### Department of Veterans Affairs VHA HANDBOOK 1301.1

**Veterans Health Administration Transmittal Sheet**

**Washington, DC 20420 August 13, 1999**

** **

**IONIZING RADIATION REGISTRY PROGRAM PROCEDURES**

 

**1.** **REASON FOR ISSUE**: This Veterans Health Administration (VHA)
Handbook establishes procedures for the Department of Veterans Affairs
(VA), VHA, Environmental Agents Service (EAS), Ionizing Radiation
Registry Program. It implements changes in health services for veterans
mandated by Public Laws 104-262 and 105-368.

 

**2.** **SUMMARY OF MAJOR CHANGES**: This Handbook constitutes a total
revision of VHA Manual M-10, \"Environmental Medicine,\" Part II,
\"Ionizing Radiation Program,\" Chapters 1 and 2. The principal changes
as mandated by Public Law 104-262 involve eligibility for care and adds
conditions which VA now recognizes as being potentially radiogenic;
Public Law 105-368 authorizes care and services, limited to examinations
and treatment of head and neck cancers for veterans who had received
nasopharyngeal radium treatments during active military, naval, or air
service.

 

**3. RELATED ISSUES:** VHA Directive 1301 and VHA Directive 98-059,
December 23, 1998.

 

**4. RESPONSIBLE OFFICIALS**: The Program Chief for Clinical Matters,
Office of Public Health and Environmental Hazards (13), is responsible
for the contents of this VHA Handbook. Questions may be referred to that
individual at VHA Headquarters. ***NOTE:** Questions relating to
eligibility for VA care, including enrollment should be directed to the
eligibility staff at your facility.*

 

**5. RESCISSIONS**: This VHA Handbook rescinds Manual M-10,
\"Environmental Medicine,\" Part II, \"Ionizing Radiation Program,\"
Chapters 1 and 2, dated March 30, 1992.

 

**6. RECERTIFICATION**: This document is scheduled for recertification
on/before the last working day of August 2004.

 

Thomas L. Garthwaite, M.D.

Acting Under Secretary for Health

 

 

Distribution: **RPC: 0005**

FD

 

 

Printing Date: 8/99

** **

**CONTENTS**

** **

**IONIZING RADIATION REGISTRY PROGRAM PROCEDURES**

** **

**PARAGRAPH** **PAGE**

 

1\. Purpose.
\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\... 1

 

2\. Authority 1

 

3\. Scope 1

 

4\. Description of Services 2

 

5\. Eligibility Criteria 2

 

6\. Program Management 3

 

7\. Registry Physician Responsibilities 4

 

8\. Registry Coordinator Responsibilities 5

 

9\. Incarcerated Veterans 8

 

10\. Veterans with Other Than Honorable Discharge 9

 

11\. Conducting the Physical Examination 9

 

12\. Reporting Requirements 12

 

13\. Records Control and Retention 12

 

14\. Education and Training 13

 

**APPENDIXES**

** **

A Sample Ionizing Radiation Follow-up Letter (Medical Problems
Indicated)...................A-1

** **

B Sample Ionizing Radiation Follow-up Letter (No Medical
Problems)........................ B-1

 

C Definitions and Acronyms C-1

 

D Instructions for Completing VA Form 10-0020A, Ionizing Radiation

Registry Code Sheet D-1

 

E Sample of Completed VA Form 10-0020A, Ionizing Radiation

Registry Code Sheet E-1

 

F Instructions for Completing and Processing Code Sheets F-1

 

G Sample of Completed VA Form 7252,Transmittal Form for Use

in Shipment of Tabulating Data G-1

 

 

**IONIZING RADIATION REGISTRY PROGRAM PROCEDURES**

 

 

**1. PURPOSE**

#  

#  This Veterans Health Administration (VHA) Handbook sets forth clinical and administrative policies related to the maintenance of the VHA Ionizing Radiation Registry (IRR) program of physical examinations for eligible, concerned veterans.

 

**2. AUTHORITY**

** **

a\. Public Law 99-576, \"Veterans Benefits Improvement and Health Care
Authorization Act of 1986,\" enacted October 28, 1986, required the
Secretary of the Department of Veterans Affairs (VA) to establish and
maintain an IRR of veterans exposed to radiation under conditions
described in Title 38 United States Code (U.S.C.) § 1710(e)(1)(B). These
conditions include:

>  

\(1\) On site participation in a test involving the atmospheric
detonation of a nuclear device

(between 1945 and 1962), (whether or not the testing nation was the
United States);

 

\(2\) Participation in the occupation of Hiroshima or Nagasaki from
August 6, 1945, through July 1, 1946; or

 

\(3\) Internment as a Prisoner of War (POW) in Japan during World War II
which the Secretary of Veteran Affairs, henceforth referred to as the
Secretary, determines resulted in an opportunity for exposure to
ionizing radiation comparable to that of veterans involved in the
occupation of Hiroshima or Nagasaki. ***NOTE:** See 38 U.S.C. §
1710(e)(4)(B), referencing 38 U.S.C. § 1112(c)(3).*

>  

b\. Section 901 of Public Law 105-368, \"Veterans Programs Enhancement
Act,\" enacted November 11, 1998, codified at 38 U.S.C. § 1720E, states
in part, that the Secretary may provide a medical examination, hospital
care, medical services, and nursing home care, which the Secretary
determines is needed for the treatment of any cancer of the head or neck
which the Secretary finds may be associated with the veteran\'s receipt
of Nasopharyngeal (NP) radium irradiation treatments while in the active
military, naval or air service.

** **

**3. SCOPE**

** **

a\. Registry examinations will be provided to eligible veterans who may
have been exposed to a radiation-risk activity under the conditions
described in this Handbook. In the absence of evidence to the contrary,
a veteran\'s assertion of exposure at a nuclear device testing site (the
Pacific Islands, e.g., Bikini, NM, NV, etc.) or in Hiroshima and/or
Nagasaki, Japan, will be accepted.

>  

b\. Medical examinations may be provided to veterans who have received
NP radium irradiation treatments while in the active military, naval or
air service, and are experiencing head or neck complaints or who are
concerned about possible adverse effects of their NP radium treatments.

 

\(1\) To be eligible for these medical examinations, a veteran must
have:

 

\(a\) Documentation of NP radium treatment in active military, naval or
air service;

 

\(b\) Served as an aviator in the active military, naval or air service
before the end of the

Korean conflict; or

 

\(c\) Undergone submarine training in active naval service before
January 1, 1965.

 

***NOTE:** Eligible veterans do not have to be enrolled in VA care to
receive IRR examinations and co-payments are not required.*

* *

**4. DESCRIPTION OF SERVICES**

The registry examination protocol for registry examinations authorized
under conditions described in 38 U.S.C. 1710 (e) (1) (B) and medical
examinations authorized for veterans who received NP treatments,
authorized under conditions described in 38 U.S.C. 1720E, is described
in paragraph 11 of this Handbook. Congress made it clear that 38 U.S.C.
Section 1710 (e) (1) (B) and 1720E provide for healthcare
[only]{.underline} and that a determination that the veteran is eligible
for such care does not constitute a basis for service-connection or in
any way affect determination regarding service-connection.

 

**5. ELIGIBILITY CRITERIA**

** **

VA will provide an IRR examinations and medical examinations to veterans
who may have been exposed to radiation-risk activity under conditions
described in paragraph 2 of this Handbook.

