Fibromyalgia secondary to SC PTSD/MST or IBS

[Navy4life]

Hi there!  Long time member here but been MIA for awhile.  Life has been busy and I have been dealing with health issues.  Long story short, I went through a battery of tests to find out what is wrong with me.  I did an ANA-TITER test, and it was positive for an auto immune disease.   Was referred to the RA doctor for further testing to see if I had lupus.  The RA doctor did blood tests and determined I don't have lupus.  We did additionally physical exam at the VA back in May and he determined I had Fibromyalgia and diagnosed me with it.  We discussed that my Fibromyalgia co-exists with PTSD/MST and IBS.  We also discussed that Fibromyalgia can be secondary to my already service-connected PTSD/MST or even maybe my IBS.  I discussed this with my representative and we decided to file a claim for Fibromyalgia (non-service connected disability) to an already service-connected disability.  Either PTSD/MST or IBS and we asked that they evaluate either causation or aggravation.

We filed in July and I had my C&P exam in September.  The examiner was asked by the rater to give his medical opinion as to the Fibro being secondary to my PTSD/MST.  The rater did not ask if it was possible to be secondary to my IBS like we requested.  The examiner did a C&P DBQ for Fibro and that was positive.  I do have Fibro, that isn't the issue.  The medical opinion is what was disturbing.  I was with the examiner for less than 5 minutes.  He stated he physically examined me when he did not and he seemed very unknowledgeable about Fibro/PTSD-MST/IBS as co-existing and determining either causation or aggravation.  Of course the medical opinion stated, "less likely than not".  I was floored, so I went to work for my claim.

I contacted my RA doctor and we talked with my representative on the phone as well.  By the end of the call he was confident enough to link my PTSD/MST as aggravation to my Fibromyalgia.  He wrote a one/two paragraph letter on my behalf.  We sent that to the rater.  Then I spoke to my MH provider last week and she too wrote me a very good NEXUS letter.  That was sent to the rater yesterday.  Both my doctor's are at the VA and both stepped out on a limb for me.  I am hoping their medical opinions outweigh the negative C&P medical opinion.

I am attaching the C&P exams (redacted), the two medical opinions (redacted) - I am hoping I am successful because this will make me 100% scheduler.  I am currently 94% overall rated.

C&P _Redacted.pdf

nexus 2_Redacted.pdf

redacted.pdf

redacted2.pdf

[Buck52]

Hi there Navy4life  long time no see

glad to see you back on hadit.

As for as this C&P it looks incomplete to me the examiner fails to answer a lot of the questions that would help a rater. so this would be an Inadequate exam

you can send in more evidence if you have not received a decision just yet?

 what they may do is send you to another C&P, go to it if they do and when you think your C&P is going South  speak up ,take extra evidence with you ...ask if he has seen in your medical records what all your RA Dr mention ect,,ect,,

you have medical records as to the opinion of your VA RA Doc  so make sure the examiner reads those...5 min in a C&P is not a good sign  unless the examiner re reads about your over all condition your claiming   which in General they don't.

Anyway I am sure your going to get an approval  but don't be surprised if it don't boosts your rating to the 100%.

  if your 90% at present you will need an additional 50% on another condition to a total combined rating of 100%...Unless they try to pin the IU on you so watch that  if your IU  then you can't be working.

I was 90%combined TDIU P&T for years until I won my 70%chronic combat PTSD Claim , that put me up to the 100%scheduler and meet the criteria for Two SMC's That sure help us out financially. 

Wishing you all the best my friend.

Good to see your still alive and kicking girl.

Take Care

[Buck52]

Note to Navy4 life

We moved out of Dallas...not sure if you know the North Tx Area?

We moved to Burleson Tx  JUST 9 miles South of Ft Worth...we truly love this little town , Lots to do ,it has everything the big city's have and then some & most Important  the people here are very friendly and helpful  unlike the social lites of Dallas.

 

[Navy4life]

9 minutes ago, Buck52 said:

Hi there Navy4life  long time no see

glad to see you back on hadit.

As for as this C&P it looks incomplete to me the examiner fails to answer a lot of the questions that would help a rater. so this would be an Inadequate exam

you can send in more evidence if you have not received a decision just yet?

 what they may do is send you to another C&P, go to it if they do and when you think your C&P is going South  speak up ,take extra evidence with you ...ask if he has seen in your medical records what all your RA Dr mention ect,,ect,,

you have medical records as to the opinion of your VA RA Doc  so make sure the examiner reads those...5 min in a C&P is not a good sign  unless the examiner re reads about your over all condition your claiming   which in General they don't.

Anyway I am sure your going to get an approval  but don't be surprised if it don't boosts your rating to the 100%.

  if your 90% at present you will need an additional 50% on another condition to a total combined rating of 100%...Unless they try to pin the IU on you so watch that  if your IU  then you can't be working.

I was 90%combined TDIU P&T for years until I won my 70%chronic combat PTSD Claim , that put me up to the 100%scheduler and meet the criteria for Two SMC's That sure help us out financially. 

Wishing you all the best my friend.

Good to see your still alive and kicking girl.

Take Care

Hi Buck;

im 94% so all I need is 10% to go to 95% rounded to 100% which is why this is a big deal for me. Did you see the MH doctor NEXUS?  I think it was very solid. I’m really hoping I either get a new CnP or win with all my evidence I submitted. I agree the CnP was inadequate for sure. My rep has messaged the rater several times with all the new evidence as well as we indicated the rater didn’t ask for a proper CnP and the CnP was erroneous. We shall see. 

[Navy4life]

5 minutes ago, Buck52 said:

Note to Navy4 life

We moved out of Dallas...not sure if you know the North Tx Area?

We moved to Burleson Tx  JUST 9 miles South of Ft Worth...we truly love this little town , Lots to do ,it has everything the big city's have and then some & most Important  the people here are very friendly and helpful  unlike the social lites of Dallas.

 

We moved to Florida in 2015. Live in Keys and really enjoy it. My husband has a great job and I work from home. Just bought our house this year. Lived through Irma. Lost material things but USAA took care of us. 

[Buck52]

Thats good Navy4life  

I bet you guys really love the Keys....gotta visit them sometimes.

Only time I spent in Florida was at the Miami Airport  headed to the Bahamas 

We have USAA too....

Also theres is not a 94%rating  if you had figured you was 94% that's still below the 95% and your considered 90% by the VA 

 So 90% AND 10% Using VA Math formula the extra 10% added to your 90% is only 91% with VA Math  and still falls below the 95% to get you over the hill at 100%.

   its very hard when a Veteran has a 90% or 94 % rating  & to get over the 95% needed for the 100% .

 example for each 10% you actually only get 1 % so this is why you need a 50% increase to boost you on up to the 100% scheduler. or 5 10% ers   combined.

Maybe with all these extra conditions you might get 50% ? not sure how they rate the Firbro ?? if its chronic  you could see a higher rating   . I hate to hear you have that  from what I hear thats bad bad.

 

no I didn't look at the MH Nuxus  I thought you had MST  for MH? AT 70%

When I GET BACK HOME I WILL LOOK AT IT.

Later on this evening. you know how the Dallas VA is... eh!

Well off to the VA For an all day outing!

.TTYL

Edited October 25, 2018 by Buck52

[Navy4life]

Hi Buck;

I know there is no 94%.  I am 94% rounded down to 90% but if I get 10% for Fibromyalgia, I will go to 95% rounded up to 100%.  That is what I was trying to say.  Yes, I am rated 70% for PTSD/MST but I was asking if you thought my MH provider's letter (NEXUS) was good?