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Routine: DVBCWLL1

DVBCWLL1.m

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  1. DVBCWLL1 ;ALB/JEH LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 19 FEBRUARY 1999
  1.  ;;2.7;AMIE;**74**;July 22, 2004
  1.  ;
  1.  ;
  1. TXT ;
  1.  ;;
  1.  ;;A. Review of Medical Records: This may be of particular importance when
  1.  ;;   hepatitis C or chronic liver disease is claimed as related to service.
  1.  ;;
  1.  ;;B. Medical History (Subjective Complaints): 
  1.  ;;
  1.  ;;   1. For Gall Bladder Disease (Including Gall bladder removal): Episodes of
  1.  ;;      colic or other abdominal pain, distention, nausea, and / or vomiting.
  1.  ;;      Include a statement on frequency of attacks (number within past year).
  1.  ;;      Provide statement as to what x-ray (or other) evidence supports diagnosis 
  1.  ;;      of chronic cholycystitis. Include current treatment - type (medication,
  1.  ;;      diet, etc.), duration, response, side effects. For Gall Bladder injury,
  1.  ;;      refer to Stomach, Duodenum and Peritoneal Adhesions worksheet. 
  1.  ;;
  1.  ;;   2. For Pancreatic conditions: Does veteran have steatorrhea, malabsorption,
  1.  ;;      or malnutrition? Comment on whether veteran has attacks of abdominal
  1.  ;;      pain. Include frequency of attacks (per year). Comment on whether veteran
  1.  ;;      has diarrhea, weight loss. Is there evidence of continuing pancreatic
  1.  ;;      insufficiency between acute attacks? Provide evidence (lab or other
  1.  ;;      clinical studies) that abdominal pain is a consequence of pancreatic
  1.  ;;      disease. Has veteran had pancreatic surgery? If so, describe. Include
  1.  ;;      current treatment - type (medication, diet, enzymes, etc.), duration,
  1.  ;;      response, side effects. 
  1.  ;;
  1.  ;;   3. For Chronic Liver disease (including hepatitis B, chronic active
  1.  ;;      hepatitis, autoimmune hepatitis, hemochromatosis, drug-induced hepatitis,
  1.  ;;      etc., but excluding bile duct disorders and Hepatitis C): (a) Does
  1.  ;;      veteran have "incapacitating episodes" (defined as periods of acute signs
  1.  ;;      and symptoms with symptoms such as fatigue, malaise, nausea, vomiting,
  1.  ;;      anorexia, arthralgia, and right upper quadrant pain with symptoms severe 
  1.  ;;      enough to require bed rest and treatment by a physician)? If so, provide
  1.  ;;      frequency of episodes and total duration of episodes over the past
  1.  ;;      12-month period. Please include comment on whether this is veteran
  1.  ;;      reported, and / or documented in the available records. (b) Include
  1.  ;;      current treatment - type (medication, diet, enzymes, etc.), duration,
  1.  ;;      response, side effects. (c) Comment on presence and severity (e.g.
  1.  ;;      near-constant, debilitating, daily or intermittent), as appropriate, of
  1.  ;;      fatigue, malaise, anorexia and weight loss, right upper quadrant pain and
  1.  ;;      hepatomegaly. (d) Include a history of risk factors for the liver
  1.  ;;      condition which the veteran is claiming service connection. For instance
  1.  ;;      (as appropriate) is there a history of occupational blood exposure? IV
  1.  ;;      drug use? Taking medications that are associated with liver disease?
  1.  ;;      Include a history of alcohol use / abuse, past and present. See and
  1.  ;;      address 4. Cirrhosis of the liver when cirrhosis is a sequelae. See and
  1.  ;;      address 7 (below) where veteran is status post liver transplant.
