Cervical Spondylosis - Cervical Intervertebral Disc Prolapse
???????Medical Report - Cervical Intervertebral Disc ProlapseCervical SpondylosisThe information you provide on this form will assist in deciding eligibility for benefits under the Veterans' Entitlements Act 1986 and/or Military Rehabilitation and Compensation Act 2004. In the event of an appeal against a decision, this information may be provided to the Veterans' Review Board, Administrative Appeals Tribunal or Federal Court.Veteran's DetailsSurnameGiven NamesDVA File NumberReport DetailA claim for service related compensation in respect of the above named leads the Department to consider whether cervical intervertebral disc prolapse could be a factor in the development of cervical spondylosis in this case. Would you please provide the following information:1.When was the clinical onset of cervical spondylosis?………./………./……….2.Has the veteran had a cervical intervertebral disc prolapse at any time??No - Please sign the form and return it to the Department?Yes 3.What levels of the cervical spine (C1-C7) are affected by spondylosis?LevelSpondylosis presentDate of onsetDate of permanent worsening *(if applicable)C1////C2////C3////C4////C5////C6////C7////* Note: For the purposes of the Veterans’ Entitlements Act (1986), permanent worsening requires an increase in the gravity of the disease beyond its natural progression. It excludes temporary exacerbations or any deterioration which is part of the normal course of the disease.4.At what levels of the cervical spine has intervertebral disc prolapse occurred?Level of disc prolapseDate of disc prolapseCause of prolapse if known////////Details of Medical Practitioner providing advice:StampSignature// ................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- cervical spondylosis cervical intervertebral disc prolapse
- emergency medicine—the differential diagnosis of syncope
- a survey of cervical spondylosis in 490 athletes and
- trauma to the neck introduction to the rma
- 4 veterans affairs
- jones bartlett learning
- lake county physical therapy
- a clinical study on cervical spondylosis and its
- neck pain boston foot
- alina bishop mccarthy
Related searches
- cervical spondylosis treatment options
- cervical artificial disc replacement surgery
- icd 10 lumbar intervertebral disc displacement
- displacement cervical intervertebral disc icd 10
- cervical bulging disc treatment options
- cervical herniated disc icd 10
- cervical degenerative disc disease
- intervertebral disc degeneration cervical
- cervical herniated disc and headaches
- intervertebral disc disorders icd 10
- cervical degenerative disc disease icd 10
- cervical degenerative disc disease surgery