- DVBCWPD5 ;BP-CIOFO/MM - PTSD WORKSHEET TEXT ;3/27/2002
- ;;2.7;AMIE;**43**;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, 38 U.S.C. 1110, from paying compensation
- ;;for a disability that is a result of the veteran's own ALCOHOL OR DRUG ABUSE.
- ;;However, when a veteran's alcohol or drug abuse disability is secondary to
- ;;or is caused or aggravated by a primary service-connected disorder, the
- ;;veteran may be entitled to compensation. See Allen v. Principi, 237 F.3d
- ;;1368, 1381 (Fed. Cir. 2001). Therefore, it is important to determine the
- ;;relationship, if any, between a service-connected disorder and a disability
- ;;resulting from the veteran's alcohol or drug abuse. Unless alcohol or drug
- ;;abuse is secondary to or is caused or aggravated by another mental disorder,
- ;;you should 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 in such cases, please 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 of 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.)
- ;;
- ;;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
- --- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWPD5 7060 printed Feb 18, 2025@23:19:37 Page 2
- DVBCWPD5 ;BP-CIOFO/MM - PTSD WORKSHEET TEXT ;3/27/2002
- +1 ;;2.7;AMIE;**43**;Apr 10, 1995
- +2 ;
- +3 ;
- TXT ;
- +1 ;;
- +2 ;;F. Assessment of PTSD
- +3 ;;
- +4 ;; * state whether or not the veteran meets the DSM-IV stressor criterion
- +5 ;; * identify behavioral, cognitive, social, affective, or somatic change
- +6 ;; veteran attributes to stress exposure
- +7 ;; * describe specific PTSD symptoms present (symptoms of trauma
- +8 ;; re-experiencing, avoidance/numbing, heightened physiological arousal,
- +9 ;; and associated features [e.g., disillusionment and demoralization])
- +10 ;; * specify onset, duration, typical frequency, and severity of symptoms
- +11 ;;
- +12 ;;G. Psychometric Testing Results
- +13 ;;
- +14 ;; * provide psychological testing if deemed necessary.
- +15 ;; * provide specific evaluation information required by the rating board or
- +16 ;; on a BVA Remand.
- +17 ;; * comment on validity of psychological test results
- +18 ;; * provide scores for PTSD psychometric assessments administered
- +19 ;; * state whether PTSD psychometric measures are consistent or inconsistent
- +20 ;; with a diagnosis of PTSD, based on normative data and established
- +21 ;; "cutting scores" (cutting scores that are consistent with or supportive
- +22 ;; of a PTSD diagnosis are as follows: PCL - not less than 50;
- +23 ;; Mississippi Scale - not less than 107; MMPI PTSD subscale a score
- +24 ;; greater than 28; MMPI code type: 2-8 or 2-7-8)
- +25 ;; * state degree of severity of PTSD symptoms based on psychometric data
- +26 ;; (mild, moderate, or severe)
- +27 ;; * describe findings from psychological tests measuring other than
- +28 ;; PTSD (MMPI, etc.)
- +29 ;;
- +30 ;;H. Diagnosis:
- +31 ;;
- +32 ;; 1. The Diagnosis must conform to DSM-IV and be supported by the findings
- +33 ;; on the examination report.
- +34 ;; 2. If there are multiple mental disorders, delineate to the extent possible
- +35 ;; the symptoms associated with each and a discussion of relationship.
- +36 ;; 3. Evaluation is based on the effects of the signs and symptoms on
- +37 ;; occupational and social functioning.
- +38 ;;
- +39 ;;NOTE: VA is prohibited by statute, 38 U.S.C. 1110, from paying compensation
- +40 ;;for a disability that is a result of the veteran's own ALCOHOL OR DRUG ABUSE.
- +41 ;;However, when a veteran's alcohol or drug abuse disability is secondary to
- +42 ;;or is caused or aggravated by a primary service-connected disorder, the
- +43 ;;veteran may be entitled to compensation. See Allen v. Principi, 237 F.3d
- +44 ;;1368, 1381 (Fed. Cir. 2001). Therefore, it is important to determine the
- +45 ;;relationship, if any, between a service-connected disorder and a disability
- +46 ;;resulting from the veteran's alcohol or drug abuse. Unless alcohol or drug
- +47 ;;abuse is secondary to or is caused or aggravated by another mental disorder,
- +48 ;;you should separate, to the extent possible, the effects of the alcohol or
- +49 ;;drug abuse from the effects of the other mental disorder(s). If it is not
- +50 ;;possible to separate the effects in such cases, please explain why.
