WVSERVER

Congratulations

congrats on the 100% p&t

Congrats, Wish I could smoke but being in a state were its illegal and working for the feds this is a no, no for me. I truly believe it would help my symptoms and be less intrusive then the meds. The only thing is I don't know if I could smoke something into my lungs.

Praying

Good luck and God speed you are in the home stretch now.

http://www.va.gov/oig/pubs/VAOIG-14-03651-203.pdf

thanks for the reply I am in the process of getting a referral, I am also thinking of switching doc as I as secured messaged him many times about fibro then when I see him its a fight to get him to write anything down. The other thing I forgot to add is I forgot about the current diagnose part. This was the first time I have had a C&P doc bring that up my Active service diagnosis have always been good enough for service connection. I know I need to see the Doctor more but it comes to a point were my clinic start getting rude when I am there every week. I pretty much feel like I have the flu every day, and I feel way worse when I exert myself. It all I can do to work my one 8hr day and four 6hr days a week.

thanks for the reply

Looking for opinions on why I keep getting denied for Fibromyalgia I was diagnosed in the Air Force with it but the VBA and VAMC will not recognize it because I don't have enough tender point when I was active duty I was diagnosed with it due to fatigue and wide speared body pain. Here's my last C&P on the issue. I was emailing with a lane coach at my RO and asked why I keep getting denied when I have a diagnosis active service and have been to pain school, pain docs and PT. This was the coach's response. I provided two medical records to the coach from active service saying I was treated for fibro. I feel the exam proves the denial statement to be false. I am leaning towards a reconsideration after I see a specialist at my VAMC I haven't been working all that much lately and can not afford a IMO right this second. As for your claim we have quite a few options: Request a reconsideration Appeal the decision (within a year of your decision letter dated 12/18/2014) After 1 year from your decision letter the Agency would need new and material evidence (from the examiners notes- it would be private medical evidence from a Rheumatologist) The rating decision rendered on 12/17/2014 states the reason for the decision as “ a review of your service treatment reports reveals diagnosis of non-specific myalgia’s and myositis, meaning tenderness or pain in the muscles and inflammation of muscle tissues. You completed an examination on 9/19/2014 at that time the examiner could not provide a diagnosis of fibromyalgia, although you have symptoms. A medical opinion was and completed on 11/3/2014. However, a diagnosis of fibromyalgia still could not be rendered. The evidence does not show a current diagnosed disability. Service connection for fibromyalgia is denied because the medical evidence of record fails to show that this disability has been clinically diagnosed.” Date/Time: 19 Sep 2014 @ 1300 Note Title: COMPENSATION AND PENSION EXAMINATION Location: MARTINSBURG VAMC Signed By: CANETE,LUCILA Z Co-signed By: CANETE,LUCILA Z Date/Time Signed: 19 Sep 2014 @ 1600 ------------------------------------------------------------------------- LOCAL TITLE: COMPENSATION AND PENSION EXAMINATION STANDARD TITLE: C & P EXAMINATION NOTE DATE OF NOTE: SEP 19, 2014@13:00 ENTRY DATE: SEP 19, 2014@16:00:13 AUTHOR: CANETE,LUCILA Z EXP COSIGNER: URGENCY: STATUS: COMPLETED Fibromyalgia Disability Benefits Questionnaire Name of patient/Veteran: Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence review --------------- Was the Veteran's VA claims file (hard copy paper C-file) reviewed? [X] Yes[ ] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: vbms efile; VAMC 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with fibromyalgia? (This is the condition the Veteran is claiming or for which an exam has been requested) [X] Yes [ ] No [X] Fibromyalgia Date of diagnosis: 2005 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's fibromyalgia condition: 33 years old USAirforce veteran from 2000 to 2006, is here for a C&P evaluation on his current condition of fibromylagia. In 2003, he started coming unexplained fatigue which described coming with similar symptoms when one suffers from flu-like symptoms when one developes generalized muscle soreness, insides of both legs, thighs, shoulder and neck areas and medial side of both arms and achiness of both hands (described it as fatigue feeling). When he would wear the body armour, he feels that his entire body feels sore and touch of the armor which is heavy makes him feel the soreness. More noticeable over the medical surfaces of the thighs. During his active service he worked with Nuclear Program at Minot, Airforce Base, North Dakota he is on strict monitoring due to the sensitivity concern of the program. (Perosonal Reliability Program). Around the same year 2003 the Base physician and several times 2003-2004. He was tried on Amytriptylline 25 mg po hs which helped X 2 months only to return back to his initial symptoms. 