- DVBCWLL3 ;ALB/RLC LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 19 FEBRUARY 1999
- ;;2.7;AMIE;**86**;July 22, 2004
- ;
- ;
- TXT ;
- ;;
- ;;A. Review of Medical Records: This may be of particular importance when
- ;; hepatitis C or chronic liver disease is claimed as related to service.
- ;;
- ;;B. Medical History (Subjective Complaints):
- ;;
- ;; 1. For Gall Bladder Disease (Including Gall bladder removal): Episodes of
- ;; colic or other abdominal pain, distention, nausea, and / or vomiting.
- ;; Include a statement on frequency of attacks (number within past year).
- ;; Provide statement as to what x-ray (or other) evidence supports diagnosis
- ;; of chronic cholycystitis. Include current treatment - type (medication,
- ;; diet, etc.), duration, response, side effects. For Gall Bladder injury,
- ;; refer to Stomach, Duodenum and Peritoneal Adhesions worksheet.
- ;;
- ;; 2. For Pancreatic conditions: Does veteran have steatorrhea, malabsorption,
- ;; or malnutrition? Comment on whether veteran has attacks of abdominal
- ;; pain. Include frequency of attacks (per year). Comment on whether veteran
- ;; has diarrhea, weight loss. Is there evidence of continuing pancreatic
- ;; insufficiency between acute attacks? Provide evidence (lab or other
- ;; clinical studies) that abdominal pain is a consequence of pancreatic
- ;; disease. Has veteran had pancreatic surgery? If so, describe. Include
- ;; current treatment - type (medication, diet, enzymes, etc.), duration,
- ;; response, side effects.
- ;;
- ;; 3. For Chronic Liver disease (including hepatitis B, chronic active
- ;; hepatitis, autoimmune hepatitis, hemochromatosis, drug-induced hepatitis,
- ;; etc., but excluding bile duct disorders and Hepatitis C): (a) Does
- ;; veteran have "incapacitating episodes" (defined as periods of acute signs
- ;; and symptoms with symptoms such as fatigue, malaise, nausea, vomiting,
- ;; anorexia, arthralgia, and right upper quadrant pain with symptoms severe
- ;; enough to require bed rest and treatment by a physician)? If so, provide
- ;; frequency of episodes and total duration of episodes over the past
- ;; 12-month period. Please include comment on whether this is veteran
- ;; reported, and / or documented in the available records. (b) Include
- ;; current treatment - type (medication, diet, enzymes, etc.), duration,
- ;; response, side effects. (c) Comment on presence and severity (e.g.
- ;; near-constant, debilitating, daily or intermittent), as appropriate, of
- ;; fatigue, malaise, anorexia and weight loss, right upper quadrant pain and
- ;; hepatomegaly. (d) Include a history of risk factors for the liver
- ;; condition which the veteran is claiming service connection. For instance
- ;; (as appropriate) is there a history of occupational blood exposure? IV
- ;; drug use? Taking medications that are associated with liver disease?
- ;; Include a history of alcohol use / abuse, past and present. Note presence
- ;; or absence of extrahepatic manifestations of veteran's liver disease (e.g.
- ;; vasculitis, kidney disease, arthritis.) Refer to additional worksheets
- ;; as necessary. See and address 4. Cirrhosis of the liver when cirrhosis
- ;; is a sequelae. See and address 7 (below) where veteran is status post
- ;; liver transplant.
