Related to fibromyalgia

[invisible]

I just recieved my determination for Fibromyalgia. They listed it as a disability, denied SC, but in the notes listed enviromental hazard. What does this mean? I wasn't expecting to be approved, since at the last moment, my primary PCM declined to fill out the Questionaire. Just wondering if anyone had any insight. Out of all the labs they took, the odd one was the Epstein Barr. I am not sure if that is to confirm, rule out FM... IDK. Thanks in advance for any insight!

fibromyalgia

Not Service Connected

Environmental Hazard in Gulf War

[invisible]

I hope the new examinations and tests result in the VA reversing their poorly made decision.

After reading the C&P exam results, they claim your medical treatment records "are silent" to a positive diagnosis for fibromyalgia. If your new rheumatism doctor formally diagnoses you with fibromyalgia, then that should be the end of denials. Have you been diagnosed with fibromyalgia by any medical professional yet? If you have, did you send the documentation from that specific visit to the VA along with their claim?

I don't want to switch gears about your fibromyalgia, but I noticed you filed for cervical/lumbar and were SC at 0%. They typically rate this due to limited range of motion, abnormal spinal curvature, abnormal gait, or IVDS (i.e. bed rest). Check all of your records and see if any of the items I listed have been documented. If you have anything in the times between when you filed and your C&P exam, it might be able to really help. Don't give up on this. Every time you have problems, go to the doc and get it documented. Keep a "pain diary" to track flare ups if it occurs fairly frequently. It could also be beneficial to buy a cheap goinometer online and have your husband measure your range of motion according to the charts in the rating criteria. Don't forget to take a separate measurement for when pain begins vs. the maximum range you can move. If you know a friend who is a nurse or doctor, ask them to check it and document it as a buddy letter. For example, my wife is a licensed RN and keeps track of everything. Having someone who is a licensed medical professional carries more weight than an average person.

The VA is supposed to list details of the evidence they used to make their decision. It's not uncommon for it to be omitted or overlooked. If the VA made the decisions based on their own examinations and records, but did not have your non-VA records, it could be as simple as sending in copies of just those specific visits. If this is the situation, you should be able to easily counter any of those "records are silent" statements from the VA.

My primary care MD has been treating me for over a year and told me it was fibromyalgia. But once I requested he fill out the DBQ, he refused. And his notes would do more harm than good, because he hardly detailed 1/2 of what was done and said, and then said other things were managed that I continued to complain about- but that he said there was nothing to be done. I have documentation thorought my MIL medical record of symptoms that are indicative of fibro. I am waiting on getting a new copy of my file- so I can go page by page. 

 

In my c spine I have a buldged disc @ c5-c6, narrowing where the nerve is, and a non-c-curve. In my L5/S1 area I have osteophyte with boney islands, degenerative changes, sacrolititis, etc. The latter was the main reason for my MEB. I have been keeping a pain dairy, but will take your advice and track range of motion. The reason that the DDD/DA in the c & l/s are 0% is because my ROM isn't bad enough. The Rheum MD said that Degenerative arthritis doesn't always have to have limited ROM to be significant. I was surprised by that because the VA will not acknowledge its a real problem without significant ROM...

 

So, yeah, I need to go through my file page by page when I get it.   

[Vync]

I understand completely about your PCP doc. That happens more than more people expect.

The spine ratings are a bit tricky. They are usually rated by ROM, but there's more to it. They just look at the ROM and ignore the rest, expect the veteran to accept their decision, and then you're stuck with a lowball rating.

Did you recalculate the range of motion degrees from your C&P exam and compare them with the actual rating table?

There are a lot of or's in the table. You only need to meet one single criteria on a single row within the table to qualify.

Arthritis might be able to be filed separately, but I don't know much about it. Could be worth a shot...

If your doctor prescribed bedrest for more than one week within the last 12 months, you can probably get a temporary increase just for that alone. I know many doctors don't do this much any more.

Check out the criteria I highlighted below because it details more than just ROM.

	Rating
General Rating Formula for Diseases and Injuries of the Spine
(For diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes):
With or without symptoms such as pain (whther or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease
Unfavorable ankylosis of the entire spine	100
Unfavorable ankylosis of the entire thoracolumbar spine	50
Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine	40
Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine	30
Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis	20
Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height	10
Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.
Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.
Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted.
Note (4): Round each range of motion measurement to the nearest five degrees.
Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.
Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.
5235   Vertebral fracture or dislocation
5236   Sacroiliac injury and weakness
5237   Lumbosacral or cervical strain
5238   Spinal stenosis
5239   Spondylolisthesis or segmental instability
5240   Ankylosing spondylitis
5241   Spinal fusion
5242   Degenerative arthritis of the spine (see also diagnostic code 5003)
5243   Intervertebral disc syndrome
Evaluate intervertebral disc syndrome (preoperatively or postoperatively) either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under §4.25.
Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes
With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months	60
With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months	40
With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months	20
With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months	10
Note (1): For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.
Note (2): If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment.

 

[k5one]

OK, I believe the problem is that the C & P examiner gave a negative nexxus, which the rater used in the decision.  In Gulf War presumptive claims, the C & P examiner is not supposed to give a nexxus, they are supposed to give an opinion of whether or not you have the disability.  That may be a CUE, I'm not sure.

