invisible

I am reading up on all you typed here, and I hope I do not sound ignorant... but I am right to assume this is from someone else's determination in a similar case? I have a healthy distrust for VA doctors but am wondering if I should contact my VA outpatient clinic and ask for a GW eval and rheum referral. I just started going to a civilian doc and ortho, but my distrust is resulting in me having to pay out of pocket for MRI- which granted my deductible is met for the year but I am still responsible for 20%co-insurance. What do you guy think is wise. I know my questions are never-ending, and forgive me for that... And I appreciate everyone's input here, you guys are very helpful.

My primary care MD has been treating me for over a year and told me it was fibromyalgia. But once I requested he fill out the DBQ, he refused. And his notes would do more harm than good, because he hardly detailed 1/2 of what was done and said, and then said other things were managed that I continued to complain about- but that he said there was nothing to be done. I have documentation thorought my MIL medical record of symptoms that are indicative of fibro. I am waiting on getting a new copy of my file- so I can go page by page. In my c spine I have a buldged disc @ c5-c6, narrowing where the nerve is, and a non-c-curve. In my L5/S1 area I have osteophyte with boney islands, degenerative changes, sacrolititis, etc. The latter was the main reason for my MEB. I have been keeping a pain dairy, but will take your advice and track range of motion. The reason that the DDD/DA in the c & l/s are 0% is because my ROM isn't bad enough. The Rheum MD said that Degenerative arthritis doesn't always have to have limited ROM to be significant. I was surprised by that because the VA will not acknowledge its a real problem without significant ROM... So, yeah, I need to go through my file page by page when I get it.

Thanks! SInce all of this, and the fact that my deductible is met for the year, I have made other appointments for IBS and GERD, so that it may be documented right. so I am not only reloading, but trading in for a better weapon. Thanks for the encouragment! This whole process is exhasting...but I am not going to back down!

and I will post here my original determination- it screams Fibro and arthritis IMHO. Some things, as I mentioned previously, I am fighting, Such as rhinitis, sleep apnea, headaches, higher IBS because how the pain and alternating affect daily activities, etc. Basically we are appealing anything that is an issue and I actively being treated for. When I got out, I ended up having two kids. So that for most of the time after seperation, I was either pregnant or nursing until just over a year ago. I mentioned this in my personal statement, that I couldn't take my meds and the VA would treat me when OBGYN was my primary. I would still go and complain of my symptoms regardless.

