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Routine: DVBCWPD2

DVBCWPD2.m

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  1. DVBCWPD2 ;ALB/ESW PTSD WKS TEXT - 2 ; 10 Oct 2000
  1.  ;;2.7;AMIE;**34**;Apr 10, 1995
  1.  ;
  1.  ;
  1. TXT ;
  1.  ;;
  1.  ;;F. Assessment of PTSD
  1.  ;;
  1.  ;;    * state whether or not the veteran meets the DSM-IV stressor criterion
  1.  ;;    * identify behavioral, cognitive, social, affective, or somatic change
  1.  ;;      veteran attributes to stress exposure
  1.  ;;    * describe specific PTSD symptoms present (symptoms of trauma
  1.  ;;      re-experiencing, avoidance/numbing, heightened physiological arousal,
  1.  ;;      and associated features [e.g., disillusionment and demoralization])
  1.  ;;    * specify onset, duration, typical frequency, and severity of symptoms
  1.  ;;
  1.  ;;G. Psychometric Testing Results
  1.  ;;
  1.  ;;   * provide psychological testing if deemed necessary.
  1.  ;;   * provide specific evaluation information required by the rating board or
  1.  ;;     on a BVA Remand.
  1.  ;;   * comment on validity of psychological test results
  1.  ;;   * provide scores for PTSD psychometric assessments administered
  1.  ;;   * state whether PTSD psychometric measures are consistent or inconsistent
  1.  ;;     with a diagnosis of PTSD, based on normative data and established
  1.  ;;     "cutting scores" (cutting scores that are consistent with or supportive
  1.  ;;     of a PTSD diagnosis are as follows: PCL - not less than 50;
  1.  ;;     Mississippi Scale - not less than 107; MMPI PTSD subscale a score
  1.  ;;     greater than 28; MMPI code type: 2-8 or 2-7-8)
  1.  ;;   * state degree of severity of PTSD symptoms based on psychometric data
  1.  ;;     (mild, moderate, or severe)
  1.  ;;   * describe findings from psychological tests measuring other than
  1.  ;;     PTSD (MMPI, etc.)
  1.  ;;
  1.  ;;H. Diagnosis:
  1.  ;;
  1.  ;;    1. The Diagnosis must conform to DSM-IV and be supported by the findings
  1.  ;;       on the examination report.
  1.  ;;    2. If there are multiple mental disorders, delineate to the extent possible
  1.  ;;       the symptoms associated with each and a discussion of relationship.
  1.  ;;    3. Evaluation is based on the effects of the signs and symptoms on
  1.  ;;       occupational and social functioning.
  1.  ;;
  1.  ;;    NOTE: VA is prohibited by statute from paying compensation for a disability
  1.  ;;    that is a result of the veteran's own ALCOHOL OR DRUG ABUSE, whether based
  1.  ;;    on direct service connection, secondary service connection, or aggravation
  1.  ;;    by a service-connected condition. Therefore, when alcohol or drug abuse
  1.  ;;    accompanies or is associated with another mental disorder, separate,
  1.  ;;    to the extent possible, the effects of the alcohol or drug abuse from
  1.  ;;    the effects of the other mental disorder(s). If it is not possible
  1.  ;;    to separate the effects, explain why.
  1.  ;;
  1.  ;;I. Diagnostic Status
  1.  ;;
  1.  ;;      Axis I disorders
  1.  ;;      Axis II disorders
  1.  ;;      Axis III disorders
  1.  ;;      Axis IV (psychosocial and environmental problems)
  1.  ;;      Axis V (GAF score - current)
  1.  ;;
  1.  ;;J. Global Assessment or Functioning (GAF):
  1.  ;;
  1.  ;;    NOTE: The complete multi-axial format as specified by DSM-IV may be required
  1.  ;;    by BVA REMAND or specifically requested by the rating specialist. If so,
  1.  ;;    include the GAF score and note whether it refers to current functioning.