The following was originally posted by pgwvet from http://www.ngwrc.org/ .  I believe the key part is the red highlighted sentence.

Like I said on the IBS sample this is the start. Only you the veteran can say about your symptom.
The DBQ should have marked your meds are not working.


This denial is in error, did not follow the law on Fibromyalgia on presumptive
illness under 38 U.S.0 § 1117 enacted in 2001 and as in 38 CFR § 3.317(a)(2)(B) (2)
Fibromyalgia. A presumptive illness does not need a nexus to the service as per
Gutierrez v. Principi, 19 Vet.App. 1, 9 (2004)
The RO did not follow the M21-1MR on how to do claims of this type as per.
1. VA Training Letter 10-01 Adjudicating Claims Based on Service in the Gulf War and
Southwest Asia (We believe this needs updating and are working on it.)
2. 38 CFR § 3.317 and 38 U.S.C. §§ 1117
3. M21-1MR, Part IV.ii.2.D ( how to rate a claim under 3.317)
4. M21-1MR, Part IV.ii.2.D.i -Rating Action Taken Based on Disability Pattern
Determination It states, "Grant service connection-"
5. M21-1MR, Part IV.ii.l.E (developing GW claims under 38 CFR § 3.317)
The rating specialist should not have relied on a medical opinion that was not to be
given as per the guide lines in the "notice to the Examiner" in the VA FL 10-01.
As the notice state the examiner is only to give an opinion on out come 3 & 4, and
Not 1 or 2, Fibromyalgia is defined in the law and in TL 10-01 as a medically
unexplained chronic multisymptom illness.
The rating specialist clearly did not follow the M21-1MR, Part IV.ii.2.D.i -Rating
Action Taken Based on Disability Pattern Determination It states, "Grant service
connection-" I was clearly diagnosed with the illness.
The DBQ showed that I am diagnosed with Fibromyalgia and that the tests show my
thyroid is fine. I have had all of the other test needed as well. I am on medication
and I am still in pain most all of the time. As per the rating guidelines I have met
the 40% rating.

[Andyman73]

I wish my contentions came with directives like that!

[invisible]

OK, I believe the problem is that the C & P examiner gave a negative nexxus, which the rater used in the decision.  In Gulf War presumptive claims, the C & P examiner is not supposed to give a nexxus, they are supposed to give an opinion of whether or not you have the disability.  That may be a CUE, I'm not sure.

The following was originally posted by pgwvet from http://www.ngwrc.org/ .  I believe the key part is the red highlighted sentence.

Like I said on the IBS sample this is the start. Only you the veteran can say about your symptom.
The DBQ should have marked your meds are not working.


This denial is in error, did not follow the law on Fibromyalgia on presumptive
illness under 38 U.S.0 § 1117 enacted in 2001 and as in 38 CFR § 3.317(a)(2)(B) (2)
Fibromyalgia. A presumptive illness does not need a nexus to the service as per
Gutierrez v. Principi, 19 Vet.App. 1, 9 (2004)
The RO did not follow the M21-1MR on how to do claims of this type as per.
1. VA Training Letter 10-01 Adjudicating Claims Based on Service in the Gulf War and
Southwest Asia (We believe this needs updating and are working on it.)
2. 38 CFR § 3.317 and 38 U.S.C. §§ 1117
3. M21-1MR, Part IV.ii.2.D ( how to rate a claim under 3.317)
4. M21-1MR, Part IV.ii.2.D.i -Rating Action Taken Based on Disability Pattern
Determination It states, "Grant service connection-"
5. M21-1MR, Part IV.ii.l.E (developing GW claims under 38 CFR § 3.317)
The rating specialist should not have relied on a medical opinion that was not to be
given as per the guide lines in the "notice to the Examiner" in the VA FL 10-01.
As the notice state the examiner is only to give an opinion on out come 3 & 4, and
Not 1 or 2, Fibromyalgia is defined in the law and in TL 10-01 as a medically
unexplained chronic multisymptom illness.
The rating specialist clearly did not follow the M21-1MR, Part IV.ii.2.D.i -Rating
Action Taken Based on Disability Pattern Determination It states, "Grant service
connection-" I was clearly diagnosed with the illness.
The DBQ showed that I am diagnosed with Fibromyalgia and that the tests show my
thyroid is fine. I have had all of the other test needed as well. I am on medication
and I am still in pain most all of the time. As per the rating guidelines I have met
the 40% rating.

 

I am reading up on all you typed here, and I hope I do not sound ignorant... but I am right to assume this is from someone else's determination in a similar case?

I have a healthy distrust for VA doctors but am wondering if I should contact my VA outpatient clinic and ask for a GW eval and rheum referral. I just started going to a civilian doc and ortho, but my distrust is resulting in me having to pay out of pocket for MRI- which granted my deductible is met for the year but I am still responsible for 20%co-insurance. What do you guy think is wise. I know my questions are never-ending, and forgive me for that...

And I appreciate everyone's input here, you guys are very helpful.

[Guest]

Of course it is your call but you can actually do both.  I mean go the civilian route then have VA verify it or you could just submit what ever the civilian doctor state that is beneficial to your claim.