 

a\. The IRR will consist of physical examinations with access to
supplemental data on compensation claims and radiation exposures from
the Veterans Benefits Administration (VBA) and the Department of
Defense\'s (DOD\'s) Defense Threat Reduction Agency (DTRA), (formerly
the Defense Special Weapons Agency (DSWA) and the Defense Nuclear Agency
(DNA). VA shall compile and consolidate all pertinent information
maintained by relevant elements of VA or DOD. According to the DTRA,
over 200,000 test participants have been identified as to their specific
involvement and their recorded radiation exposure. Approximately an
equal number of service personnel were involved in occupation duties at
Hiroshima and/or Nagasaki.

 

b\. The Environmental Epidemiology Service (EES) in conjunction with
DTRA will share

files, when deemed appropriate, to obtain updated information on each
veteran in the IRR, i.e., radiation exposures, unit assignments, etc.

 

c\. Eligible veterans applying for treatment in a VA medical center
and/or outpatient clinic

should be encouraged to undergo an ionizing radiation examination, if
they have not previously done so. Under the new eligibility program,
veterans requesting IRR examinations [do not]{.underline} have to be
enrolled in the VA\'s healthcare system.

 

d\. Veterans should be advised that examination or treatment for
radiation-related diseases does not constitute a formal claim for
compensation. Although the results of an IRR examination may be used to
support a compensation claim, the examination will not, in and of
itself, be considered such a claim. Veterans who wish to submit a claim
for conditions possibly related to radiation exposure should do so via
the normal claims process at the nearest VA Regional Office of
jurisdiction, or through a veterans benefits counselor physically
located at VA health care facilities.

 

**6. PROGRAM MANAGEMENT**

 

***NOTE:** The Registry Physician (RP), Registry Coordinator (RC), and
health administration staff of each VA facility play a significant role
in determining the perceptions Ionizing Radiation (IRAD) veterans have
concerning the quality of VA health care service and of their individual
treatment by VA health care providers.*

* *

a\. **[RP]{.underline}**. An RP and one or more alternates will be
designated by the facility Chief of Staff (COS). In order to keep
abreast of current information and program activities, RPs and
assistants should be familiar with various materials distributed by VHA
Headquarters. All program officials should attend the periodic
Environmental Agents Service (EAS) conference calls from VHA
Headquarters, and all RPs, with computer access, should contact VHA
Headquarters, EAS to be enrolled in the electronic mail group in
Microsoft (MS) Exchange identified as \"Registry Physicians.\"

 

b\. **[RC]{.underline}**. The RC and alternate(s) will be designated by
the facility Director\'s office. All RCs should attend the periodic EAS
conference calls from VHA Headquarters, and all RCs, with computer
access, should contact VHA Headquarters, EAS to be enrolled in the
electronic mail group in MS Exchange identified as \"Registry
Coordinators.\"

 

**c**. **[RP and RC Listings]{.underline}**. Separate listings of the
RPs and RCs are maintained by EAS. In an effort to keep these listings
current, facilities are requested to notify EAS of changes as they occur
in status of the RPs and RCs at their respective facilities and/or
satellite clinics. These listings will include the name, title, mail
routing, and commercial telephone and FAX numbers with area code, and
should be submitted, in writing, to EAS (131), Department of Veterans
Affairs, 810 Vermont Avenue, NW, Washington, DC 20420.

**7. RP RESPONSIBILITIES**

 

The RP is responsible for the program\'s clinical management and will
serve in an advisory capacity for the administrative management of the
program. Major responsibilities include:

 

a\. **[Counseling.]{.underline}** The RP advises the veteran of all
aspects of the IRR examination.

 

b\. **[Documenting the Physical Examination]{.underline}**. The RP must:

 

\(1\) Conduct and document the physical examination in the Consolidated
Health Record (CHR).

 

\(a\) This examination involves the taking of a complete medical history
to include information about:

 

> [1]{.underline}. Family;

 

> [2]{.underline}. Occupation;

 

> [3]{.underline}. Social activities noting tobacco, alcohol, and drug
> use; and

 

> [4]{.underline}. Psychosocial condition.

 

\(b\) If a veteran is subsequently diagnosed with a significant
radiation-related health problem by a non-VA physician, the veteran is
to be encouraged to contact the veteran\'s local VA medical center to
include additional diagnoses in the CHR and IRR.

 

[1]{.underline}. This new diagnosis must be submitted over the non-VA
physician\'s signature on official letterhead.

 

[2]{.underline}. A code sheet identified as, follow-up examination, Type
C, will be completed with this diagnosis and forwarded to the Austin
Automation Center (AAC) for inclusion in the IRR.

 

\(2\) Review and complete Part I of VA Form 10-0020A, Ionizing Radiation
Code Sheet, if necessary. ***NOTE:** No edition of VA Form 10-0020A,
earlier than July 1999 may be used.*

\(3\) Complete Part II of VA Form 10-0020A (see App. D).

 

\(4\) Review the records of every IRAD veteran examined to ensure that a
complete physical examination was performed and documented.

 

\(5\) Personally discuss with each veteran the:

 

\(a\) Findings of the physical examination and completed diagnostic
studies. ***NOTE:** The interview will be conducted in such a way as to
encourage the veteran to discuss health*

*concerns, as well as those of family members, as they relate to
ionizing radiation exposure. This information will be documented in the
veteran\'s CHR. Every effort should be made to maintain the veteran\'s
current address in the veteran\'s health care records and in the
Veterans Health Information Systems and Technology Architecture (VISTA)
computerized information system.*

 

\(b\) Need for follow-up examination(s) either recommended by the RP or
requested by the veteran.

c\. **[Preparing and Signing Follow-up Letter]{.underline}**. The RP
will ensure that appropriate personalized follow-up letters, explaining
the results of the examination and laboratory studies, have been signed
and mailed to the veteran (see App. A).

 

\(1\) Follow-up letters will be mailed to the veteran within 2 weeks of
the initial examination. The only exception to this timeframe will be
when a consultation at a specialty clinic is requested as part of the
initial examination process. This exception suspends, but does not
remove, the requirement for the follow-up letter. The follow-up letter
will be sent within 2 weeks after the consultation.

 

\(2\) A dated copy of the follow-up letter will be filed in the
veteran\'s CHR. ***NOTE:** It is essential that this letter be written
in language that can be easily understood by the veteran. Inappropriate
wording could unduly alarm or confuse the veteran. A great deal of
sensitivity and care should be exercised in the preparation of this
correspondence.*

 

\(3\) The follow-up letter will explain that:

 

\(a\) If the veteran examined has no detectable medical problems, the
follow-up letter should so indicate and suggest that the veteran contact
the nearest VA health care facility if health problems appear later.

 

\(b\) If it is determined upon examination that the veteran does have
medical problems, it is not necessary to specify the problems in the
letter. The veteran is to be advised in the letter that the recent
examination indicated a health condition and/or problem, which may
require further examination and/or treatment.

 

\(c\) If the veteran requires medical treatment, the letter is to advise
the veteran to apply for enrollment and provide the name of a contact
person, including telephone number, within the facility. If the veteran
is not eligible for treatment, the letter is to so advise and recommend
that the veteran seek appropriate medical care elsewhere.

 

**8.** **REGISTRY COORDINATOR RESPONSIBILITIES**

 

The RC is responsible for the [administrative management]{.underline} of
the program, including:

 

a\. **[Scheduling of Appointments]{.underline}.** Every effort should be
made to give veterans ionizing radiation examinations within 30 days of
the request date.

> **[ ]{.underline}**

b\. **[Monitoring Timeframe Compliance]{.underline}.** All of the
following require timeframe

compliance:

\(1\) **Follow-up Letters.** Mail to veteran within 2 weeks of initial
registry examination.

