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

[FormerMember]

The answer, sadly, is no- the documents you attached to your post have little or no probative value in a court of law. The DBQ shows the medical specialist reviewed your claims file whereas the VA doctor did not. That, right off the bat, kills the nexus letter. Reonal v. Brown. In order to be probative, a nexus must say more that "it's SC". It must then give reasons and examples of peer-reviewed studies the doctor relied on to reach his conclusions so others may review it for its probity.  

The nexus letter states: " This condition is likely related to PTSD as several studies..."  At least as likely as not is the minimum legal standard of review. Later the doctor does say it's at least as likely as not but gives no cites to peer-reviewed articles he referred to. You cannot have two different determinations of degree of belief that something is related to service. Either it's "likely" or else it's "at least as likely as not".  

As for your VA agent writing you a nexus letter, he would need to be a medical doctor or Registered Nurse with a two-year degree to write it. If he doesn't know this, you may want to shop around for new legal help. Remember, IMO doctors write their letters a lot differently than practicing physicians. They review any and all medical records, including your service and current ones. No serious doctor would write a nexus based on nothing more than what the patient recites to him. Fibromyalgia, secondary to PTSD (or any major mental disorder) is attainable but there's a recipe for a winning nexus. Get all you records and give them to the VA doctor who wrote the nexus. Let him/her review them and cite to the medical studies s/he mentioned showing the relationship between the PTSD and the fibromyalgia. Present it to the BVA Judge on appeal and you will win. 

Here's an attached example of how I file. I ask for benefit of the doubt but I have quite a bit of argument to back up the benefit of the doubt argument. As you can see, I always get more than one nexus too but the professional one is always the chicken dinner winner.

Best of luck.

Filed IMO to BVA 1-8-2018 redacted.pdf

[Navy4life]

15 hours ago, asknod said:

As for your VA agent writing you a nexus letter, he would need to be a medical doctor or Registered Nurse with a two-year degree to write it. If he doesn't know this, you may want to shop around for new legal help.

My VSO didn't write ANY Nexus letters.  What I attached for review, was his cover letters with the doctor's NEXUS letters.  Both my doctors are experts in their fields.  One is a Psychiatrist and the other is a Rheumatologist.

 

15 hours ago, asknod said:

Remember, IMO doctors write their letters a lot differently than practicing physicians. They review any and all medical records, including your service and current ones. No serious doctor would write a nexus based on nothing more than what the patient recites to him.

My doctor's that wrote their letters for me, are my VA doctor's.  I didn't hire any doctor to write letters and my VA doctor's have all my medical records, so they know my medical history.

 

15 hours ago, asknod said:

Fibromyalgia, secondary to PTSD (or any major mental disorder) is attainable but there's a recipe for a winning nexus

I agree and I didn't want to "feed" or "pump" information to my VA doctors.  I simply asked them after they reviewed the negative medical opinion from the C&P examiner if they would help me out.  

 

15 hours ago, asknod said:

Present it to the BVA Judge on appeal and you will win. 

Still in the initial claim process, so if I get denied I will have to go this route for sure.  Too late now, as I have presented what I have from both my VA doctors, the literature to support the claim, and additional evidence my VSO provided.

I appreciate your response and the letter you provided.  Will read it thoroughly and if I need one like that, I will have to go that path.  As of today, I have been successful with my claims.  Buck52 knows my history and my representative has been a guest on Hadit talk show.  He is good and knows what he is doing.  I trust him so far and I will continue to use him if I need to appeal.  I even had my husband hire him.  He got him from 60% to 90% and now they are working on the appeals.

[FormerMember]

<<<<< I didn't hire any doctor to write letters and my VA doctor's have all my medical records, so they know my medical history.>>>>>>

Are you saying you gave them all your service medical records or simply that they have all your VA VistA (CAPRI) records? There is a major difference. By operation of law, VA Hospitals are not allowed to store and view your military treatment records so I doubt they have your military service "medical history". If you tell a doctor what happened to you in the military, unsubstantiated by any service treatment records, that is simply your version of events attenuated through your perceptions of what you say happened. It isn't corroborated by anything on paper. In VAland, they call that "history" as in "the Veteran contends..., or Veteran avers... or Veteran claims..." I could claim I got Hepatitis C on my third alien abduction from the  colonoscopy they gave me. I don't think they'd believe me unless I showed them the pictures or the records. Lay testimony, while useful, must still be supported by evidence.

