Eating Disorders (Mental Disorders)

Name:	SSN:
Date of Exam:	C-number:
Place of Exam:

The following health care providers can perform initial examinations for Eating Disorders:
a board-certified or board "eligible" psychiatrist;
a licensed doctorate-level psychologist;
a doctorate-level mental health provider under the close supervision of a board-certified or board eligible psychiatrist or licensed doctorate-level psychologist;
a psychiatry resident under close supervision of a board-certified or board eligible psychiatrist or licensed doctorate-level psychologist;
or a clinical or counseling psychologist completing a one-year internship or residency (for purposes of a doctorate-level degree) under close supervision of a board-certified or board eligible psychiatrist or licensed doctorate-level psychologist.

The following health care providers can perform review examinations for Eating Disorders:
a board-certified or board "eligible" psychiatrist;
a licensed doctorate-level psychologist;
a doctorate-level mental health provider under close supervision of a board-certified or board eligible psychiatrist or licensed doctorate-level psychologist;
a psychiatry resident under close supervision of a board-certified or board eligible psychiatrist or licensed doctorate-level psychologist;
a clinical or counseling psychologist completing a one year internship or residency (for purposes of a doctorate-level degree) under close supervision of a board-certified or board eligible psychiatrist or licensed doctorate-level psychologist;
a licensed clinical social worker (LCSW); or
a nurse practitioner (NP), a clinical nurse specialist or physician assistant, if they are clinically privileged to perform activities required for C&P mental disorder examinations, under close supervision of a board-certified or board eligible psychiatrist or licensed doctorate-level psychologist.

A. Review of Medical Records:

B. Medical History (Subjective Complaints):

Comment on:

1. Past Medical History:

1. Medical and occupational history from the time between the last such rating examination and the present needs to be accounted for, UNLESS the purpose of this examination is to ESTABLISH service connection, then a complete medical and occupational history since discharge from military service is required.
2. History of onset of eating disorder, course, and treatment.
3. Previous hospitalizations for parenteral nutrition or tube feeding.
4. Periods of incapacitation (during which bedrest and treatment by a physician are required due to the eating disorder). Describe the frequency and duration.

2. Present Medical, Occupational and Social History - over the past one year.

1. Current status of eating disorder.
2. Current treatment, response, side effects.
3. Extent of time lost from work over the past 12 month period. If employed, identify current occupation and length of time at this job.
4. Describe any social impairment over the past 12 month period.

3. Subjective Complaints:

1. Describe fully any current symptoms.
2. Additionally, to allow evaluation by the rating specialist, describe and fully explain the existence, frequency, and extent of the following signs and symptoms and relate how they interfere with employment:

• Binge eating followed by self-induced vomiting or other measures to prevent weight gain.
• Measures taken to resist weight gain when weight is already below expected minimum normal weight.

C. Examination (Objective Findings):

Address each of the following and fully describe:

1. Mental status exam to confirm or establish diagnosis in accordance with DSM-IV.
2. Additionally, please provide this specific information:

1. Current weight.
2. Expected minimum weight based on age, height, and body build.
3. Obtain weight history.

D. Diagnostic Tests (including psychological testing if deemed necessary):

1. Provide specific evaluation information required by the rating board or on a BVA Remand. Diagnostic Tests (See the examination request remarks for specifics.):

1. CAPACITY TO MANAGE FINANCIAL AFFAIRS Mental competency, for VA benefits purposes, refers only to the ability of the veteran to manage VA benefit payments in his or her own best interest, and not to any other subject. Mental incompetency, for VA benefits purposes, means that the veteran, because of injury or disease, is not capable of managing benefit payments in his or her best interest. In order to assist raters in making a legal determination as to competency, please address the following:
   • What is the impact of injury or disease on the veteran's ability to manage his or her financial affairs, including consideration of such things as knowing the amount of his or her VA benefit payment, knowing the amounts and types of bills owed monthly, and handling the payment prudently? Does the veteran handle the money and pay the bills?
   • Based on your examination, do you believe that the veteran is capable of managing his or her financial affairs? Please provide examples to support your conclusion.
   • If you believe a Social Work Service assessment is needed before you can give your opinion on the veteran's ability to manage his or her financial affairs, please explain why.
2. Other Opinion: Furnish any other specific opinion requested by the rating board or BVA Remand furnishing the complete rationale and citation of medical texts or treatise supporting opinion, if medical literature review was undertaken. If the requested opinion is medically not ascertainable on exam or testing please state why. If the requested opinion cannot be expressed without resorting to speculation or making improbable assumptions say so, and explain why. If the opinion asks "...is it at least as likely as not...", fully explain the clinical findings and rationale for the opinion.

2. Include results of all diagnostic and clinical tests conducted in the examination report.

E. Diagnosis:

Include your name; your credentials, (i.e., a board certified psychiatrist, a licensed psychologist, a psychiatry resident or a psychology intern, LCSW, or NP); and circumstances under which you performed the examination, if applicable (i.e., under the close supervision of an attending psychiatrist or psychologist); include name of supervising psychiatrist or psychologist.