atd1972

Broncovet, Thanks for your feedback. I been out of work since approx. 2006 because of my disabilities. I have received SSDI since 2008. The doctor only asked me what I did now, I told him I was unable to work because of my disabilities in which I suffer from. I submitted a statement in support of claim to refute functional impact and to let them know I have been out of work because of inability to sustain gainful employment because of my disabilities . I will see what happens when they make a decision one way or the other.

Here is my C& P Exam results for Fibromyalgia, Chronic Bronchitis & Chronic Sinusitis: I put in a new claim for chronic fatigue/malaise. I put in for an increase based upon increased shortness of breath for lung condition Pulmonary Nodules (related to Environmental Hazard in Gulf War) currently rated at 0%. I put in new claims for chronic sinusitis (related to: Environmental Hazard in Gulf War) (New), chronic bronchitis (related to: Environmental Hazard in Gulf War) (New). What does all this mean as far as service connection/possible percentages? I am currently rated at 90% total: 70 % for eye condition bilateral CRVO (related to: Environmental Hazard in Gulf War), macular edema secondary to Bilateral CRVO (related to: Environmental Hazard in Gulf War); 50 % for post traumatic stress disorder (Non-Combat) with unspecified depressive disorder;10% for tinnitus; and 0% for lung condition Pulmonary Nodules (related to Environmental Hazard in Gulf War). Two other new claims were not addressed at this C & P exam. Dont know why???? Trying to get to 100% combined disability. Any feedback would be appreciated. Sorry for long post. Did not know how to hide info, if in an attachment. Feel free to move this post, if in wrong section. LOCAL TITLE: C&P MD NOTE STANDARD TITLE: PHYSICIAN NOTE DATE OF NOTE: MAR 07, 2018@12:30 ENTRY DATE: MAR 07, 2018@14:02:03 AUTHOR: XXXXXXXXXXX EXP COSIGNER: URGENCY: STATUS: COMPLETED Gulf War General Medical Examination Disability Benefits Questionnaire * Internal VA or DoD Use Only* Name of patient/Veteran: XXXXXXXXXXXXXXXXXX 1. Evidence Review ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS 2. Medical History ------------------ a. No symptoms, abnormal findings or complaints: No answer provided b. Skin and scars: No answer provided XXXXXXXXXXXXXXXXXXX CONFIDENTIAL Page 38 of 139 c. Hematologic/lymphatic: No answer provided d. Eye: No answer provided e. Hearing loss, tinnitus and ear: No answer provided f. Sinus, nose, throat, dental and oral: Sinusitis/Rhinitis and Other Conditions of the Nose, Throat, Larynx and Pharynx g. Breast: No answer provided h. Respiratory: Respiratory Conditions (other than tuberculosis and sleep apnea) i. Cardiovascular: No answer provided j. Digestive and abdominal wall: No answer provided k. Kidney and urinary tract: No answer provided l. Reproductive: No answer provided m. Musculoskeletal: No answer provided n. Endocrine: No answer provided o. Neurologic: Fibromyalgia p. Psychiatric: No answer provided q. Infectious disease, immune disorder or nutritional deficiency: No answer provided r. Miscellaneous conditions: No answer provided 3. Diagnosed illnesses with no etiology --------------------------------------- From the conditions identified and for which Questionnaires were completed, are there any diagnosed illnesses for which no etiology was established? [ ] Yes [X] No 4. Additional signs and/or symptoms that may represent an "undiagnosed illness" or "diagnosed medically unexplained chronic multisymptom illness" ----------------------------------------------------------------------------- Does the Veteran report any additional signs and/or symptoms not addressed through completion of DBQs identified in the above sections? XXXXXXXXXXXXXXXXXX CONFIDENTIAL Page 39 of 139 [ ] Yes [X] No 5. Physical Exam ---------------- Normal PE, except as noted on additional Questionnaires included as part of this report 6. Functional impact of additional signs and/or symptoms that may represent an "undiagnosed illness" or "diagnosed medically unexplained chronic multisymptom illness" ----------------------------------------------------------------------------- [X] Yes [ ] No If yes, describe the impact of each additional sign and/or symptom that impacts his or her ability to work, providing one or more examples: See individual DBQS 7. Remarks, if any: ------------------- No answer provided **************************************************************************** Fibromyalgia Disability Benefits Questionnaire Name of patient/Veteran: XXXXXXXXXXXXXXXXXXXX Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination XXXXXXXXXXXXXXXXX CONFIDENTIAL Page 40 of 139 Evidence Review --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS 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 ICD code: M79.7 Date of diagnosis: 1991 