Subjective/History Elements
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ankle

Describe the history (including onset and course) of the veteran's ankle condition (brief summary):
[frontload soapnote="subjective/drgfms-va-dbq-hpi"]

Does the veteran report pain of the ankle being evaluated on this dbq?
[select value="|no|yes"]
[comment memo="if yes, document the veteran's description of pain in his or her own words"]
[textarea rows=2 cols=45]



2c. Does the veteran report that flare-ups impact the function of the ankle?

right ankle [select value="|no|yes"]
[comment memo="if yes, document the veteran's description of the flare-ups in his or her own words:"]
[textarea rows=2 cols=45]

How often do flare-ups occur?
[textarea rows=2 cols=45]

How severe are the flare-ups (mild, moderate, severe)?
[textarea rows=2 cols=45]

How long do the flare-ups last?
[textarea rows=2 cols=45]

Describe what events cause flare-ups to occur (precipitating):
[textarea rows=2 cols=45]

Describe what helps make the flare-ups better (alleviate):
[textarea rows=2 cols=45]


Left ankle [select value="|no|yes"]
[comment memo="if yes, document the veteran's description of the flare-ups in his or her own words:"]
[textarea rows=2 cols=45]

How often do flare-ups occur?
[textarea rows=2 cols=45]


How severe are the flare-ups (mild, moderate, severe)?
[textarea rows=2 cols=45]


How long do the flare-ups last?
[textarea rows=2 cols=45]


Describe what events cause flare-ups to occur (precipitating):
[textarea rows=2 cols=45]


Describe what helps make the flare-ups better (alleviate):
[textarea rows=2 cols=45]



does the veteran report having any functional loss or functional impairment of the ankle being evaluated on this dbq (regardless of repetitive use)?
[select value="|no|yes"]
[comment memo="if yes, document the veteran's description of functional loss or functional impairment in his or her own words:"]
[textarea rows=2 cols=45]


Does the veteran now have or has he or she ever had "shin splints", stress fractures, achilles tendonitis, achilles tendon rupture, malunion of calcaneus (os calcis) or talus (astragalus), or has the veteran had a talectomy (astragalectomy)? [select value="|no|yes"]
[comment memo="if yes, document the veteran's description:"]
[textarea rows=2 cols=45]

Has the veteran had ankle surgery (arthroscopic or open)?
Indicate any surgical procedures that the veteran has had performed. [select value="|no|yes"]
[comment memo="if yes, describe date, side (left or right), facility, procedure:"] [textarea cols=45 rows=2]



does the veteran have any scars (surgical or otherwise) related to any conditions in the diagnosis section above? [select value="|no|yes"]

Is there pain, weakness, fatigability, or incoordination that significantly limits functional ability during flare-ups or when the ankle is used repeatedly over a period of time?
Right ankle [select value="|no|yes"]
left ankle [select value="|no|yes"]

Is there any other functional loss during flare-ups or when the ankle is used repeatedly over a period of time? [select value="|no|yes"]

Have imaging studies of the ankle been performed and are the results available? [select value="|no|yes"]
[comment memo="if yes, describe including date, study type, facility, results:"] [textarea cols=45 rows=2]

Regardless of the veteran's current employment status, do the condition(s) listed in the diagnosis section impact his or her ability to perform any type of occupational task (such as standing, walking, lifting, sitting, etc.)?
[frontload soapnote="subjective/va-dbq-work-impact"]

=====================================================================================
ankle

Describe the history (including onset and course) of the veteran's ankle condition (brief summary):


Does the veteran report pain of the ankle being evaluated on this dbq?

if yes, document the veteran's description of pain in his or her own words




2c. Does the veteran report that flare-ups impact the function of the ankle?

right ankle
if yes, document the veteran's description of the flare-ups in his or her own words:


How often do flare-ups occur?


How severe are the flare-ups (mild, moderate, severe)?


How long do the flare-ups last?


Describe what events cause flare-ups to occur (precipitating):


Describe what helps make the flare-ups better (alleviate):



Left ankle
if yes, document the veteran's description of the flare-ups in his or her own words:


How often do flare-ups occur?



How severe are the flare-ups (mild, moderate, severe)?



How long do the flare-ups last?



Describe what events cause flare-ups to occur (precipitating):



Describe what helps make the flare-ups better (alleviate):




does the veteran report having any functional loss or functional impairment of the ankle being evaluated on this dbq (regardless of repetitive use)?

if yes, document the veteran's description of functional loss or functional impairment in his or her own words:



Does the veteran now have or has he or she ever had "shin splints", stress fractures, achilles tendonitis, achilles tendon rupture, malunion of calcaneus (os calcis) or talus (astragalus), or has the veteran had a talectomy (astragalectomy)?
if yes, document the veteran's description:


Has the veteran had ankle surgery (arthroscopic or open)?
Indicate any surgical procedures that the veteran has had performed.
if yes, describe date, side (left or right), facility, procedure:



does the veteran have any scars (surgical or otherwise) related to any conditions in the diagnosis section above?

Is there pain, weakness, fatigability, or incoordination that significantly limits functional ability during flare-ups or when the ankle is used repeatedly over a period of time?
Right ankle
left ankle

Is there any other functional loss during flare-ups or when the ankle is used repeatedly over a period of time?

Have imaging studies of the ankle been performed and are the results available?
if yes, describe including date, study type, facility, results:

Regardless of the veteran's current employment status, do the condition(s) listed in the diagnosis section impact his or her ability to perform any type of occupational task (such as standing, walking, lifting, sitting, etc.)?
Functional Impact

Does the veteran's claimed condition impact his or her ability to work?

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