Here is what is on ebenefits- blue button, I did complain of pain and flinching, and I have significant crepedation...which was remarked by her first. This is why I refuse to be treated at the VA primarily, I know less is more, most be the directive to VA md's concerning documenting pt's issues. Another thing is that I was told that the appointment was related to FM only, but it was listed as a general gulf war exam. I mentioned IBS, TMJ, all the other stuff and how much of it flares worse together and that was not noted. And I told her that I have a 3.4 right now, but that I am failing a science class right now because its just too much- I am taking A&P 2 which is a super intense course and I am overwhelmed. And that the school I am transfering back to, I had failed chem for the same reason, so the institutional gpa there is worse... I do well in the social sciences where I naturally do well even if I do not open the textbook. I told her I have hardly any energy and do what I can for my kids but beyond that, I sit becuase I hurt and do not have the energy. And that sometimes I either do not go to class or cannot focus due to the discomfort. I copy and pasted the pertinent, and left out labs. She also said that I had no symptoms... but it doesn't surprise me that in one appointment a Rheumy said it is highly likely I have FM, but the VA doc says no, and didn't even do anything near or similar in physical exam to what was done today. The labs taken today were related to arthritis and other rheum conditions and reg blood work- and the VA did epstein barr and reg blood. I swear they do it that way on purpose, or I am just paranoid. Describe the history (including onset and course) of the Veteran's fibromyalgia condition: Reports that she has been treated for nerve pain/fibromyalgia. Medications are Gabapentin Baclofen and Cymbalta, no side effects from medication. Diagnosed by her PCP Dr. Sam Peng, private practice. Stated he has refused to complete the DBQ paperwork because it is to confusing. Diagnosed 9 months ago. She has no swelling of joints but feels as though they are swollen, no diagnosis of Epstein Barr virus or mononucleosis, no history of lyme's disease, thyroid disease nor connective tissue disease. She requires no power scooter, crutches, cane or walker, to aid in walking. States has he has 2 children 2.5 and 4 years, she does what she has to do for them and sit down. Currently unemployed but is a full-time student, major is occupation therapy assistant, with plans to transfer back to Georgia Perimeter College, for Associates degree in Psychology to Currently taking a full load, no problems with attending class, she has lack of focus and energy but she has ADD, GPA 3.2. Pain is located " it is a chain reaction, lower back and radiates to the hips and buttock to lower legs, numbness and tingling aggravated by certain positions and driving for long distances, her neck pain radiating to shoulders, sensation of knotted rubber bands deep inside, ultimately pain is described as a shooting and pinching pain in the joints and deep muscles and knots, pain is 6/10 good day, bad day 8.5-9/10. The medication does help to provide some relief. When her pain increases she has other problems with TMJ, IBS and headaches. She does have sleep apnea, which is allowing her to get more rest. The veteran has claimed a disability pattern of fibromyalgia, associated with the environmental hazards of South west Asia (Iraq). Fibromyalgia a diagnosable chronic multi-symptom illness with a partially explained etiology. It is less likely as not that the claimed condition, is a disability pattern that is associated with a specific exposure to Southwest Asia environmental hazards, medical literature does not provide evidence to support claim. Service treatment records, document veteran complained of fatigue with decreased libido, requested Implanon birth control removal. Diagnosis is absent from DOD records, Altoona and Wilkes Barre Pennsylvania VA records. Atlanta VA medical records have no diagnosis or treatment for fibromyalgia. Highland Rivers progress notes document no initial assessment of fibromyalgia 8/21/2015; however, on return visit 8/25/2015, it is documented veteran has stated VA sent her for Cymbalta 30mg, for fibromyalgia. Fibromyalgia is a diagnosis, after a medical evaluation has been completed, the records are silent a medical evaluation, to rule other disease states. Current labs are normal, except for a positive Epstein Barr Virus (EBV), which has some co-existing symptoms of fibromyalgia but transmission is usually through infected saliva. It is less likely as not the veteran incurred fibromyalgia during active duty service, etiology of diagnosis is unknown at this time, this is a self-reported diagnosis, no records were presented from Dr. Sam Peng's office, further comments would be speculative. The veteran was able to complete range of motion of her upper and lower extremities, without complaints of pain, weakness, fatigability, or incoordination. There are no current range of motion measurements available during an exacerbation and this examiner has had no contact with the patient during a flare-up; this provider cannot determine or accurately estimate the degree of functional loss of this joint without resorting to mere speculation.

I know that the primary reason is because my Primary care MD refused to fill out the DBQ related. The notes he did make were sub-par, which I didn't realize until it was too late. And he stated things like my IBS being managed when I continued to have problems, its just that he said there was nothing really that could be done. He was thorough during appts, I guess he just lacks annotating it in notes. The Rheum MD I saw today believes that it is highly likely I do have fibro but ordered lots of tests to rule out other things before she says it definitively. It is a little complicated because I have SC and established degen. arthritis. It seems like they (VA) is using my Epstein barr results against me, even though in interpretation, tests just show that I have had mono it in the past. I tested neg to an acute infection, but positive to the parts that point to a past infection and antibodies. It must be convient to use something like mono, which most people have had in their life. Since this whole debackle, I have decided to make appointments with specialists related to all my issues, and never to assume that they are accurately noting what I complain of or what they say and do in the appointment. I had an ortho and rhuemotogy and am scheduled for an MRI, and just had x-rays done both yesterday and today. It will be documented by the time I appeal. What does bother me is that I complained about stuff related to muscle and joint pain in the military, fatigue, etc esp to my nurse case manager in the WTU which I know is noted, along with in my MEB evaluation... not to mention physical therapy etc, etc. I am waiting on getting a new copy of my full medical file, and I will go page by page and make folders for each condition and fill each folder with stuff related to each condition. I don't see how a physical examination should be abnormal, when you cannot "see" FM like...say rheum arthritis where there is swelling, but I digress.

Yikes! My doctor said that 81% was bad, I assumed that it was bad but 73 is significantly lower! Now I understand the SA... I think in terms of SA branching off to either CSA and OSA or a combo of both, and just "SA" threw me a curve ball. I guess my medical terminology class is actually helping me over complicate these short hand abbreviations here. Thanks for the input!

Basically, what I am most confused about is that they denied SC but in the notes section stated Enviromental Hazard in Gulf War. Does Gulf War related file have to be filed first, before fibro can be SC? I understand the medical side much more than I am experienced with the VA technicality side, hence why I am here now, asking questions.

