Fast Letter 10-36
Revised Fibromyalgia; Genitourinary; Gynecological Conditions and Disorders of the Breast; Hand, Thumb, and Fingers; and Brain and Spinal Cord Examination Worksheets

DEPARTMENT OF VETERANS AFFAIRS

Veterans Benefits Administration
Washington, D.C.  20420
September 8, 2010 In Reply Refer To:  211

Director (00/21)                              Fast Letter 10-36

All VA Regional Offices and Centers

SUBJ:  Revised Fibromyalgia; Genitourinary; Gynecological Conditions and Disorders of the Breast; Hand, Thumb, and Fingers; and Brain and Spinal Cord Examination Worksheets

The contents of the Fibromyalgia; Genitourinary; Gynecological Conditions and Disorders of the Breast; and Hand, Thumb, and Fingers examination worksheets were revised to conform to their current corresponding computerized examination templates, previously approved by the Compensation and Pension Service.  The changes also include minor updating and editing.  In addition, the Brain and Spinal Cord examination worksheet was minimally revised to clarify an instruction about following the Traumatic Brain Injury worksheet.

A.  For Fibromyalgia, the changes to the worksheet include:

1.   Under History:

a.  The whole history area was rewritten and reorganized.

b.  Listed the major symptoms of unexplained fatigue, sleep disturbances, headaches, paresthesias, diarrhea, constipation, alternating constipation and diarrhea, abdominal cramps or bloating, depression, anxiety, Raynauds-like symptoms, musculoskeletal symptoms in a single item.
c.  Added specific questions about musculoskeletal symptoms in a separate item:  type, location, and whether pain, if present, is widespread, as defined in the narrative introduction.
d.  Added question about whether symptoms are constant or episodic and whether, if episodic, are present more than one-third of the time.

e.  Asked if continuous medication is required for control and if symptoms are refractory to therapy.

f.   Moved item about effects on occupation and daily activities to Diagnosis section.

2.  Under Physical Examination:

a.  Added vital signs.

b.  Provided the list of tender points identified by the American College of Rheumatology and added a direction to indicate all tender points found.

c.  Deleted item about muscle strength in involved areas.

3.  Under Diagnostic and Clinical Tests:

a.  Added item: as appropriate, to rule out other conditions.

4.  Under Diagnosis:

a.  Added item:  Diagnosis and date of diagnosis, if known.

b.  Added item:  State amount of time lost from work during past 12-month period due to fibromyalgia.

c.  Added item:  Describe the effects of the condition on usual occupation and daily activities.


B.  For Genitourinary,
(The rest of this fast letter was removed as it is not for gulf war illness.)