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Possible Nod - Questions Fibromyalgia

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onrope

Question

I just posted my success story in that forum. To recap, I have been awarded 80% total.

I was granted 0% for Fibro. Reason is this as stated on my award letter.

We have assigned a non-compensable evaluation for your fibromyalgia, claimed as joint pain based on: Widespread musculoskeletal pain.

Widespread pain means pain in both left and right sides of the body, that is both above and below the waist, and that effects both the axial skeleton and the extremities.

A higher evaluation of 10 percent is not warranted unless the evidence shows *Widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety or Raynauds like symptoms that require medication for control.

I have complained of all the problems to my PCP and the C&P doctor (who was actually a PA not a doctor.) My DBQ for the fibro has been attached to make the reading of this post easier. The only issue I can se is that the reason I was only granted 0% was because I wasn't receiving treatment or therapy for it. Reason I have not received therapy is that no one would diagnose me with anything. I am pasting this portion.

b. Is continuous medication required for control of fibromyalgia symptoms?
[ ] Yes [X] No
c. Is the Veteran currently undergoing treatment for this condition?
[ ] Yes [X] No
d. Are the Veteran's fibromyalgia symptoms refractory to therapy?
[ ] 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
b. Frequency of fibromyalgia symptoms (check all that apply):
[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
Thoughts?...suggestions?

fibro DBQ.txt

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  • Content Curator/HadIt.com Elder

Hiya Onrope,

In my opinion, you should have received a 20% rating. The "criteria for 10%" quoted by the VA is just a basic description of fibromyalgia itself quoted directly from 5025 (below).

Look at the areas highlighted in BOLD below:

§4.71a Schedule of ratings—musculoskeletal system

5025 Fibromyalgia (fibrositis, primary fibromyalgia syndrome)
With widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud's-like symptoms:
That are constant, or nearly so, and refractory to therapy 40
That are episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but that are present more than one-third of the time 20
That require continuous medication for control 10
Note: Widespread pain means pain in both the left and right sides of the body, that is both above and below the waist, and that affects both the axial skeleton (i.e., cervical spine, anterior chest, thoracic spine, or low back) and the extremities.

Your DBQ has this checked:

b. Frequency of fibromyalgia symptoms (check all that apply):

[X] Present more than one-third of the time

The Medical History section of your attached DBQ mentions:

"It comes and goes, there is no pattern to it"
-- episodic


"When I try to do any exercise like running or anything I makes me scream in pain"
-- overexertion

Because this was very recent, I recommend filing a reconsideration. If they drag their feet and the reconsideration timer starts running out, you should file an NOD.

Keep in mind that a potential future rating increase to 40% means that it is near constant "and" refractory to therapy. Refractory basically means that whatever therapy has been tried does not work.

One more thing... Because the VA rater messed up this rating, it is possible that they might have messed up other ratings. Look over your award letter and carefully compare it with the rating criteria.

Good luck!

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Thanks for the reply.

Because this was very recent, I recommend filing a reconsideration. If they drag their feet and the reconsideration timer starts running out, you should file an NOD

Keep in mind that a potential future rating increase to 40% means that it is near constant "and" refractory to therapy. Refractory basically means that whatever therapy has been tried does not work.

One more thing... Because the VA rater messed up this rating, it is possible that they might have messed up other ratings. Look over your award letter and carefully compare it with the rating criteria.

Good luck!

I thought the same. But I also realize I have just been DX'd with the issue and need to participate in therapy in order to determine the full gravity of this disability. It's been very debilitating but was attributed by my PCP to age. It'll be good to move forward with treatment.

As you stated about the other ratings. I was denied for contentions of headaches. I will post the DBQ when I get to a computer. But the reason was because there was no history in my SMR and no presumptive condition was mentioned.

My fear is that a 20% rating from a monetary standpoint does nothing for me. My other fear is what if a mistake was made for my other positive ratings and I get reduced.

So I am real worried as what I should do anything or just be satisfied with my outcome.

Edited by onrope
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