Are C&P exams done for presumptive claims?

[AFgal]

In March I filed a presumptive claim for GWI for fibromyalgia.  I know that C&P exams are not always required and so was wondering if anyone knows if they are usually required or not for a presumptive claim. I also wondered if it matters to the VA that my diagnosis was given by a military doctor at a major military hospital versus a civilian doctor. 

I included a letter in my documentation clearly stating this was a presumptive claim quoting the 38 CFR § 3.317 reg for fibromyalgia.

Edited April 17, 2018 by AFgal

[NordicZulu]

I applied back in 2011.  Unless something has changed between then and now regarding presumptive conditions they will require a C&P. 

[broncovet]

It depends on your circunstances.  If there is already evidence in your file, then it should not be necessary.

However, for example, maybe you dont even have a diagnosis of the presumptive condtion?  Also, a c and p exam may be needed to document your symptoms, as your rating will be based on symptoms.  

As far as the diagnosis military vs civilian it does not matter except in the case of PTSD, because VA thinks "only va docs" can diagnose PTSD to meet VA's criteria.  

[Buck52]

If you file a presumption A.O. Claim  I believe they will send you to a C&P

Here is a little more information on A.O. Claims clink link below.

I tell every veteran I see if they were exposed to A.O. While in Military and come down with any condition that's on the presumption list and the new added conditions. file that claim ASAP.

I am not so sure fibromyalgia is on the P-List?

Although a veteran can get S.C. For it if he/she has medical records while in military that you were treated for it.

http://www.veteransdisabilitylawyersite.com/agent_oran ge_presumption.html

[Berta]

I assume this is your first VA claim and that you can prove this excerpt from 38 CFR, 3.317 puts you into the 10% manifestation criteria:

"(i) With three exceptions, the disease must have become manifest to a degree of 10 percent or more within 1 year from the date of separation from a qualifying period of service as specified inparagraph (c)(3)(ii) of this section. Malaria must have become manifest to a degree of 10 percent or more within 1 year from the date of separation from a qualifying period of service or at a time when standard or accepted treatises indicate that the incubation period commenced during a qualifying period of service. There is no time limit for visceral leishmaniasis or tuberculosis to have become manifest to a degree of 10 percent or more."

https://www.law.cornell.edu/cfr/text/38/3.317

A C & P exam is needed to confirm the diagnosis, and then determine how it should be rated. :

"Code 5025: Fibromyalgia is a disease that causes pain and sensitivity throughout the entire body. The pain must be present on both sides of the body and both above and below the waist to be rated under this code. Likewise, a rheumatologist must evaluate and diagnose the condition for it to be rated under this code.

If the pain is constant and is resistant to treatment, then it is rated 40%. If the pain is not constant, but recurring and present 1/3 of the time, then it is rated 20%. As long as the pain requires continuous medication to control it, it at least receives 10%."

http://www.militarydisabilitymadeeasy.com/diseasesofthemusculoskeletalsystem.html#fibro

[AFgal]

39 minutes ago, Buck52 said:

If you file a presumption A.O. Claim  I believe they will send you to a C&P

Here is a little more information on A.O. Claims clink link below.

I tell every veteran I see if they were exposed to A.O. While in Military and come down with any condition that's on the presumption list and the new added conditions. file that claim ASAP.

I am not so sure fibromyalgia is on the P-List?

Although a veteran can get S.C. For it if he/she has medical records while in military that you were treated for it.

http://www.veteransdisabilitylawyersite.com/agent_oran ge_presumption.html

Fibromyalgia is on the presumptive list for Gulf War Illness. I was in from Sept 1997-Sept 2001. 

[AFgal]

23 minutes ago, Berta said:

I assume this is your first VA claim and that you can prove this excerpt from 38 CFR, 3.317 puts you into the 10% manifestation criteria:

"(i) With three exceptions, the disease must have become manifest to a degree of 10 percent or more within 1 year from the date of separation from a qualifying period of service as specified inparagraph (c)(3)(ii) of this section. Malaria must have become manifest to a degree of 10 percent or more within 1 year from the date of separation from a qualifying period of service or at a time when standard or accepted treatises indicate that the incubation period commenced during a qualifying period of service. There is no time limit for visceral leishmaniasis or tuberculosis to have become manifest to a degree of 10 percent or more."

https://www.law.cornell.edu/cfr/text/38/3.317

A C & P exam is needed to confirm the diagnosis, and then determine how it should be rated. :

"Code 5025: Fibromyalgia is a disease that causes pain and sensitivity throughout the entire body. The pain must be present on both sides of the body and both above and below the waist to be rated under this code. Likewise, a rheumatologist must evaluate and diagnose the condition for it to be rated under this code.

If the pain is constant and is resistant to treatment, then it is rated 40%. If the pain is not constant, but recurring and present 1/3 of the time, then it is rated 20%. As long as the pain requires continuous medication to control it, it at least receives 10%."

http://www.militarydisabilitymadeeasy.com/diseasesofthemusculoskeletalsystem.html#fibro

Yes, I already know this. This is my first claim for fibromyalgia.