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Routine: DVBCWME7

DVBCWME7.m

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  1. DVBCWME7 ;BPOIFO/RLC - MENTAL DISORDERS (EXCEPT PTSD & EATING DISORDERS) ; 12/26/06 2:23pm
  1.  ;;2.7;AMIE;**118**;Apr 10, 1995;Build 3
  1.  ;Per VHA Directive 10-92-142, this routine should not be modified
  1.  ;
  1. TXT ;
  1.  ;;
  1.  ;;The following health care providers can perform initial examinations for
  1.  ;;Mental Disorders:
  1.  ;;a board-certified or board "eligible" psychiatrist;
  1.  ;;a licensed doctorate-level psychologist;
  1.  ;;a doctorate-level mental health provider under the close supervision of a
  1.  ;;board-certified or board eligible psychiatrist or licensed doctorate-level
  1.  ;;psychologist;
  1.  ;;a psychiatry resident under close supervision of a board-certified or
  1.  ;;board eligible psychiatrist or licensed doctorate-level psychologist; or
  1.  ;;a clinical or counseling psychologist completing a one-year internship
  1.  ;;or residency (for purposes of a doctorate-level degree) under close
  1.  ;;supervision of a board-certified or eligible psychiatrist or licensed
  1.  ;;doctorate-level psychologist.
  1.  ;;
  1.  ;;The following health care providers can perform review examinations for
  1.  ;;Mental Disorders:
  1.  ;;a board-certified or board "eligible" psychiatrist;
  1.  ;;a licensed doctorate-level psychologist;
  1.  ;;a doctorate-level mental health provider under close supervision of a
  1.  ;;board-certified or board eligible psychiatrist or licensed doctorate-level
  1.  ;;psychologist;
  1.  ;;a psychiatry resident under close supervision of a board-certified or board
  1.  ;;eligible psychiatrist or licensed doctorate-level psychologist;
  1.  ;;a clinical or counseling psychologist completing a one-year internship or
  1.  ;;residency (for purposes of a doctorate-level degree) under close
  1.  ;;supervision of a board-certified or board eligible psychiatrist or licensed
  1.  ;;doctorate-level psychologist;
  1.  ;;a licensed clinical social worker (LCSW); a nurse practitioner, a clinical
  1.  ;;nurse specialist or physician assistant, if they are clinically privileged
  1.  ;;to perform activities required for C&P mental disorder examinations, under
  1.  ;;the close supervision of a board-certified or board eligible psychiatrist
  1.  ;;or licensed doctorate-level psychologist.
  1.  ;;
  1.  ;;A. Review of Medical Records:
  1.  ;;
  1.  ;;B. Medical History (Subjective Complaints):
  1.  ;;
  1.  ;;    Comment on:
  1.  ;;
  1.  ;;    1. Past Medical History:
  1.  ;;
  1.  ;;        a. Previous hospitalizations and outpatient care.
  1.  ;;        b. Medical and occupational history from the time between last rating
  1.  ;;           examination and the present, unless the purpose of this examination
  1.  ;;           is to ESTABLISH service connection, then the complete medical,
  1.  ;;           occupational and social history pre-military, military and since
  1.  ;;           discharge from military service is required.
  1.  ;;        c. Substance use and its consequences.
  1.  ;;
  1.  ;;    2. Present Medical, Occupational, and Social History - 
  1.  ;;       over the past one year.
  1.  ;;
  1.  ;;        a. Frequency, severity, and duration of psychiatric symptoms.
  1.  ;;        b. Length of remissions, to include capacity for adjustment during
  1.  ;;           periods of remissions.
  1.  ;;        c. Social functioning and adjustment.
  1.  ;;        d. Extent of time lost from work over the past 12 month period.
  1.  ;;           If employed, identify current occupation and length of time at
  1.  ;;           this job. If unemployed, note in complaints whether veteran
  1.  ;;           contends it is due to the effects of a mental disorder.
  1.  ;;           Further indicate following DIAGNOSIS what factors, and objective 
  1.  ;;           findings support or rebut that contention.
  1.  ;;        e. Treatments including statement on effectiveness and side effects
  1.  ;;           experienced.
  1.  ;; 
  1.  ;;    3. Subjective Complaints:
  1.  ;;
  1.  ;;        a. Describe fully.
  1.  ;;
  1.  ;;C.  Examination (Objective Findings):
  1.  ;;
  1.  ;;     Address each of the following and fully describe:
  1.  ;;
  1.  ;;     1. Mental status exam to confirm or establish diagnosis in 
  1.  ;;        accordance with DSM-IV.
