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Routine: DVBCWPA4

DVBCWPA4.m

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DVBCWPA4 ;ALB/RLC POW, GENERAL WKS TEXT - 1 ; 7 MARCH 1997

 ;;2.7;AMIE;**183**;Apr 10, 1995;Build 8

 ;

 ;

TXT ;

 ;;

 ;;Narrative: This is the protocol for conducting initial examinations on former 

 ;;POWs.  Approach these veterans with the greatest sensitivity because the 

 ;;POW experience likely resulted in a great deal of psychological and physical 

 ;;trauma.  Details about beatings, torture, forced marches, forced labor, diet, 

 ;;disease, brainwashing, extremes of hot and cold, and anxiety may be 

 ;;significant parts of the veteran's history; eliciting these details requires  

 ;;that one establish a trusting relationship with the veteran. Examine

 ;;veteran for each disability / disease / condition veteran is claiming 

 ;;as a consequence of the POW experience.  A former POW may be entitled 

 ;;to service connection for presumptive POW diseases; the worksheet contains

 ;;a list of these presumptive diseases.  Based on veteran's claim(s) and your

 ;;findings, please refer to and follow additional worksheets to assure

 ;;the examination  provides information adequate for rating purposes.

 ;;

 ;;

 ;;

 ;;PRESUMPTIVE POW DISABILITIES: 

 ;;

 ;;If a veteran is a former prisoner of war, the following diseases shall be

 ;;service connected if manifest to a degree of disability of 10 percent or more

 ;;at any time after service:

 ;;

 ;;   - Psychosis.

 ;;   - Any of the anxiety states.

 ;;   - Dysthymic disorder (or depressive neurosis).

 ;;   - Organic residuals of frostbite, if it is determined that the veteran was

 ;;     interned in climatic conditions consistent with the occurrence of

 ;;     frostbite.

 ;;   - Post-traumatic osteoarthritis.

 ;;   - Atherosclerotic heart disease or hypertensive vascular disease (including

 ;;     hypertensive heart disease) and their complications (including myocardial

 ;;     infarction, congestive heart failure, arrhythmia).

 ;;   - Stroke and its complications.

 ;;   - On or after October 10, 2008, Osteoporosis, if the Secretary determines

 ;;     that the veteran has posttraumatic stress disorder (PTSD).

 ;;

 ;;If a veteran is a former prisoner of war and was interned or detained for not

 ;;less than 30 days, the following diseases shall be service connected if

 ;;manifest to a degree of 10 percent or more at any time after service:

 ;;

 ;;   - Avitaminosis.

 ;;   - Beriberi (including beriberi heart disease).

 ;;   - Chronic dysentery.

 ;;   - Helminthiasis.

 ;;   - Malnutrition (including optic atrophy associated with malnutrition).

 ;;   - Pellagra.

 ;;   - Any other nutritional deficiency.

 ;;   - Irritable bowel syndrome.

 ;;   - Peptic ulcer disease.

 ;;   - Peripheral neuropathy except where directly related to infectious causes.

 ;;   - Cirrhosis of the liver.

 ;;   - On or after September 28, 2009, Osteoporosis.

 ;;

 ;;A.  Review of Medical Records:

 ;;

 ;;    1.  Include a review of VA form 10-0048, Former POW Medical 

 ;;        History, which the veteran should have completed, prior to 

 ;;        conducting the examination.

 ;;    2.  Review the Social Survey.

 ;;

 ;;B.  Medical History (Subjective Complaints):  NOTE:  If the veteran 

 ;;    has had a previous protocol examination, only an interval history

 ;;    is required.

 ;;

 ;;    Comment on:

 ;;

 ;;    1.  Past medical history, including childhood and adult illnesses.

 ;;        History of hospitalizations or surgery, reason or type of surgery,

 ;;        location and dates, if known.  History of trauma, with type and date

 ;;        of injury and cause.

 ;;    2.  Family history.

 ;;    3.  Social history - state civilian and military occupations, 

 ;;        including dates and locations.  Describe use of alcohol, 

 ;;        tobacco, and drugs.

 ;;    4.  Indicate the dominant hand and how determined (i.e., writes, eats,

 ;;        combs hair, etc.).

 ;;    5.  Symptoms of fever/chills, night sweats, malaise.

 ;;    6.  If there are flare-ups of any joint (including spine, hands, and feet)

 ;;        or muscle disease, state the frequency, duration, precipitating

 ;;        factors, alleviating factors, and the extent, if any, per veteran,

 ;;        they result in additional limitation of motion or other functional

 ;;        impairments during the flare-up.

 ;;    7.  Comment on amount of weight lost as a prisoner.  Record initial and

 ;;        release weights.

 ;;    8.  Describe initial symptoms, time of onset, course, and current symptoms

 ;;        of all presumptive POW disabilities found.

 ;;    9.  Describe current and relevant past treatments (specify type, frequency,

 ;;        duration, response, side effects).

 ;;    10. If a neoplasm is or was present, state whether benign or malignant and

 ;;        provide:

 ;;

 ;;        a. Exact diagnosis and date of confirmed diagnosis.

