Gulf War Syndrome Nexus Letter

[usmc0331]

I was a 0331 machinegunner in the USMC. I was awarded the Combat Action Ribbon, Naval Achievement medal for actions in Iraq, and PUC. I have been disgusted by the VA so far. My file has been on hold because they sent my records to another veteran. I thought it was a prank call until the veteran started rattling off my SSN, address, phone number, DOB, etc.

I recieved a C & P Exam and the examiner noted in the report:

Diagnostic Impression: 1. Fibromyalgia. 2. Irritable Bowel Syndrome.

Discussion: Based upon the classic history for both irritable bowel syndrome and fibromyalgia, I do think that the Veteran suffers from both of these disorders primarily, but it would be speculation on my judgement to say that it is truly Gulf War Syndrome when he is so classic for each in and of themselves.

I have already provided a nexus letter from my doctor stating that my fibromyalgia and IBS "is due" to the activities and exposures while he was in Iraq. After the C & P Exam i will submit the following nexus:

To Whom It May Concern:

Veteran has been a patient of mine for several years. I have also reviewed his Military Service Medical Records. While in Iraq he was constantly exposed to Industrial Pollution, Raw Sewage, Smoke from Burning Trash and Feces, Solvents, Pesticide-Treated Uniforms, DEET, Raw Sewage, Vehicle and JP8 Exhaust Fumes, and Environmental Pesticides. He was also given numerous vaccinations to include Anthrax vaccinations.

In 2003 upon returning from Iraq, as evident in his Military File, he complained of Diarrhea, Chronic Fatigue, Difficulty Remembering, Muscle Aches, Headaches, Swollen Stiff and Painful Joints, Weakness, Dizziness and Light Headedness. He also listed he had health concerns about the exposures and events during his deployment.

In regards to his Fibromyalgia:

His Fibromyalgia is characterized as widespread musculoskeletal pain and tender points, with associated fatigue, sleep disturbance, stiffness, headaches, irritable bowel symptoms, depression, and anxiety. These symptoms are constant and refractory to therapy.

In regards to his Irritable Bowel Syndrome:

His Irritable Bowel Syndrome is characterized by constant daily abdominal distress. The symptoms consist of constant episodes of severe diarrhea and constipation with mucous in the stool.

In regards to his Migraine Headaches:

His migraines are characteristic of prostrating attacks occurring on average of two to three times per month.

It is my medical opinion that these medically unexplained chronic multi-symptom illnesses are more likely than not a direct result of his exposures and military service.Sincerely,John Smith, M.D.

Before I submit the Nexus letter, does he need to change any wording?

[pacmanx1]

From reading this post, it appears that the veteran already has diagnosis of Fibromyalgia and IBS and now trying to get them service connected. Since they already have diagnosis of the conditions, they have to prove they had the conditions or the symptoms while on active duty.

Discussion: Based upon the classic history for both irritable bowel syndrome and fibromyalgia, I do think that the Veteran suffers from both of these disorders primarily, but it would be speculation on my judgment to say that it is truly Gulf War Syndrome when he is so classic for each in and of themselves

The veteran will have to show a connection of their in service records to these conditions and overcome the words "speculation on my judgment" to an actual service connection. In my experience VA will jump on the words "speculation on my judgment" and say that they cannot resolve the claim at this time because there is no evidence that relates the current condition to an in service condition. Keep in mind that fibromyalgia and IBS are ratable conditions, fibromyalgia 5025 and IBS 7319

Edited February 28, 2010 by pacmanx1

[Frank0469]

Pete,

Nothing against you but I totally disagree with your statement about having to prove that since had the condition of Fibromyalgia and IBS already diagnosised that this leads to having to find an connection to it on while on active duty. Are you totally nuts? Are you familar at all with 38 CFR 3.317?

§ 3.317 Compensation for certain disabilitiesdue to undiagnosed illnesses.

(a)(1) Except as provided in paragraph © of this section, VA will pay compensation in accordance with chapter 11 of title 38, United States Code, to a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability, provided that such disability:

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

(ii) By history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis.

(2)(i) For purposes of this section, a qualifying chronic disability means a chronic disability resulting from any of the following (or any combination ofthe following):

(A) An undiagnosed illness;

(:D The following medically unexplained chronic multisymptom illnesses that are defined by a cluster of signs or symptoms:

(1) Chronic fatigue syndrome;

(2) Fibromyalgia;

(3) Irritable bowel syndrome; or

(4) Any other illness that the Secretary determines meets the criteria in paragraph (a)(2)(ii) of this section for a medically unexplained chronic multisymptomillness; or

© Any diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. 1117(d) warrants a presumption of service-connection.