  1.  ;;     2. Additionally, to allow evaluation by the rating specialist, describe
  1.  ;;        and fully explain the existence, frequency, and extent of the following
  1.  ;;        signs and symptoms, or any others present, and relate how they interfere
  1.  ;;        with employment and social functioning:
  1.  ;;
  1.  ;;           a. Impairment of thought process or communication.
  1.  ;;           b. Delusions, hallucinations and their persistence.
  1.  ;;           c. Inappropriate behavior cited with examples.
  1.  ;;           d. Suicidal or homicidal thoughts, ideations or plans or intent.
  1.  ;;           e. Ability to maintain minimal personal hygiene and other basic 
  1.  ;;              activities of daily living.
  1.  ;;           f. Orientation to person, place and time.
  1.  ;;           g. Memory loss or impairment (both short and/or long term).
  1.  ;;           h. Obsessive or ritualistic behavior that interferes with routine
  1.  ;;              activities.
  1.  ;;           i. Rate and flow of speech and note irrelevant, illogical, or obscure
  1.  ;;              speech patterns and whether constant or intermittent.
  1.  ;;           j. Panic attacks noting the severity, duration, frequency and effect
  1.  ;;              on independent functioning and whether clinically observed or good
  1.  ;;              evidence of prior clinical or equivalent observation.
  1.  ;;           k. Depression, depressed mood, or anxiety.
  1.  ;;           l.  Impaired impulse control and its effect on motivation or mood.
  1.  ;;           m. Sleep impairment and describe extent it interferes with daytime
  1.  ;;              activities.
  1.  ;;           n. Other symptoms and the extent to which they interfere with
  1.  ;;              activities.
  1.  ;;
  1.  ;;D.  Diagnostic Tests:
  1.  ;;
  1.  ;;     1. Provide psychological testing if deemed necessary.
  1.  ;;     2. If testing is requested, the results must be reported and considered in
  1.  ;;        arriving at the diagnosis.
  1.  ;;     3. Provide any specific evaluation information required by the rating board
  1.  ;;        or on BVA Remand (in claims folder).
  1.  ;;
  1.  ;;           a. CAPACITY TO MANAGE FINANCIAL AFFAIRS Mental competency, for
  1.  ;;           VA benefits purposes, refers only to the ability of the veteran
  1.  ;;           to manage VA benefit payments in his or her own best interest,
  1.  ;;           and not to any other subject. Mental incompetence, for VA benefits
  1.  ;;           purposes, means that the veteran, because of injury or disease,
  1.  ;;           is not capable of managing benefit payments in his or her best
  1.  ;;           interest. In order to assist raters in making a legal determination
  1.  ;;           as to competency, please address the following:
  1.  ;;             - What is the impact of injury or disease on the veteran's ability
  1.  ;;               to manage his or her financial affairs, including consideration
  1.  ;;               of such things as knowing the amount of his or her VA benefit
  1.  ;;               payment, knowing the amounts and types of bills owed monthly,
  1.  ;;               and handling the payment prudently? Does the veteran handle
  1.  ;;               the money and pay the bills?
  1.  ;;
  1.  ;;             - Based on your examination, do you believe that the veteran is
  1.  ;;               capable of managing his or her financial affairs?
  1.  ;;             - Please provide examples to support your conclusion.
  1.  ;;
  1.  ;;               If you believe a Social Work Service assessment is needed before
  1.  ;;               you can give your opinion on the veteran's ability to manage his
  1.  ;;               or her financial affairs, please explain why.
  1.  ;;
  1.  ;;           b. Other Opinion: Furnish any other specific opinion requested 
  1.  ;;              by the rating board or BVA Remand furnishing the complete
  1.  ;;              rationale and citation of medical texts or treatise supporting
  1.  ;;              opinion, if medical literature review was undertaken.
  1.  ;;              If the requested opinion is medically not ascertainable on exam
  1.  ;;              or testing, please indicate why. If the requested opinion cannot
  1.  ;;              be expressed without resorting to speculation or making improbable
  1.  ;;              assumptions say so, and explain why. If the opinion asks "...is it
  1.  ;;              at least as likely as not..?", fully explain the clinical findings
  1.  ;;              and rationale for the opinion.
  1.  ;;
  1.  ;;     4. Include results of all diagnostic and clinical tests conducted
  1.  ;;        in the examination report.
  1.  ;;