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This eBook will teach you how to get C-Files (paper and electronic) from the VA Regional Office.
How to Get your VA C-File




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    • Full Knee Replacement
      First, if you  have newer x-rays from outside the VA, get them and the reports into your VA med file. The distance from the VA hospital initially is not as important as the distance to a local VA outpatient clinic. But, once you convince the clinic PCP then outside care (consult in VA speak) can be authorized, since the VAMC is farther away than 40 miles. 
    • Dro Review Processing Time
      I sent in an NOD requesting DRO review about two months ago.  Nothing appeared on ebenefits so I sent an ISIS message.   Took them 2 weeks to reply  (ignore their note that days reply would be sent in 5 workdays)   Return meggage said NOD was received but ebenefits is a little behind   Message said a letter was sent to me asking if I wanted DRO review.  Msg said ignore letter because I already asked for DRO in NOD. Here's  the killer.  Average time for DRO review    631 days
    • Code Sheet
      After reading my code sheet I saw I have one of those. I'm rated on my ankle as 5020-5271. It's also static.  To me the code sheet eases the Veterans MNF. I know what my codes are and I know that my contentions are either static or non-static.  This shoulf not be a secret to is at it is vital information. Nor should this be a huge issue to get. 
    • Auto Adaptive Reimbursement
      I'd try to get something in writing concerning changes/refusals, than, "run the flag up the pole" any way that I thought would help. Automatic transmissions are more or less standard these days, so I'd not be surprised about that.  Bureaucratic screw ups in budgets are not a valid reason for failing to provide benefits required by title 38. Looking at things from a different perspective, some vehicle options are often listed as options,even though they are really "standard". A/C and automatic transmissions are just two. Another possible go-around is that different trim levels of the same vehicle have different options as "standard". You could possibly buy a base version, and add options at extra cost, or an up trim version with the "options" already included as "standard". It may be that the VA is looking at what the "normal" buyer options are, and trying to avoid paying for them.  
    • CUE? Not using SMR?
      Yes, if they notice the CUE they can adjust on their own.  I just had the EED adjusted on my initial claims for asthma and left ankle, the rater looked at my entire record while processing my unadjudicated claim for diabetes.  He immediately file a cue and adjusted the EED.  I didn't have to do anything for the EED/CUE. However, my ED was actually a CU they started them in 98 vs. 97.  
    • C&P Exam Results, WTH is going on, Please Help!!!
      Agree with killemall. You got this Navy04, we can't wait for you to come back here and say DONE!    
    • Code Sheet
      Thanks Asknod My problem is finding out the code for the disability.?? PTSD Code has it at 9411&9435 Code for Unspecific Depresssive Disorder VA Notes from  PCP  has PTSD  As : SCT47505003  My Sleep Apnea Notes has the code as SCT 73430006, Some of these I get confused with Insurance Codes  for Insurance Purposes. Jbasser & Jerrel Cook had a blog talk radio show on these rating codes Last year some times Maybe I'll recheck the Archives Shows. I tried to look up the code for OSA but never found it. just the SCT #73430006..?  And I have a Boo-Coo List of NSC disability's/contentions.  with the SCT# at the end of them
    • Auto Adaptive Reimbursement
      Update. My friend talked to the head of prosthetics in Tucson(kristine) and she informed him that the VA will not cover some items like power options,automatic transmissions and a few others.(I can't remember the list of things he told me).These were all covered by the VA previously.
    • NOD / DRO or TARP?
      All, Thank you for the response's. Due to me posting all of my documents intermittently, there seems to be some confusion with the timeline and issues. I will attempt to run thru this chronologically and repost all documents including my 2015 decision which I had not previously posted and answer all questions. March 2009- Filed original Claim for the following issues and received results October 2009 (see 2009 - Rating Sheet below) I do not have the entire decision packet: TBI - 10 % SC Residuals, gallbladder removal - 0% SC Back Condition - declined SC Psoriasis - declined SC PTSD - declined SC / Stressor conceded as combat action badge. October 2010 - Filed NOD / DRO for PTSD March - 2011 - Appeal decision received. I never stated that PTSD was due to MST. The paragraph on page 2 of 2011Appeal decision below is just the last part of 10 pages that I cut out covering rules and US code that they sent in the letter. The actual decision starts at the bottom of that page. Results: PTSD declined - I did not submit any new evidence. Diagnosed as "adjustment disorder with mixed anxiety and depressed mood". Blamed on me worrying about my husband returning to Iraq, even though he had just returned??? October 2014  - Initiated following claims: (I had transferred to the North Texas VA and had finally began receiving treatment after being fed up with OKC VA. I live in southern Oklahoma, so its a drive for me to go to either one) PTSD - Re-open Claim. TBI - Request for increase. May 2015 -  I reported for C&P exams at the Dallas VA clinic for PTSD and TBI. I'm not sure if this is relevant, but I received a call while my husband and I were driving there stating that the TBI examiner had to leave early and they would have to re-schedule that exam. I protested because it is a 3 hour drive. They called me back 10 minutes later stating that he would conduct the exam. He seemed pissed the whole time. His notes stated that No TBI residuals were present.  