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's fibromyalgia condition: He reports of generalized and wide spread musculoskeletal pain with weakness, stiffness, chronic tiredness as well fatigue, multiple joints and body pain including lower back, mid back, upper back in between scapula, neck area, both hip, both pelvis, both thigh area, both knee joints, both ankle area, both shoulder, both wrists, both elbow area as well as both foot and hand area, while he was while he was in Gulf countries in 1991. His condition has been getting worse since then. He also reports of difficulty to fall in sleep and maintain sleep. He reports of headaches, and frequency of headaches 2 to 3 times in a month and it lasts for 8 to 12 hours. He reports of band like sensation of his head during headaches. b. Is continuous medication required for control of fibromyalgia symptoms? [X] Yes [ ] No If yes, list only those medications required for the Veteran's fibromyalgia condition: OTC Aleeve PRN c. Is the Veteran currently undergoing treatment for this condition? [ ] Yes [X] No d. Are the Veteran's fibromyalgia symptoms refractory to therapy? XXXXXXXXXXXXXXXXX CONFIDENTIAL Page 41 of 139 [ ] Yes [X] 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] Stiffness [X] Muscle weakness If checked, describe: See my history part [X] Fatigue [X] Sleep disturbances [X] Paresthesias [X] Headache [X] Depression [X] Anxiety b. Frequency of fibromyalgia symptoms (check all that apply): [X] Episodic with exacerbations [X] Present more than one-third of the time c. Does the Veteran have tender points (trigger points) for pain present? [X] Yes [ ] No [X] All bilaterally 4. Other pertinent physical findings, complications, conditions, signs, symptoms and scars ----------------------------------------------------------------------- a. 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 b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of 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 XXXXXXXXXXXXXXXXXXXXX CONFIDENTIAL Page 42 of 139 6. Functional impact --------------------- Does the Veteran&apos ;s fibromyalgia impact his or her ability to work? [ ] Yes [X] No 7. Remarks, if any: ------------------- Fibromyalgia: I reviewed his STR and he had no issue regarding his fibromyalgia condition before deployment. As per history from the Veteran, he developed all the signs and symptoms of fibromyalgia symptoms while he was in Gulf countries. As per CPRS, his CBC, BMP, LFT, UA and chest x-ray were negative. His HIV test, and hep C and hep B and ESR were negative. So his Fibromyalgia condition is at least as likely as not an undiagnosed illness due VA statutes and regulations provide for service connecting certain chronic disability patterns based on exposure to environmental hazards experienced during military service in Southwest Asia. The environmental hazards may have included: exposure to smoke and particles from oil well fires; exposure to pesticides and insecticides; exposure to indigenous infectious diseases; exposure to solvent and fuel fumes; ingestion of pyridostigmine bromides tablets, as a nerve gas antidote; the combined effect of multiple vaccines administered upon deployment; and inhalation of ultra fine-grain san particles. In addition, there may have been exposure to smoke and particles from military installation "burn pit" fires that incinerated a wide range of toxic waste materials. Fibromyalgia is recognized as an undiagnosed illness. VA recognizes this is one of the presumptive diseases related to GULF War Exposure. Therefore, it does not need medical opinion. **************************************************************************** Respiratory Conditions (Other Than Tuberculosis and Sleep Apnea) Disability Benefits Questionnaire Name of patient/Veteran: XXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXX CONFIDENTIAL Page 43 of 139 Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS SECTION I: DIAGNOSES -------------------- Does the Veteran now have or has he/she ever been diagnosed with a respiratory condition? (This is the condition the Veteran is claiming or for which an exam has been requested): Yes [X] Chronic bronchitis ICD code: J42 Date of diagnosis: SC SECTION II: MEDICAL HISTORY --------------------------- Describe the history (including onset and course) of the Veteran's respiratory condition (brief summary): The Veteran reports that he developed chronic cough and shortness of breath due to due to exposure to toxic fumes due to burn pit and other inorganic and organic environmental hazardous exposure while he was in Gulf countries in 1991 and his condition has been getting worse . Does the Veteran's respiratory condition require the use of oral or parenteral corticosteroid medications? No Does the Veteran's respiratory condition require the use of inhaled medications? Yes Check all that apply: [X] Inhalational