There is a whole group of conditions/symptoms that are related or commonly co-exist with Fibro. If you look at my original claim, I have basically most of them. I was amazed at the overlap, and many of the related symptoms/conditions are also other things that show up in unexplained illnesses of Gulf War. Just compare the lists in these two articles: http://www.cfidsselfhelp.org/library/overlapping-and-related-conditions and http://www.publichealth.va.gov/exposures/gulfwar/medically-unexplained-illness.asp . Right now regarding to my primary care civilian MD who "doesn't feel comfortable" filling out the Fibro DBQ, I am still going to try and get him to fill out other ones related to things I currently have on appeal. In addition to seeking specialists and eventually asking them also. Beyond that, I will probably seek a IME, even if I have to travel far for it, and make sure the MD is highly qualified and has much more experienced than whoever is reviewing my file at the VA. While Obstructive Sleep Apnea is obstruction, normally in the throat, it is not always just there. Depending on the size and position of the tounge, basically anything related to airway that can become obstructed....whether it is the nasopharynx, oropharynx, larynopharynx, etc. In my case, when I first had a sleep study done, I presented with significant snoring, and the ENT evaluated me structurally, and based on my deviated septum, snoring, and sinus irritation, she did the UPPP, basically fixing my deviated septum, shrinking my turbinates, removing part of my uvula and soft palate, and tonsilectomy. This surgery did eliminate snoring, but aside from that nothing changed. My actual obstruction is that my larynopharynx airway is smaller in diameter than it should be I think 3-5mm and it calapses partially while I sleep. I asked if it was possible it would be from structural issues in my cervical spine or what- and he said it is possible that my cervical problems could have redcuced the airway or contributed to other things that might also cause it- there is no way of telling definitively. In the long explaination to my original claim determination, the only justification for denying SC for sleep apnea is that I have not had another study and that I report not snoring anymore. Hence why I had a sleep study done and am now prescribed and using CPAP. My ENT doc is double board certified, also holding a medical degree in Sleep Apnea related- so he is the one who both physically evaluated my ENT and reviewed and interpreted my Lab sleep study results. He actually also diagnosed me with plms, rhinnitis with atrophy, delayed sleep phase sleeping disorder, in addition to the OSA diagnosis. What are you referring to "SA"? service aggrevated? vesus SC? While I was getting out through my MEB, I had alot of documentation. I was complaining about symptoms back then, that are the same symptoms which now are identified as Fibro symptoms. And I asked the VA doc for sleep study and he denied it saying he thought it wasn't resp but rather MH. My civilian doc is the one that was scared to fill out the FM DBQ. I might not have been clear enough on that.

I totally agree with you, and would never take offense to you stating that. With my doctor treating me over a year, I never imagined he wouldn't fill out the papers. I never planned on going to my C&P without doctor documentation. But I was to trusting to my civilian PCM, and even though he was going to fill them out, he refused later. I learned my lesson. I have corrected my course of action and am going to specialists, and plan on getting both an IME and IMO done after I have been treated by specialists, even if the specialists fill out DBQs, too. Next time I am going to have stuff in hand before I file. And I am going through a private VA lawyer local to me. Ironically the VA is fighting most of what I was medically seperated for, but I have a combined rating for mental health and IBS/Gerd of 60%. 50 for Chronic adjustment mixed anxiety and depressed mood w/ insomnia 50% and IBS/GERD 10%, but the things I have the most documetation from they are fighting.

I did not ask a VA doc to fill out the DBQ because I trust a civilian MD more and do not go to the VA PCM but biannually. I just didn't expect my MD to refuse to fill out the paperwork. I will be much wiser picking out providers from here on out. Sleep Apnea-(I had a study while on active duty and they refused to give me a cpap- my AHI wasn't high enough and had me have an ENT surgery instead). They never rechecked me while on active duty. SInce I reported that I no longer snore (due to the surgery UPPP) they equated that as my apnea being resolved. I requested it but they said, while I was in the Warrior Transition Unit that the VA would provide a sleep study when I got out. My fully developed claim which was filed in 2011, wasn't dealt with till late 2014. It hurt me that I didn't have much treatment during those years. Everytime I went to the VA about something, they couldn't do much because during those years I was pregant and/or nursing and that OB/GYN was considered my PCM. But I brought up the stuff to them anyways... I am in the process of appeals to many of the things that I was actually MEB'd with. I received a sleep study recently. After I knew my private insurance would cover it, I still contacted my VA PCM to see if he would put me in for a sleep study before I went ahead with it via my private insurance. He (the VA doc) refused saying that he didn't think it was a respiratory issue but rather a mental health one. I went ahead with my insurance and when I got the reulsts back my AHI is only 11, but my RHI was 19 (moderate) and my oxygen level was only 81% all night, which is dangerous. My ENT civilian doctor said that just bc you don't snore has no bearing to apnea, which is common sense- and that they should have rechecked after the surgery. I made sure to provide a copy of the results to my VA doc to let him know that it was indeed a respiratory issue, not a mental health one. I knew he was saying that to try to pass my issues off on something I am already rated for. Thats why I prefer non-VA. I feel much better with the CPAP but am still exhasted, worn out and having the same issues, atleast I now can get oxygen-rich sleep even if I still feel like a train ran over me, daily. I am going to bring up my conditions from the military, and the "new" diagnosis. The thing is the complains related to fibro, I was complaining about while I was still in the military...so I think its just going to be an up hill battle, but one I am willing to fight.