- ;;
- ;; 4. For Cirrhosis of the Liver, primary biliary cirrhosis, cirrhotic phase of
- ;; sclerosing cholangitis, or as a sequelae of hepatitis from any cause:
- ;; (a)Fully describe the following, indicating, as appropriate, the number
- ;; of episodes, periods of remission, or whether the condition is refractory
- ;; to treatment: (i) ascites, (ii) hepatic encephalopathy, (iii) hemorrhage
- ;; from varicies (include comment on episodes of hemetemesis and/or melana,
- ;; (iv) portal gastropathy (v) portal hypertension, (vi) jaundice. (b)
- ;; comment on: (i) current treatment (s) (medications, diet, response, side
- ;; effects, duration) (ii) Discuss presence, frequency (e.g., daily,
- ;; intermittent, etc.) and severity of each of the following: weakness,
- ;; anorexia, malaise, abdominal pain, weight loss (include amount and time
- ;; frame), weight gain, and weakness. Note presence or absence of
- ;; extrahepatic manifestations of veteran's liver disease (e.g.
- ;; vasculitis, kidney disease, arthritis.) Refer to additional worksheets
- ;; as necessary. See and address 3 (above) where cirrhosis is a sequaele
- ;; of Chronic Liver disease (including hepatitis B, chronic active
- ;; hepatitis, autoimmune hepatitis, hemochromatosis, drug-induced
- ;; hepatitis, etc., but excluding bile duct disorders and Hepatitis C).
- ;; See and address 7 (below) where veteran is status post liver transplant.
- ;;
- ;; 5. For Hepatitis C: (a) Does veteran have "incapacitating episodes" (defined
- ;; as periods of acute signs and symptoms with symptoms such as fatigue,
- ;; malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant
- ;; pain with symptoms severe enough to require bed rest and treatment by a
- ;; physician)? If so, provide frequency of episodes and total duration of
- ;; episodes over the past 12-month period. Please include comment on whether
- ;; this is veteran reported, and/ or documented in the available records.
- ;; (b) comment on: (i) current treatment (s) (medications, diet, response,
- ;; side effects, duration) (ii) Discuss presence, frequency (e.g., daily,
- ;; intermittent, etc.) and severity of each of the following: weakness,
- ;; anorexia, malaise, abdominal pain, weight loss (include amount and time
- ;; frame), weight gain, and weakness. (c) Include a history of risk factors
- ;; for the liver condition for which the veteran is claiming service
- ;; connection. For instance (as appropriate) is there a history of
- ;; occupational blood exposure? IV drug use? See established risk factors
- ;; for Hepatitis C, below. Note presence or absence of extrahepatic
- ;; manifestations of veteran's liver disease (e.g. vasculitis, kidney
- ;; disease, arthritis.) Refer to additional worksheets as necessary.
- ;; See and address 7 (below) where veteran is status post liver transplant.
- ;;
- ;; 6. For Liver Malignancy: Address presence or absence of symptomatolgy, etc.,
- ;; as outlined in both: 3. (For Chronic Liver disease (including hepatitis B,
- ;; chronic active hepatitis, autoimmune hepatitis, hemochromatosis,
- ;; drug-induced hepatitis, etc., but excluding bile duct disorders and
- ;; Hepatitis C) and 4. (For Cirrhosis of the Liver, primary biliary
- ;; cirrhosis, cirrhotic phase of sclerosing cholangitis, or as a sequelae
- ;; of hepatitis from any cause) above.
- ;;
- ;; 7. For Liver Transplant: Provide date of transplant. Describe current
- ;; treatment(s) (medications, diet, response, side effects, duration).
- ;; Please refer to additional AMIE worksheets to address conditions veteran
- ;; has as a consequence of the transplant, treatment for the transplant, and
- ;; as a consequence of any underlying disease that prompted the transplant
- ;; in the first place (e.g. extrahepatic complications / manifestations of
- ;; hepatitis C).
- ;;
- --- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWLL3 7589 printed Feb 18, 2025@23:18:41 Page 2
- DVBCWLL3 ;ALB/RLC LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 19 FEBRUARY 1999
- +1 ;;2.7;AMIE;**86**;July 22, 2004
- +2 ;
- +3 ;
- TXT ;
- +1 ;;
- +2 ;;A. Review of Medical Records: This may be of particular importance when
- +3 ;; hepatitis C or chronic liver disease is claimed as related to service.
