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Routine: DVBCWLL3

DVBCWLL3.m

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  1. DVBCWLL3 ;ALB/RLC LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 19 FEBRUARY 1999
  1. ;;2.7;AMIE;**86**;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. Note presence
  1. ;; or absence of extrahepatic manifestations of veteran's liver disease (e.g.
  1. ;; vasculitis, kidney disease, arthritis.) Refer to additional worksheets
  1. ;; as necessary. See and address 4. Cirrhosis of the liver when cirrhosis
  1. ;; is a sequelae. See and address 7 (below) where veteran is status post
  1. ;; 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. Note presence or absence of
  1. ;; extrahepatic manifestations of veteran's liver disease (e.g.
  1. ;; vasculitis, kidney disease, arthritis.) Refer to additional worksheets
  1. ;; as necessary. See and address 3 (above) where cirrhosis is a sequaele
  1. ;; of Chronic Liver disease (including hepatitis B, chronic active
  1. ;; hepatitis, autoimmune hepatitis, hemochromatosis, drug-induced
  1. ;; hepatitis, etc., but excluding bile duct disorders and Hepatitis C).
  1. ;; See and address 7 (below) where veteran is status 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. Note presence or absence of extrahepatic
  1. ;; manifestations of veteran's liver disease (e.g. vasculitis, kidney
  1. ;; disease, arthritis.) Refer to additional worksheets as necessary.
  1. ;; See and address 7 (below) where veteran is status 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. ;;