 ;;        b. Location of neoplasm.

 ;;        c. Types and dates of treatment.

 ;;        d. For malignant neoplasm, also state exact date of the last surgical,

 ;;           X-ray, antineoplastic chemotherapy, radiation, or other therapeutic

 ;;           procedure.  If treatment is already completed, provide date of last

 ;;           treatment and fully describe residuals.  If not completed, state

 ;;           expected date of completion.

 ;;

 ;;    11. Conduct a complete system review, with a focus on symptoms related to

 ;;        the presumptive conditions, and comment on all positive symptoms.

 ;;

 ;;C.  Physical Examination (Objective Findings):

 ;;

 ;;    Address each of the following and fully describe current findings.

 ;;    Report any other significant physical abnormalities.  The examiner should

 ;;    incorporate all ancillary study results into the final diagnoses.

 ;;

 ;;    1.  GENERAL:  Pulse, respirations, height, weight, maximum weight in past

 ;;        year, percentage of weight change in past year compared to baseline

 ;;        (average weight in the 2 years preceding onset of disease), body build,

 ;;        and state of nutrition.

 ;;

 ;;    2.  BLOOD PRESSURE:  (Per the rating schedule, hypertension means that the

 ;;        diastolic blood pressure is predominantly 90mm. or greater, and

 ;;        isolated systolic hypertension means that the systolic blood pressure

 ;;        is predominantly 160mm. or greater with a diastolic blood pressure of

 ;;        less than 90mm.).

 ;;

 ;;        i.  If the diagnosis of hypertension has not been previously

 ;;            established, and it is a claimed issue, B.P. readings must be

 ;;            taken two or more times on each of at least three different days.

 ;;       ii.  If hypertension has been previously diagnosed and is claimed, but

 ;;            the claimant is not on treatment, B.P. readings must be taken two

 ;;            or more times on at least three different days.

 ;;      iii.  If hypertension has been previously diagnosed, and the claimant is

 ;;            on treatment, take three blood pressure readings on the day of the

 ;;            examination.

 ;;       iv.  If hypertension has not been claimed, take three blood pressure

 ;;            readings on the day of the examination.  If they are suggestive of

 ;;            hypertension or are borderline, readings must be taken two or more

 ;;            times on at least two additional days to rule hypertension in or

 ;;            out.

 ;;        v.  In the diagnostic summary, state whether hypertension is ruled in

 ;;            or out after completing these B.P. measurements.  If hypertensive

 ;;            heart disease is suspected or found, follow worksheet for Heart.

 ;;

 ;;    3.  POSTURE AND GAIT:  Describe if abnormal.

 ;;

 ;;    4.  SKIN:  If abnormal, describe appearance, location, extent of rash or

 ;;        lesions.  If there are scars, including burn scars, describe the 

 ;;        location, measurements (cm. x cm.), shape, depression, type of tissue

 ;;        loss, adherence, color difference, and whether there is tenderness, 

 ;;        skin breakdown, or functional limitation of activity or motion due to

 ;;        the scarring.  If there are scars, including burn scars, or other

 ;;        disfigurement of the head, face, or neck, follow the Scars worksheet.

 ;;        (NOTE:  If there are disfiguring scars of the head, face, or neck,

 ;;        obtain and submit COLOR PHOTOGRAPHS of the affected area(s).  Report

 ;;        nail abnormalities).

 ;;

 ;;    5.  HEMIC AND LYMPHATIC:  (Describe local or generalized adenopathy, 

 ;;        tenderness, edema, suppuration, etc., as well as splenomegaly,

 ;;        hepatomegaly, signs of anemia or bleeding tendency, etc.).

 ;;

 ;;    6.  HEAD AND NECK:  Describe cervical adenopathy, carotid bruit,

 ;;        deformities, etc.

 ;;

 ;;    7.  EYES:  Report corrected visual acuity, pupil reactions, gross visual

 ;;        fields, and retinopathy or other abnormality of fundus, eyelids,

 ;;        eyebrows, conjunctivae, etc.  Refer for an examination by an Eye

 ;;        specialist as indicated.

 ;;

 ;;    8.  EARS:  Describe hearing loss, tinnitus, vertigo, status of tympanic

 ;;        membrane, pain, discharge, etc.  Refer for an examination by a

 ;;        specialist as indicated.

 ;;

 ;;    9.  NOSE, SINUSES, MOUTH AND THROAT:  Describe nasal vestibule, turbinates,

 ;;        polyps, signs of obstruction, position of septum.  Describe mouth and

 ;;        tongue, gums, tonsils, uvula and palate, gross dental findings.  For

 ;;        sinuses, describe any tenderness, purulent discharge, crusting, etc.

 ;;

 ;;   10.  ENDOCRINE:  Describe neck mass or nodule, lid lag, exophthalmos,

 ;;        abnormality of hair or skin, effects of any endocrine condition on

 ;;        other body systems.

 ;;

 ;;   11.  PULMONARY:  Inspection, palpation, percussion, auscultation.  Report

 ;;        abnormal breath sounds, pleural rub, prolonged expiration, etc.

 ;;