 

\(2\) **Registry Examination Appointment.** Schedule within 30 days of
request date.

 

\(3\) **VA Staff (RC and RP) Changes.** Advise VHA Headquarters (131) as
they occur.

 

\(4\) **Registry Code Sheets (VA Form 10-0020A) for Initial and
Follow-up Examinations** Mail to AAC by the 15^th^ workday of the
following month (see App. D).

 

\(5\) **Invalid Registry Code Sheets (VA Form 10-0020A).** Correct and
mail to the AAC ten workdays following receipt from the AAC.

 

c\. **[Reviewing Records for Accuracy and Completion]{.underline}.** All
required records, e.g., computerized or card file records, follow-up
letters, transmittal forms, registry code sheets of veteran
participants, and CHRs are to be completed and reviewed for accuracy.

>  

d\. **[Data for Reporting Purposes]{.underline}.** Required registry
data should be obtained from the veteran or family, entered on IRAD Code
Sheets and submitted to the AAC for entry into the IRR dataset. The AAC
will provide IRR data reports to VHA Headquarters based on VA facility
input.

>  

e\. **[Disseminating Information]{.underline}.** It is important that
each veteran be fully advised of the IRR examination program. Facility
staff is encouraged to fully communicate all aspects of the IRR
examination program by any appropriate means. The following suggestions
might be considered:

 

\(1\) Provide each veteran reporting to the Outpatient and Admission
areas with a handout describing the purpose of the examination and its
limitations. The examining physician during the course of the physical
examination can further clarify this, preferably prior to beginning the
physical examination process.

 

\(2\) Provide each veteran with current Office of Public Affairs News
Service Fact Sheets and display these in prominent areas (outpatient
clinics, admission areas, etc.) to ensure availability to veterans and
other interested individuals.

 

> \(3\) The RC receives all IRAD related inquiries, and is responsible
> for communicating appropriate information.
>
>  
>
> \(4\) The RC posts and communicates the names, locations, and office
> telephone numbers of the RP and the RC to concerned VA facility staff.
> ***NOTE:** An appropriate method is the use of medical center
> memoranda providing registry policy and procedures and those
> responsible for carrying out these policies.*
>
>  

f\. **[Maintaining a Computerized Record or Card File]{.underline}**.
The RC must establish and maintain a computerized record (or alpha card
file) of all registry participants. Each record prepared should include
the veteran\'s:

 

\(1\) Full name,

 

\(2\) Address,

 

\(3\) Telephone number,

 

\(4\) Date of birth,

 

\(5\) Social Security Number (SSN),

 

\(6\) Service Number,

 

\(7\) Date of initial examination (including date of code sheet
submission to AAC), and

 

\(8\) Date(s) of subsequent follow-up examination(s) to include date of
code sheet submission to AAC.

 

g\. **[Completing Code Sheet]{.underline}**

 

\(1\) The RC completes Part I of VA Form 10-0020A, before the veteran is
referred to the clinician for the examination (see App. D).

 

\(2\) To further ensure the form\'s completeness, the clinical examiner
will review it and, if necessary, enter missing items at the veteran\'s
direction. In addition, the RP will inquire whether any of the
veteran\'s natural children or grandchildren have any birth defects
\"Y(es),\" \"N(o),\" or \"U(nknown),\" in Item 15, describing these
defects in Item 18 \"Remarks\" section of the code sheet and in the CHR.
***NOTE:** Refer to instructions in Appendix D.*

 

\(3\) In the event the veteran applying for care, who claims exposure to
IRAD does not wish to participate in the registry, a code sheet will be
completed and retained in the veteran\'s CHR. ***NOTE:*** *Do not send
it to AAC.* In the \"Remarks\" section, Item 18, indicate current date
and note that the veteran did not want to participate in the registry.

 

\(4\) Establishing and updating the CHR. The RC will establish a medical
record if one does not already exist. VA Form 10-1079, Emergency Medical
Identification, should be affixed to the front of the record and the
word \"RADIATION\" circled. Any veteran claiming exposure to IRAD and
all veterans participating in the registry should have VA Form 10-1079
affixed to the front of the CHR. Completed original code sheets (VA Form
10-0020A), dated follow-up letters, all medical records of registry
examinations, and laboratory and/or test results will be maintained in
veteran\'s CHR.

**9.** **INCARCERATED VETERANS**

 

a\. Circumstances under which incarcerated veterans may be accepted for
treatment in VA facilities are limited. A veteran in the custody of
penal authorities, or under criminal charges, does not forfeit any right
to medical care by VA.

 

b\. Incarcerated veterans may be accepted, if otherwise eligible, for
medical care only when released by an authorized official under
circumstances where there is no obligation placed on VA to exercise
custodial restraint, or to ensure the return of the veteran to custody
upon completion of treatment.

 

c\. VA will not provide outpatient treatment at a penal institution for
an incarcerated veteran.

 

d\. If a veteran is paroled from a penal institution for the purpose of
receiving VA staff care, the penal institution will be informed that VA
is under no obligation for:

 

\(1\) The custody of the veteran, or

 

\(2\) The administration of punishment to the veteran, and/or

 

\(3\) The return of the veteran to civil authorities either during or
upon completion of treatment.

 

***NOTE:** The clinic Director, or designee, will notify the civil
authorities when treatment will be completed.*

 

e\. VA will not routinely bill the Bureau of Prisons for the treatment
of eligible veterans who are treated in VA facilities.

 

f\. For purposes of entry into the IRR, VA medical facilities can
provide assistance to penal authorities or institutions agreeable to
conducting examinations to veterans. ***NOTE:** The VA will not
reimburse the penal authorities when they conduct these IRR
examinations.*

 

\(1\) Copies of directives, code sheets, etc., will be provided to penal
institutions upon request.

 

\(2\) Penal authorities must be advised at the time of such requests
that the results of the examination provided at their institutions must
be returned to the VA medical facility of jurisdiction for inclusion, in
the veteran\'s behalf, in VA\'s IRR.

 

\(3\) A recommendation can be made to the penal institution to retain a
copy of the examination documents submitted to VA. Such documents should
be maintained by penal authorities until release of the individual from
the penal institution.

 

**10.** **VETERANS WITH OTHER THAN HONORABLE DISCHARGES**

 

The requirements of VHA Manual M-1, Part I, Chapter 4, apply to veterans
with less than honorable discharges applying for IRR examinations.

 

**11.** **CONDUCTING THE PHYSICAL EXAMINATION**

 

a\. It is essential that a complete medical history, physical
examination, and interview be performed and documented on appropriate
medical record standard forms, by/or under the direct supervision of the
RP or alternate.

 

b\. The person actually performing the physical examination will be
identified with the signature and title Doctor of Osteopathy (D.O.),
Doctor of Medicine (M.D.), Physician\'s Assistant (P.A.), Certified
Nurse Practitioner (CNP), etc. Examination completed by other than a
physician must be completed by medical personnel privileged to do
physical examinations. A physician\'s countersignature (preferably the
RP\'s) is required on all examinations completed by other than a
physician.

 

c\. When an IRAD examination is done as part of a compensation and
pension examination, the physical examination will be done by/or under
the direct supervision of the RP or alternate.