6 months before he left the USAirforce, he had sleep study done which confirmed sleep apnea which he wears CPAP to date. It seemed to help his drowsiness during the daytime but it has not affected his sensation of muscle soreness. He had a medical board but was honorably discharged. He was recommended not eligible to re-enlist and or serve the remaining 2 years of inactive reserve. He has been coming here at Martinsburg VA since 2012 for scheduled Compensation & Pension Evaluation. He has been placed on Sertraline for depression which did not help his body pain. It has been discontinued and not on any medications. He sees the Pain Mgmt for his neck complaints and have an appointment for PT regarding the rest of his body pains. Reviewed vbms STRS efile: 11/10/2005: Routine Physical Examination Note on his active problem list: Mylagias/Myositis (Non-specified) Multiple progress notes/Behavioral Clinic: Mild Depression 2003/ Major Depression 2005/ Involutional Melancholia 2005. Medications: Amitriptylline 25 mg po qd (prescribed to problems with Depression) No specific mention that this was given for fibromyalgia. 1/25/2005 Progress notes: Mentioned that member was seen prior for fibromyalgia which responded well to Elavil a hs. Mention about implication for his work statys (PRP) using Elavil. There as a discussion with Dr. Higgins who mentioned that the medication causes no limiting side effects, and is not being used for anti-depressant purposes, that this case does not automatically require PRP suspension. Memorandum from XXXXwritten by TODD P Huhn, CAPT, USAF, MC XXXXXhas been seen for symptoms consistent with fibromylgia, a condition of chronic muscle pain. He responded very well to medication for this which he takes at night. This is not being used as an anti-depressant medication. After conferring with the AFSPC PRP medical consultant, Lt. Col Higgins, we concurred that Sra XXX was medically cleared to take this medication and maintain his PRP clearance. Routine H&P by an outpatient primary care provider at Martinsburg VA 7/18/2014: LOCAL TITLE: PHYSICIAN, PRIMARY CARE/OUTPATIENT CLINIC STANDARD TITLE: PRIMARY CARE PHYSICIAN NOTE DATE OF NOTE: JUL 18, 2014@08:59 ENTRY DATE: JUL 18, 2014@09:01:34 AUTHOR: VU,PETER D EXP COSIGNER: URGENCY: STATUS: COMPLETED CHIEF COMPLAINT: chronic neck strain w/ headache PRESENT ILLNESS: said he has chronic neck strain and occasional tension headache w/o any trauma or injury. pt said he needs clearance to participate in walk for wellness at home. pt gained some wt w/ BMI >35. Today,PT denies any SI or HI,fever,chills,sob,cp, productive cough, n/v,abdominal pain,vision problems, weakness, dizziness,headache, change of bm,orthopnea, palpitation,syncope, LOC, urinary or stool incontinence, hematuria or hematochezia. PAST HISTORY: Active problems - Computerized Problem List is the source for the following: 1. Recurrent major depression (SNOMED CT 66344007) 09/30/13 ASGHAR,ALI 2. Nonallopathic lesions of rib cage 3. Pain in Thoracic Spine 05/09/13 NEFF,SHAWN M 4. Somat Dysfunc Thorac Reg 05/09/13 NEFF,SHAWN M 5. Somat Dysfunc Cervic Reg 04/09/13 NEFF,SHAWN M 6. Cervicalgia 04/09/13 NEFF,SHAWN M 7. Headache 8. Hyperlipidemia 01/24/13 VU,PETER D 9. SUBJECTIVE TINNITUS 01/23/13 SHALLIS,JULIE B 10. Depression 01/18/13 VU,PETER D 11. GERD 01/18/13 VU,PETER D 12. Anxiety 01/18/13 VU,PETER D 13. Cholelithiasis 01/18/13 VU,PETER D 14. Hx of tobacco user in remission 01/18/13 VU,PETER D 15. OSA on c-pap 01/18/13 VU,PETER D 16. Hx of tinnitus 01/18/13 VU,PETER D 17. Irritable Bowel Syndrome PHYSICAL EXAM: GENERAL: ambulatory, awake, alert, oriented x3,nad, pleasant,obese young man. HEENT: PERRLA. Clear oropharynx and tympanic membrane. no sinus tenderness. no cervical adenopathy. NECK: No bruits or stiffness. Good ROM w/o difficulty but mild discomfort on rotation and moderate trapezius muscle stiffness on palpation. CHEST: Chest normal shape and symmetrical.No masses,tenderness or other abnormalities LUNGS: Clear, no crackles, wheezing, or rhonchi. HEART: RSR, no murmurs, no gallop ABDOMEN: obese. Soft, non tender, positive bowel sounds, liver and spleen are not palpable. No rebound tenderness to palpation. BACK: No cva tenderness or point tenderness.slr negative. EXTREMITIES: No edema. Good ROM w/o pain or difficulty. Good muscle strength and tone plus well developed muscle. nl sensation and good radial pulse and capillary refill. NEUROLOGICAL: Cranial nerve intact, no focal deficit, ambulatory w/o difficulty. ASSESSMENT: - Hx of chronic neck strain: discussed and full explaination about his condition and booklet about neck given w/ instruction for home exercise. increase flexeril to 10mg qhs prn w/advise of side effects and continue heating pad alternate w/icepack. pt already was tx by PT, chiropractor and pain school in past. pt said he does not want to be on pain medication. pt had xray of neck in past was negative. -hx of IBS: Discussed and tx w/ bentyl 10mg bid and metamucil and f/u GI as directed. -hx GERD: on prilosec -hx Depression/anxiety: stable and denies any SI or HI. f/u w/ MHC as directed. -hx of OSA:stable on C-pap b. Is continuous medication required for control of fibromyalgia symptoms? [ ] Yes [X] No c. Is the Veteran currently undergoing treatment for this condition? [ ] Yes [X] No d. Are the Veteran's fibromyalgia symptoms refractory to therapy? [X] Yes [ ] No 3. Findings, signs and symptoms ------------------------------- Does the Veteran currently have any findings, signs or symptoms attributable to fibromyalgia? [X] Yes [ ] No a. Findings, signs and symptoms (check all that apply): [X] Widespread musculoskeletal pain [X] Fatigue [X] Sleep disturbances [X] Headache [X] Depression [X] Irritable bowel symptoms For all checked conditions, describe: Musculoskeletal symtpoms: 1) constant sensation of 'muscle fatigue/sore'on both anterior thighs, skin feels sore over the medial portion of both thighs, localized sensitivity(soreness) over the specific medial portion of both arms, bilateral scapular muscles and back of his neck. 2) Feels tired even if he has not done anything but can still do his routines both at home and at work. 3) He feels no motivation, problems with concentration, crying for no reasons, feels anxiety and hx/o bouts of panic attack and chest pain while in the active service. Diagnosed with Depression while in the active service and was not placed on medication because he wants to continue working with Nuclear Program. Taking a anti-depressants will disqualify him from that program. He was evaluated by a psychologist. He was receiving regular psychological therapy while in the active service. He is currently seen by psychologist here at Martinsburg VA and received Cognitive Therapy and currently on the HOPE Program (Group Therapy). No medications for depression given to date. 4) Hx/o IBS and is service connected for IBS. Takes Dicyclomine BID. He said his current meds seem to help him. b. Frequency of fibromyalgia symptoms (check all that apply): [X] Constant or nearly constant c. Does the Veteran have tender points (trigger points) for pain present? [ ] Yes [X] No 4. Other pertinent physical findings, complications, conditions, signs and/or symptoms ----------------------------------------------------------------------------- Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis section above? [ ] Yes [X] No 5. Diagnostic testing --------------------- Are there any significant diagnostic test findings and/or results? [ ] Yes [X] No 6. Functional impact --------------------- Does the Veteran's fibromyalgia impact his or her ability to work? [ ] Yes [X] No 7. Remarks, if any: ------------------- He now works both patroling and now in the office. He has so far able to carry on his duties as a security officer. Physical examination today revealed: (-) direct tenderness on palpation over the occipital, supraspinatus, sternal, knees. He points to overall sensation of soreness on his neck area, and localized sensitivity on the bilateral thigh muscles and linear medial thigh bilaterally and medial areas on both arms. Strength 5/5 all throughout. Sensory are all WNL both upper and lower extremeties. This is the second opinion given by the same doc Medical Opinion Disability Benefits Questionnaire Name of patient/Veteran: WVSERVER Indicate method used to obtain medical information to complete this document: [X] Review of available records (without in-person or video telehealth examination) using the Acceptable Clinical Evidence (ACE) process because the existing medical evidence provided