....

undiagnosed illness or medically unexplainedchronic multisymptom illnessinclude, but are not limited to:

(1) Fatigue

(2) Signs or symptoms involving skin

(3) Headache

(4) Muscle pain

(5) Joint pain

(6) Neurologic signs or symptoms

(7) Neuropsychological signs or symptoms

(8) Signs or symptoms involving the respiratory system (upper or lower)

(9) Sleep disturbances

(10) Gastrointestinal signs or symptoms

(11) Cardiovascular signs or symptoms

(12) Abnormal weight loss

(13) Menstrual disorders.

...

</B></FONT></FONT>

So first since he has the dx of fibromyalgia and IBS these are presumptive conditions if they prsent themselves from time of service to the end of the presumptive period ending currently at the end of next year. Secondly he has headaches and other problems listed in 13 conditions list. If one get a dx in these it can mean a death sentence to gettting them as presumptive or undiagnosied because they are then diagnosised. It is better to have them refered to as a syndrome of symptoms that include.. vs a diagnosises of migranes or headaches.

I have seen many vets screwed over by these facts. Also it is important to look at and understand what fibromyaglia actually is from the diagnostic document from the Rheumatology association. Because many other things usually do come along with those but joint pain and other muscle pain is seperate.

The only one that will fight as hard for you is you and need to understand everything about the process that you can. IT IS a matter of life and death.

Frank Clark

From reading this post, it appears that the veteran already has diagnosis of Fibromyalgia and IBS and now trying to get them service connected. Since they already have diagnosis of the conditions, they have to prove they had the conditions or the symptoms while on active duty.

The veteran will have to show a connection of their in service records to these conditions and overcome the words "speculation on my judgment" to an actual service connection. In my experience VA will jump on the words "speculation on my judgment" and say that they cannot resolve the claim at this time because there is no evidence that relates the current condition to an in service condition. Keep in mind that fibromyalgia and IBS are ratable conditions, fibromyalgia 5025 and IBS 7319

[pacmanx1]

§ 3.317 Compensation for certain disabilitiesdue to undiagnosed illnesses.

(a)(1) Except as provided in paragraph © of this section, VA will pay compensation in accordance with chapter 11 of title 38, United States Code, to a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability, provided that such disability:

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

(ii) By history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis.

(2)(i) For purposes of this section, a qualifying chronic disability means a chronic disability resulting from any of the following (or any combination ofthe following):

(A) An undiagnosed illness;

( :D The following medically unexplained chronic multisymptom illnesses that are defined by a cluster of signs or symptoms:

(1) Chronic fatigue syndrome;

(2) Fibromyalgia;

(3) Irritable bowel syndrome; or

(4) Any other illness that the Secretary determines meets the criteria in paragraph (a)(2)(ii) of this section for a medically unexplained chronic multisymptomillness; or

© Any diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. 1117(d) warrants a presumption of service-connection.

....

undiagnosed illness or medically unexplainedchronic multisymptom illnessinclude, but are not limited to:

(1) Fatigue

(2) Signs or symptoms involving skin

(3) Headache

(4) Muscle pain

(5) Joint pain

(6) Neurologic signs or symptoms

(7) Neuropsychological signs or symptoms

(8) Signs or symptoms involving the respiratory system (upper or lower)

(9) Sleep disturbances

(10) Gastrointestinal signs or symptoms

(11) Cardiovascular signs or symptoms

(12) Abnormal weight loss

(13) Menstrual disorders.

Frank, you are entitled to your opinion but anyone who ever got a C & P back and the doctor's opinion was "it would be speculation on my judgment to say it is Whatever they claimed " it was/will be denied. It must say that it "is as least likely as not 50/50 probability" anything else will be denied. I am very familiar with fibromyalgia and IBS since I am service connected for them and still going through the process of a remand for conditions that a C & P doctor said it would be "speculation on his part if my conditions were related". I am not going on my opinion; I am going on my experience. VA loves to play games with the interpretation of their regulations. The conditions cannot be service connected as Undiagnosed Illness if the veteran has diagnosis. The diagnosed conditions must be related to some incident that happened on active duty, example: treated for recurring headaches, treated for chronic abdominal pain or chronic muscle aches or joint pain. The key again is a "diagnosed condition" which the veteran has cannot be awarded service connection for an "Undiagnosed Illness". Since the veteran is diagnosed fibromyalgia and IBS, That is what they should claim and not GWS. I hope this will help you understand.

So let's agree to disagree and let the veteran have all the information as possible. Since the veteran is already diagnosed, let's try to follow the requirements for diagnosed conditions to be awarded service connection.

Edited March 10, 2010 by pacmanx1