 

d\. Special attention will be given to the following conditions which VA
has recognized by statute or regulation as being associated with
radiation exposure:

 

***NOTE:** The International Classification of Diseases - Clinical
Modification (Ninth Edition) (ICD-9-CM).*

 

**DIAGNOSIS** **ICD-9-CM (Reference Guides)**

 

\(1\) Leukemia, Lymphoid (except chronic 204-204.9

lymphatic leukemia) (except 204.1)

 

\(2\) Leukemia, Myeloid 205

 

\(3\) Leukemia, Monocytic 206

\(4\) Leukemia, Hairy Cell 202.4

 

\(5\) Leukemia, other 207

 

\(6\) Leukemia, Unspecified cell type 208

 

\(7\) Thyroid Cancer 193

>  

\(8\) Breast Cancer 174-175

**DIAGNOSIS** **ICD-9-CM (Reference Guides)**

 

\(9\) Lung Cancer (malignant neoplasm of

trachea, bronchus, and lung) 162

>  

\(10\) Bone Cancer 170

>  

\(11\) Primary Liver Cancer 155

>  

\(12\) Skin Cancer 172-173

 

\(13\) Esophageal Cancer 150

 

\(14\) Stomach Cancer 151

 

\(15\) Colon Cancer 153

 

\(16\) Pancreatic Cancer 157

 

\(17\) Kidney Cancer 189.0

 

\(18\) Urinary Bladder Cancer 188

 

\(19\) Salivary Gland Cancer (malignant

neoplasm of major salivary gland) 142.

\(20\) Multiple myeloma 203

 

\(21\) Posterior Subcapsular Cataracts 366.02

 

\(22\) Non-malignant Thyroid Nodular Disease 241, 226

 

\(23\) Ovarian Cancer 183

 

\(24\) Parathyroid Adenoma 227.1

 

\(25\) Tumors of the brain and central nervous system 191-192

 

\(26\) Lymphomas other than Hodgkins Disease 200,202.0, 202.1,

> 202.2, 202.8, 202.9

 

\(27\) Cancer of the Rectum 154.1

\(28\) Cancer of the Small Intestine 152

**DIAGNOSIS** **ICD-9-CM (Reference Guides)**

 

\(29\) Cancer of the Pharynx 146, 147, 148, 149

 

\(30\) Cancer of the Bile Duct 156.1

 

\(31\) Cancer of the Gall Bladder 156.0

 

\(32\) Cancer of the Renal Pelves, 189.1, 189.2, 189.3

Ureters and Urethra

 

> (33)    Cancer of the Prostate 185

 

*       * (34) Other malignancy(ies), not listed in the preceding
diagnoses. ***NOTE:** Other conditions may be recognized in the future.*

 

e\. In gathering medical history data, it is important to record the
time of the onset of the veteran\'s:

 

\(1\) Symptoms or conditions,

 

\(2\) Intensity,

 

\(3\) Degree of physical incapacitation, and

 

\(4\) Details of any treatment received.

 

f\. Each veteran will be given the following baseline laboratory
studies:

 

\(1\) Chest X-ray (as determined to be medically necessary);

 

\(2\) Complete blood count;

 

\(3\) SMA-6, SMA-12, or equivalent blood chemistries and enzyme studies;
and

 

\(4\) Urinalysis.

 

g\. Appropriate additional diagnostic studies are to be performed and
consultations obtained as indicated by the patient\'s symptoms and
physical and laboratory findings.

 

h\. Non-routine diagnostic studies, such as computed tomography or
magnetic resonance imaging, should be performed only if medically
indicated.

 

i\. Laboratory test results are to be filed in the CHR.

**12.** **REPORTING REQUIREMENTS**

 

> a.       **[Code Sheet Submission]{.underline}**
>
>  

\(1\) Reports Control Number 10-0110, applies to this reporting
requirement.

>  

\(2\) A monthly submission of VA Form 10-0020A, will be made to the AAC
by the 15th workday of the following month (see App. D).

 

\(3\) Medical data should [NOT]{.underline} be attached to the submitted
code sheets.

 

\(4\) One legible copy should be sent to AAC, and the original filed in
the veteran\'s CHR.

 

\(5\) Code sheets should be alphabetized by veteran\'s last name.

 

\(6\) Two copies of VA Form 7252, Transmittal Form for Use in Shipment
of Tabulating Data, will be used to transmit code sheets.

 

b\. **[Monthly Statistical Report]{.underline}**

 

\(1\) Submit statistical information using VA Form 7252 as indicated
(see example in App. D).

 

\(2\) The \"cumulative count\" figure is the total number of veterans
who have had registry examinations for the calendar year.

 

\(3\) Negative Reports. Negative reports are not required; i.e., if
there were no exams or code sheets processed for the month.

 

c\. **[RP and RC Listings]{.underline}**. Separate listings of the RPs
and RCs are maintained by the EAS. In an effort to keep these listings
current, facilities are required to notify the EAS of any changes at
their respective facilities and/or satellite clinics (refer to subpar
6c).

 

d\. **[Forms Acquisition]{.underline}**.

 

\(1\) Forms indicated in this manual may be obtained from the Forms and
Publication Depot through local channels. ***NOTE:** VA Form 30-7252 has
been changed to VA Form 7252. The form itself has not been revised.*

 

\(2\) Facilities can use either form when submitting reports. VA Form
10-0020A is available on the Intranet at
http://vaww.gov/forms/medical/searchlist.asp.

 

**13. RECORDS CONTROL AND RETENTION**

 

a\. **[Records Control]{.underline}**

 

\(1\) Consolidated Health Record (CHR) will be established if one does
not exist.

 

\(2\) A locator record will be created for the card file.

 

\(3\) A VA Form 10-1079, Emergency Medical Identification, sticker will
be affixed to the front of the CHR and word \"Radiation\" circled.

 

\(4\) The code sheet will be prepared with one copy.

 

\(a\) The original and the laboratory test results, progress notes,
etc., will be filed in the CHR, and

 

\(b\) A legible copy of the code sheet will be sent to the AAC in
Austin, TX, for entry into the IRR master record.

b\. **[Records Retention]{.underline}**. IRAD examination documents
become part of the patient\'s CHR, i.e., medical records, and are
retained in accordance with VHA Records Control Schedule 10-1. This
includes:

 

\(1\) VA Form 10-0020A,

 

\(2\) Progress notes,

 

\(3\) Laboratory reports,

 

\(4\) Patient locator cards,

 

\(5\) X-rays, and

 

\(6\) Any other documentation that may have been part of a radiation
examination.

 

**14.** **EDUCATION AND TRAINING**

** **

a\. Current information on the status of the IRAD Program should be
presented to VA medical center staff (e.g., at staff conferences or
grand rounds), veterans organizations, and community groups. ***NOTE:**
This is an excellent means of exchanging ideas in a continuing effort to
update and provide quality management of the IRAD Program*

 

\(1\) Telephone Conferences with VA medical facilities are held
periodically by EAS, VHA Headquarters. ***NOTE:** Minutes of these
telephone conferences, research journal reprints, and other educational
items such as current Office of Public Affairs News Service VA Fact
Sheet on \"VA Programs for Veterans Exposed to Radiation\" and VA Fact
Sheet on \"Nasopharyngeal Radium Therapy\" are distributed by EAS to all
RPs and RCs.*

 

b\. Education and training should ensure the successful accomplishment
of the following goals:

 

\(1\) Communicate effectively with special program participants by
understanding the individual needs of specific groups of veterans.

 

\(2\) Acquire an in-depth knowledge of the specific processes,
designated responsibilities, and time standard requirements of the
Ionizing Radiation Program.

