities on account of the
;; diabetes (e.g., avoiding strenuous activity to prevent
;; hypoglycemic reactions).
;;
;; 7. Treatment - oral hypoglycemic, insulin (frequency of injections).
;;
;; 8. Frequency of visits to diabetic care provider.
;;
;; 9. Other symptoms, such as anal pruritus, loss of strength.
;;
;; 10. Visual problems.
;; Refer to examination worksheet: Eye examination, if
;; indicated.
;;
;; 11. Vascular (including hypertension, if appropriate) or cardiac
;; symptoms.
;; Refer to examination worksheet(s): Hypertension, Heart,
;; Arteries, Veins, and Misc., etc., if indicated.
;;
;; 12. Neurologic symptoms.
;; Refer to examination worksheets(s): Peripheral Nerves, etc.,
;; if indicated.
;;
;; 13. Bladder or bowel functional impairments.
;; Refer to examination worksheets(s): Genitourinary, Rectum
;; and Anus exam, etc., if indicated.
;;
;;C. Physical Examination (Objective Findings):
;;
;;Assess for chronic complications of diabetes mellitus. Complete
;;appropriate additional worksheets.
;;
;; 1. Cardiovascular examination to include blood pressure and status
;; of peripheral arteries, presence of peripheral edema.
;;
;; 2. Neurologic examination.
;;
;; 3. Eye examination.
;;
;; 4. Skin examination.
;;
;; 5. Examination of extremities, including feet.
;;
;;D. Diagnostic and Clinical Tests:
;;
;;Provide:
;;
;; 1. Fasting blood sugars, or other laboratory evaluation if
;; necessary to establish the diagnosis.
;;
;; 2. Blood sugars.
;;
;; 3. Evaluation for kidney function including: urinalysis with urine
;; for microalbumenuria; blood urea nitrogen (BUN) and creatinine
;; (Cr).
;;
;; 4. Include results of all diagnostic and clinical tests conducted
;; in the examination report.
;;
;;E. Diagnosis:
;;
;; 1. State whether the veteran has diabetes mellitus. Indicate type.
;;
;; 2. Specifically list each identified complication of the veteran's
;; diabetes. Indicate these conditions as complications of the
;; veteran's diabetes. If the veteran has peripheral edema,
;; indicate whether it is a consequence of diabetic kidney disease
;; or other non-diabetic related etiology.
;;
;; 3. For each identified complication of the veteran's diabetes,
;; provide a brief rationale for your conclusion. You may base
;; your rationale on such things as the duration of the veteran's
;; diabetes, whether the veteran's diabetes has been poorly
;; controlled, the onset of the condition that you deem to be a
;; complication of the veteran's diabetes in relation to the onset
;; of the veteran's diabetes, the severity of the complication, or
;; anything else you consider relevant.
;;
;; 4. Where the veteran has visual impairment, cardiovascular disease
;; (including hypertension), kidney disease, neurologic disease,
;; amputations, or any other disabilities which, in your opinion,
;; are not complications of the veteran's diabetes, please state so
;; and provide a supporting rationale as to the basis for your
;; conclusion.
;;
;; 5. Where the veteran has a condition that is worsened or increased
;; by the veteran's diabetes but is not a diabetic complication,
;; discuss the relationship between the condition and the veteran's
;; diabetes. In particular, discuss what the degree of disability
;; is of the condition over and above the degree of disability that
;; existed prior to aggravation/worsening by the diabetes. Provide
;; your rationale. Indicate if this is not possible to do without
;; resorting to speculation.
;;
;;
;;Signature: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWDI2 5535 printed Apr 09, 2024@20:51:15 Page 2
DVBCWDI2 ;ALB/JEH DIABETES MELLITUS WKS TEXT - 1 ; 24 MAY 2004
+1 ;;2.7;AMIE;**69**;Apr 10, 1995
+2 ;
+3 ;
TXT ;
+1 ;;When a Diabetes Mellitus examination is requested, begin with this
+2 ;;worksheet. For each diabetic complication manifested by the veteran,
+3 ;;complete appropriate additional worksheets.
+4 ;;
+5 ;;Chronic complications from diabetes include vascular and nonvascular
+6 ;;complications. Vascular complications include microvascular
+7 ;;(eye disease, neuropathy, nephropathy) and macrovascular complications
+8 ;;(coronary artery disease, peripheral vascular disease, cerebrovascular
+9 ;;disease). Nonvascular complications include gastroparesis, sexual
+10 ;;dysfunction, and skin changes.
+11 ;;
+12 ;;Reference: Harrison's Principles of Internal Medicine, 2001, page 2119.
+13 ;;
+14 ;;
+15 ;;A. Review of Medical Records:
+16 ;;
+17 ;;
+18 ;;B. Medical History (Subjective Complaints):
+19 ;; As pertains to Diabetes Mellitus or its complications, comment on:
+20 ;;
+21 ;; 1. Age of onset.