- +4 ;;
- +5 ;;B. Medical History (Subjective Complaints):
- +6 ;;
- +7 ;; 1. For Gall Bladder Disease (Including Gall bladder removal): Episodes of
- +8 ;; colic or other abdominal pain, distention, nausea, and / or vomiting.
- +9 ;; Include a statement on frequency of attacks (number within past year).
- +10 ;; Provide statement as to what x-ray (or other) evidence supports diagnosis
- +11 ;; of chronic cholycystitis. Include current treatment - type (medication,
- +12 ;; diet, etc.), duration, response, side effects. For Gall Bladder injury,
- +13 ;; refer to Stomach, Duodenum and Peritoneal Adhesions worksheet.
- +14 ;;
- +15 ;; 2. For Pancreatic conditions: Does veteran have steatorrhea, malabsorption,
- +16 ;; or malnutrition? Comment on whether veteran has attacks of abdominal
- +17 ;; pain. Include frequency of attacks (per year). Comment on whether veteran
- +18 ;; has diarrhea, weight loss. Is there evidence of continuing pancreatic
- +19 ;; insufficiency between acute attacks? Provide evidence (lab or other
- +20 ;; clinical studies) that abdominal pain is a consequence of pancreatic
- +21 ;; disease. Has veteran had pancreatic surgery? If so, describe. Include
- +22 ;; current treatment - type (medication, diet, enzymes, etc.), duration,
- +23 ;; response, side effects.
- +24 ;;
- +25 ;; 3. For Chronic Liver disease (including hepatitis B, chronic active
- +26 ;; hepatitis, autoimmune hepatitis, hemochromatosis, drug-induced hepatitis,
- +27 ;; etc., but excluding bile duct disorders and Hepatitis C): (a) Does
- +28 ;; veteran have "incapacitating episodes" (defined as periods of acute signs
- +29 ;; and symptoms with symptoms such as fatigue, malaise, nausea, vomiting,
- +30 ;; anorexia, arthralgia, and right upper quadrant pain with symptoms severe
- +31 ;; enough to require bed rest and treatment by a physician)? If so, provide
- +32 ;; frequency of episodes and total duration of episodes over the past
- +33 ;; 12-month period. Please include comment on whether this is veteran
- +34 ;; reported, and / or documented in the available records. (b) Include
- +35 ;; current treatment - type (medication, diet, enzymes, etc.), duration,
- +36 ;; response, side effects. (c) Comment on presence and severity (e.g.
- +37 ;; near-constant, debilitating, daily or intermittent), as appropriate, of
- +38 ;; fatigue, malaise, anorexia and weight loss, right upper quadrant pain and
- +39 ;; hepatomegaly. (d) Include a history of risk factors for the liver
- +40 ;; condition which the veteran is claiming service connection. For instance
- +41 ;; (as appropriate) is there a history of occupational blood exposure? IV
- +42 ;; drug use? Taking medications that are associated with liver disease?
- +43 ;; Include a history of alcohol use / abuse, past and present. Note presence
- +44 ;; or absence of extrahepatic manifestations of veteran's liver disease (e.g.
- +45 ;; vasculitis, kidney disease, arthritis.) Refer to additional worksheets
- +46 ;; as necessary. See and address 4. Cirrhosis of the liver when cirrhosis
- +47 ;; is a sequelae. See and address 7 (below) where veteran is status post
- +48 ;; liver transplant.