<<<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.>>>>

I apologize. From the way it was written, I inadvertently took it to mean that by the end of the call, your accredited representative was confident enough to link the Fibro to a MH or IBS problem. I only saw one nexus letter from a doctor and a DBQ. 

While I wish you the very best in your claims, I merely point out problem areas I have encountered in the past that you may want to have your representative address. 

[Navy4life]

1 minute ago, asknod said:

<<<<< I didn't hire any doctor to write letters and my VA doctor's have all my medical records, so they know my medical history.>>>>>>

Are you saying you gave them all your service medical records or simply that they have all your VA VistA (CAPRI) records? There is a major difference. By operation of law, VA Hospitals are not allowed to store and view your military treatment records so I doubt they have your military service "medical history". If you tell a doctor what happened to you in the military, unsubstantiated by any service treatment records, that is simply your version of events attenuated through your perceptions of what you say happened. It isn't corroborated by anything on paper. In VAland, they call that "history" as in "the Veteran contends..., or Veteran avers... or Veteran claims..." I could claim I got Hepatitis C on my third alien abduction from the  colonoscopy they gave me. I don't think they'd believe me unless I showed them the pictures or the records. Lay testimony, while useful, must still be supported by evidence.

<<<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.>>>>

I apologize. From the way it was written, I inadvertently took it to mean that by the end of the call, your accredited representative was confident enough to link the Fibro to a MH or IBS problem. I only saw one nexus letter from a doctor and a DBQ. 

While I wish you the very best in your claims, I merely point out problem areas I have encountered in the past that you may want to have your representative address. 

Hi there;

I have NO inservice medical records for Fibromyalgia.  I am trying to service connect secondary to my service-connected PTSD/MST or my service-connected IBS.  What I was referring to, was that my MH doctor has all my medical records from our contacts with one another and my RA doctor as well.

I provided the C&P exams that I had and I provided two letters, one from my MH doctor and one from my RA doctor.  I also provided cover letters from my VSO to the rater stating that he was attaching the medical opinions from the doctors and that he further urged the rater to approve the claim.

Sorry if it got confusing....I think this is going to be a hard one for me, and I originally thought it would be easy but I am finding out that it might not be the case.  Right now the claim is in "gathering of evidence" according to Ebenefits.gov so we shall see how this plays out.

I do appreciate your responses!

[FormerMember]

3 hours ago, Navy4life said:

I have NO inservice medical records for Fibromyalgia.  I am trying to service connect secondary to my service-connected PTSD/MST or my service-connected IBS. 

I fully understand your claims posture (i.e. Fibro 2ndy to PTSD/IBS). Nevertheless, even though your contemporary service medical records have no entries for fibromyalgia, the probity, and subsequent value, of any IMO hinges on the reviewer (i.e.the RA Dr. or MH provider) having surveyed each and every document from beginning to end. You will note in the C&P doctor's form on page one that s/he checked off the box  stating they had reviewed the VBMS electronic file (your claims file) or the Virtual VA file.  That's called ACE (Acceptable Clinical Evidence)

I think there is some confusion here. I keep asking you if the doctors reviewed your claims file. A claims file is not the VAMC's medical records file on you. The C&P doctor reviewed all your files-both VAMC Dr. notes and the Navy medical records from the time you served. If your VAMC doctors have not, or never will, review your Navy service medical records, the VA will continue to deny you forever. If these same VAMC doctors are unwilling to quote from, and send in recognized, peer-reviewed studies pointing to a strong correlation between Fibro and PTSD, then you will be denied forever. I tell my clients to watch Judge Judy for a month to get the gist of law and evidence.