  1.  ;;    A BVA REMAND may also request, in addition to an overall GAF score,
  1.  ;;    that a separate GAF score be provided for each mental disorder present when
  1.  ;;    there are multiple Axis I or Axis II diagnoses and not all are service-
  1.  ;;    connected. If separate GAF scores can be given, an explanation and
  1.  ;;    discussion of the rationale is needed. If it is not possible, an explanation
  1.  ;;    as to why not is needed. (See the above note pertaining to alcohol or drug
  1.  ;;    abuse, the effects of which cannot be used to assess the effects of
  1.  ;;    a service-connected condition.)
  1.  ;;
  1.  ;;    DSM-IV is only for application from 11/7/96 on. Therefore, when applicable
  1.  ;;    note whether the diagnosis of PTSD was supportable under DSM-III-R prior
  1.  ;;    to that date.
  1.  ;;
  1.  ;;K. Competency:
  1.  ;;
  1.  ;;   Competency, for benefits purposes, has a special meaning,
  1.  ;;   and refers ONLY to veterans' ability to manage benefit payments in their own
  1.  ;;   best interests without restriction, and not to any other subject. State
  1.  ;;   whether the veteran is capable of managing his/her or her benefit payments
  1.  ;;   in the individual's own best interests (a physical disability which prevents
  1.  ;;   the veteran from attending to financial matters in person is not a proper
  1.  ;;   basis for a finding of incompetency unless the veteran is, by reason of that
  1.  ;;   disability, incapable of directing someone else in handling the individual's
  1.  ;;   financial affairs).
  1.  ;;
  1.  ;;L. Other Opinion:
  1.  ;;
  1.  ;;   Furnish any other specific opinion requested by the rating
  1.  ;;   board or BVA remand (furnish the complete rationale and citation of medical
  1.  ;;   texts or treatise supporting opinion, if medical literature review was
  1.  ;;   undertaken). If the requested opinion is medically not ascertainable
  1.  ;;   on exam or testing please state WHY. If the requested opinion can not be
  1.  ;;   expressed without resorting to speculation or making improbable assumptions
  1.  ;;   say so, and explain why. If the opinion asks "... is it at least as likely
  1.  ;;   as not..", fully explain the clinical findings and rationale for the opinion.
  1.  ;;
  1.  ;;M. Integrated Summary and Conclusions
  1.  ;;
  1.  ;;- Describe changes in PSYCHOSOCIAL FUNCTIONAL STATUS and QUALITY of LIFE
  1.  ;;  following trauma exposure (performance in employment or schooling, routine
  1.  ;;  responsibilities of self care, family role functioning, physical health,
  1.  ;;  social/interpersonal relationships, recreation/leisure pursuits)
  1.  ;;- Describe linkage between PTSD symptoms and aforementioned changes in
  1.  ;;  impairment in functional status and quality of life. 
  1.  ;;    Particularly in cases where a veteran is unemployed, specific details about
  1.  ;;    the effects of PTSD and its symptoms on employment are especially 
  1.  ;;    important.
  1.  ;;- If possible, describe extent to which disorders other than PTSD
  1.  ;;  (e.g., substance use disorders) are independently responsible for impairment
  1.  ;;  in psychosocial adjustment and quality of life. If this is not possible,
  1.  ;;  explain why (e.g., substance use had onset after PTSD and clearly is a means
  1.  ;;  of coping with PTSD symptoms).
  1.  ;;- If possible, describe pre-trauma risk factors or characteristics that may
  1.  ;;  have rendered the veteran vulnerable to developing PTSD subsequent to trauma
  1.  ;;  exposure.
  1.  ;;- If possible, state prognosis for improvement of psychiatric condition
  1.  ;;  and impairments in functional status.
  1.  ;;- Comment on whether veteran should be rated as competent for VA purposes
  1.  ;;  in terms of being capable of managing his/her benefit payments in his/her
  1.  ;;  own best interest.
  1.  ;;
  1.  ;;
  1.  ;;Signature:                              Date:
  1.  ;;END