This is also the exam where the PTSD screener stated "However, it should be pointed out that most of the symptoms the veteran described during today's MH examination certainly those common to a PTSD diagnosis- she also described during her 7/8/09 Initial PTSD examination, in Oklahoma City, three years PRIOR to her son's illness."  ( see 2015 C&P exam notes below) June 2015 - Latest decision received. Results (see 2015 - decision part 1 &2 below): TBI - Decreased to 0% SC PTSD - 50% SC May 2016 - Wondering what my best next COA should be? Would like to get PTSD effective date back to 2009 and get TBI increased to at least percentage it was before. I have about 50 days to file my NOD. Q&A: Berta: What did the C & P doc diagnose you with? 2009 - TBI (SC) and adjustment disorder with mixed anxiety and depressed mood (not SC) 2015 - No TBI residuals and PTSD w/ major depressive disorder.   Berta: Have you googled the doctor who did the C & P? I do not know the Doctor's name from 2009. But I have found several articles referring to a Dr. Gail Poyner who was conducting PTSD exams at OKC VA at the time. She was fired from the VA in 2010 for applying test to Veterans to see if they were malingering or faking. Her research paper can be found here: http://link.springer.com/article/10.1007%2Fs12207-010-9076-x?LI=true I would like to have my C-File to see if she conducted the evaluation.   Gastone: What did you claim as the PTSD Stressors in your 09 app for PTSD? Combat Action Badge   Gastone: The 1st Denial, discussed "No Evidence of Personal Assault," MST? No MST ever claimed. The paragraph that covers PTSD due to MST was just the last paragraph of 10 pages of regulations that they sent with the decision. Actual decision starts at the bottom of that page.   Gastone: Did you know anything about the DRO Process Requirement, for the N & M Evidence? I did. My fault I didn't send any. I was fed up with OKC VA and assumed they would send me for a new C&P exam. Stupid on my part.   Gastone: Did you ever get a copy of your 09 PTSD C & P DBQ? No, I did not. Blue button records do not go back that far. I have requested a copy of my C-File. EBenefits states that I will get it between NOV 2017 and NOV 2018.   Gastone:  Do you currently have a VA MH Psychiatrist/Psychologist that treats you on a regular basis? I was being seen at Bohnam, TX VA. After they kept switching Dr's a few times, I now just get my meds re-filled thru my family physician. My husband is active duty, so we are on tri-care prime remote. I also qualify for VA choice, but have not used it.   Gastone: Have they given you an official PTSD DX? I have a PTSD diagnosis and receive 50% SC in 2015.   Berta: Did they have the incident reports? I faxed in two incident reports. They do not show on the evidence list, but stressor was conceded with CAB.   Flores97: Email congressman for C-File. Thank You for the advice. I emailed my congressman today and reiterated the time crunch I am under.     2011 - Appeal decision.pdf 2015 - C&P exam Notes.pdf 2015 - decision part 1.pdf 2015 - decision part 2.pdf 2009 - Rating Sheet.pdf
    • Full Knee Replacement
      I just came back from the Ortho doctor in town he said I need a full knee replacement for my service connected injury after looking at past 11 years of x-rays from the VA and what he just took today. The Marine Corps. somehow don't keep x-rays after a certain period of time. The VA says they will not do one until I'm 60 years old, all they wanted to do was give me injections for the pain. What I have now is a Torn ACL and I'm running bone on bone, and my knee cap is just about gone so here is the question. I already receive 20% for my left knee, due to the past 3 surgery's. So after having the knee replacement what will I be looking at? for an increase? Does the VA have to pay for this since I live 178 miles from the Nearest VA hospital? because they are still telling me if you were injured on active duty you must go to the VA hospital even through the VA says They will not do a knee replacement until I'm 60? I already talked to two Veterans in town at the Vet center and they had the same problem but they paid for it out of their own pocket for the surgery then filed for an increase award. So far they are still waiting for the VA to answer them back. any ideals on the best route to take? I hate to get this done out in a local hospital then fine out the VA will not pay and give me an increase for the full knee replacement. Thank for any information on this subject.