On page 7 of the c&p exam, in Section IV -Medical Opinion,, the doctor clearly stated: "there are no medical records or studies showing a direct or causal relationship with the two conditions."  Part of submitting a claim is submitting evidence that supports it. Here, the VA-contracted doctor says you did not submit any evidence to support your contention that the fibro is secondary to PTSD. That is what is necessary to win. Your VSO, who works for VA, knows you need three things to win. We also teach these three elements to each and everyone who comes to Hadit or asknod- 1) disease/injury/risk factor or presumptive in service; 2) same disease/injury now; and 3) a nexus letter connecting the two. (Caluza v. Brown 1994; Cf. Shedden; Hickson et al). You basically have only #2- a current diagnosis of Fibro.

What you need is #3- a legitimate Independent Medical Opinion (IMO/IME/nexus). At a minimum, your IMO doctor has to connect the fibro to the PTSD with sound medical principles (and recognized studies-not internet articles) all doctors can reasonably agree on. See 38 CFR §3.310.  I would talk this over seriously with your VSO. If you say "What about the Caluza golden triangle?" and he looks back at you like a deer in the headlights and says "Who's Caluza?", you may want to reread what we're trying to teach you in this thread and rethink your legal strategy. 

I always benefit from getting the denial and seeing what they used for the  rationale. It's easier to make a battle plan when you know why they denied you and what they used to determine it with. Best of luck. 

[Navy4life]

7 minutes ago, asknod said:

You will note in the C&P doctor's form on page one that s/he checked off the box  stating they had reviewed the VBMS electronic file (your claims file) or the Virtual VA file.  That's called ACE (Acceptable Clinical Evidence)

I think there is some confusion here. I keep asking you if the doctors reviewed your claims file. A claims file is not the VAMC's medical records file on you. The C&P doctor reviewed all your files-both VAMC Dr. notes and the Navy medical records from the time you served.

I have a hard time believing the C&P examiner reviewed all my files.  His C&P was really inaccurate.  He even stated in the C&P I wasn't actively being treated and I am under my RA's care as we speak.

 

8 minutes ago, asknod said:

On page 7 of the c&p exam, in Section IV -Medical Opinion,, the doctor clearly stated: "there are no medical records or studies showing a direct or causal relationship with the two conditions."  Part of submitting a claim is submitting evidence that supports it. Here, the VA-contracted doctor says you did not submit any evidence to support your contention that the fibro is secondary to PTSD. That is what is necessary to win

Issues here.....my VSO in the initial claim request asked for either causation or aggravation to either PTSD/MST or IBS.  The rater only asked for a medical opinion of causation.  Also, we did submit literature to support the claim.  I even showed it to the C&P examiner but like I said, he saw me for a whole 5 minutes, wrote down when I was diagnosed with PTSD/MST, how long I served, and reviewed my RA's notes about the FMS diagnosis.

 

12 minutes ago, asknod said:

What you need is #3- a legitimate Independent Medical Opinion (IMO/IME/nexus). At a minimum, your IMO doctor has to connect the fibro to the PTSD with sound medical principles (and recognized studies-not internet articles) all doctors can reasonably agree on. See 38 CFR §3.310.  I would talk this over seriously with your VSO. If you say "What about the Caluza golden triangle?" and he looks back at you like a deer in the headlights and says "Who's Caluza?", you may want to reread what we're trying to teach you in this thread and rethink your legal strategy. 

 

My VSO is a very known guy with Hadit...In fact I met him on the Hadit radio show in 2016 so I am hoping he does know this.  I have a feeling we will go to appeals with this and have to fight it out.  I will talk this over with him because at this point I have done all I can.  As of now, I am doing the claim on my own but with his assistance.  He has been great and has helped me out tremendously so I know he will be there for me to appeal this, IF I have to appeal.  

 

13 minutes ago, asknod said:

I always benefit from getting the denial and seeing what they used for the  rationale. It's easier to make a battle plan when you know why they denied you and what they used to determine it with. Best of luck.

As soon as I have the decision, I will share it with you and see what you think.