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Routine: DVBCWPD7

DVBCWPD7.m

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DVBCWPD7 ;BPOIFO/ESW - PTSD WORKSHEET TEXT ; 10/1/02 5:46pm

 ;;2.7;AMIE;**46**;Apr 10, 1995

 ;Per VHA Directive 10-92-142, this routine should not be modified

 ;

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. CAPACITY TO MANAGE FINANCIAL AFFAIRS

 ;;

 ;;       Mental competency, for VA benefits purposes, refers only to the ability

 ;;       of the veteran to manage VA benefit payments in his or her own best

 ;;       interest, and not to any other subject. Mental incompetency,

 ;;       for VA benefits purposes, means that the veteran, because of injury

 ;;       or disease, is not capable of managing benefit payments in his or her

 ;;       best interest. In order to assist raters in making a legal determination

 ;;       as to competency, please address the following:

 ;;             What is the impact of injury or disease on the veteran's ability

 ;;             to manage his or her financial affairs, including consideration

 ;;             of such things as knowing the amount of his or her VA benefit

 ;;             payment, knowing the amounts and types of bills owed monthly,

 ;;             and handling the payment prudently? Does the veteran handle

 ;;             the money and pay the bills himself or herself?

 ;;

 ;;             Based on your examination, do you believe that the veteran is

 ;;             capable of managing his or her financial affairs?

 ;;             Please provide examples to support your conclusion.

 ;;

 ;;             If you believe a Social Work Service assessment is needed  before

 ;;             you can give your opinion on the veteran's ability to manage his

 ;;             or her financial affairs, please explain why.

 ;;

 ;;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