  1.  ;;
  1.  ;;   4. For Cirrhosis of the Liver, primary biliary cirrhosis, cirrhotic phase of
  1.  ;;      sclerosing cholangitis, or as a sequelae of hepatitis from any cause:
  1.  ;;      (a)Fully describe the following, indicating, as appropriate, the number
  1.  ;;      of episodes, periods of remission, or whether the condition is refractory
  1.  ;;      to treatment: (i) ascites, (ii) hepatic encephalopathy, (iii) hemorrhage
  1.  ;;      from varicies (include comment on episodes of hemetemesis and/or melana,
  1.  ;;      (iv) portal gastropathy (v) portal hypertension, (vi) jaundice. (b)
  1.  ;;      comment on: (i) current treatment (s) (medications, diet, response, side
  1.  ;;      effects, duration) (ii) Discuss presence, frequency (e.g., daily,
  1.  ;;      intermittent, etc.) and severity of each of the following: weakness,
  1.  ;;      anorexia, malaise, abdominal pain, weight loss (include amount and time 
  1.  ;;      frame), weight gain, and weakness. See and address 3 (above) where
  1.  ;;      cirrhosis is a sequaele of Chronic Liver disease (including hepatitis B,
  1.  ;;      chronic active hepatitis, autoimmune hepatitis, hemochromatosis,
  1.  ;;      drug-induced hepatitis, etc., but excluding bile duct disorders 
  1.  ;;      and Hepatitis C). See and address 7 (below) where veteran is status
  1.  ;;      post liver transplant. 
  1.  ;;
  1.  ;;   5. For Hepatitis C: (a) Does veteran have "incapacitating episodes" (defined
  1.  ;;      as periods of acute signs and symptoms with symptoms such as fatigue,
  1.  ;;      malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant
  1.  ;;      pain with symptoms severe enough to require bed rest and treatment by a
  1.  ;;      physician)? If so, provide frequency of episodes and total duration of
  1.  ;;      episodes over the past 12-month period. Please include comment on whether
  1.  ;;      this is veteran reported, and/ or documented in the available records.
  1.  ;;      (b) comment on: (i) current treatment (s) (medications, diet, response,
  1.  ;;      side effects, duration) (ii) Discuss presence, frequency (e.g., daily,
  1.  ;;      intermittent, etc.) and severity of each of the following: weakness,
  1.  ;;      anorexia, malaise, abdominal pain, weight loss (include amount and time
  1.  ;;      frame), weight gain, and weakness. (c) Include a history of risk factors
  1.  ;;      for the liver condition for which the veteran is claiming service
  1.  ;;      connection. For instance (as appropriate) is there a history of
  1.  ;;      occupational blood exposure? IV drug use? See established risk factors
  1.  ;;      for Hepatitis C, below. See and address 7 (below) where veteran is status
  1.  ;;      post liver transplant. 
  1.  ;;
  1.  ;;   6. For Liver Malignancy: Address presence or absence of symptomatolgy, etc.,
  1.  ;;      as outlined in both: 3. (For Chronic Liver disease (including hepatitis B,
  1.  ;;      chronic active hepatitis, autoimmune hepatitis, hemochromatosis,
  1.  ;;      drug-induced hepatitis, etc., but excluding bile duct disorders and
  1.  ;;      Hepatitis C) and 4. (For Cirrhosis of the Liver, primary biliary
  1.  ;;      cirrhosis, cirrhotic phase of sclerosing cholangitis, or as a sequelae
  1.  ;;      of hepatitis from any cause) above. 
  1.  ;;
  1.  ;;   7. For Liver Transplant: Provide date of transplant. Describe current
  1.  ;;      treatment(s) (medications, diet, response, side effects, duration).
  1.  ;;      Please refer to additional AMIE worksheets to address conditions veteran
  1.  ;;      has as a consequence of the transplant, treatment for the transplant, and
  1.  ;;      as a consequence of any underlying disease that prompted the transplant
  1.  ;;      in the first place (e.g. extrahepatic complications / manifestations of
  1.  ;;      hepatitis C). 
  1.  ;;