DVBCWFI3.m

DVBCWFI3 ;ALB/RLC FIBROMYALGIA WKS TEXT - 1 ; 12 FEB 2007

 ;;2.7;AMIE;**121**;Apr 10, 1995;Build 9

 ;

 ;

TXT ;

 ;;Narrative:  For VA compensation purposes, the diagnosis of fibromyalgia 

 ;;(sometimes called fibrositis, primary fibromyalgia syndrome, or 

 ;;myofascial pain syndrome) requires the presence of widespread 

 ;;musculoskeletal pain and tender points.  Additional findings may also

 ;;be present:  fatigue, sleep disturbance, stiffness, paresthesias, 

 ;;headache, irritable bowel symptoms, depression, anxiety, or Raynaud's

 ;;-like symptoms.  Widespread pain is defined as pain in both the left 

 ;;and right sides of the body, that is both above and below the waist, 

 ;;and that affects both the axial skeleton (i.e., cervical spine, 

 ;;anterior chest, thoracic spine, or low back) and the extremities.  

 ;;Rule out other diagnostic entities that may be responsible for the 

 ;;symptomatology presented.

 ;;

 ;;A.  Review of Medical Records:

 ;;

 ;;B.  Medical History (Subjective Complaints):

 ;;

 ;;    Comment on:

 ;;

 ;;    1.  Date of onset of symptoms, date of diagnosis (if known).

 ;;    2.  Are symptoms constant or nearly so?  If episodic, how often are they

 ;;        present?  What precipitates and alleviates symptoms?  Are they

 ;;        refractory to therapy?

 ;;    3.  Location, severity, frequency of any musculoskeletal pain, 

 ;;        stiffness, or muscle weakness.

 ;;    4.  Unexplained fatigue, sleep disturbances, headaches, paresthesias.

 ;;    5.  GI symptoms.

 ;;    6.  Treatment, (type, duration, response, side effects).  Has treatment

 ;;        been continuous?

 ;;    7.  Is there depression or anxiety?

 ;;    8.  Effects of symptoms on daily activities.

 ;;    9.  Lost time from work?

 ;;    10. History of hospitalizations, dates and location, if known, reason.

 ;;

 ;;C.  Physical Examination (Objective Findings):

 ;;

 ;;    Address each of the following and fully describe current findings:

 ;;    (Please incorporate all ancillary study results into the final 

 ;;    diagnosis.)

 ;;

 ;;    1.  Musculoskeletal areas involved.

 ;;    2.  Trigger or tender points.

 ;;    3.  Muscle strength in involved areas.

 ;;

 ;;D.  Diagnostic and Clinical Tests:

 ;;

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

 ;;        in the examination report.

 ;;

 ;;E.  Diagnosis:

 ;;

 ;;    1.  Is the condition currently active or in remission?

 ;;

 ;;

 ;;

 ;;Signature:                             Date:

 ;;END

--- Routine Detail   --- with STRUCTURED ROUTINE LISTING ---DVBCWFI3   2548     printed  Apr 23, 2025@18:05:33                                                                                                                                                                                                    Page 2

DVBCWFI3  ;ALB/RLC FIBROMYALGIA WKS TEXT - 1 ; 12 FEB 2007

 +1       ;;2.7;AMIE;**121**;Apr 10, 1995;Build 9

 +2       ;

 +3       ;

TXT       ;

 +1       ;;Narrative:  For VA compensation purposes, the diagnosis of fibromyalgia 

 +2       ;;(sometimes called fibrositis, primary fibromyalgia syndrome, or 

 +3       ;;myofascial pain syndrome) requires the presence of widespread 

 +4       ;;musculoskeletal pain and tender points.  Additional findings may also

 +5       ;;be present:  fatigue, sleep disturbance, stiffness, paresthesias, 

 +6       ;;headache, irritable bowel symptoms, depression, anxiety, or Raynaud's

 +7       ;;-like symptoms.  Widespread pain is defined as pain in both the left 

 +8       ;;and right sides of the body, that is both above and below the waist, 

 +9       ;;and that affects both the axial skeleton (i.e., cervical spine, 

 +10      ;;anterior chest, thoracic spine, or low back) and the extremities.  

 +11      ;;Rule out other diagnostic entities that may be responsible for the 

 +12      ;;symptomatology presented.

 +13      ;;

 +14      ;;A.  Review of Medical Records:

 +15      ;;

 +16      ;;B.  Medical History (Subjective Complaints):

 +17      ;;

 +18      ;;    Comment on:

 +19      ;;

 +20      ;;    1.  Date of onset of symptoms, date of diagnosis (if known).

 +21      ;;    2.  Are symptoms constant or nearly so?  If episodic, how often are they

 +22      ;;        present?  What precipitates and alleviates symptoms?  Are they

 +23      ;;        refractory to therapy?

 +24      ;;    3.  Location, severity, frequency of any musculoskeletal pain, 

 +25      ;;        stiffness, or muscle weakness.

 +26      ;;    4.  Unexplained fatigue, sleep disturbances, headaches, paresthesias.

 +27      ;;    5.  GI symptoms.

 +28      ;;    6.  Treatment, (type, duration, response, side effects).  Has treatment

 +29      ;;        been continuous?

 +30      ;;    7.  Is there depression or anxiety?

 +31      ;;    8.  Effects of symptoms on daily activities.

 +32      ;;    9.  Lost time from work?

 +33      ;;    10. History of hospitalizations, dates and location, if known, reason.

 +34      ;;

 +35      ;;C.  Physical Examination (Objective Findings):

 +36      ;;

 +37      ;;    Address each of the following and fully describe current findings:

 +38      ;;    (Please incorporate all ancillary study results into the final 

 +39      ;;    diagnosis.)

 +40      ;;

 +41      ;;    1.  Musculoskeletal areas involved.

 +42      ;;    2.  Trigger or tender points.

 +43      ;;    3.  Muscle strength in involved areas.

 +44      ;;

 +45      ;;D.  Diagnostic and Clinical Tests:

 +46      ;;

 +47      ;;    1.  Include results of all diagnostic and clinical tests conducted

 +48      ;;        in the examination report.

 +49      ;;

 +50      ;;E.  Diagnosis:

 +51      ;;

 +52      ;;    1.  Is the condition currently active or in remission?

 +53      ;;

 +54      ;;

 +55      ;;

 +56      ;;Signature:                             Date:

 +57      ;;END