Yeah that is what I thought, but I did a google search and found va disability appeals with Epstein-Barr related to both fibro and CFS among other Gulf War conditions. There are different aspects they look at, and I tested negative for an acute Epstein-Barr infection, but showed that I had the antibodies related to a past infection. I have documented upper respiratory infections and mono documented. The acute marker if positive would undermine the claim but that was the one negative I had in the panel of four. Therefore the similar symptomology of Epstein cannot be a more "convenient" explanation because my labs ruled that out. But I also read that Epstein Barr is suspected to relate/trigger/contribute to things such as CFS, FM, etc. With all that on both sides, it becomes a gray area where it could help or hurt either way makes it kind of confusing for the bottom line. I only go to the VA 2x a year, generally. I have a healthy distrust and prefer to go the civilian route. I had a PCM who was an Internist, who has been treating me with medication for nerve pain, fibro, chronic headaches, IBS, etc. I asked if I needed a specialist to confirm and he said no. Then after over a year of continual treatment, I brought the Fibro packet for him to fill out and he stalled and then refused to fill it out saying it was too confusing and that he didn't feel comfortable filling it out. Once I requested his notes, I realized that only half of what he did was noted. I learned my lesson, periodically retrieve notes, and I should have requested a referral to a specialist months ago. Live and learn... Next week I have an ortho and Rheumatology appointments. This hassle with the PCM is a great segway to bring up everything right away. I didn’t want to bring up claim type stuff right away last time, because I didn’t want my PCM to be prejudice in his treatment. Since I have DDD/DA and issues in my cervical and lumbar/sacral, and fibro, I will explain all of it and just explain I want to figure out what the heck is going on. Yeah that is where I am at now, I have multiple appointments with specialists next week. And I am a Gulf War veteran, I was deployed to Iraq and qualify for the registries related to the hazards. Concerning the presumptive conditions, tell me about it! At least the VA recognizes I have FM. I am confused that they listed it as environmental hazard, but denied SC, esp since it is presumptive. I must be missing something…

I just recieved my determination for Fibromyalgia. They listed it as a disability, denied SC, but in the notes listed enviromental hazard. What does this mean? I wasn't expecting to be approved, since at the last moment, my primary PCM declined to fill out the Questionaire. Just wondering if anyone had any insight. Out of all the labs they took, the odd one was the Epstein Barr. I am not sure if that is to confirm, rule out FM... IDK. Thanks in advance for any insight! fibromyalgia Not Service ConnectedEnvironmental Hazard in Gulf War

I would prefer to, time is money, and I bet you spent plenty of time on these ebooks!

USMC_VET- I plan on donating on Friday. I went a head and downloaded some of the ebooks, but Friday is payday this month. I hope that is okay. I know you said it is free, but I would rather donate. I have a Lawyer who helps, but I like to wrap my head around all the ins and outs, and prefer reading the regulation when it comes to this type stuff. I don't just figure the Lawyer should know, but do my own duew deligence and these will help me better understand the implication of a lot of the codes and rules I have been studying. -Me

That is really helpful! Thanks!

I choose the name "invisible" not because I feel invisible, but rather because I thought it might be ill-advised to use my real name, and was not in a particularly creative mood to make up a more clever username. Plus I am in the middle of starting up my own forum for something unrelated to VA type stuff, and my administrator account username is "invisible" (to be gender nuetral, males sometimes react differently to a female and if I need to moderate a thread, me being a female will in that case be a non-issue). I know the back story to my username is off-topic, but thought I would explain it anyways. I just recently requested my personel and service medical records (I had but were lost in a move). I will have to ask my lawyer about the C-file.

While it would be nice to ask her to do that, I do not want to go that route. Granted she is a step-sister, but I would rather not take advantage of her, and use her as a sounding board and clarification.

