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    • C&P Exam Completed [Bad Vibe]
      Yes, she used a Ganiometer.    Weird, I reviewed my last C&P exam which stated my ROM was less than 45 deg last time. But I was still provided the minimum rating of 10%.
    • VA Stupidity Has No Limits!
      I don't know whether it was BUD/S or SAR School, but I'm pretty sure the logs weren't easy on my back or shoulders and neither were the mile long swims with heavy fins. The dirty waters I swam in didn't help with the GERD, and the PTSD was the first thing the VA diagnosed me with and it took them almost 3 years to convince me I had it. Yet, no service connection can be found for any of these things, and these pics are just of the training!! Do they simply "DONT GIVE A xxxx?" or are they just plain "STUPID?" 
    • Ebenefits Claim Status????
      EBenefits is not that reliable.  You have a congressperson involved, no?  That would be a response to your request for help to a congress representative I would think.     Try to call Peggy (the 800 827-1000 number) and ask them what the status is.  Its more likely that they can give more complete info to you.
    • ratings
      In EBenefits, under Disabilities, it will show exactly what your current ratings are.  This should show if you have 2 10's or 1 10, same with the back rating.   I would think that they are just updated verifications of SC. One spine rating cover sacroiliac, the lumbar and thoracic sections all in just 1 rating, so you can not have 2 separate ratings on DDD for L5/S1.
    • ratings
      sorry I do have others,  attached is all that i have been awarded.   I will have to look for those decision letters also degenerative disc disease, L5-S1 20% Service Connected   11/13/2002 depressive disorder 50% Service Connected   10/24/2014 peripheral neuropathy, bilateral lower extremities   Not Service Connected     esophageal reflux (formerly DC 7205) 10% Service Connected   01/29/2009 abdominal surgical scar 10% Service Connected   07/23/2003 hiatal hernia secondary to esophageal reflux surgery 0% Service Connected   07/23/2003 right ankle condition   Not Service Connected     allergic rhinitis (claimed as sinus condition) 30% Service Connected   10/24/2014 sleep apnea   Not Service Connected     hyperparathyroidism 0% Service Connected   09/21/1993 hypertension 10% Service Connected   01/29/2009 residual scar, status post adenoma resection (formerly DC 7800) 20% Service Connected   03/06/2014 degenerative disc disease, L5-S1 20% Service Connected   09/26/2003
    • C&P Exam Completed [Bad Vibe]
      Did the examiner use any type of measuring tools for your ROM?   Shoulder and Arm Limitation of Motion Code 5201: If the arm cannot be raised to the side more than 25°, it is rated 40% for the dominant arm and 30% for the non-dominant arm. If it cannot be raised more than 45° from the side, it is rated 30% for the dominant arm and 20% for the non-dominant arm. If the arm can be raised to shoulder level (90°), then it is rated 20% for either arm.    
    • My husband died in motorcycle accident
      Found this today; Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159. Lay evidence may be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition (i.e., when the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer); (2) the layperson is reporting a contemporaneous medical diagnosis, or; (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009) (where widow seeking service connection for cause of death of her husband, the Veteran, the Court holding that medical opinion not required to prove nexus between service connected mental disorder and drowning which caused Veteran's death). In essence, lay testimony is competent when it regards the readily observable features or symptoms of injury or illness and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465 (1994). In ascertaining the competency of lay evidence, the Courts have generally held that a layperson is not capable of opining on matters requiring medical knowledge. Ruten v. Brown, 10 Vet. App. 183 (1997). In certain instances, however, lay evidence has been found to be competent with regard to a disease with "unique and readily identifiable features" that is "capable of lay observation." See, e.g., Barr v. Nicholson, 21 Vet. App. 303 (2007) (concerning varicose veins); see also Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (a dislocated shoulder); Charles v. Principi, 16 Vet. App. 370 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398 (1995) (flatfeet). Laypersons have been found to not be competent to provide evidence in more complex medical situations. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (concerning rheumatic fever).         The whole effect of PTSD can be observed by a wife, who is a lay person.  Her statement is a powerful tool, as shown in the BVA rulings, when it is not a complex medical issue.  Behavior can be readily observed in this case, carelessness, thrill seeking, dangerous behavior is something that you can assert as a lay person.  Writing the statement, I would describe his behavior before and after, deliberately drawing out the changes in behavior and how you note them, and why/how you believe it contributed to the accident.  As long as you dont try to inject medical expertise, they can not ignore your statement.  If you son is capable of doing this same thing, and of sufficient age to understand what it means, his statement would be admissible as well.  Friends, family, employers, also can provide lay statements to the effect of behavior that was risky and dangerous.  That sense of excitement, or thrills, can be directly attributed to PTSD by a medical professional.
    • Ebenefits Claim Status????
      I have a claim I that was put in 3/20/16 its red flashed for homeless and FDC however it has been closed I looked  on E Benefits and saw that is status was no longer open saw no letters being mailed out just close. When  I looked further on my page on the left in the my profile   section under disability portion of my claim on E benefits where they have my disabilities listed at the very Bottom as Pending Disabilities then it Table of pending disabilities it say  a Congressional Inquiry 5/18/2016 New and Folliculitus  dated back to 3/20/2014 what does that mean the 2014 case is an appeal is this about to be rated is that why its in Pending Disabliites??? Help Pending Disabilities Table of Pending Disabilities Disability Submitted Type Actions Congressional Inquiry 05/18/2016 NEW   Folliculitis Face/beard 03/20/2014 NEW
    • VSO
      I believe that I have and yes this is a remand that back to the regional to appeal board then to my VSO. Everytime I check my file location it shows it as being with  my VSO at the board. All the document I sent to the AMC shows as being unsoliciated. But  since I haven't  received  anything from VA or DAV since then I'm lost about my claim.

