DVBCWDO1.m

DVBCWDO1 ;ALB/CMM DENTAL AND ORAL WKS TEXT - 1 ; 5 MARCH 1997

 ;;2.7;AMIE;**12**;Apr 10, 1995

 ;

 ;

TXT ;

 ;;Narrative:  Regional Office action is required for all dental treatment

 ;;based on combat wounds, service trauma, prisoner of war or extracted 

 ;;teeth under 38 CFR 17.123.

 ;;

 ;;A.  Review of Medical Records:

 ;;

 ;;

 ;;B.  Medical History (Subjective Complaints):

 ;;

 ;;

 ;;

 ;;C.  Physical Examination (Objective Findings):

 ;;

 ;;    Address each of the following and fully describe:

 ;;    1.  Describe extent of functional impairment due to loss of motion

 ;;        and masticatory function loss.

 ;;

 ;;

 ;;    2.  Describe the extent and number of missing teeth and whether 

 ;;        the masticatory surface can be replaced by a prosthesis.

 ;;

 ;;

 ;;    3.  If limitation of inter-incisal range of motion, provide actual

 ;;        range in mm (i.e., 0-Xmm) and also provide lateral excursion 

 ;;        (i.e., 0-Xmm).

 ;;

 ;;

 ;;    4.  Describe the extent of any bone loss of mandible, maxilla, or

 ;;        hard palate.  For hard palate and maxilla bone loss, state 

 ;;        whether replaceable by prosthesis.

 ;;

 ;;

 ;;D.  Diagnostic and Clinical Tests:

 ;;

 ;;    Provide:

 ;;    1.  X-ray to determine extent of bone tissue loss.

 ;;    2.  Include results of all diagnostic and clinical tests conducted

 ;;        in the examination report.

 ;;

 ;;TOF

 ;;E.  Diagnosis:

 ;;

 ;;    1.  Give etiology where there is loss of teeth due to loss of 

 ;;        substance of body of maxilla or mandible.

 ;;

 ;;

 ;;Signature:                             Date:

 ;;END

--- Routine Detail   --- with STRUCTURED ROUTINE LISTING ---DVBCWDO1   1652     printed  Mar 13, 2025@20:55:09                                                                                                                                                                                                    Page 2

DVBCWDO1  ;ALB/CMM DENTAL AND ORAL WKS TEXT - 1 ; 5 MARCH 1997

 +1       ;;2.7;AMIE;**12**;Apr 10, 1995

 +2       ;

 +3       ;

TXT       ;

 +1       ;;Narrative:  Regional Office action is required for all dental treatment

 +2       ;;based on combat wounds, service trauma, prisoner of war or extracted 

 +3       ;;teeth under 38 CFR 17.123.

 +4       ;;

 +5       ;;A.  Review of Medical Records:

 +6       ;;

 +7       ;;

 +8       ;;B.  Medical History (Subjective Complaints):

 +9       ;;

 +10      ;;

 +11      ;;

 +12      ;;C.  Physical Examination (Objective Findings):

 +13      ;;

 +14      ;;    Address each of the following and fully describe:

 +15      ;;    1.  Describe extent of functional impairment due to loss of motion

 +16      ;;        and masticatory function loss.

 +17      ;;

 +18      ;;

 +19      ;;    2.  Describe the extent and number of missing teeth and whether 

 +20      ;;        the masticatory surface can be replaced by a prosthesis.

 +21      ;;

 +22      ;;

 +23      ;;    3.  If limitation of inter-incisal range of motion, provide actual

 +24      ;;        range in mm (i.e., 0-Xmm) and also provide lateral excursion 

 +25      ;;        (i.e., 0-Xmm).

 +26      ;;

 +27      ;;

 +28      ;;    4.  Describe the extent of any bone loss of mandible, maxilla, or

 +29      ;;        hard palate.  For hard palate and maxilla bone loss, state 

 +30      ;;        whether replaceable by prosthesis.

 +31      ;;

 +32      ;;

 +33      ;;D.  Diagnostic and Clinical Tests:

 +34      ;;

 +35      ;;    Provide:

 +36      ;;    1.  X-ray to determine extent of bone tissue loss.

 +37      ;;    2.  Include results of all diagnostic and clinical tests conducted

 +38      ;;        in the examination report.

 +39      ;;

 +40      ;;TOF

 +41      ;;E.  Diagnosis:

 +42      ;;

 +43      ;;    1.  Give etiology where there is loss of teeth due to loss of 

 +44      ;;        substance of body of maxilla or mandible.

 +45      ;;

 +46      ;;

 +47      ;;Signature:                             Date:

 +48      ;;END