bronchodilator therapy Indicate frequency: Daily Does the Veteran's respiratory condition require the use of oral bronchodilators? No XXXXXXXXXXXXXXXXXXXXXXXX CONFIDENTIAL Page 44 of 139 Does the Veteran's respiratory condition require the use of antibiotics? No response provided Does the Veteran require outpatient oxygen therapy for his or her respiratory condition? No SECTION III: Pulmonary conditions --------------------------------- Does the Veteran have any of the following pulmonary conditions? No Other pertinent physical findings, scars, complications, conditions, signs, symptoms and scars ----------------------------------------------------------------------- Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? No Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above? No Comments, if any: No response provided SECTION IV: Diagnostic testing ------------------------------ Have imaging studies or procedures been performed? Yes Has pulmonary function testing (PFT) been performed? Yes Do PFT results reported below accurately reflect the Veteran's current pulmonary function? No PFT results Date: 09/02/2016 Pre-bronchodilator: Post-bronchodilator, if indicated: FVC: 89% predicted FVC: 89% predicted FEV-1: 89% predicted FEV-1: 90% predicted FEV-1/FVC: 82% FEV-1/FVC: 104% DLCO: 122% predicted Which test result most accurately reflects the Veteran's level of disability (based on the condition that is being evaluated for this report)? FEV-1% predicted Does the Veteran have multiple respiratory conditions? No Has exercise capacity testing been performed? No XXXXXXXXXXXXXXXXXXX CONFIDENTIAL Page 45 of 139 Are there any other significant diagnostic test findings and/or results? No SECTION V: Functional impact and remarks ---------------------------------------- 1. Functional impact -------------------- Does the Veteran's respiratory condition impact his or her ability to work? No 2. Remarks, if any: ------------------- Chronic bronchitis: As per history from the Veteran, the developed chronic cough and shortness of breath due to due to exposure to toxic fumes due to burn pit and other inorganic and organic environmental hazardous exposure while he was in Gulf. So, his condition is at least as likely as not a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology due to VA statutes and regulations provide for service connecting certain chronic disability patterns based on exposure to environmental hazards experienced during military service in Southwest Asia. The environmental hazards may have included: exposure to smoke and particles from oil well fires; exposure to pesticides and insecticides; exposure to indigenous infectious diseases; exposure to solvent and fuel fumes; ingestion of pyridostigmine bromide tablets, as a nerve gas antidote; the combined effect of multiple vaccines administered upon deployment; and inhalation of ultra fine-grain sand particles. In addition, there may have been exposure to smoke and particles from military installation "burn pit" fires that incinerated a wide range of toxic waste materials. Chronic bronchitis is a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology. VA recognizes this is one of the presumptive diseases related to GULF War Exposure. Therefore, it does not need medical opinion. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. **************************************************************************** XXXXXXXXXXXXXXXXXXX CONFIDENTIAL Page 46 of 139 Sinusitis, Rhinitis and Other Conditions of the Nose, Throat, Larynx and Pharynx Disability Benefits Questionnaire Name of patient/Veteran: XXXXXXXXXXXXXXXXXXX Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes[ ] No ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS SECTION I: Diagnosis: --------------------- Does the Veteran now have or has he/she ever been diagnosed with a sinus, nose, throat, larynx, or pharynx condition? (This is the condition the Veteran is claiming or for which an exam has been requested) [X] Yes [ ] No [X] Chronic sinusitis ICD code: J32 Date of diagnosis: 1991 SECTION II: Medical history --------------------------- The Veteran reports that he developed sinus congestion, runny nose due to exposure to toxic fumes due to burn pit and other inorganic and organic environmental hazardous exposure while he was in Gulf countries back in 1991. His condition has been getting worse. SECTION III: Nose, throat, larynx or pharynx conditions ------------------------------------------------------- Does the Veteran have any of the following nose, throat, larynx or pharynx conditions? XXXXXXXXXXXXXXXXX CONFIDENTIAL Page 47 of 139 [X] Yes [ ] No [X] Sinusitis 1. Sinusitis ------------ a. Indicate the sinuses/type of sinusitis currently affected by the Veteran's chronic sinusitis (check all that apply): [ ] None [X] Maxillary [X] Frontal [X] Ethmoid [ ] Sphenoid [ ] Pansinusitis b. Does the Veteran