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Schedule For Rating Disabilities; Fibromyalgia

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Regulation affected: 38 CFR 4.71a.


Date Secretary approved regulation: March 24, 1999

Federal Register Citation: 64 FR 32410 (June 17, 1999)

In the Federal Register of May 7, 1996 (61 FR 20438), we published an interim final rule adding a new diagnostic code, 5025, and evaluation criteria for fibromyalgia to § 4.71a of 38 CFR part 4, the rating schedule. This final rule responds to comments received in response to the interim final rule and adopts the interim final rule without change.

The Federal Register document follows.


------------------------------------ DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 4

RIN 2900-AH05

Schedule for Rating Disabilities; Fibromyalgia

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.-----------------------------------------------------------------------

SUMMARY: This document adopts as a final rule without change an interim final rule adding a diagnostic code and evaluation criteria for fibromyalgia to the Department of Veterans Affairs' (VA's) Schedule for Rating Disabilities. The intended effect of this rule is to insure that veterans diagnosed with this condition meet uniform criteria and receive consistent evaluations.

DATES: Effective Date: This final rule is effective June 17, 1999. The interim rule adopted as final by this document was effective May 7, 1996.

FOR FURTHER INFORMATION CONTACT: Vickie Milton, M.D., Consultant, Policy and Regulations Staff (211B), Compensation and Pension Service, Veterans Benefits Administration, Department of Veterans Affairs, 810 Vermont Avenue, NW, Washington, DC 20420, (202) 273-7230.

SUPPLEMENTARY INFORMATION: On May 7, 1996, VA published in the Federal Register an interim final rule with request for comments (61 FR 20438). The rule added a diagnostic code, 5025, and evaluation criteria for fibromyalgia to the section of the VA Schedule for Rating Disabilities (38 CFR part 4) that addresses the musculoskeletal system (38 CFR 4.71a). A 60-day comment period ended July 8, 1996, and we received three comments, one from two physicians in the Department of Medicine at The Oregon Health Sciences University, and two from VA employees.

The evaluation criteria for fibromyalgia under diagnostic code 5025 have one requisite that applies to all levels: ``[w]ith widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud's-like symptoms.'' The 40-, 20-, and 10-percent evaluation levels are additionally based on whether these findings are constant, or nearly so, and refractory to therapy; are episodic, but present more than one-third of the time; or require continuous medication for control. One commenter felt that the use of the phrase ``with or without'' as used in diagnostic code 5025 is confusing and might be interpreted as rendering the symptoms that follow the phrase as superfluous and unnecessary in the evaluation of fibromyalgia.

Some individuals with fibromyalgia have only pain and tender points; others have pain and tender points plus stiffness; still others have pain and tender points plus stiffness and sleep disturbance; etc. As a shorter way of stating this, we have used the phrase ``with or without,'' followed by a list of symptoms, to indicate that any or all of these symptoms may be part of fibromyalgia, but none of them is necessarily present in a particular case. When symptoms in addition to pain and tenderness are present, they may be used as part of the assessment of whether fibromyalgia symptoms are episodic or constant. When none of the symptoms on the list is present, the determination of whether the condition is episodic or constant must be based solely on musculoskeletal pain and tender points. The term ``with or without'' is also used in Sec. 4.116 (Schedule of ratings--gynecological conditions and disorders of the breast) of the rating schedule under diagnostic code 7619, ``Ovary, removal of,'' where the criterion for a zero-percent evaluation is ``removal of one with or without partial removal of the other.'' We believe that in both cases the phrase ``with or without,'' rather than adding confusion, better defines the potential scope of the condition under evaluation. We therefore make no change based on this comment.

