SUBJECT: Revised Disability Examination Worksheets

Does anyone have link to the actual recent VA directive or fast letter on AO & hypertension

I just saw this.. from April 2007








DEPARTMENT OF VETERANS AFFAIRS

Veterans Benefits Administration

Washington, D.C. 20420






April 24, 2007 In Reply Refer To: 211D

Fast Letter 07-10



Director (00/21)

All VA Regional Offices and Centers



SUBJECT: Revised Disability Examination Worksheets



Revised disability examination worksheets for Audio; Ear Disease; Hand, Thumb and Fingers; Feet; Mental Disorders; Eating Disorders; Esophagus and Hiatal Hernia; Intestines; and Stomach, Duodenum, and Peritoneal Adhesions have been released nationally to VA Medical Centers for C&P examiner use.


These worksheets are changed in the following significant ways:


Audio and Ear Disease

· The Audio examination worksheet no longer requires frequency and duration for tinnitus. The examiner only needs to state whether tinnitus is persistent or recurrent.

· On the Audio examination worksheet, the request for an opinion about the etiology of tinnitus has been removed. If an opinion about etiology is required for a specific veteran, the regional office must request it.

· On the Ear Disease examination worksheet, questions have been added about history of hospitalizations, surgery, noise exposure and ear trauma.

· On both examination worksheets, examiners are asked to describe effects on occupational functioning and daily activities.



Hand, Thumb and Fingers

· Under history, questions about hospitalizations, surgery, trauma and neoplasm have been added.

· Examiners are asked to describe current symptoms and effects on occupational functioning and daily activities.

· On physical examination, the requirement for passive range of motion has been removed.



Feet

· Under history, questions about neoplasm have been added.

· On physical examination, all requirements for range of motion of the toes; active, passive and after repetition have been removed.

· On physical examination, assessment of posture in various positions has been removed.



Mental Disorders and Eating Disorders

· The credentials of examiners who VBA and VHA recently agreed can perform these types of examinations are listed.

· On a Mental Disorders examination, the examiner is expected to select the appropriate assessment of the veteran from the list provided and support the assessment with examples.



Esophagus and Hiatal Hernia

· Under history, questions about hospitalizations, surgery, trauma and neoplasm have been added as well as the effects of the condition on occupational functioning and daily activities.

· Under diagnostic tests, if there is a history of bleeding (past 12 months) or signs of anemia, a hemoglobin/hematocrit is required.



Intestines

· Under history, questions about hospitalizations, surgery, trauma and neoplasm have been added as well as effects of the condition on occupational functioning and daily activities.

· Under history, for ulcerative colitis, the number of attacks per year has been added as a requirement.

· Under diagnostic tests, if there are signs of anemia, a hemoglobin/ hematocrit is required.



Scars

· Under history, the treatment used and response to treatment has been removed.



Stomach, Duodenum, and Peritoneal Adhesions

· Under history, questions about hospitalizations, surgery, trauma and neoplasm have been added as well as effects of the condition on occupational functioning and daily activities.

· Under diagnostic tests, if there is a recent history (past 12 months) of hematemesis, melena or signs of anemia, a hemoglobin/hematocrit is required.



The following worksheets will be released in approximately 8 weeks: Bones; Chronic Fatigue Syndrome; Cranial Nerves; Cushing’s Syndrome; Eye; Fibromyalgia; HIV-Related Illness; Liver, Gall Bladder, and Pancreas; Lymphatic Disorders; Nose, Sinus, Larynx, and Pharynx; and Rectum and Anus.


These worksheets have been changed in the following significant ways:


Bones

· Under history, questions about hospitalizations, surgery and neoplasm have been added.

· If a joint is involved, the examiner is referred to the Joint worksheet.



Chronic Fatigue Syndrome

· Under history, a question about hospitalizations has been added.

· Under history, questions about debilitating fatigue, incapacitating episodes and cognitive impairment have been added.

· A cursory physical examination has been added.



Cranial Nerves

· Under history, the question about flare-ups has been deleted.

· Under history, the examiner is asked to comment on onset, course since onset and current symptoms.

· Under history, questions about hospitalization, surgery, neoplasm and trauma have been added.

· Under history, a question about effects on occupational functioning and daily activities has been added.



Cushing’s syndrome

· Under history, questions about hospitalizations, surgery, and neoplasm have been added.

· Under history, a question about effects on occupational functioning and daily activities has been added.

· Diagnostic and Clinical tests are only to be performed if not of record or to confirm a diagnosis.



Eye

· Under history, questions about hospitalizations, surgery, and trauma have been added.

· Under history, a specific question for congestive or inflammatory glaucoma has been added.

· Under physical examination, a specific question about the ability to wear a prosthesis after enucleation has been added.



Fibromyalgia

· Under history, a question about hospitalizations has been added.





HIV-Related Illness

· Under history, questions about hospitalizations, surgery and neoplasm have been added.



Liver, Gall Bladder, and Pancreas

· Under history, a question about effects on occupational functioning and daily activities has been added.



Lymphatic Disorders

· Under history, a question about hospitalizations and surgery has been added.

· Under history, a question about effects on occupational functioning and daily activities has been added.

· A focused physical examination has been added.



Nose, Sinus, Larynx, and Pharynx

· Under history, for chronic sinusitis, a question about incapacitating and non-incapacitating episodes per year has been added.

· Under history, a question about effects on occupational functioning and daily activities has been added.

· Under history, questions about neoplasm have been added.

· Under physical examination, the examination for larynx and pharynx has been added.



Rectum and Anus

· Under history, questions about hospitalizations, surgery, trauma, and neoplasm have been added.

· Under history, a question about effects on occupational functioning and daily activities has been added.

· Under Diagnostic and Clinical tests, the examiner is asked to obtain a CBC if there is a history of bleeding, signs of anemia or chronic infection.



If you have any questions about this letter, please contact Vicki Milton, M.D., at (202) 273-9646 or by e-mail.






/S/

Bradley G. Mayes

Director

Compensation & Pension Service

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