sufficient information on which to prepare the DBQ and such an examination will likely provide no additional relevant evidence. [ ] Review of available records in conjunction with a telephone interview with the Veteran (without in-person or telehealth examination) using the ACE process because the existing medical evidence supplemented with a telephone interview provided sufficient information on which to prepare the DBQ and such an examination would likely provide no additional relevant evidence. [ ] Examination via approved video telehealth [ ] In-person examination Evidence review --------------- Was the Veteran's VA claims file reviewed? Yes If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: vbms efile/VAMC MEDICAL OPINION SUMMARY ----------------------- UPDATE Information for Clinical Diagnosis of Fibromyalgia: Hints for early and cost-effective diagnosis of fibromyalgia Chronic widespread musculoskeletal pain for =three months Absence of other systemic condition accounting for pain Excess tenderness in soft-tissues Characteristic symptoms: ? "I hurt all over" ? "It feels like I always have the flu" ? Fatigue, sleep and mood disturbances ? IBS, irritable bladder, multiple other somatic complaints Exclusion of structural or systemic disease ? Not a "fishing" expedition ? Avoid "screening" rheumatology tests ? Most efficient with early subspecialty referral Recommended diagnostic workup for fibromyalgia Establishing the diagnosis is an essential component of FM management. Diagnostic criteria for FM include the ACR and the Canadian Consensus Guidelines. A complete history, physical exam, and laboratory testing should be done to exclude diseases that may mimic or complicate FM. Each patient should be assessed for a =three-month history of chronic widespread pain; patient self-report should be used as an index of pain. The presence of tender points should be confirmed. However, tenderness is subjective and depends upon the examiner's strength of palpation. FM: fibromyalgia; ACR: American College of Rheumatology. Data from: Goldenberg, DL, Burckhardt, C, Crofford, L. Management of fibromyalgia syndrome. JAMA 2004; 292:2388. Graphic 56396 Version 4.0 Mr. Booth have several of the subjective symptoms compatible with Fibromyalgia as well as the other co-existing conditions which can exist with its diagnosis. Review the STRS: He has been diagnosed with Non-specific Myalgias and Myositis-active service. An opinion was made one time by his superior that he has symptoms consistent with fibromyalgia and was given Elavil. It was primarily indicated for it and not for depression and to be able to work with RPR (Nuclear facility). Reviewed all his outpatient clinic follow-ups by his primary care provider here at VAMC Martinsburg since 2012 and there has been no specific diagnosis of Fibromyalgia. He was diagnosed with Chronic Neck pains, Headaches, Depression on Rx.and He has been referred to Chiropractic Tx. multiple times and has been DX as Somatic Dysfunction on the cervical and thoracic spines. My physical examination during the C&P evaluation fall short of the physical criteria of specific number of trigger points to diagnose Fibromyalgia. His main sore spots has been primarily on his neck and thoracic areas, supraspinatus, soreness on both thighs. He has not been referred by any of his primary care providers here at Martinsbsurg to see a Rheumatologist to rule out any other inflammatory musculoskeletal conditions. Reviewed earlier serological testings while in the active service has been non-diagnostic. At this point one can at least assume, that his documented symptoms noted while in the active service are similar to his current symptoms. It is at least as likely as not (50% probability) that his current multi-symptoms is consistent with fibromylagia. He has not been referred to a Rheumatologist who can evaluate him and confirm this diagnosis and have ruled out any other rheumatological conditions. He is currently not treated for fibromylagia. Comments on the functional loss/impairment questions: He has constant soreness on his neck, trapezius muscle areas all the time however, he is able to accomplish all the ROM. I stand corrected that I should have noted pain on movement. RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: Clarification on the physical examination done C&P evaluation on 9/2014: See 2507 request: b. Indicate type of exam for which opinion has been requested: ACE- Fibromylagia ************************************************************************* /es/ LUCILA Z. CANETE,MD PHYSICIAN