currently have any findings, signs or symptoms attributable to chronic sinusitis? [X] Yes [ ] No If yes, check all that apply: [ ] Chronic sinusitis detected only by imaging studies (see Diagnostic testing section) [X] Episodes of sinusitis [ ] Near constant sinusitis If checked, describe frequency: [X] Headaches [X] Pain of affected sinus [X] Tenderness of affected sinus [X] Purulent discharge [ ] Crusting [ ] Other For all checked conditions, describe: c. Has the Veteran had NON-INCAPACITATING episodes of sinusitis characterized by headaches, pain and purulent discharge or crusting in the past 12 months? [ ] Yes [X] No If yes, provide the total number of non-incapacitating episodes over the past 12 months: [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 [ ] 6 [ ] 7 or more d. Has the Veteran had INCAPACITATING episodes of sinusitis requiring prolonged (4 to 6 weeks) of antibiotics treatment in the past 12 months? [ ] Yes [X] No NOTE: For VA purposes, an incapacitating episode of sinusitis means one that requires bed rest and treatment prescribed by a physician. If yes, provide the total number of incapacitating episodes of sinusitis requiring prolonged (4 to 6 weeks) of antibiotic treatment over past 12 XXXXXXXXXXXXXXXXXXX CONFIDENTIAL Page 48 of 139 months: [ ] 1 [ ] 2 [ ] 3 or more e. Has the Veteran had sinus surgery? [ ] Yes [X] No If yes, specify type of surgery: [ ] Radical (open sinus surgery) [ ] Endoscopic [ ] Other: Type of procedure, sinuses operated on and side(s): Date(s) of surgery (if repeated sinus surgery, provide all dates of surgery): If Veteran has had radical sinus surgery, did chronic osteomyelitis follow the surgery? [ ] Yes [ ] No f. Has the Veteran had repeated sinus-related surgical procedures performed? [ ] Yes[X] No 6. Other pertinent physical findings, complications, conditions, signs, symptoms and scars ----------------------------------------------------------------------- a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to the conditions listed in the Diagnosis Section above? [ ] Yes[X] No b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above? [ ] Yes[X] No c. Comments, if any: No answer provided d. Does the Veteran have loss of part of the nose or other scars of the nose exposing both nasal passages?: No answer provided e. Does the Veteran have loss of part of the nose or other scars causing loss of part of one ala?: No answer provided f. Does the Veteran have loss of part of the nose or other scars causing other obvious disfigurement?: No answer provided SECTION IV: Diagnostic testing ------------------------------ a. Have imaging studies of the sinuses or other areas been performed? [ ] Yes[X] No XXXXXXXXXXXXXXXXXX CONFIDENTIAL Page 49 of 139 b. Has endoscopy been performed?: No c. Has the Veteran had a biopsy of the larynx or pharynx?: No d. Has the Veteran had pulmonary function testing to assess for upper airway obstruction due to laryngeal stenosis? No answer provided e. Are there any other significant diagnostic test findings and/or results? No answer provided SECTION V: Functional impact and remarks ---------------------------------------- 1. Functional impact -------------------- Does the Veteran's sinus, nose, throat, larynx or pharynx condition impact his or her ability to work? [ ] Yes [X] No 2. Remarks, if any: ------------------- Chronic sinusitis : As per history from the Veteran, he developed sinus congestion, runny nose due to exposure to toxic fumes due to burn pit and other inorganic and organic environmental hazardous exposure. So, his condition is at least as likely as not a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology due to VA statutes and regulations provide for service connecting certain chronic disability patterns based on exposure to environmental hazards experienced during military service in Southwest Asia. The environmental hazards may have included: exposure to smoke and particles from oil well fires; exposure to pesticides and insecticides; exposure to indigenous infectious diseases; exposure to solvent and fuel fumes; ingestion of pyridostigmine bromide tablets, as a nerve gas antidote; the combined effect of multiple vaccines administered upon deployment; and inhalation of ultra fine-grain sand particles. In addition, there may have been exposure to smoke and particles from military installation "burn pit" fires that incinerated a wide range of toxic waste materials. Chronic sinusitis is a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology. VA recognizes this is one of the presumptive diseases related to GULF War Exposure. Therefore, it does not need medical opinion. ***************************************************************** XXXXXXXXXXXXXXXXXXXX CONFIDENTIAL Page 50 of 139 The Veteran has no question and concern about my examination. He understands me well. /es/ XXXXXXXXXXXX MD Signed: 03/07/2018 14:02