 

**SAMPLE IONIZING RADIATION FOLLOW-UP LETTER**

**(MEDICAL PROBLEMS INDICATED)**

** **

(Date)

(Name/Address)

 

Dear \_\_\_\_\_\_\_\_\_\_\_\_:

 

We wish to acknowledge your recent participation in the Department of
Veterans Affairs (VA) Ionizing Radiation Registry (IRR) Program. This
effort should prove to be helpful in assisting us to serve you with the
possible health problems that may have resulted from a radiation-risk
activity during

> a.       active military service; OR
>
> b.      as a member of a reserve component of the Armed Forces during
> a period of active duty for training or inactive duty training; OR
>
> c.       active military service for those persons who received
> nasopharyngeal irradium treatments).

 

As discussed at the conclusion of your visit, results of your
examination and laboratory tests showed certain problems (optional \--
these findings may be described in lay terms). In view of these
findings, we have scheduled you for treatment of these health problems
on (date). If for any reason you cannot keep this appointment, please
call (phone number) at the earliest possible time to cancel and
reschedule.

 

If you have any questions or concerns about your IRR examination, please
contact the Registry Coordinator (phone number) for assistance.

 

Please remember that this examination does not automatically initiate a
claim for VA benefits. If you wish to file a claim for compensation to
establish service connection, please contact your nearest VA Regional
Office. In your area, the Regional Office is located at (address). Their
telephone number is (phone number). Compensation claims need not be
filed only for injury or illness incurred in combat; the law requires
only that a disease or disability was incurred or aggravated during
military service. If you need any further assistance, you may contact a
Veterans Benefits Counselor by calling the VA toll-free telephone number
1-800-827-1000.

 

If a non-VA physician subsequently evaluates you and finds an new
diagnosis, you are encouraged to provide the VA with all additional
diagnoses, which will be included in your medical record as well as the
IRR.

 

We trust this information is helpful to you.

Sincerely,

> \_\_\_\_\_\_\_\_\_ (Name) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

 

\_\_\_\_\_ (Registry Physician) \_\_\_\_\_\_\_\_\_\_

**SAMPLE IONIZING RADIATION REGISTRY FOLLOW-UP LETTER**

**(NO MEDICAL PROBLEMS)**

 

 

(Date)

(Name/Address)

 

Dear\_\_\_\_\_\_\_\_\_\_:

 

We wish to acknowledge your recent participation in the Department of
Veterans Affairs (VA) Ionizing Radiation Registry (IRR) Program. This
effort should prove to be helpful in assisting us to serve you with the
possible health problems that may have resulted from a radiation-risk
activity during:

 

> a.       active military service; OR
>
> b.      as a member of a reserve component of the Armed Forces during
> a period of active duty for training or inactive duty training; OR
>
> c.       active military service for those persons who received
> nasopharyngeal irradium treatments).

 

As discussed at the conclusion of your visit, results of your
examination and laboratory tests indicate that there are no detectable
medical problems. At this time you have no reason to be concerned about
any adverse health effects resulting from your active military service
(either during the American occupation of Hiroshima and/or Nagasaki,
Japan, and/or at the testing of a nuclear device, and/or as Prisoner of
War during World War II with possible exposure to ionizing radiation,
and/or treatment with Nasopharyngeal Radiation).

 

If a non-VA physician subsequently evaluates you and finds a new
diagnosis, you are encouraged to provide the VA with all additional
diagnoses, which will be included in your medical record as well as the
IRR.

 

We trust this information is helpful to you.

 

Sincerely,

 

> \_\_\_\_\_\_\_\_\_ (Name) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

 

\_\_\_\_\_ (Registry Physician) \_\_\_\_\_\_\_\_\_\_

**DEFINITIONS AND ACRONYMS**

 

1\. **Austin Automation Center (AAC).** The AAC, Austin, TX, is the
location where code sheets are collected and entered into the
computerized registry.

 

2.  **Automated Management Information System (AMIS).**

** **

3.  **Certified Nurse Practitioner (CNP).**

** **

4.  **Chief of Staff (COS).**

** **

5.  **Consolidated Health Record (CHR).** The CHS is a file containing
medical records relating

to patient identity, diagnosis, prognosis, or treatment at VA health
care facility.

 

6\. **Defense Special Weapons Agency (DSWA).** The DSWA was formerly the
Defense Nuclear

Agency (DNA) and is now identified at the Defense Threat Reduction
Agency (DTRA)

 

7\. **Defense Threat Reduction Agency (DTRA).** The DTRA was formerly
the DSWA and DNA.

 

8\. **Department of Defense (DOD).**

 

9\. **Department of Veterans Affairs (VA).**

 

10\. **Doctor of Osteopathy (D.O.).**

 

11\. **Doctor of Medicine (M.D.).**

 

12\. **Environmental Agents Service (EAS).** The EAS, VHA Headquarters,
has the responsibility to coordinate and monitor all VHA activities,
research and otherwise, relating to the ionizing radiation issue.

 

13\. **Environmental Epidemiology Service (EES).** The EES, VA, is the
Service responsible for providing epidemiological expertise to support
clinical care as well as performing relevant research studies.

 

14\. **Facility.** A facility is any VA entity which provides IRR
examinations to veterans.

 

15\. **Follow-up Examination.** A follow-up examination is an
examination which is performed subsequent to the completed initial
(first) examination. ***NOTE:*** *This is not a consultation associated
with the initial examination.* Code sheets for the first follow-up
examination are to be submitted to AAC. Code sheets for subsequent
follow-up examinations, if performed, do not have to be submitted to the
AAC unless there is a change in diagnosis.

16\. **Initial Examination.** An initial examination is the first
physical examination which is completed and sent to the AAC for the
purpose of entering a veteran into the IRR system.

 

17\. **Ionizing Radiation (IRAD).** Ionizing Radiation is any of the
various forms of radiant energy that causes ionization when it interacts
with matter. The most common types are alpha radiation, made up of
helium nuclei; beta radiation, made up of electrons; and gamma and x
rays, consisting of high-energy electromagnetic radiation.

 

18\. **International Classification of Diseases - Clinical Modification
(Ninth Edition)(ICD-9-CM).** The ICD-9-CM provides standardized
classification of diseases.

 

19\. **Ionizing Radiation Registry (IRR).** The IRR, managed centrally
by the EAS in VA

Headquarters, is a computerized index of veteran participants, and the
coded findings of radiation physical examinations including related
diagnostic data.

 

20\. **Patient Treatment File (PTF).**

** **

21\. **Physician\'s Assistant (P.A.).**

** **

22\. **Prisoner of War (POW).**

         

23\. **Records Control Schedule (RCS) 10-1.** The RCS-10-1 is a document
providing instructions for record retention and disposition.

 

24\. **Registry Coordinator (RC).** The RC is a non-physician
responsible for administrative management of the Ionizing Radiation
program at each VA medical facility.

 

25\. **Registry Physician (RP).** The RP is responsible for clinical
management of the Ionizing Radiation Program at each VA medical
facility.

 

26\. **SMA (6/12).** The SMA (6/12) is the Manufacturer\'s Trademark for
a Chemistry Analyzer.

 

27\. **Social Security Number (SSN).**

 

28\. **Veterans Benefits Administration (VBA).**

 

29\. **Veterans Benefits Counselor (VBC).**

 

30\. **VA Form 10-0020A.** VA Form 10-0020A, the July 1999 edition, is
the updated Ionizing Radiation Registry code sheet replacing the May
1987 edition of VA Form 10-0020A.

 

31\. **VA Form 10-1079.** VA Form 10-1079 is the Emergency Medical
Identification sticker which is to be affixed to front of CHR.