congratulations

Congrats on the award you got awesome advice in the above post.

I don't agree with ether one of the above Ranger 11 bv is posting to the correct topic to the correct forum. Its simple if you don't like it don't read it but don't alienate a brother. Some of us are interested in the corruption in the VA or infomercial as you call it.

praying

How do you all manage treatment, work and homelife because it stress me out we I have to be at the VA so much for groups and treatment plus work and home I end cutting it short the VA wanted me to attend 4 groups a week plus weekly counseling and monthly doctor visits its way too much. But then they act like if I don't do that I have no chances of a full recovery. My goal has always been a full recovery over compensation I have just not been able to obtain the results.

This whole contaminated site issue is way out of hand in my opinion the netfilx documentary titled Simper FI show all the heart ache and pain a retired Marine went thru to get the Government to acknowledge and make the proper notifications about the Camp Lejeune issue. At one point the Government tried to say they did not know who was on Camp Lejeune during the contamination years. I do caution anyone who watches it because it a sad stories as the Government cover up killed kids and will piss you off.

I for one feel that the calamite of the VBA is built into there system it not that they can't read. The way veterans are treated by both the VAM and VBA is budgetary for the most part and no one wants to come out and say it. For example when a 100% P&T/SMC vet dies it makes room for a few more vets at a lower rating but this is just my opinion since no one tracks how many SC vet die to how many initial claims get approved. I would bet the number correlate.

I have been there brother georgiapapa is given you great advice. I am even worried to have my wife sit in on my secessions but I get thru it and in the end its a big help to our relationship. I have hid a lot of the way I feel and think from my wife over the years. When my mental health conditions are really over whelming me I can be short tempered and triggered easily by loud sounds other around be perceive and think I am mad at them when it really has nothing to due with any one personally. But getting to that place were my family and wife can understand and support me has been along but worth while journey. Seeking care for your wife is just as importing as seeking care for yourself it took me along time to realize all the suffering my wife goes thru with three kids in tow to help me deal with my problems.

I was never in combat I have all the symptoms you state which started in service for me my VA Doc say I have all the classic symptoms of PTSD but lack a stressor for VA standards which I agree with I am service connected for Major Depressive Disorder with anxious distress. I have been thru CBT, CPT and Bio Feedback. So even if you don't think its PTSD still seek help all the recycling of emotions really becomes hard on our families seek help and support for them also.

I side with the vet what would he have to gain by lying http://www.va.gov/oig/pubs/VAOIG-13-03411-167.pdf

This is a subject that I am always confused by because none of my award letter state anything about a re-exam one way or the other how ever the my C-file did contain a few pages from virtualva.gov that shows that the VSRO mark the static box after all my service connected disabilities.

This has happened to me a couple of times don't worry about it. Prof is prof even if the doc has a negative opinion.

This is something I have always been confused by, do they count the five years from the time you were officially service connected and rated or to the date you were back paid to for me they service connected be back to march 2011 but did not officially rate me until 2013. My first and second letters when they rated me at 70 and 90 contained no mention of a re-exam date.

Good luck guys

Cool I narrowly missed an adverse incident last Friday with the VA I had an EKG prior to having some GI scopes I never heard a word about it but on the day of the scopes I brought it up and asked it anyone looked at it. Well they looked at it and my heart rate was not like by the DOC so all scope were cancelled. I was sent over to my PCP and low and behold once I see the Doc first words out of his mouth is you are here to get you Plavix refilled right. No Doc I don't take Plavix he you sure then he corrected himself and said sorry I am on the wrong record you are not 58 either. Anyway all this earned yet another nuclear stress test, echo cardiogram and halter monitor. I have a great fear of the VA putting me under and killing me to get another 90%er off the books they are not helping this fear.

I agree get copies of everything, I was meb/peb boarded out of the Air Force for sleep apnea actually they let me finish the 6months or so left on my enlistment, honorable discharged me but did not allow me to reenlist by a reenlistment code of kbk and was never given a rating from the Air Force and knew noting about the VA. My liaison did mention I could apply to the VA but maybe would get a zero well I would have receive 50% right off the bat. No one will stick up for your need only you will so don't be afraid to. Start reading now so you know what to expect from the VA there is a 38 CFR forum hear on hadit.