Service Connection Fibro 1977

[SueEdel]

I recently received a denial to SC fibromyalgia. My symptoms started while I was enlisted in the Navy. One of the issues is that it is the term fibromyalgia was not used in medical jargon on a regular basis until about 1988 which is 11 years from my honorable discharge (under medical conditions). Nothing in my military medical records says fibro--but the symptoms--which they were chasing around trying to find a diagnosis were there.

The statement is "SC for fibro is denied because evidence does not show an event, disease or injury in service. You submitted a lay statement to support your claim. A credible lay statement may establish what was seen, heard and directly experienced. The lay evidence was found not to be competent and sufficient in this case to establish a link of nexus between your medical condition and military service or to establish that such a link has been found by a medical professional."

I provided two letter to provide a nexus. One was from my PCP at the VA who has treated me for about 10 years (although recently was removed as my doctor for reasons unexplained to me). The other letter was provided by my rehab chronic pain specialist who has treated me for over 15 years. Both letters follow the sample nexus formula.

I am wondering why they would not consider one of their own doctors a medical professional? For that matter, why a highly respected doctor in the treatment of pain and fibro is disregarded? Why are these considered lay statements and not medical opinions?

[71M10]

Are those two items listed in the evidence listing contained in the decision? File your NOD, if they don't list all the letters provided as evidence resent the letters and a copy of the proof of mailing from the first time they were sent. If the letters are listed, state in your NOD they are not LAY statements but opinions from Health Care Professionals and as such have to be weighed as clinical evidence not Lay evidence!

[SueEdel]

I am not seeing them listed in the evidence.

[free_spirit_etc]

"Why are these considered lay statements and not medical opinions?"

Because if they distort the information and the veteran doesn't catch it the veteran gives up and quits pursuing the claim.

[FormerMember]

A nexus letter is a compendium of three things. The doctor or specialist opining must, at a minimum, have reviewed your service medical records. Secondly, when making a determination that it is related to an event or disease/injury in service, s/he must be able to point to a documented , seminal event. Lastly, s/he must present cogent, rational thinking and current medical theory that supports the hypothesis. A simple statement that has no corroboration or support is pure conjecture and, as such, speculative in nature.

Since 2010, VA has forbidden its doctors to opine on nexus letters saying that is the province of the VBA rather than the VHA. Some still do and get gigged for it. A nexus letter needs to be nuanced and constructed such that there can be no holes in it. The codicil about having reviewed the contemporary records from service is not ironclad but if the VA examiner mentions s/he has done so, the Courts tend to consider that more probative than one where they were not perused.

Sorry. P.S. I just absorbed this. Give me slack. I'm stage 4/62 yrs old. My brain is differentially disabled.

The lay evidence was found not to be competent and sufficient in this case to establish a link of nexus between your medical condition and military service or to establish that such a link has been found by a medical professional."

A credible lay statement may establish what was seen, heard and directly experienced.

Layno v. Brown 1994. Lay testimony is limited to the five senses(hearing, sight, touch, smell and taste.)

The language clearly discusses "lay testimony" and "lay evidence". Therein lies the denial, not the doctors' nexi. If you give information (VA calls it "history" if not supported by the record) to a doctor and he simply records it by writing it down, it is merely what you remember it to be. It does not become proof or evidence it happened in VA's eyes. Look there for your problem. Lay testimony is limited to the five senses medically. You cannot say "I was diagnosed with X by a doctor in 1988" at a doctor's appointment in 1994, then come back in 2013 and say "See. Right here in 1994 the doctor says I have X." Usually it says "Patient reports a recurrent history of X". This is just an example. It may be another facet you haven't mentioned. This is just the most common one I've seen.

Edited October 11, 2013 by asknod

[SueEdel]

This is similar to what was submitted by two my VA PCP and My civilian doctor.

C-File #XXXXXXXX

As the Physical Medicine and Rehabilitation provider for XXXXX XXXXX, I have treated XXXXXXX for over 15 years. Rehabilitation Medicine is the medical specialty concerned with evaluating, diagnosing, and treating patients with physical disabilities.

Rehabilitation Specialists of Uniontown is a multidisciplinary group practice with four board certified/eligible physicians utilizing comprehensive evaluation, assessment and treatment for musculoskeletal injuries, pain, and impairment. Rehab Specialists offers Physical Medicine and Rehabilitation, Interventional Pain Management, Pharmacological Pain Management, Osteopathic Manual Medicine, Manual, Aqua and Physical Therapy and Medical Acupuncture.

As I have provided care for XXXX XXXXXXX, I’ve become familiar with her medical history, past and present infirmities and I’ve reviewed pertinent parts of her military record that document her illness, disease and clinical conditions related to the events that occurred during her military service.

I note XXXX XXXXXXXX became ill during her active duty military service on 00/00/1976. The results of her illness have been ongoing, long lasting, and as she has gotten older her condition has deteriorated.

