invisible

That is really helpful! Thanks!

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!

For clarification, the Gulf War Registry Exam, which is not a C&P exam, is separate from regular C&P exams where Gulf War Veterans’ Medically Unexplained Illnesses presumptive rules if they apply for various conditions.

OK, I believe the problem is that the C & P examiner gave a negative nexxus, which the rater used in the decision.  In Gulf War presumptive claims, the C & P examiner is not supposed to give a nexxus, they are supposed to give an opinion of whether or not you have the disability.  That may be a CUE, I'm not sure.
The following was originally posted by pgwvet from http://www.ngwrc.org/ .  I believe the key part is the red highlighted sentence.
Like I said on the IBS sample this is the start. Only you the veteran can say about your symptom.
The DBQ should have marked your meds are not working.


This denial is in error, did not follow the law on Fibromyalgia on presumptive
illness under 38 U.S.0 § 1117 enacted in 2001 and as in 38 CFR § 3.317(a)(2)(B) (2)
Fibromyalgia. A presumptive illness does not need a nexus to the service as per
Gutierrez v. Principi, 19 Vet.App. 1, 9 (2004)
The RO did not follow the M21-1MR on how to do claims of this type as per.
1. VA Training Letter 10-01 Adjudicating Claims Based on Service in the Gulf War and
Southwest Asia (We believe this needs updating and are working on it.)
2. 38 CFR § 3.317 and 38 U.S.C. §§ 1117
3. M21-1MR, Part IV.ii.2.D ( how to rate a claim under 3.317)
4. M21-1MR, Part IV.ii.2.D.i -Rating Action Taken Based on Disability Pattern
Determination It states, "Grant service connection-"
5. M21-1MR, Part IV.ii.l.E (developing GW claims under 38 CFR § 3.317)
The rating specialist should not have relied on a medical opinion that was not to be
given as per the guide lines in the "notice to the Examiner" in the VA FL 10-01.
As the notice state the examiner is only to give an opinion on out come 3 & 4, and
Not 1 or 2, Fibromyalgia is defined in the law and in TL 10-01 as a medically
unexplained chronic multisymptom illness.
The rating specialist clearly did not follow the M21-1MR, Part IV.ii.2.D.i -Rating
Action Taken Based on Disability Pattern Determination It states, "Grant service
connection-" I was clearly diagnosed with the illness.
The DBQ showed that I am diagnosed with Fibromyalgia and that the tests show my
thyroid is fine. I have had all of the other test needed as well. I am on medication
and I am still in pain most all of the time. As per the rating guidelines I have met
the 40% rating.

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!

Ooh, weapons upgrade! Power up!!!
I can't even imagine how it must be for you.  I know how mine feels, like I'm being tripped, then kicked while I'm down.
Semper Fi!
Andyman

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!

I think your rheumatologist will be able to unscrewup your fibromyalgia denial.
You have a solid grasp on having mono antibodies and an active infection. The C&P exam text would help clarify the C&P doctor's justification of denying, which I assume he attributed to mono. If you had an active infection, I would understand - but not having one should mean approval (in my opinion). Once your rheumatologist finishes ruling everything out and has you officially diagnosed, ask for a statement clarifying the fibro is from gulf service, not from epstein-barr antibodies because you do not test positive for that. Also, his opinion would outweigh that of the generic C&P doctor.
They are pretty much gaming the exclusion criteria for the "there must be no other cause" part...
 
 
 
 

Time to reload and charge back into the fight!  I'm pulling for you!
Semper Fi.
Andyman

Thanks Andy for helping explain the acronyms.
You would assume that if you served in areas covered by presumptives that the VA would recognize that. I guess even when evidence is glaring them in the face, you still have to take the extra steps to connect those dots for them.

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!

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.

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!

The crazy one here, first things first, if you have a treating doctor who refuse to assist you or treat you, you need to change doctors.  The most important thing is when you feel the symptoms coming on that is when you need to be seen and make sure that your symptoms get documented. As to your claim, I am still under the understanding that VA is still working on denying veterans claim just to decrease the backlog.  I am not sure how you filed your claim but VA should have processed your claim as directly service related and as gulf war related.  IMHO, there are good doctors,  bad doctors, lazy doctors and non veteran friendly doctors but you will still need a medical opinion that your condition is military related with a good medical rationale and a clear diagnosis.  It really does not matter if you get it from a VA doctor or a civilian doctor.  As I stated above the most important thing you can do is when you hurt go see a doctor VA or not.  A lot of veterans file claims but fail to have the evidence they need to warrant a grant. I am not trying to put you or other veterans down, I am trying to say never go to a C & P exam without a clear diagnosis from a treating doctor.  Most people who suffer from chronic pain/chronic illness also suffer from some type of mental depression, you might want to ask for a referral to a mental health specialist.

