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Routine: DVBCWPD7

DVBCWPD7.m

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  1. DVBCWPD7 ;BPOIFO/ESW - PTSD WORKSHEET TEXT ; 10/1/02 5:46pm
  1.  ;;2.7;AMIE;**46**;Apr 10, 1995
  1.  ;Per VHA Directive 10-92-142, this routine should not be modified
  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, 38 U.S.C. 1110, from paying compensation
  1.  ;;for a disability that is a result of the veteran's own ALCOHOL OR DRUG ABUSE.
  1.  ;;However, when a veteran's alcohol or drug abuse disability is secondary to
  1.  ;;or is caused or aggravated by a primary service-connected disorder, the  
  1.  ;;veteran may be entitled to compensation.  See Allen v. Principi, 237 F.3d
  1.  ;;1368, 1381 (Fed. Cir. 2001).  Therefore, it is important to determine the
  1.  ;;relationship, if any, between a service-connected disorder and a disability
  1.  ;;resulting from the veteran's alcohol or drug abuse.  Unless alcohol or drug
  1.  ;;abuse is secondary to or is caused or aggravated by another mental disorder,
  1.  ;;you should separate, to the extent possible, the effects of the alcohol or
  1.  ;;drug abuse from the effects of the other mental disorder(s).  If it is not
  1.  ;;possible to separate the effects in such cases, please 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 of 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.)
  1.  ;;
  1.  ;;K. CAPACITY TO MANAGE FINANCIAL AFFAIRS
  1.  ;;
  1.  ;;       Mental competency, for VA benefits purposes, refers only to the ability
  1.  ;;       of the veteran to manage VA benefit payments in his or her own best
  1.  ;;       interest, and not to any other subject. Mental incompetency,
  1.  ;;       for VA benefits purposes, means that the veteran, because of injury
  1.  ;;       or disease, is not capable of managing benefit payments in his or her
  1.  ;;       best interest. In order to assist raters in making a legal determination
  1.  ;;       as to competency, please address the following:
  1.  ;;             What is the impact of injury or disease on the veteran's ability
  1.  ;;             to manage his or her financial affairs, including consideration
  1.  ;;             of such things as knowing the amount of his or her VA benefit
  1.  ;;             payment, knowing the amounts and types of bills owed monthly,
  1.  ;;             and handling the payment prudently? Does the veteran handle
  1.  ;;             the money and pay the bills himself or herself?
  1.  ;;
  1.  ;;             Based on your examination, do you believe that the veteran is
  1.  ;;             capable of managing his or her financial affairs?
  1.  ;;             Please provide examples to support your conclusion.
  1.  ;;
  1.  ;;             If you believe a Social Work Service assessment is needed  before
  1.  ;;             you can give your opinion on the veteran's ability to manage his
  1.  ;;             or her financial affairs, please explain why.
  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,
  1.  ;;     routine responsibilities of self care, family role functioning, physical
  1.  ;;     health, 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 
  1.  ;;       details about the effects of PTSD and its symptoms on employment
  1.  ;;       are especially important.
  1.  ;;   - If possible, describe extent to which disorders other than PTSD
  1.  ;;     (e.g., substance use disorders) are independently responsible for
  1.  ;;     impairment in psychosocial adjustment and quality of life. If this is
  1.  ;;     not possible, explain why (e.g., substance use had onset after PTSD 
  1.  ;;     and clearly is a means of coping with PTSD symptoms).
  1.  ;;   - If possible, describe pre-trauma risk factors or characteristics that
  1.  ;;     may have rendered the veteran vulnerable to developing PTSD subsequent
  1.  ;;     to trauma 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
  1.  ;;     his/her own best interest.
  1.  ;;
  1.  ;;
  1.  ;;Signature:                              Date:
  1.  ;;END