The same commenter questioned whether the intent is to place a ceiling of 40 percent on the evaluation of fibromyalgia despite the presence of one or more of the symptoms following the phrase ``with or without.'' As the evaluation criteria indicate, there may be multi-system complaints in fibromyalgia. If signs and symptoms due to fibromyalgia are present that are not sufficient to warrant the diagnosis of a separate condition, they are evaluated together with the musculoskeletal pain and tender points under the criteria in diagnostic code 5025 to determine the overall evaluation. The maximum schedular evaluation for fibromyalgia in such cases is 40 percent. If, however, a separate disability is diagnosed, e.g., dysthymic disorder, that is determined to be secondary to fibromyalgia, the secondary condition can be separately evaluated (see 38 CFR 3.310(a)), as long as the same signs and symptoms are not used to evaluate both the primary and the secondary condition (see 38 CFR 4.14 (Avoidance of pyramiding)). In such cases, fibromyalgia and its complications may warrant a combined evaluation greater than 40 percent. Since these rules are for general application, they need not be specifically referred to under diagnostic code 5025.

Another commenter referred to a statement in the supplementary information to the interim final rule that indicated that fibromyalgia is a benign disease that does not result in loss of musculoskeletal function. The commenter said that while it is not a malignant disease which leads to anatomic crippling, the result of persistent chronic pain is often musculoskeletal dysfunction.

The statement regarding the lack of loss of musculoskeletal function is supported by medical texts which state, for example, that objective musculoskeletal function is not impaired in fibromyalgia (``The Manual of Rheumatology and Outpatient Orthopedic Disorders'' 349 (Stephen Padgett, Paul Pellicci, John F. Beary, III, eds., 3rd ed. 1993)); that the syndrome is not accompanied by abnormalities that are visible, palpable, or measurable in any traditional sense; and that the patient must recognize the physical benignity of the problem (``Clinical Rheumatology'' 315 (Gene V. Ball, M.D. and William J. Koopman, M.D., 1986)). These medical texts confirm that fibromyalgia does not result in objective musculoskeletal pathology. The criteria we have established to evaluate disability due to fibromyalgia are therefore based on the symptoms of[[Page 32411]]fibromyalgia rather than on objective loss of musculoskeletal function.

The same commenter said that more could have been said about the wide clinical spectrum of fibromyalgia and the associated stress response which may lead to clinical problems of psychopathology, inappropriate behavior, deconditioning, hormonal imbalance, and sleep disorder.

The evaluation criteria do include a broad spectrum of possible symptoms, and sleep disturbance is one of them. As discussed above, any disability, including a mental disorder, that is medically determined to be secondary to fibromyalgia, can be separately evaluated. The rating schedule is, however, a guide to the evaluation of disability for compensation, not treatment (see 38 CFR 4.1), and it is unnecessary for that purpose to include a broad discussion of the clinical aspects of fibromyalgia. We therefore make no change based on this comment.

The same commenter said that it is important to stress that fibromyalgia may co-exist with other rheumatic disorders and have an additive effect on disability. If two conditions affecting similar functions or anatomic areas are present, and one is service-connected and one is not (a situation that is not unique to rheumatic disorders), the effects of each are separately evaluated, if feasible.

When it is not possible to separate the effects of the conditions, VA regulations at 38 CFR 3.102, which require that reasonable doubt on any issue be resolved in the claimant's favor, dictate that the effects be attributed to the service-connected condition. Since there is an established method of evaluating co-existing conditions, there is no need to stress the point that other diseases may co-exist with fibromyalgia, resulting in additive effects, and we make no change based on this comment.

The commenter also stated that the correct diagnosis of fibromyalgia and the exclusion of other rheumatic conditions are of paramount importance in ensuring a successful treatment program.

The diagnosis of fibromyalgia and exclusion of other rheumatic disorders are functions of the examiner and outside the scope of the rating schedule, which, as noted earlier, is a guide for the evaluation of disability for purposes of compensation, not treatment. We therefore make no change based on this comment.

One commenter stated that claimants with fibromyalgia will present with limitation of motion of various joints of the body, and the rating agency will have to take into consideration pain on movement and functional loss due to pain (see 38 CFR 4.40 and 4.45). The commenter felt that the proposed scheme invites separate ratings for limitation of motion of each joint.

Fibromyalgia is a ``nonarticular'' rheumatic disease (``The Merck Manual'' (1369, 16th ed. 1992)), and objective impairment of musculoskeletal function, including limitation of motion of the joints, is not present, in contrast to the usual findings in ``articular'' rheumatic diseases. Joint examinations in fibromyalgia are necessary only to exclude other rheumatic diseases because physical signs other than tender points at specific locations are lacking. The pain of fibromyalgia is not joint pain, but a deep aching, or sometimes burning pain, primarily in muscles, but sometimes in fascia, ligaments, areas of tendon insertions, and other areas of connective tissue (Ball and Koopman, 315). The evaluation criteria require that the pain be widespread, and that the symptoms be assessed based on whether they are constant or episodic, or require continuous medication, but they are not based on evaluations of individual joints or other specific parts of the musculoskeletal system. We believe the evaluation criteria make clear the basis of evaluation, and we therefore make no change based on this comment.


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Layman's terms???

We've long thought my wife has fibro. It can be crippling. But knowing little about it, how does one sc fibro? Or does it carry only as a secondary?

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this appears to be the last time that this part of the rating criteria was changed, which was in 1999. Probably just a post for reference and to study.

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