Disability Examination Worksheets
Mouth, Lips, and Tongue
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A. Review of Medical Records:
B.
Medical History (Subjective Complaints): C. Physical Examination
(Objective Findings):
Address each of the following and fully describe current
findings:
- Disfigurement - if present, order color photographs.
- Interference with mastication.
- Interference with speech - state extent.
- Absence of all or part of tongue - describe.
D. Diagnostic and Clinical Tests:
1. Include results of all diagnostic and clinical tests
conducted in the examination report. E. Diagnosis:
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![it says not signed](https://webarchive.library.unt.edu/eot2008/20080917164541im_/http://www.vba.va.gov/bln/21/Images/compnsig.gif) |
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![it says not dated](https://webarchive.library.unt.edu/eot2008/20080917164541im_/http://www.vba.va.gov/bln/21/Images/compndat.gif) |
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Reviewed/Updated Date:
April 30, 2007
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