+22 ;;
+23 ;; 2. Frequency of ketoacidosis or hypoglycemic reactions.
+24 ;;
+25 ;; 3. Hospitalizations per year for ketoacidosis or hypoglycemic
+26 ;; reactions.
+27 ;;
+28 ;; 4. Restricted diet.
+29 ;;
+30 ;; 5. Weight loss or gain since last exam.
+31 ;;
+32 ;; 6. Describe any restriction of activities on account of the
+33 ;; diabetes (e.g., avoiding strenuous activity to prevent
+34 ;; hypoglycemic reactions).
+35 ;;
+36 ;; 7. Treatment - oral hypoglycemic, insulin (frequency of injections).
+37 ;;
+38 ;; 8. Frequency of visits to diabetic care provider.
+39 ;;
+40 ;; 9. Other symptoms, such as anal pruritus, loss of strength.
+41 ;;
+42 ;; 10. Visual problems.
+43 ;; Refer to examination worksheet: Eye examination, if
+44 ;; indicated.
+45 ;;
+46 ;; 11. Vascular (including hypertension, if appropriate) or cardiac
+47 ;; symptoms.
+48 ;; Refer to examination worksheet(s): Hypertension, Heart,
+49 ;; Arteries, Veins, and Misc., etc., if indicated.
+50 ;;
+51 ;; 12. Neurologic symptoms.
+52 ;; Refer to examination worksheets(s): Peripheral Nerves, etc.,
+53 ;; if indicated.
+54 ;;
+55 ;; 13. Bladder or bowel functional impairments.
+56 ;; Refer to examination worksheets(s): Genitourinary, Rectum
+57 ;; and Anus exam, etc., if indicated.
+58 ;;
+59 ;;C. Physical Examination (Objective Findings):
+60 ;;
+61 ;;Assess for chronic complications of diabetes mellitus. Complete
+62 ;;appropriate additional worksheets.
+63 ;;
+64 ;; 1. Cardiovascular examination to include blood pressure and status
+65 ;; of peripheral arteries, presence of peripheral edema.
+66 ;;
+67 ;; 2. Neurologic examination.
+68 ;;
+69 ;; 3. Eye examination.
+70 ;;
+71 ;; 4. Skin examination.
+72 ;;
+73 ;; 5. Examination of extremities, including feet.
+74 ;;
+75 ;;D. Diagnostic and Clinical Tests:
+76 ;;
+77 ;;Provide:
+78 ;;
+79 ;; 1. Fasting blood sugars, or other laboratory evaluation if
+80 ;; necessary to establish the diagnosis.
+81 ;;
+82 ;; 2. Blood sugars.
+83 ;;
+84 ;; 3. Evaluation for kidney function including: urinalysis with urine
+85 ;; for microalbumenuria; blood urea nitrogen (BUN) and creatinine
+86 ;; (Cr).
+87 ;;
+88 ;; 4. Include results of all diagnostic and clinical tests conducted
+89 ;; in the examination report.
+90 ;;
+91 ;;E. Diagnosis:
+92 ;;
+93 ;; 1. State whether the veteran has diabetes mellitus. Indicate type.
+94 ;;
+95 ;; 2. Specifically list each identified complication of the veteran's
+96 ;; diabetes. Indicate these conditions as complications of the
+97 ;; veteran's diabetes. If the veteran has peripheral edema,
+98 ;; indicate whether it is a consequence of diabetic kidney disease
+99 ;; or other non-diabetic related etiology.
+100 ;;
+101 ;; 3. For each identified complication of the veteran's diabetes,
+102 ;; provide a brief rationale for your conclusion. You may base
+103 ;; your rationale on such things as the duration of the veteran's
+104 ;; diabetes, whether the veteran's diabetes has been poorly
+105 ;; controlled, the onset of the condition that you deem to be a
+106 ;; complication of the veteran's diabetes in relation to the onset
+107 ;; of the veteran's diabetes, the severity of the complication, or
+108 ;; anything else you consider relevant.
+109 ;;
+110 ;; 4. Where the veteran has visual impairment, cardiovascular disease
+111 ;; (including hypertension), kidney disease, neurologic disease,
+112 ;; amputations, or any other disabilities which, in your opinion,
+113 ;; are not complications of the veteran's diabetes, please state so
+114 ;; and provide a supporting rationale as to the basis for your
+115 ;; conclusion.
+116 ;;
+117 ;; 5. Where the veteran has a condition that is worsened or increased
+118 ;; by the veteran's diabetes but is not a diabetic complication,
+119 ;; discuss the relationship between the condition and the veteran's
+120 ;; diabetes. In particular, discuss what the degree of disability
+121 ;; is of the condition over and above the degree of disability that
+122 ;; existed prior to aggravation/worsening by the diabetes. Provide
+123 ;; your rationale. Indicate if this is not possible to do without
+124 ;; resorting to speculation.
+125 ;;
+126 ;;
+127 ;;Signature: Date:
+128 ;;END
