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Routine: DVBCWPT2

DVBCWPT2.m

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DVBCWPT2 ;ALB/CMM PTSD WKS TEXT - 2 ; 6 MARCH 1997

 ;;2.7;AMIE;**12**;Apr 10, 1995

 ;

 ;

TXT ;

 ;;TOF

 ;;E.  Diagnosis:

 ;;

 ;;    Provide:

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

 ;;    findings on the examination report.

 ;;    2.  If the diagnosis is changed, explain fully whether the new

 ;;    diagnosis represents a progression of the prior diagnosis or

 ;;    development of a new and separate condition.

 ;;    3.  If there are multiple mental disorders, delineate, to the

 ;;    extent possible, the symptoms associated with each and a 

 ;;    discussion of relationship.

 ;;    4.  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.

 ;;

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

 ;;

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

 ;;    be required for REMAND or specifically requested by the rating 

 ;;    specialist.  If so, include the GAF, whether it refers to current

 ;;    functioning over the past year, etc.

 ;;

 ;;    If multiple Axis I or Axis II diagnoses exist, attempt to the

 ;;    extent possible, to provide a GAF score on service connected 

 ;;    conditions alone as well as a separate GAF score based on all

 ;;    mental disorders present and explain and discuss your rationale. 

 ;;    (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).  If unable to separate 

 ;;    symptomatology, explain why. 

 ;;

 ;;    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.  The prior criteria under DSM-III-R

 ;;    are provided as an attachment.

 ;;

 ;;Signature:                                   Date:

 ;;

 ;;TOF

 ;;Attachment A

 ;;

 ;;Historical DSM-III-R Diagnostic criteria for PTSD

 ;;

 ;;A.  The veteran has experienced an event that is outside the range of 

 ;;    usual human experience and that would be markedly distressing to 

 ;;    almost anyone (e.g., serious threat to one's life or physical 

 ;;    integrity; serious threat to one's children, spouse, or other 

 ;;    close relatives and friends; sudden destruction of one's home or 

 ;;    community; seeing another person who has recently been seriously 

 ;;    injured or killed as the result of an accident or physical violence).

 ;;

 ;;B.  The traumatic event is persistently re-experienced in at least one

 ;;    of the following ways:

 ;;

 ;;    1. Recurrent and intrusive distressing recollections of the event.

 ;;    2. Recurrent distressing dreams of the event.

 ;;    3. Sudden acting or feeling as if the traumatic event were recurring 

 ;;       (includes a sense of reliving the experience, illusions, 

 ;;       hallucinations and dissociative [flashback] episodes, even 

 ;;       those that occur upon waking or when intoxicated).

 ;;    4. Intense psychological distress at exposure to events that 

 ;;       symbolize or resemble an aspect of the traumatic event, including

 ;;       anniversaries of the trauma.  

 ;;

 ;;C.  Persistent avoidance of stimuli associated with the trauma or 

 ;;    numbing of general responsiveness (not present before the trauma),

 ;;    as indicated by at least three of the following:

 ;;

 ;;    1. Efforts to avoid thoughts or feelings associated with the trauma.

 ;;    2. Efforts to avoid activities or situations that arouse 

 ;;       recollections of the trauma.

 ;;    3. Inability to recall an important aspect of the trauma 

 ;;       (psychogenic amnesia).

 ;;    4. Markedly diminished interest in significant activities.

 ;;    5. Feeling of detachment or estrangement from others.

 ;;    6. Restricted range of affect, e.g., unable to have love feelings.

 ;;    7. Sense of foreshortened future, e.g., does not expect to have a

 ;;       career, marriage, children, or a long life.

 ;;

 ;;TOF

 ;;D.  Persistent symptoms of increased arousal (not present before the 

 ;;    trauma), as indicated by at least two of the following:

 ;;

 ;;    1. Difficulty falling or staying asleep.

 ;;    2. Irritability or outbursts of anger.

 ;;    3. Difficulty concentrating.

 ;;    4. Hyper vigilance.

 ;;    5. Exaggerated startle response.

 ;;    6. Physiologic reactivity upon exposure to events that symbolize or 

 ;;       resemble an aspect of the traumatic event (e.g., a woman who was 

 ;;       raped in an elevator breaks out in a sweat when entering any 

 ;;       elevator).

 ;;END