I was med boarded through a WTU in 2011, recieved my determination in 2014. After the ourcome of the determination, I hired a Attourney. What hurt me in the determination is that the whole time since seperation, I was pregnant or breastfeeding and therefore that affected MD documentation following my seperation. Every time I went to the VA about things, they said that due to pregnancy etc OBGYN was my primary. I currently recieve 60%, but many of the things they sc with 0% or denied-which I am going to fight. So once I hired a lawyer, and I started to dilegently go to a civilian doctor, to recieve my treatment for all my issues. Fast forward, I have some areas that have empirical tests (sleep apnea, plms/rls from my awesome double board certified MD in sleep and ENT specialty)... but many of the things I recieved 0% on were due to ROM measurements not being limiting enough. I did not discuss this with my primary care (my intent to claim/appeal bc I didn't want that to make him biased or stereorype me...many people do not understand the difference in MIL/VA disability and SSI/SSDI. They trasnfer their stereotypes of civilian disability over to MIL-related disability...), but all these issues have honestly been getting worse, and I want to get to the root issues. Anyways, my PC MD begun prescribing me gabapetin for nerve pain, cymbalta for fibromyalga, fiercet for headaches and baclopen for muscle spasms. The funny thing is that if you look at the things in my claim (whether denied, SC with any %, I meet all the related symptomology of fibromyalga). Plus there is plently of the same complaints while I was active, brought up to my medical team while in the warrior transition unit, and during my MEB. Just this last month I brought the associated questionaire for FM (It was the most important and I didn't want to overload him) for my MD to fill out. He kept delaying filling it out, and when I finally went to talk to him- he claimed at he didn't remeber diagnosing me with FM. I had even asked him like 6 months ago if other diagnostics or othger specialties needed to be considered- to confirm or rule out his diagnosis, to which he said there was no tests. He told me he didn't feel comfortable filling it out bc it was confusing and that he didn't want to fill out it wrong, and is referring me to a rhumetologist. Granted...I should have asked for a referral a while back. But he even seemed iffy filling out the easy ones like headaches, etc. I requested a copy of all my treatment notes from him and his MD notes are sub par and do not mention much, and in some ways contradict. They are good enough to show the rheumatologist, and a perfect segway to let him know up front I want to figure out what is actually going on. My issue is that my attourney had already filed a appeal for some of the things in my original claim, and had filed a new condition for FM. I have gone through my C&P appt, but due to my wishy-washy PC MD, I will not have much other evidence from any forms I needed the PC MD to fill out. The sleep/ENT related ones are filling out and ready, and I might want to add TMJ which I have documented in MIL, flares when the FM stuff flares, and the DDS/MD is one of the ones that mentioned I should go see a rheumatologist beacuse it seems like I have systemic musculoskeletal issues that need to be looked at- FM, tmj, arthritis DDD/DA, msucle spasms, TMJ, etc etc. I am dissapointed that certain primary MD's have no problem stating you have certain issues, treating and medicating, and getting paid for F/U's, but without offically diagnosising, or being willing to stand by their treatment, and diagnosis and "too confused" to fill out simple VA packets. If someone graduated medical school and residency, a VA packet is easy. One of my sisters is a MD and I talked to her at length after this happened, and she explained some of the possible reasons why, and that overall, a Rheumy and other specialty MD will be better at taking detailed notes, confidence in diagnosis, etc. Has anyone else had issues like this with a MD not cooperating? For DDD/DA, ROM is key, is there anyt exception to that? I have been reading through stuff and the painful motion(4.59) rule would work, or under MS system, Joints (4.45) d, e and f would apply to me, plus I have bad crepedation but my ROM isn't bad enough. Is there another way or terminology? I assume the VA is going to categorize it in the way that best suits them. I do have ddd of the cervical and lumbarsacral- the SI- L5-S1 with osteophyte and boney islands. In my C5/C6 I have a buldging disc, which hasnt had a mri or CT since 2010 during my MEB. The rules they did consider were not the ones I listed above, and unless there is another reason, I guess they considered those to benefit them... I can include my original claim, and determination details below in a bit if its is helps, just let me know. I apologize if my post is scattered. I have been reading, researching, plus I have taken some classes in A&P, and have a civilian sister who is a MD who can better explain medical things if I need clarification. My issue is that there are so many working parts and variables, not to mention the variables of the VA system. At this point, I am not letting the set back from my PC MD bring me down, I just need to refocus and learn from my oversights... I plan on expalining more, but I tend to be very thorough in figuring out and researching things and don't want to overload anyone willing to read my post. I tend to be long winded and for that, I apologize. Thanks in advance!