32\. **VA Form 7252.** The VA Form 7252, May 1989, is the transmittal
form for use in shipment of tabulating data. ***NOTE:** This form was
previously numbered VA Form 30-7275.*

 

33\. **Veterans Health Administration (VHA).**

** **

34\. **Veterans Health Information Systems and Technology Architecture
(VISTA).** VA computer system (formerly called Decentralized Hospital
Computer Program \[DHCP\]) that supports day-to-day operations at local
VA health care facilities.

** **

35\. **Veterans Integrated Service Network (VISN).**

** **

** **

**INSTRUCTIONS FOR COMPLETING VA FORM 10-0020A,**

**IONIZING REGISTRY CODE SHEET**

 

**1. [General Instructions for Completing VA Form
10-0020A]{.underline}**

** **

a\. A legible copy of the original code sheet will be prepared and
submitted to the Austin Automation Center (AAC), Austin, TX, in the
initial and the first follow-up examinations (if required). The original
code sheet will be filed in the medical record after verification for
correctness by AAC. Additional follow-up examinations, as required, will
continue to be documented in the Consolidated Health Record (CHR) and a
code sheet will be prepared for the first follow-up examination and
submitted to AAC. All subsequent code sheets for follow-up examinations
will not be submitted to AAC, with the exception that if there is a
change in diagnosis, then a code sheet will be prepared and submitted
for entry into the Ionizing Radiation Registry (IRR).

>  

b\. Print clearly using a BLACK ball-point pen or a BLACK felt-tipped
pen. Follow instructions carefully to ensure that ALL data fields are
accurately completed. Enter one letter or number per block. The numeric
zero must be slashed \"0\" to distinguish it from the alpha character,
as Ø.

\(1\) Part I of the code sheet should be completed in the presence of
the veteran.

 

\(2\) Part II of the code sheet should be completed at the time of the
examination by the Registry Physician (RP) or alternate. Once completed,
this code sheet should be returned to the Registry Coordinator (RC) for
review and mailing to AAC.

 

**2. [Instructions for Completing Part I]{.underline}**

 

**Item 1. Facility Number and Suffix - [Blocks 2-7.]{.underline}**

 

Enter facility code as listed in the Department of Veterans Affairs (VA)
Manual MP-6, Part XVI, Supplement Number 4.1, Appendix A. Use the
Automated Management Information Systems (AMIS) suffix (BY, BZ, etc.) to
indicate your satellite facility. [DO NOT USE]{.underline} Q, R, or S.

 

**Item 2. Last Name of Veteran - [Blocks 8-33. ]{.underline}**

[ ]{.underline}

Beginning in Block 8, enter veteran\'s last name. Do not use accent
marks in the name or skip blocks between the letters of the last name.
Skip a block if the last name is followed with JR, SR, I, II, III, etc.

 

**Item 3. First Name of Veteran - [Blocks 34-48.]{.underline}**

[ ]{.underline}

Beginning in Block 34, print the veteran\'s first name.

**Item 4. Middle Name of Veteran - [Blocks 49-58.]{.underline}**

** **

Beginning in Block 49, enter veteran\'s middle name or initial.

 

**Item 5. Type of Examination - [Block 59]{.underline}**

 

The following transaction type should be entered in Block 59 as
appropriate.

 

A - Initial examination. Veteran\'s first IRR examination.

 

B - To delete an entire initial examination with a noted error, after it
has been accepted into the registry, resubmit the original code sheet,
white out the \"A\" and enter a \"B\", using a RED pen or pencil. After
the AAC has deleted this examination record from the registry dataset,
submit another code sheet with the correct information with an \"A.\"
All fields must be completed on a resubmission.

 

C - Follow-up examination(s). Veteran\'s second and subsequent IRR
examinations. Additional follow-up examinations (these are not
consultations relating to the initial examination) required, will
continue to be documented in the CHR, and a code sheet will not be
prepared or submitted to AAC with the following exception: if a
diagnoses differs from previously submitted code sheets, then a code
sheet should be prepared and submitted for entry into the IRR.

 

D - to delete an entire follow-up examination with a noted error, after
it has been accepted into the registry, resubmit the original code sheet
with a \"D\" and after the AAC has deleted this record from the registry
dataset, submit another code sheet with the correct information with a
\"C.\"

E - To submit a change in demographics (i.e., name, address or date of
birth), enter \"E.\" Complete items with name, Social Security Number
(SSN), date of birth, and address. No other items need to be completed.

 

X - When a registry participant has been identified and verified as
being deceased, enter \"X.\" Complete items with name, SSN, and date of
birth. No other items need to be completed. (AAC will retain these
records in data set noting that veteran is deceased.)

 

**Item 6. SSN - [Blocks 60-69]{.underline}.**

 

Block 60 is to be used ONLY if a pseudo SSN is being submitted. In this
event, the letter \"P\" will be entered in Block 60. Leave Block 60
blank when the actual SSN is used as the AAC will enter the pseudo
number in these blocks.

 

***NOTE**:* *See MP-6, Part XVI, Supplement Number 41, Chapter 2, for
instruction on pseudo SSN assignment*.

 

**Item 7. Service Serial Number - [Blocks 70-79]{.underline}.**

 

Beginning in Block 70, enter the Service Serial Number. Unused blocks
remain blank. If the serial number begins with \"US\" Blocks 72-79 must
be completed. Fill unused block(s) with \"0\" for this instance only. If
the serial number is unknown, enter a \"U\" in Block 70. Unused blocks
remain blank. However, every effort must be made to obtain the Service
Serial Number as it will allow research staff to link this questionnaire
to exposure data at the Defense Threat Reduction Agency.

** **

**Item 8. Date of Birth - [Blocks 80-87.]{.underline}**

Beginning in Block 80, enter numerical equivalent for the month, day and
four digit year (e.g., 01/19/1950). All blocks must be completed.

 

**Item 9. Claim Number - [Blocks 88-95.]{.underline}**

**[ ]{.underline}**

Beginning in Block 88, enter the VA claim number. If unknown, enter
\"U\" in Block 88.

 

**Item 10. Claimant\'s Telephone Number (include Area Code) - [Blocks
96-105.]{.underline}**

**[ ]{.underline}**

Beginning in Block 96, enter the veteran\'s current telephone number,
including area code (if available).

 

**Item 11. Address (Street Name and Apartment Number (if applicable) -
[Blocks 106-131]{.underline}**

** **

Beginning in Block 106, enter veteran\'s current street address, Post
Office Box, etc. Leave one blank block between street number and name.

 

**Item 12. City or Town, County, State, Zip Codes - [Blocks
132-171]{.underline}**

** **

a\. [Block 132]{.underline}*.* Beginning in Block 132, enter veteran\'s
city or town.

 

b\. [County and State]{.underline}. Enter name of county and state in
fields without Block numbers.

 

c\. [Blocks 158-162]{.underline}. Enter the five-digit Zip Code.

 

d\. [Blocks 163-166]{.underline}. Optional -- enter the extended four
digit Zip Code.

 

e\. [Blocks 167-169]{.underline}. Enter County Code.

 

f*.* [Blocks 170-171]{.underline}. Enter State Code.

[ ]{.underline}

**Item 13. Sex. [Block 172]{.underline} - Enter either \"M\" for Male or
\"F\" for Female**.

**Instructions for Completing Part II**

Items 14 through 21 will be completed as indicated:

** **

**Item 14 . Did veteran receive nasopharyngeal radium treatments while
in active military, naval or air service? [Block 173]{.underline}**

Enter in Block 173 one of the following codes: Y(es); N(o); or U(nknown)

** **

**Item 15. Is there Evidence of Birth Defects Among Veteran\'s Children
or Grandchildren? [Block 174]{.underline}**

[ ]{.underline}

Enter in Block 174 one of the following codes: Y(es); N(o); or
U(nknown). If \"Yes, please describe birth defects in Item 18 -
\"Remarks.\"

 

**Item 16. Date of Examination - [Blocks 175-182]{.underline}**

 

Enter in Blocks 175-182 the numerical equivalent for the month, day, and
year (e.g., 11/17/1988). If the veteran did not want an examination,
note this in Item 18 \"Remarks\" section, and do not send the code sheet
to the AAC- file this code sheet in veteran\'s chart. All eligible
veterans claiming exposure to ionizing radiation should be offered the
IRR examination.

