DVBCWLL6 ;ALB/RLC LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 12 FEB 2007
;;2.7;AMIE;**121**;Apr 10, 1995;Build 9
;
;
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 cholecystitis. 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 sequelae
;; 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).
;;
;; 8. Effects of the condition on occupational functioning and daily activities.
;;
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWLL6 7684 printed Oct 16, 2024@17:53:08 Page 2
DVBCWLL6 ;ALB/RLC LIVER, GALL BLADDER AND PANCREAS WKS TEXT - 1 ; 12 FEB 2007
+1 ;;2.7;AMIE;**121**;Apr 10, 1995;Build 9
+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 cholecystitis. 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 sequelae
+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 ;;
+106 ;; 8. Effects of the condition on occupational functioning and daily activities.
+107 ;;