XXXXX XXXXXX suffers from constant widespread musculoskeletal pain, sleep disturbance, stiffness and fatigue. She continues to undergo treatment by me and is prescribed medications for insomnia, anxiety, and pain.

It is my opinion that it is as least likely as not that her current fibromyalgia symptoms began in 1976 and that there is a medical nexus between XXXX XXXXXX active duty service-connected illness and her fibromyalgia disability of today.

____________________________________ _______________________
My Doctor

[Shyne-I]

Hi Sue,

I ran into almost the same problem. I was denied for my Fibromyalgia claim as well. I wasn't diagnosed until 15 years after service, being treated for the symptoms without ever getting a diagnosis!! The C& P examiner said that although the symptoms exhibited in my SMR's could be symptoms of Fibromyalgia, they also have other common etiologies, etc...etc... AskNod is right on point when he says. "rational thinking and current medical theory that supports the hypothesis. A simple statement that has no corroboration or support is pure conjecture and, as such, speculative in nature." I believe this is why your statement was not successful. I submitted my IMO on 8/15 and they denied me again on 9/6 but they did not have it listed as evidence in the SOC. I believe that they had received the information but they rushed to close it out so that I would have to do a appeal at the BVA. I resubmitted the IMO as new and material evidence since they failed to include it as evidence listed in the SOC. Here is the one that I resubmitted after they supposedly didn't see the first one:

I am Dr. XXXXXX. I am board certified to practice in my specialty of Rheumatology. My credentials are included below. I have been asked to write a statement in support of the afore mentioned veterans claim. After speaking with Mrs. XXXXXX's representative, I have elected to provide her with a written statement. She informed me that she believes that the statement that I provided on August 13, 2013 was not recognized because it was not on my office letter head, so I am providing another statement. I have personally reviewed her medical history in her service medical records as well as her more contemporary private medical records and history. I have also reviewed and have noted the medical circumstances and events during her military service. After reviewing the veteran’s service medical records I found several entries in which she complained of various symptoms indicative of Fibromyalgia and its chronic multi-symptom illnesses. While in service the veteran was treated for complaints of “low back pain, lower pelvic pain noted on 11/14, 11/16, and 11/22/94; bilateral knee pain noted on 4/9/94; as well as abdominal pain and gastrointestinal symptoms that included nausea, diarrhea and cramping, headaches noted on several different occasions, hyperventilation and dizziness noted on 3/3/94”. There are also very frequent upper respiratory illnesses, as well as various headache types (Sinus and Tension headaches), that could have been caused by Multiple Chemical Sensitivity which causes negative health effects in multiple organ systems. Multiple Chemical Sensitivity is a syndrome associated with Fibromyalgia and can cause respiratory distress which explains the hyperventilation and dizziness, and the nausea and headaches could have been caused by MCS as well.

Mrs. XXXXX has been under my care since May 2012. Her diagnosis is Fibromyalgia with a co-occurrence of Mixed Connective Tissue Disease, with Migraines and Depression secondary to her Fibromyalgia. Mrs. XXXXXX’s initial examination with me displayed chronic widespread musculoskeletal pain and tender/trigger points (14/18) which have been refractory to treatment with medication. She continues to have migraine headaches, upper respiratory/chronic sinus infections, as well as intermittent irritable bowel symptoms. The combination of her symptoms and the various medications that she takes for her symptoms: Cymbalta, Neurontin, Plaquenil, Flexeril, Tramadol, and Ibuprofen, for Fibromyalgia and Depression; Verapamil, Epidrin for Migraines; and Zyrtec for Sinus symptoms, currently severely limits her ability to maintain employment.

After a review of the pertinent service medical records, her C-file and her medical records and history from 1996 to the present, it is my professional opinion that it is at least as likely as not, meaning at least a 50% chance that the veterans Fibromyalgia was manifested during her military service.

In my personal and professional experience and in medical literature, it is agreed that Fibromyalgia is a disorder of unknown etiology, even though some believe it can be triggered by stress or physical strain. Although the symptoms the veteran complained of in service may have multiple etiologies as well as pregnancy; it is the entire picture of the veteran’s medical history and subsequent manifestations of the same chronic illnesses that show both chronicity and continuity of a chronic disorder. Fibromyalgia has a tendency to “flare up”, meaning that it can cause the sufferer great discomfort and distress one day and show no symptoms at all the next. It is unfortunate, because it can take some time to develop to the extent where it is diagnosable by a doctor. It is worth noting that no two sufferers will have the same ailments as a result of Fibromyalgia which is also why the process of diagnosing it can take so long. It is my opinion that this is what has occurred in the veteran’s case.

Signed,

XXXXXXXXXXX, M.D.

Board Certified in Internal Medicine

Board Certified in Rheumatology

License #: XXXXXXX