- +49 ;;
- +50 ;; 4. For Cirrhosis of the Liver, primary biliary cirrhosis, cirrhotic phase of
- +51 ;; sclerosing cholangitis, or as a sequelae of hepatitis from any cause:
- +52 ;; (a)Fully describe the following, indicating, as appropriate, the number
- +53 ;; of episodes, periods of remission, or whether the condition is refractory
- +54 ;; to treatment: (i) ascites, (ii) hepatic encephalopathy, (iii) hemorrhage
- +55 ;; from varicies (include comment on episodes of hemetemesis and/or melana,
- +56 ;; (iv) portal gastropathy (v) portal hypertension, (vi) jaundice. (b)
- +57 ;; comment on: (i) current treatment (s) (medications, diet, response, side
- +58 ;; effects, duration) (ii) Discuss presence, frequency (e.g., daily,
- +59 ;; intermittent, etc.) and severity of each of the following: weakness,
- +60 ;; anorexia, malaise, abdominal pain, weight loss (include amount and time
- +61 ;; frame), weight gain, and weakness. Note presence or absence of
- +62 ;; extrahepatic manifestations of veteran's liver disease (e.g.
- +63 ;; vasculitis, kidney disease, arthritis.) Refer to additional worksheets
- +64 ;; as necessary. See and address 3 (above) where cirrhosis is a sequaele
- +65 ;; of Chronic Liver disease (including hepatitis B, chronic active
- +66 ;; hepatitis, autoimmune hepatitis, hemochromatosis, drug-induced
- +67 ;; hepatitis, etc., but excluding bile duct disorders and Hepatitis C).
- +68 ;; See and address 7 (below) where veteran is status post liver transplant.
- +69 ;;
- +70 ;; 5. For Hepatitis C: (a) Does veteran have "incapacitating episodes" (defined
- +71 ;; as periods of acute signs and symptoms with symptoms such as fatigue,
- +72 ;; malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant
- +73 ;; pain with symptoms severe enough to require bed rest and treatment by a
- +74 ;; physician)? If so, provide frequency of episodes and total duration of
- +75 ;; episodes over the past 12-month period. Please include comment on whether
- +76 ;; this is veteran reported, and/ or documented in the available records.
- +77 ;; (b) comment on: (i) current treatment (s) (medications, diet, response,
- +78 ;; side effects, duration) (ii) Discuss presence, frequency (e.g., daily,
- +79 ;; intermittent, etc.) and severity of each of the following: weakness,
- +80 ;; anorexia, malaise, abdominal pain, weight loss (include amount and time
- +81 ;; frame), weight gain, and weakness. (c) Include a history of risk factors
- +82 ;; for the liver condition for which the veteran is claiming service
- +83 ;; connection. For instance (as appropriate) is there a history of
- +84 ;; occupational blood exposure? IV drug use? See established risk factors
- +85 ;; for Hepatitis C, below. Note presence or absence of extrahepatic
- +86 ;; manifestations of veteran's liver disease (e.g. vasculitis, kidney
- +87 ;; disease, arthritis.) Refer to additional worksheets as necessary.
- +88 ;; See and address 7 (below) where veteran is status post liver transplant.
- +89 ;;
- +90 ;; 6. For Liver Malignancy: Address presence or absence of symptomatolgy, etc.,
- +91 ;; as outlined in both: 3. (For Chronic Liver disease (including hepatitis B,
- +92 ;; chronic active hepatitis, autoimmune hepatitis, hemochromatosis,
- +93 ;; drug-induced hepatitis, etc., but excluding bile duct disorders and
- +94 ;; Hepatitis C) and 4. (For Cirrhosis of the Liver, primary biliary
- +95 ;; cirrhosis, cirrhotic phase of sclerosing cholangitis, or as a sequelae
- +96 ;; of hepatitis from any cause) above.
- +97 ;;
- +98 ;; 7. For Liver Transplant: Provide date of transplant. Describe current
- +99 ;; treatment(s) (medications, diet, response, side effects, duration).
- +100 ;; Please refer to additional AMIE worksheets to address conditions veteran
- +101 ;; has as a consequence of the transplant, treatment for the transplant, and
- +102 ;; as a consequence of any underlying disease that prompted the transplant
- +103 ;; in the first place (e.g. extrahepatic complications / manifestations of
- +104 ;; hepatitis C).
- +105 ;;