Neurological Disorders, Miscellaneous
(Migraine, Tic, Paramyoclonus Multiplex, Sydenham's and Huntington's Chorea, and Athetosis)

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

A. Review of Medical Records:

B. Medical History (Subjective Complaints):

Comment on:

1. Onset and course - If flare-ups exist, describe precipitating factors, aggravating factors, alleviating factors, alleviating medications, frequency, severity, duration, and whether the flare-ups include pain, weakness, fatigue or functional loss.
2. Current treatment, response, side effects.

C. Physical Examination (Objective Findings):

1. If Migraine: - Obtain the history of frequency and duration of attacks and description of level of activity the veteran can maintain during the attacks. For example, state if the attacks are prostrating in nature or if ordinary activity is possible.
2. If Tics and Paramyoclonus Complex: - Ascertain the muscle group(s) involved and obtain the best possible history of frequency and severity of attacks. State the effects on daily activities.
3. If Chorea, Choreiform Disorders, etc.: - Describe manifestations by impairment of strength, coordination, tremor, etc., with particular attention to the effects of the performance of ordinary activities of daily living.

D. Diagnostic and Clinical Tests:

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

E. Diagnosis:

Signature:

Date: