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DVBCWPD2.m

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DVBCWPD2 ;ALB/ESW PTSD WKS TEXT - 2 ; 10 Oct 2000

 ;;2.7;AMIE;**34**;Apr 10, 1995

 ;

 ;

TXT ;

 ;;

 ;;F. Assessment of PTSD

 ;;

 ;;    * state whether or not the veteran meets the DSM-IV stressor criterion

 ;;    * identify behavioral, cognitive, social, affective, or somatic change

 ;;      veteran attributes to stress exposure

 ;;    * describe specific PTSD symptoms present (symptoms of trauma

 ;;      re-experiencing, avoidance/numbing, heightened physiological arousal,

 ;;      and associated features [e.g., disillusionment and demoralization])

 ;;    * specify onset, duration, typical frequency, and severity of symptoms

 ;;

 ;;G. Psychometric Testing Results

 ;;

 ;;   * provide psychological testing if deemed necessary.

 ;;   * provide specific evaluation information required by the rating board or

 ;;     on a BVA Remand.

 ;;   * comment on validity of psychological test results

 ;;   * provide scores for PTSD psychometric assessments administered

 ;;   * state whether PTSD psychometric measures are consistent or inconsistent

 ;;     with a diagnosis of PTSD, based on normative data and established

 ;;     "cutting scores" (cutting scores that are consistent with or supportive

 ;;     of a PTSD diagnosis are as follows: PCL - not less than 50;

 ;;     Mississippi Scale - not less than 107; MMPI PTSD subscale a score

 ;;     greater than 28; MMPI code type: 2-8 or 2-7-8)

 ;;   * state degree of severity of PTSD symptoms based on psychometric data

 ;;     (mild, moderate, or severe)

 ;;   * describe findings from psychological tests measuring other than

 ;;     PTSD (MMPI, etc.)

 ;;

 ;;H. Diagnosis:

 ;;

 ;;    1. The Diagnosis must conform to DSM-IV and be supported by the findings

 ;;       on the examination report.

 ;;    2. If there are multiple mental disorders, delineate to the extent possible

 ;;       the symptoms associated with each and a discussion of relationship.

 ;;    3. Evaluation is based on the effects of the signs and symptoms on

 ;;       occupational and social functioning.

 ;;

 ;;    NOTE: VA is prohibited by statute from paying compensation for a disability

 ;;    that is a result of the veteran's own ALCOHOL OR DRUG ABUSE, whether based

 ;;    on direct service connection, secondary service connection, or aggravation

 ;;    by a service-connected condition. Therefore, when alcohol or drug abuse

 ;;    accompanies or is associated with another mental disorder, separate,

 ;;    to the extent possible, the effects of the alcohol or drug abuse from

 ;;    the effects of the other mental disorder(s). If it is not possible

 ;;    to separate the effects, explain why.

 ;;

 ;;I. Diagnostic Status

 ;;

 ;;      Axis I disorders

 ;;      Axis II disorders

 ;;      Axis III disorders

 ;;      Axis IV (psychosocial and environmental problems)

 ;;      Axis V (GAF score - current)

 ;;

 ;;J. Global Assessment or Functioning (GAF):

 ;;

 ;;    NOTE: The complete multi-axial format as specified by DSM-IV may be required

 ;;    by BVA REMAND or specifically requested by the rating specialist. If so,

 ;;    include the GAF score and note whether it refers to current functioning.

 ;;    A BVA REMAND may also request, in addition to an overall GAF score,

 ;;    that a separate GAF score be provided for each mental disorder present when

 ;;    there are multiple Axis I or Axis II diagnoses and not all are service-

 ;;    connected. If separate GAF scores can be given, an explanation and

 ;;    discussion of the rationale is needed. If it is not possible, an explanation

 ;;    as to why not is needed. (See the above note pertaining to alcohol or drug

 ;;    abuse, the effects of which cannot be used to assess the effects of

 ;;    a service-connected condition.)

 ;;

 ;;    DSM-IV is only for application from 11/7/96 on. Therefore, when applicable

 ;;    note whether the diagnosis of PTSD was supportable under DSM-III-R prior

 ;;    to that date.

 ;;

 ;;K. Competency:

 ;;

 ;;   Competency, for benefits purposes, has a special meaning,

 ;;   and refers ONLY to veterans' ability to manage benefit payments in their own

 ;;   best interests without restriction, and not to any other subject. State

 ;;   whether the veteran is capable of managing his/her or her benefit payments

 ;;   in the individual's own best interests (a physical disability which prevents

 ;;   the veteran from attending to financial matters in person is not a proper

 ;;   basis for a finding of incompetency unless the veteran is, by reason of that

 ;;   disability, incapable of directing someone else in handling the individual's

 ;;   financial affairs).

 ;;

 ;;L. Other Opinion:

 ;;

 ;;   Furnish any other specific opinion requested by the rating

 ;;   board or BVA remand (furnish the complete rationale and citation of medical

 ;;   texts or treatise supporting opinion, if medical literature review was

 ;;   undertaken). If the requested opinion is medically not ascertainable

 ;;   on exam or testing please state WHY. If the requested opinion can not be

 ;;   expressed without resorting to speculation or making improbable assumptions

 ;;   say so, and explain why. If the opinion asks "... is it at least as likely

 ;;   as not..", fully explain the clinical findings and rationale for the opinion.

 ;;

 ;;M. Integrated Summary and Conclusions

 ;;

 ;;- Describe changes in PSYCHOSOCIAL FUNCTIONAL STATUS and QUALITY of LIFE

 ;;  following trauma exposure (performance in employment or schooling, routine

 ;;  responsibilities of self care, family role functioning, physical health,

 ;;  social/interpersonal relationships, recreation/leisure pursuits)

 ;;- Describe linkage between PTSD symptoms and aforementioned changes in

 ;;  impairment in functional status and quality of life. 

 ;;    Particularly in cases where a veteran is unemployed, specific details about

 ;;    the effects of PTSD and its symptoms on employment are especially 

 ;;    important.

 ;;- If possible, describe extent to which disorders other than PTSD

 ;;  (e.g., substance use disorders) are independently responsible for impairment

 ;;  in psychosocial adjustment and quality of life. If this is not possible,

 ;;  explain why (e.g., substance use had onset after PTSD and clearly is a means

 ;;  of coping with PTSD symptoms).

 ;;- If possible, describe pre-trauma risk factors or characteristics that may

 ;;  have rendered the veteran vulnerable to developing PTSD subsequent to trauma

 ;;  exposure.

 ;;- If possible, state prognosis for improvement of psychiatric condition

 ;;  and impairments in functional status.

 ;;- Comment on whether veteran should be rated as competent for VA purposes

 ;;  in terms of being capable of managing his/her benefit payments in his/her

 ;;  own best interest.

 ;;

 ;;

 ;;Signature:                              Date:

 ;;END