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bigoc

Fibromyalgia

23 posts in this topic

I was wondering if anyone is rated for Fibromyalgia?  And what was involved in getting it service connected.

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Some claims for fibrolyalgia had succeeded at the BVA:

http://www.va.gov/vetapp09/files4/0928506.txt

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For any condition to be awarded service connection you would need:

1. A diagnosed condition while in service or symptoms of a condition while in service.

2. A current diagnosed condition.

3. A nexus (a medical opinion) that the diagnosed condition/symptoms while in service are related or were the onset of the current condition.

Conditions Automatically Recognized for Service Connection

Many Gulf War Veterans encountered problems when trying to prove that their difficult-to-diagnose or undiagnosed illnesses were connected to military service. This affected these Veterans' access to disability compensation.

In response, VA asked Congress for the authority to provide compensation benefits to Gulf War Veterans who are chronically disabled by undiagnosed illnesses. The 1994 statute authorizes VA to pay compensation for disabilities that cannot be diagnosed as a specific disease or injury, or for certain illnesses with unknown cause, including chronic fatigue, persistent rashes, hair loss, headaches, muscle pain, joint pain, neurological symptoms, neuropsychological symptoms such as memory loss, respiratory system symptoms, sleep disturbances, gastrointestinal symptoms, cardiovascular symptoms, abnormal weight loss, and menstrual disorders.

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Current rating for fibromyalgia:

5025

Fibromyalgia (fibrositis, primary fibromyalgia syndrome) With 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:

That are constant, or nearly so, and refractory to therapy ........................................... 40

That are episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but that are present more than one-third of the time .......................................................... 20

That require continuous medication for control.............................................................. 10

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I have a claim in for it I have been experiencing joint pain and muscle fatigue since about 1996 I did not know what it was until I filed my presumptive claim for skin cancer. I finally recieved a gulf war exam and my PCP prescribed me naproxen 500mg twice a day. I told the doctor at a physical in 2004 and I waviered from push ups in PT and told to walk insted of running. I hope this is enough to show it exsisted in service. The Va must of done a thousand xrays with nothing abnormal. Some days my shoulders and hips hurt so bad I cant sleep my knees have swollen up for no reason and I could bearly walk but nothing showed up on xrays. I will keep you informed gulf war cases are tough to win, despite obvious skin problems I was denied presumptive SC before winning by providing two nexus letters.

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I was diagnosed with FMS and recieve 40% for it. Was diagnosed by my VA doctor and also when I had my c&p exam. good luck with your claim.

I was wondering if anyone is rated for Fibromyalgia?  And what was involved in getting it service connected.

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What would be the difference between Fibromyalgia and Undiagnosed illness?  Fibromyalgia does not have a specific cause.  

As I look at it, it seems that Fibromyalgia is the civilian equivalent of Gulf War related mystery diagnoses.  Yet both are rated by the VA.  

What would be the best to pursue if you have similar symptoms?

I have joint pain, joint swelling, wide spread muscle pain, fatigue, neurological symptoms, sleep disturbances, irritable bowel symptoms.  Would and IMO for a diagnosis of Fibromyalgia from a private Doc or a IMO of multi-symptom unknown diagnosis be helpful.  I think private doctors would be hesitant to put something in writing that says "I am treating this patient but I have no known diagnosis."

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A diagnoses from a civilian or a VA doctor with a statement, stating that you have fibromyalgia, Irritable Bowel syndrome, sleep disturbance, wide spread muscle pain and any other condition you have. In order for a doctor to make this statement they must review your medical records or have been treating you for about six months (not sure on the time frame but think it is six months). Fibromyalgia and Irritable bowel syndrome can be rated separately without pyramiding.

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What would be the difference between Fibromyalgia and Undiagnosed illness?  Fibromyalgia does not have a specific cause.  

bigoc,

You are correct in that very seldom is there a specific cause

know for a persons diagnosis of fibromyalgia.

Once someone has a diagnosis of fibromyalgia -

they then have a diagnoised illness.

jmho,

carlie

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Yes, I have sc entitlement for fibromyalgia secondary to AS rated (separately) at 60%.

Received VAMC dx by VA rheumatologist and then(not intenitonally)confirmed by two community rheumatologists, along with C&P examiner.