I'm not an expert on Gulf War conditions, but fibromyalgia is listed as a Gulf War presumptive: http://www.benefits.va.gov/COMPENSATION/claims-postservice-gulfwar.asp
Epstein-Barr was likely to rule out mono

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

if you want to, theres no requirement at all  i would rather have the vets get the info i have and others have had to learn the hard way.  feel free to email, post, send, etc to anyone and everyone.  No one is going to help vets but our fellow vets, we have to do it ourselves. 

Some Dr's will help out a veteran (veteran friendly) & Unfortunately some won't... I had the same thing happen so I got a private Doc specialist  and ask him if he would go by the VA standards (guidlines) (printed them off here on hadit) and the language they prefer  I assured the Dr The VA would not question his expertise, because its his own professional opinion.   he deserves that right by going to medical school.
 
I had ask the Dr's Secretary about what all I needed on the phone and she said yes she thinks he will help  for me to come in and explain to him what I need.
It worked 100% in my favor.
 
................Buck

Also remember that once you get your C-File you will want to keep it updated.
Example:
You got out in 2005 and filed your first claim and you request your C-file and got it today.
You notice in your file the latest record is from June 1, 2015 the last entry related to a recently closed claim.
Once a year or after every claim is finished, appeal finalized, etc. request a copy of your c file since then.
The C-File you would have gotten SHOULD cover you from your first claim to last.  2005 - June 1, 2015.
So if you request your whole c-file again they CAn and probably will charge you for copies of all the docs they already sent you.  Instead in that new request state....
"I hereby request a copy of all documents contained in JOHN DOE’S claims folder from 6/2/2015 to present and anything that may have not been included for any reason in my (1)st request for my Claims file dated (insert date for initial c-file request), including, but not limited to, all documents in the right flap, left flap, and center flap, and the reverse side of any documents with writing on both sides, including all handwritten notes, post-its and all decision forms or blue sheets as they are sometimes known"
This will ensure that you get all the updates but wont be charged for recopying.  The Government is required to provide you this information free of charge...but only once.

invisible,
I see you!  Not invisible anymore, but I do know what you mean, kinda like that Clay Aiken song about being invisible, and the one line says something about being invisible, oh wait, he already is.
My wife's cousin's husband is an ER Trauma doc(she's a lawyer) and we don't ask too much of him, either.
Gotta tell you this, I didn't notice if you said, but if not, request a complete copy of your C-file and service treatment records, too.  I got my c-file this past summer, and found an old C&P exam from '06, that was never decided, but was SC this summer, from a new claim on same contention, for 30%.  So I'm filing a NOD for EED, earlier effective date.  I'm looking at $50Gs or more possibly...
So, just remember one thing, we here, are all visible, if not to our own selves, to each other.
 
Semper Fi.
Andyman

VA Form 3288 is the official form for C-File requests. 
The VA now considers C-File requests as a seperate "claim" so know that if you file for your c file request and have a claim pending that they will be "combined" and one will hold up the other until both are done.
Send the http://www.va.gov/vaforms/va/pdf/VA3288.pdfForm 3288 to YOUR claims intake Center.
See below for where you send yours.

DEPARTMENT OF VETERANS AFFAIRS CLAIMS INTAKE CENTER
PO BOX 5235
NEWNAN, GA 30271-0020
FAX: TOLL FREE: 844-531-7818
DID: 248-524-4260
SERVING THESE AREAS:
ALABAMA, CONNECTICUT, DELAWARE, FLORIDA, GEORGIA, INDIANA, KENTUCKY, MAINE, MARYLAND, MASSACHUSETTS, MICHIGAN, MISSISSIPPI, NEW HAMPSHIRE, NEW JERSEY, NEW YORK, NORTH CAROLINA, OHIO, PENNSYLVANIA, RHODE ISLAND, SOUTH CAROLINA, TENNESSEE, VERMONT, VIRGINIA, WEST VIRGINIA, AND PUERTO RICO
DEPARTMENT OF VETERANS AFFAIRS
CLAIMS INTAKE CENTER
PO BOX 5235
JANESVILLE, WI 53547-5235
FAX: TOLL FREE: 844-822-5246 (844VACLAIM)
DID: 608-373-6690
SERVING THESE AREAS:
ALASKA, ARIZONA, ARKANSAS, CALIFORNIA, COLORADO, HAWAII, IDAHO, ILLINOIS, IOWA, KANSAS, LOUISIANA, MINNESOTA, MISSOURI, MONTANA, NEBRASKA, NEVADA, NEW MEXICO, NORTH DAKOTA, OKLAHOMA, OREGON, SOUTH DAKOTA, TEXAS, UTAH, WASHINGTON, WISCONSIN, WYOMING, AND THE PHILIPPINES

