DVBCWFI5.m

DVBCWFI5 ;ALB/RLC FIBROMYALGIA WKS TEXT - 1 ; 12 FEB 2007

 ;;2.7;AMIE;**183**;Apr 10, 1995;Build 8

 ;

 ;

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 and circumstances of onset.

 ;;    2.  History of hospitalizations or surgery, dates and locations, if known,

 ;;        and reason.

 ;;    3.  Report which of the following are present:  Unexplained fatigue, sleep

 ;;        disturbances, headaches, paresthesias, diarrhea, constipation,

 ;;        alternating constipation and diarrhea, abdominal cramps or bloating,

 ;;        depression, anxiety, Raynaud's-like symptoms, musculoskeletal symptoms.

 ;;    4.  For musculoskeletal symptoms, describe type (myalgia, arthralgia,

 ;;        stiffness, etc.) and location.  State whether pain, if present, is

 ;;        widespread (meaning in both the left and right sides of the body, 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).

 ;;    5.  State whether symptoms are constant, or nearly so, or are episodic.

 ;;        If episodic, are they present more than one-third of the time?

 ;;    6.  What precipitates or exacerbates symptoms?

 ;;    7.  Treatment, (type, duration, response, side effects).  Is continuous

 ;;        medication required for control?  Are symptoms refractory to therapy?

 ;;

 ;;C.  Physical Examination (Objective Findings):

 ;;

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

 ;;

 ;;    1.  Vital signs.

 ;;    2.  Indicate all tender points found (and state if on left, right, or both

 ;;        sides) from the following list of fibromyalgia tender points

 ;;        identified by the American College of Rheumatology.

 ;;        Occiput:  at the suboccipital muscle insertions.

 ;;        Low cervical:  at the anterior aspects of the intertransverse spaces

 ;;        at C5-C7.

 ;;        Trapezius:  at the midpoint of the upper border.

 ;;        Supraspinatus:  at origins, above the scapula spine near the medial

 ;;        border.

 ;;        Second rib:  at the second costochondral junctions, just lateral to

 ;;        the junctions on upper surfaces.

 ;;        Lateral epicondyle:  2 cm distal to the epicondyles.

 ;;        Gluteal:  in upper outer quadrants of buttocks in anterior fold of

 ;;        muscle.

 ;;        Greater trochanter:  posterior to the trochanteric prominence.

 ;;        Knee:  at the medial fat pad proximal to the joint line.

 ;;

 ;;D.  Diagnostic and Clinical Tests:

 ;;

 ;;    1.  As appropriate, to rule out other conditions.

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

 ;;        in the examination report.

 ;;

 ;;E.  Diagnosis:

 ;;

 ;;    1.  Diagnosis and date of diagnosis, if known.

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

 ;;    3.  State amount of time lost from work during past 12-month period due to

 ;;        fibromyalgia.

 ;;    4.  Describe the effects of the condition on usual occupation and daily

 ;;        activities.

 ;;

 ;;

 ;;

 ;;Signature:                             Date:

 ;;END

--- Routine Detail   --- with STRUCTURED ROUTINE LISTING ---DVBCWFI5   4141     printed  Mar 13, 2025@20:55:48                                                                                                                                                                                                    Page 2

DVBCWFI5  ;ALB/RLC FIBROMYALGIA WKS TEXT - 1 ; 12 FEB 2007

 +1       ;;2.7;AMIE;**183**;Apr 10, 1995;Build 8

 +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 and circumstances of onset.

 +21      ;;    2.  History of hospitalizations or surgery, dates and locations, if known,

 +22      ;;        and reason.

 +23      ;;    3.  Report which of the following are present:  Unexplained fatigue, sleep

 +24      ;;        disturbances, headaches, paresthesias, diarrhea, constipation,

 +25      ;;        alternating constipation and diarrhea, abdominal cramps or bloating,

 +26      ;;        depression, anxiety, Raynaud's-like symptoms, musculoskeletal symptoms.

 +27      ;;    4.  For musculoskeletal symptoms, describe type (myalgia, arthralgia,

 +28      ;;        stiffness, etc.) and location.  State whether pain, if present, is

 +29      ;;        widespread (meaning in both the left and right sides of the body, both

 +30      ;;        above and below the waist, and that affects both the axial skeleton

 +31      ;;        (i.e., cervical spine, anterior chest, thoracic spine, or low back)

 +32      ;;        and the extremities).

 +33      ;;    5.  State whether symptoms are constant, or nearly so, or are episodic.

 +34      ;;        If episodic, are they present more than one-third of the time?

 +35      ;;    6.  What precipitates or exacerbates symptoms?

 +36      ;;    7.  Treatment, (type, duration, response, side effects).  Is continuous

 +37      ;;        medication required for control?  Are symptoms refractory to therapy?

 +38      ;;

 +39      ;;C.  Physical Examination (Objective Findings):

 +40      ;;

 +41      ;;    Address each of the following and fully describe current findings:

 +42      ;;

 +43      ;;    1.  Vital signs.

 +44      ;;    2.  Indicate all tender points found (and state if on left, right, or both

 +45      ;;        sides) from the following list of fibromyalgia tender points

 +46      ;;        identified by the American College of Rheumatology.

 +47      ;;        Occiput:  at the suboccipital muscle insertions.

 +48      ;;        Low cervical:  at the anterior aspects of the intertransverse spaces

 +49      ;;        at C5-C7.

 +50      ;;        Trapezius:  at the midpoint of the upper border.

 +51      ;;        Supraspinatus:  at origins, above the scapula spine near the medial

 +52      ;;        border.

 +53      ;;        Second rib:  at the second costochondral junctions, just lateral to

 +54      ;;        the junctions on upper surfaces.

 +55      ;;        Lateral epicondyle:  2 cm distal to the epicondyles.

 +56      ;;        Gluteal:  in upper outer quadrants of buttocks in anterior fold of

 +57      ;;        muscle.

 +58      ;;        Greater trochanter:  posterior to the trochanteric prominence.

 +59      ;;        Knee:  at the medial fat pad proximal to the joint line.

 +60      ;;

 +61      ;;D.  Diagnostic and Clinical Tests:

 +62      ;;

 +63      ;;    1.  As appropriate, to rule out other conditions.

 +64      ;;    2.  Include results of all diagnostic and clinical tests conducted

 +65      ;;        in the examination report.

 +66      ;;

 +67      ;;E.  Diagnosis:

 +68      ;;

 +69      ;;    1.  Diagnosis and date of diagnosis, if known.

 +70      ;;    2.  Is the condition currently active or in remission?

 +71      ;;    3.  State amount of time lost from work during past 12-month period due to

 +72      ;;        fibromyalgia.

 +73      ;;    4.  Describe the effects of the condition on usual occupation and daily

 +74      ;;        activities.

 +75      ;;

 +76      ;;

 +77      ;;

 +78      ;;Signature:                             Date:

 +79      ;;END