 

**Item 17. Possible Radiogenic Related Disease(s) - [Blocks
183-218]{.underline}**

 

Enter one of the following codes in Blocks 183-218 listing possible
radiogenic-related diseases:

**Y(es); N(o); or U(nknown).**

 

All Blocks must be completed, as indicated on code sheet. ***NOTE:**
Refer to paragraph 9, for ICD-9 codes identifying the following
radiogenic related diseases.*

 

\(1\) [Block 183]{.underline} - None (If there were no radiogenic
related diseases, enter a Y(es) in Block 183 and go to Item 18
\"Remarks.)\" No entries are required in Blocks 184-218.

\(2\) [Block 184]{.underline} - Leukemia, Lymphoid (except chronic
lymphatic leukemia)

 

\(3\) [Block 185]{.underline} - Leukemia, Myeloid

 

\(4\) [Block 186]{.underline} - Leukemia, Monocytic

 

\(5\) [Block 187]{.underline} - Leukemia, Hairy Cell

 

\(6\) [Block 188]{.underline} - Leukemia, other

 

\(7\) [Block 189]{.underline} - Leukemia, unspecified cell type

 

\(8\) [Block 190]{.underline} - Thyroid Cancer

 

\(9\) [Block 191]{.underline} - Breast Cancer

 

\(10\) [Block 192]{.underline} - Lung Cancer (malignant neoplasm of
trachea, bronchus and lung)

 

\(11\) [Block 193]{.underline} - Bone Cancer

 

\(12\) [Block 194]{.underline} - Primary Liver Cancer

\(13\) [Block 195]{.underline} - Skin Cancer

 

\(14\) [Block 196]{.underline} - Esophageal Cancer

 

\(15\) [Block 197]{.underline} - Stomach Cancer

 

\(16\) [Block 198]{.underline} - Colon Cancer

 

\(17\) [Block 199]{.underline} - Pancreatic Cancer

 

\(18\) [Block 200]{.underline} - Kidney Cancer

 

\(19\) [Block 201]{.underline} - Urinary Bladder Cancer

 

\(20\) [Block 202]{.underline} - Salivary Gland Cancer (malignant
neoplasm of major salivary gland)

 

\(21\) [Block 203]{.underline} - Multiple Myeloma

 

\(22\) [Block 204]{.underline} - Posterior Subcapsular Cataracts

 

\(23\) [Block 205]{.underline} - Non-malignant Thyroid Nodular Disease

 

\(24\) [Block 206]{.underline}- Ovarian Cancer

 

\(25\) [Block 207]{.underline} - Parathyroid Adenoma

 

\(26\) [Block 208]{.underline} - Tumors of the brain and central nervous
system

 

\(27\) [Block 209]{.underline} - Lymphomas other than Hodgkin\'s Disease

 

\(28\) [Block 210]{.underline} - Cancer of the Rectum

 

\(29\) [Block 211]{.underline} - Cancer of the Small Intestine

 

\(30\) [Block 212]{.underline} - Cancer of the Pharynx

 

\(31\) [Block 213]{.underline} - Cancer of the Bile Duct

 

\(32\) [Block 214]{.underline} - Cancer of the Gall Bladder

 

\(33\) [Block 215]{.underline} - Cancer of the Renal Pelves, Ureters,
and Urethra

 

> (34)    [Block 216]{.underline} - Cancer of the Prostate
>
>  

\(35\) [Block 217]{.underline} - Any other malignancies not previously
listed; if Y(es), list on code sheet.

 

\(36\) [Block 218]{.underline} - Other possible radiogenic diseases; if
Y(es) list on code sheet. ***NOTE:** Other conditions may be recognized
in the future.*

 

d\. **Item 18. Remarks - [Block 219]{.underline} -** This section should
be used for noting informational

comments, if applicable, such as elaborating on birth defects, noting if
the examination was not performed, identifying the veteran\'s military
unit assignment, etc. Also, if veteran is deceased, indicate so, and
give the date of death, if available. ***NOTE**: Enter one of the
following codes in **Block 219** indicating that you have or have not
made any remarks in Item 18: Y=Y(es) or N=N(o)*

**Item 19. Name of Examiner or RP (Print in Full).**

** **

**Item 20 . Title of Examiner (Full Title).**

** **

**Item 21. Signature of Examiner.**

 

**Item 22. Signature of RP (if other than examiner).** The name and
title of the examiner should be printed in the spaces provided and
accompanied by the signature.

 

** **

**SAMPLE OF COMPLETED VA FORM 10-0020A,**

**IONIZING RADIATION REGISTRY CODE SHEET**

 

Sample has been electronically imbedded in this Appendix. This form may
also be found at:

 

<http://www.va.gov/forms/medical/searchlist.asp#formlist>

 

 

 

 

**INSTRUCTIONS FOR PROCESSING CODE SHEETS**

 

**1. [Submission of VA Form 10-0020A, Ionizing Radiation Registry Code
Sheet to the Austin Automation Center (AAC)]{.underline}** (formerly the
Data Processing Center, Austin, TX).

 

Completed, legible copies of code sheets are submitted to the AAC to be
entered into the Ionizing Radiation Registry (IRR). Code sheets should
be scanned to ensure all required fields are completed. ***NOTE:** No
medical record documentation should be attached to these code sheets.*

** **

**2. [Batching of Code Sheets]{.underline}**

 

a\. Code sheets should be stapled in the upper-left hand corner.
Completed code sheets will be batched in groups of no more than 25.
Divisions of a consolidated facility must keep submissions separate,
i.e., each batch will include code sheets from one facility.

 

b\. Corrected code sheets do not have to be batched separately. They can
be mailed with the regular code sheets as long as they are from the same
facility.

 

c\. If a veteran has had two examinations within the same mailing
period, that is, an initial and follow-up examination, only the initial
examination code sheet should be submitted in the batch. Hold the
follow-up examination code sheet until it is certain the AAC has
processed and accepted the initial examination code sheet. If submitted
simultaneously, an error message may occur (see par. 6).

 

**3. [Transmittal Form]{.underline}**

 

a\. Two copies of the VA Form 7252, Transmittal Form for the Use in
Shipment of Tabulating Data, will accompany each batch of code sheets.
One copy will be retained at the AAC and the other copy will be returned
by the AAC to the transmitting facility with the code sheets and the
edit analysis printout, entitled \"Transaction Report -- Part II --
Invalid Transactions.\" \"Transaction Report -- Part II, Valid
Transactions,\" (code sheets that were accepted and data entered into
the AAC dataset) will also be sent to the facility of origin, but will
not include copies of code sheets.

 

b\. If there were no examinations and/or code sheets processed for the
month, no transmittal form is required.

 

c\. Completion of VA Form 7252 is as follows (see sample):

 

**Item 1** - Addressee - Department of Veterans Affairs, Austin
Automation Center (200/397A), 1615 Woodward Street, Austin, TX
78772-0001, ATTN: Input/Data Entry Contract Control/VADS Function.