- +51 ;;
- +52 ;;I. Diagnostic Status
- +53 ;;
- +54 ;; Axis I disorders
- +55 ;; Axis II disorders
- +56 ;; Axis III disorders
- +57 ;; Axis IV (psychosocial and environmental problems)
- +58 ;; Axis V (GAF score - current)
- +59 ;;
- +60 ;;J. Global Assessment of Functioning (GAF):
- +61 ;;
- +62 ;; NOTE: The complete multi-axial format as specified by DSM-IV may be required
- +63 ;; by BVA REMAND or specifically requested by the rating specialist. If so,
- +64 ;; include the GAF score and note whether it refers to current functioning.
- +65 ;; A BVA REMAND may also request, in addition to an overall GAF score,
- +66 ;; that a separate GAF score be provided for each mental disorder present when
- +67 ;; there are multiple Axis I or Axis II diagnoses and not all are service-
- +68 ;; connected. If separate GAF scores can be given, an explanation and
- +69 ;; discussion of the rationale is needed. If it is not possible, an explanation
- +70 ;; as to why not is needed. (See the above note pertaining to alcohol or drug
- +71 ;; abuse.)
- +72 ;;
- +73 ;;K. Competency:
- +74 ;;
- +75 ;; Competency, for benefits purposes, has a special meaning,
- +76 ;; and refers ONLY to veterans' ability to manage benefit payments in their own
- +77 ;; best interests without restriction, and not to any other subject. State
- +78 ;; whether the veteran is capable of managing his/her or her benefit payments
- +79 ;; in the individual's own best interests (a physical disability which prevents
- +80 ;; the veteran from attending to financial matters in person is not a proper
- +81 ;; basis for a finding of incompetency unless the veteran is, by reason of that
- +82 ;; disability, incapable of directing someone else in handling the individual's
- +83 ;; financial affairs).
- +84 ;;
- +85 ;;L. Other Opinion:
- +86 ;;
- +87 ;; Furnish any other specific opinion requested by the rating
- +88 ;; board or BVA remand (furnish the complete rationale and citation of medical
- +89 ;; texts or treatise supporting opinion, if medical literature review was
- +90 ;; undertaken). If the requested opinion is medically not ascertainable
- +91 ;; on exam or testing please state WHY. If the requested opinion can not be
- +92 ;; expressed without resorting to speculation or making improbable assumptions
- +93 ;; say so, and explain why. If the opinion asks "... is it at least as likely
- +94 ;; as not..", fully explain the clinical findings and rationale for the opinion.
- +95 ;;
- +96 ;;M. Integrated Summary and Conclusions
- +97 ;;
- +98 ;; - Describe changes in PSYCHOSOCIAL FUNCTIONAL STATUS and QUALITY of LIFE
- +99 ;; following trauma exposure (performance in employment or schooling,
- +100 ;; routine responsibilities of self care, family role functioning, physical
- +101 ;; health, social/interpersonal relationships, recreation/leisure pursuits)
- +102 ;; - Describe linkage between PTSD symptoms and aforementioned changes in
- +103 ;; impairment in functional status and quality of life.
- +104 ;; Particularly in cases where a veteran is unemployed, specific
- +105 ;; details about the effects of PTSD and its symptoms on employment
- +106 ;; are especially important.
- +107 ;; - If possible, describe extent to which disorders other than PTSD
- +108 ;; (e.g., substance use disorders) are independently responsible for
- +109 ;; impairment in psychosocial adjustment and quality of life. If this is
- +110 ;; not possible, explain why (e.g., substance use had onset after PTSD
- +111 ;; and clearly is a means of coping with PTSD symptoms).
- +112 ;; - If possible, describe pre-trauma risk factors or characteristics that
- +113 ;; may have rendered the veteran vulnerable to developing PTSD subsequent
- +114 ;; to trauma exposure.
- +115 ;; - If possible, state prognosis for improvement of psychiatric condition
- +116 ;; and impairments in functional status.
- +117 ;; - Comment on whether veteran should be rated as competent for VA purposes
- +118 ;; in terms of being capable of managing his/her benefit payments in
- +119 ;; his/her own best interest.
- +120 ;;
- +121 ;;
- +122 ;;Signature: Date:
- +123 ;;END