C&p Exam Contradiction With Va Denial

[Shyne-I]

Good morning all,

I would like to ask if anyone can suggest what I need to do from here.

I requested a copy of my C&P exam for Fibromyalgia from my local VA hospital on March 4, 2013. My exam was done on Nov 05, 2012. In reading my exam, it shows that:

2. Medical record review--- Indicate medical records reviewed in preparation of this report: [X] C-file (VA only); but once it gets to 8. Remarks, if any: C-File Not Available- Veteran sees outside Rheumatologist-Baylor Texas Arthritis Center. Unable to confirm information in DBQ without C-File.

On the Medical Opinion portion it states:

2. Restatement of requested opinion---

a. Insert requested opinion from general remarks: UNABLE TO PROVIDE OPINION WITHOUT C-FILE

b. Indicate type of exam for which opinion has been requested (e.g. Skin Deseases) : FIBROMYALGIA

3. Evidence review---

Was the Veteran's VA claims file reviewed?

[ ] Yes [X] No

Everything else in the exam (The Diagnosis, Medical history, Findings, signs, and symptoms,and the Functional impact) was favorable and an accurate portrayal of my current disability.

I received my decision in the mail yesterday and I was denied. The Denial Reasons:

- The evidence does not show an event, disease or injury in service.

- We did not find a link between Fibromyalgia and military service.

Explanation:

The VA medical opinion from Fort Worth VA Outpatient Clinic found no link between your diagnosed medical condition and military service. We received your medical evidence from Fort Worth VA Outpatient Clinic, Dr. Andrea V. Brown and Dr. Robert Jenkins which discusses the symptoms of your medical condition. Your service treatment records do not contain complaints, treatment, or diagnosis for this condition.

Because the multiple symptoms found in service have an etiology unrelated to fibromyalgia, and because you were not provided with a diagnosis of such condition until about 15 years subsequent to discharge from service, the VA examiner opined that fibromyalgia is less likely than not incurred in or caused by military service.

My objections to this denial and explanation are as follows:

1. I provided the VA with a DBQ filled out by my Rheumatologist on Aug 23, 2012 and although they mention this in the Evidence portion of my letter, they did not state that it was received and used as evidence. My Rheumatologist's name is not mentioned in the above explanation nor is the DBQ that he provided.

2. The multiple symptoms that they are referring to having an etiology unrelated to fibromyalgia, are actually listed by the Arthritis Foundation as being Non- defining symptoms associated w/fibromyalgia. They also did not mention my exit examination that listed: swollen or painful joints, frequent or severe headache, ear, nose, or throat trouble, sinusitis, shortness of breath, or palpitation or pounding heart. There was not any where on the exam to list fatigue which I also experienced during service.

3. The most disturbing thing to me about this explanation is that they mention an opinion from the VA examiner but on the copy of the C&P Exam I received, there was no medical opinion listed. The fact that they said that I was not provided with a diagnosis until about 15 years subsequent to discharge also bothers me because it took doctors that long to diagnose me. Through out the years I was being treated for the individual symptoms and no one every looked at them as a whole. I was given vitamin B injections for fatigue. I was given naproxen for swollen and painful joints. Headaches were being treated as tension headaches and so on!!

I know that I will most likely need an IMO from my Rheumatologist and possibly my Neurologist but it concerns me because of the so-called opinion "they say" was provided by the VA examiner!!

Any suggestions?? and sorry this was so long.

Edited April 16, 2013 by Shyne-I

[Shyne-I]

Hello Everyone,

Just wanted to give an update. I received my Claims folder and there was an addendum to my C & P exam 5 days before they made there denial decision. They forwarded my C-file to the examiner and she had in fact given the above mentioned opinion.

Her rationale was that: " The symptoms mentioned in my file had a clear etiology. While those symptoms can also be part of the multisystem condition of Fibromyalgia, they are also common symptoms with multiple etiologies. Because the multiple symptoms have logical etiology and veterans diagnosis of Fibromyalgia is over 10 years after discharge from the military, it is this providers opinion that the veterans fibromyalgia is not as likely as not due to, caused by or incurred in military service."

My question is "What happened to giving the veteran the benefit of the doubt or at least relative equipoise?" She states that the symptoms could also be part of the multisystem condition of Fibromyalgia, but because they were considered " GERD", or " knee pain due to boot camp", or "URI", "headaches due to sinusitis, or OTM". Under 38 CFR 3.317(b) signs or symptoms of undiagnosed illness and medically unexplained chronic multisystem illnesses. You will find these same illnesses under this listing.

I recently was able to find a big portion (1997 - 2004) of my medical records from my then, primary care physician. I thought the records had been destroyed because the doctor lost his practice. I am wondering, now that I have these records, if I could prove service connection based on "continuity of symptomatology". Any suggestions?

[JT24usn]

Fibromyalgia should be considered a presumptive or a recognized presumptive under gulf war. Etiology seems like it wouldn't seem to matter to much. You have the service, check. You have the diagnosis, check. You have the symptoms, relative to what percentage ( that should be what the dr should be worrying about). Continuity if anything should help but not be needed to prove a considered presumptive to gulf war service. I am sure others will chime in, but this one is important to me as well. I too am getting ready to file too for fibromyalgia.

Think of it like dm ii and AO. Doesn't matter where it can from, but have service ( boots on the ground) and a diagnosis. If on metformin that should be an auto 20%. Jmho

Those cp drs get my BP up. Good luck to you and hope you find what you need here.

[Shyne-I]

Hi T8r,

I may be using 3.317(b) incorrectly. I did not serve overseas, so it's not considered a presumptive for me. I was just referencing the description of the signs and symptoms of Fibromyalgia, to say these are the same symptoms throughout my record over all these years!! Thanks for the well wishes.

[JT24usn]

Regardless. Good luck and hope you get what you deserve.

[meghp0405]

your continuity of symptomology needs to be expressed and detailed in an IMO from your Rheumatologist doctor. Did he/she speak of that in their nexus letter. If not, you may want to have another prepared.

[Berta]

Meg is right.

The examiner said:

"it is this providers opinion that the veterans fibromyalgia is not as likely as not due to, caused by or incurred in military service."

That sounds like a double negative.........NOT as likely as not ?????? Geez

John said:

"The exam doctor said he could not determine if I was TDIU because I was unemployed at the present time." WTF?

I swear sometimes that the VA needs a truckload of "Reading for Dummies"