Edited by luvHIM

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luvhim,

Yes, I have sc entitlement for fibromyalgia secondary to AS rated (separately) at 60%.

Can you please verify your rating? The max for fibromyalgia is currently 40% is it combined with something else?

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Sorry. Did not state right...I am 40% for the fibromyalgia and 40% for the AS equalling 60% for those two conditiions.

Plus TDIU P&T. So, 100%.

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How did you get the 100% TDIU? How long did it take you to get this? What era did you serve in?[

quote name='luvHIM' date='Oct 12 2009, 07:15 PM' post='170511']

Sorry. Did not state right...I am 40% for the fibromyalgia and 40% for the AS equalling 60% for those two conditiions.

Plus TDIU P&T. So, 100%.

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Interesting I have been diagnosed with this, and just about everything else, Intestinal disease, and all pains everywhere..

The doctors put this in my records a long time ago, but since then more diagnosis's have come been done to explain the pain... but before those, the one catch all diax or Fibromyalgia was used before they found the cause of some of the pain..

Not sure, but I would think the cause would have to be linked to an illness or injury related to the Fibro while on active duty..

If someone gets this later with no relation to active duty, not sure if they would give you benefits for it..

as Fibro is still a catch all for unexplained all over body pain..

but hey! I am just a basket case.. so my case probably will not match other people's illness..

:rolleyes:

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I don't know if you are just a basket case.  I have wide spread pain, joint issues, psoriasis, intestinal, urinary, neurological issues, and sleep apnea and host that i am sure I am forgetting right now.  So there are others with multiple problems.

I am wondering if some of your multitude of symptoms start to get diagnosed or already have a few with diagnosis will that hurt your case for fibromyalgia.  

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My husband is a Gulf War Veteran, He was in combat for several months.... He was diagnosed with fibromyalgia, He was given several medicines until a couple o months the reumathologist prescribed Lyrica, She said she was sorry she couldn't give Him this earlier, but those were the instructions (by who or why she didn't say) and he was sent to acuatic therapy, She told him this therapy will be for life.... His claim for this and other injures are in the post determination team.... any comments will be really appreciated. Thanks....

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As long as he was diagnosed with Fibromyalgia or the symptoms of fibromyalgia in service, it should be fine

hope the best

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Ok, I am confused, the article for fibromyalgia states:

Title 38 laws on Chronic Fatigue, Fibromyalgia, Irritable Bowel Syndrome (unexplained illnesses)

(i) Became manifest either during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2011; and

My husband was diagnosed with fibromyalgia last year, aquatic theraphy didn't work, so why the heck his fibromyalgia claim is DEFERRED????/ HELP

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I'm service connected for fibro at 30 percent.

The claim was deferred because that's what they do.

It has nothing to do with the patient, the diagnosis, the medication or the onset date.

They like to stretch things out because the claim dies with the veteran, when the vet dies while pursuing a claim, regardless of the merits of the claim.

It's what they do.

sledge

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cachanilla73

Ok, I am confused, the article for fibromyalgia states:

Title 38 laws on Chronic Fatigue, Fibromyalgia, Irritable Bowel Syndrome (unexplained illnesses)

(i) Became manifest either during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2011; and

My husband was diagnosed with fibromyalgia last year, aquatic theraphy didn't work, so why the heck his fibromyalgia claim is DEFERRED????/ HELP

VA will most likely request another C & P exam

I filed a claim for fibromyalgia in 2006, VA denied my claim and said I was never diagnosed with the disorder. My Dr. diagnosed the disorder again and then I was service connected for it after two C & P exams.

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Thank you everyone for your responses, this is the best way to learn about the rights and benefits veterans have. We have been fighting to get my husband benefits since 2004, and the claims he has win is because all the information from all of You. Thanks.

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VA will most likely request another C & P exam

I filed a claim for fibromyalgia in 2006, VA denied my claim and said I was never diagnosed with the disorder. My Dr. diagnosed the disorder again and then I was service connected for it after two C & P exams.

My husband already has the diagnosis, physical and acuatic therapy failed and the doctor increased the Lyrica dosis, told Him to learn to live with it, (ha, so easy for them to say that ) One VSO told him since he has the diagnosis, and was a Gulf War Vet, and it was before the onset dateline (dic-31-2011) He should of get the claim automatically, but...... here we are, in Limbo againg. I just don't get why the VA didn't schedule a C&P exam, guess they are trying to find a way out... :D

Thanks for you info...

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