This is the wording i put in the Form 3288 (bolded sections are important)
----------------------------------------
I hereby request a copy of all documents contained in JOHN DOE’S claims folder, including, but not limited to, all documents in the right flap, left flap, and center flap, and the reverse side of any documents with writing on both sides, including all handwritten notes, post-its and all decision forms or blue sheets as they are sometimes known
Please note that this request for documents is being made pursuant to the Privacy Act, 5 U.S.C. § 552, and the Freedom of Information Act (FOIA), 5 U.S.C. § 552a, as well as 38 C.F.R.§1.550 and 38 C.F.R.  § 1.577.  Your agency has a duty to respond to this request within TWENTY (20) DAYS of the date of this request pursuant to 5 U.S.C. § 552 (a)(6)(A)(2)(i).
Additionally, although an extension of time to respond may be requested, it may only be granted for “unusual circumstances.” “Predictable agency workload” is not typically considered an unusual circumstance as stated in 5 U.S.C. § 552(a)(6)(C)(ii).   Moreover, even to the extent that unusual circumstances could be demonstrated in this instance, the time limit for the extension is limited to “10 working days” pursuant to 38 C.F.R.§ 1.553(d).
Please also be aware that your agency’s failure to respond to this request within twenty (20) days may result in the filing of an administrative appeal with the office of the Secretary of the Department of Veterans Affairs pursuant to 38 C.F.R.§ 1.557 and 5 U.S.C. §552(a)(6)(A)(2)(ii), and potentially, the filing of a federal lawsuit to compel the production of the information.
This may subject your agency to contempt of court and a fine, including attorney fees and litigation expenses in compelling the production of this information pursuant to 38 U.S.C. § 552a(g)(l) of the Privacy Act, and 38 U.S.C. § 552(a)(4)(B) of FOIA.
----------------------------------------
 
In my signature line is my site that has ebooks, all are free, one being on c file requests.

Invisible,
I see(or don't?)  makes perfect sense, I think most of us use nicknames we already have, or some mix of our MOS and name.  Mine is one an older Vet where I had worked, called me..it was Andy...man, like hey man, so I adapted it to what it is here.  Back story is perfectly fine.  As for me being invisible....well...I'll leave that one for some rainy day...
You can request your C-file several different ways, through the Freedom of Info Act(FOIA), or IRIS on VA.gov, the contact us link.  Also VA form for statement in support of claim, I think the benefits counselor use that for me, he requested my complete service, service medical, and C-file.  Your C-file is based on your VA claims, and contains exam notes and such that aren't available via Blue Button on Myhealthevet. 
I found a C&P exam from 2006 for my feet that went decided and was left off the decision letter.  I have no memory of that, however I had new foot claim this past summer that netted me 30% for foot condition.  I received my C-file afterwards, and only just this past week or two discovered that old foot exam.  Which now gives me cause for NOD for EED, earlier effective date of my foot rating award.
Semper Fi.
Andyman

Just make sure they know that they need THESE words and what THESE words mean to the VA...
 
 
“is due to/caused by” = 100%
“very likely” = >90%
“much more likely than not” = >75%
“more likely than not” = >50%
 “at least as likely as not” = ≥50% (reasonable doubt)
“not at least as likely as not” <50%
“is not due to” = 0%
 
Attached is the ROUGH copy of my IMO/IME book, it has way more information than you probably need to know, but it has the references in the 38CFR and M21 for the docs reference on things like P&T, TDIU, SMC, Staged/aggravated/analagous ratings, etc.
 
 
 
HOW TO GET IMO DRAFT.pdf