 

**Item 2** - Facility name and address - Enter facility name and
address.

 

**Item 3** - Reply reference - Enter facility number and routing symbol.

 

**Item 4** - Leave blank.

 

**Item 5** - Number of packages - Enter number of batches.

 

**Item 6** - Dispatch date - Enter date submitting to AAC.

 

**Item 6a** - Final batch - Leave blank.

 

**Item 7** - Official responsible for shipment - Enter name, title, and
telephone number of individual responsible for transmitting code sheets
to the AAC.

 

**Item 8** - Tabulating data.

 

Column A - Leave blank.

 

Column B - Job Number - Enter \"10\" in first segment and \"20A1\" in
second segment.

 

Column C - Description - First line enter \"IONIZING RADIATION\", second
line enter \"Facility Number,\" third line enter \"Month Ending,\"
fourth line enter \"Batch Number,\" fifth line enter \"Code Sheet
Count,\" and sixth line enter \"Cumulative Count (for calendar year).\"

 

Columns D and E - Leave blank.

 

**Item 9** - Remarks - Enter \"VA Form 10-0020A\'s,\" and provide
breakdown of \"code sheet count\" (Line 5) i.e. (5) initial (Type A),
(2) follow-up (Type C), (1) deceased (Type X), etc.

 

**4. [Control Log]{.underline}**

 

a\. An Ionizing Radiation (IRAD) control log will be established and
maintained at each facility. As batches are prepared for submission to
the AAC an entry should be made on the batch control log. Using the
control log, assign the appropriate number and record it on the
transmittal form. Begin with batch number ~~00~~1 for January of each
year and continue with sequential numbers throughout the year, i.e., if
there are 50 code sheets to be submitted to the AAC during the month of
January, two batches will be prepared with the control log numbers
~~00~~1 and ~~00~~2.

 

b\. The Control Log should consist of the following:

 

\(1\) Facility code number;

 

\(2\) Batch number assigned sequentially by facility beginning with
~~00~~1 in January of each year (also, to be recorded on transmittal
sheet);

 

\(3\) Number of code sheets in the batch (also, to be recorded on
transmittal sheet);

 

\(4\) Date the batch(es) was (were) mailed to the AAC; and

 

\(5\) Date the batch(es) and associated edit output was (were) returned
from the AAC.

 

**5. [Mailing]{.underline}**

 

a\. Code sheets will be submitted to the AAC monthly.

 

b\. The mailing address for the AAC is:

 

Department of Veterans Affairs

Austin Automation Center (200/397A)

1615 Woodward Street

Austin, TX 78772

ATTN: Input/Data Entry Contract Control/VADS Function

 

c\. The AAC will process the data from the code sheets once each month
(25th). The AAC will return all rejected code sheets with the printout
\"Transaction Change and Error (Reject) Listing\" to the transmitting
facility. Code sheets that are correct and entered into the IRR dataset
will not be returned to VA facilities. ***NOTE:** Rejected Code sheets
should be corrected and returned to the AAC within 10 working days
following receipt from the AAC.*

 

d\. It is not appropriate to call the AAC in regard to questions on code
sheet completion or correction. These questions should be referred to
the Registry Coordinator (131), VHA Headquarters.

**6. [Transaction Reports]{.underline}**

 

a\. A computerized printout \"Transaction Report -- Part I -- Valid
Transactions\" will be

returned by the AAC to the transmitting facility listing the veteran\'s
last name, middle initial, Social Security Number, type and date of
examination. Since these code sheets were valid and data entered into
the AAC registry, code sheets will not be returned to the facility of
origin. They will be forwarded to Veterans Health Administration (VHA)
Headquarters for archiving. This report may include the following
information:

 

> \"Message -- Transaction accepted, initial examination already
> established at (facility

number); transaction will be processed as a follow-up examination for
your facility.\"

> [Action]{.underline} - This code sheet does not have to be resubmitted
> to the AAC. It has been accepted as

a follow-up examination. Indicate facility number where initial
examination was obtained on computerized or card file. Also, the
cumulative number of examinations in the monthly statistical report must
be adjusted accordingly.

 

b\. A computerized printout entitled \"Transaction Report -- Part II --
Invalid Transactions\" will be returned to the transmitting facility
with the rejected code sheets. These printouts will list the veteran\'s
last name, first name, middle initial, Social Security Number, type and
date of examination and describe the rejected or invalid field name,
code sheet location, data, reason for rejection and fields to verify
with any additional explanatory information.

***NOTE:** Facilities should verify the number of code sheets sent to
the AAC against the Transaction Reports.*

 

c\. Invalid or rejected code sheets where data has not been entered into
the dataset are to be corrected as follows:

\(1\) White-out the incorrect entries and enter the correct data with
RED pen or RED felt-tipped pen; OR

 

\(2\) Prepare a new code sheet with the corrections in the appropriate
field(s). If a new code sheet is prepared for the return of a
correction, do not complete just the corrected field(s)\--ALL of the
fields must be completed as if it were an initial input.

 

d\. Examples of the messages on the \"Transaction Report -- Part II --
Invalid Transaction:\"

 

\(1\) \"Rescinded VA Form 10-0020A, TT no longer valid. Use revised VA
Form 10-0020A, TT.

 

\(2\) \"Required entry not made.\"

 

\(3\) \"Response must be either a \"Y,,\" \"N,\" or \"U.\"

 

\(4\) \"Response must be either a \"M\" or \"F.\"

 

\(5\) \"Zip Code is invalid for State.\"

 

\(6\) \"Duplicate Follow-up Segment.\"

 

[Action]{.underline} - This message will appear if the examination date
on the code sheet submitted on the veteran is identical to an
examination date already existing in the registry. There is the
possibility of a coding or entry error. Examination date should be
verified using the computerized log, veteran\'s medical record, or AAC
printouts. If there is a duplicate record, it should be deleted by
submitting a code sheet in accordance with instructions for deleting a
record (see App. D, Item 5.)

 

\(7\) \"Message - No matching initial exam\"

** **

[Action]{.underline} - When deletion of an initial record in the
registry is attempted, the code sheet submitted with a type \"B\" must
have the identical information as on the original record previously
accepted into the registry, otherwise the deletion process cannot be
carried out. Correct code sheet and resubmit to AAC within 10 working
days.

 

**7.** **[Master File List]{.underline}**

 

Twice annually (February and August) AAC will provide all facilities
with a computerized printout entitled, \"Ionizing Radiation Registry
Master File List.\" This is a listing of all veterans who have been
examined and accepted into the automated registry system. This
AAC-generated master listing will assist in the verification of veterans
who have been accepted into the system nationwide. This list will
contain the following information:

**[ ]{.underline}**

a\. Veteran\'s full name,

 

b\. Social Security Number,

 

c\. Date of examination,

 

d\. Type of examination (initial and/or follow-up), and

 

e\. Facility where examination was performed.

 

>  

**8.** **[Master Record Type (MRT)]{.underline}**

**[ ]{.underline}**

The MRT or record type, associated with each transaction (i.e., each
veteran\'s examination) is listed on the computerized printout. The MRT
is generated by the automated IRR system after processing of the code
sheets (transactions) submitted by facilities to the AAC. ***NOTE:**
These printouts records will be replaced by Facility access to AAC IRAD
dataset in the near future.*

***NOTE:** The MRT should not be confused with the transaction \"Type\"
(Item 5) which is indicated on VA Form 10-0020A.*

 

**SAMPLE OF COMPLETED VA FORM 7252, TRANSMITTAL FORM FOR USE**

## IN SHIPMENT OF TABULATING DATA

 

A Sample of completed VA Form 7252 is not available electronically.