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]

I think you miss the big picture. VA is an Insurance Company. They pay out claims. They are the only Insurance co. in town. Either you play by their rules or you lose. The c&p doctor cans say whatever he wants to. You will never succeed in making him out to be incompetent (see Presumption of Regularity). If he says he reviewed your records, then he did in VA's eyes.

<<<<.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. >>>>>

In a VA claim, you present evidence to support your claim. You cannot, as a matter of law, demand VA prove your causation or aggravation. All they can do is review the EOD and if it supports your contentions, you win. Ignoring the IBS is implicit denial (Cogburn). If you didn't bring any evidence or IMO to the claim, then deciding it on the merits of anything, including IBS, is beside the point. No tickee-no laundry.

<<< Also, we did submit literature to support the claim.>>>>> 

By "literature" do you mean internet articles which do not refer to you personally? An IMO is a specialty item. It applies solely to you and no one else. Your VSO's letterhead says he is accredited by the OGC- the same as me. That fact, in and of itself, is scary.  I really don't care if someone has appeared on Hadit as a guest. That fact doesn't automatically impart he or she is knowledgeable of VA law. VSOs have what is called a "group coverage" under the umbrella of one Senior Veterans Service Officer who is accredited by the OGC. He can have 250 of these worker bees helping him. He has passed the same test I have and he is ostensibly versed in VA law. Your individual representative has probably not passed that test. As such, he has no "pedigree". It appears you are not well-acquainted with the process either-nor should you be. That's why you sought out legal help. I read about this claims game for two years before I even began to understand it. By that time, I had 18 years into losing. I studied it for ten years before I sat for the exam. I now do it for a living as everyone on Hadit probably knows. Trust me when I say I wouldn't waste my time giving you bogus advice that will not help. There's only one way to win your claim-the right way. Any effort wasted in waiting to "see what happens" is going to prolong your wait for a win. 

[Navy4life]

Understand!  I appreciate your responses....

[Navy4life]

So here is the UPDATE...My rep said that they are now going to send me to another C&P exam but this time for Fibro secondary to my IBS.  Remember my original claim was for Fibro secondary to either my PTSD or my IBS.

My RA and MH doctors both wrote medical opinions for me to trump the negative C&P exam.  

 

[AmberLove]

On 10/25/2018 at 6:38 AM, 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 Buck52,

Thanks for the helpful information. I have another question for you. I am 70 percent P&T TDIU PTSD/Depression/Anxeity and have been since 2015. I also have one other rating at 0 percent for lumbar strain. My other ratings are on appeal. You mentioned below that you were able to switch to a scheduler for chronic PTSD and SMC’s for the others. How long did it take you to do that and how did you do that? I appreciate your time. 

 

Thanks,

amber

 

[Buck52]

Well it don't matter how you get a rating  like your 70% MH/Depression rating  if you were already IU  with P&T at 70%  JUST AS LONG AS YOU GOT THE 70%

basicly IU is a 100% award being your paid at the 100%rate  they just keep saying although you are IU  Your rating  is a combined rating of 70% because you can't work due to this disability at 70% although  we are paying you at the 100% rate.

Here is kinda how that works

When you get another rating  of 60% or  higher  but at least 60%  this qualifies   you for the mandatory rating for SMC S- H.B. and also a 100% final degree rating, if you get the SMC S H.B. ....>check e benefits EOB and it should tell you just how your rated,   if you get another S.C. Condition...and I think that can be a secondary condition too. (not sure on this?)

I got mine when I filed the PTSD Claim...as I was already 90%combined for the TDIU P&T  With my disability not expected to improve in my life time   and no future exams scheduled, if your P&T you should have received these letters?

When a Veteran has IU w/P&T and files for another condition totally separate from the IU ...And that condition is S.C. and given a rating at 60% or higher  then you should meet the SMC Criteria for the SMC.S.H.B. its about 360.00 extra depending on your dependents.

All SMC Payments are added to what you already get.

So if you have a new claim in I hope you get the 60% ...now if this is for an increase as long as it don't have anything to do with your IU Claim  your good to go.

Normal they give a low ball rating  like 50% so check the rating scheduled for your condition and make sure your getting a fair ratings.

 

[seminoles]

6 minutes ago, Buck52 said:

Well it don't matter how you get a rating  like your 70% MH/Depression rating  if you were already IU  with P&T at 70%  JUST AS LONG AS YOU GOT THE 70%

basicly IU is a 100% award being your paid at the 100%rate  they just keep saying although you are IU  Your rating  is a combined rating of 70% because you can't work due to this disability at 70% although  we are paying you at the 100% rate.

Here is kinda how that works

When you get another rating  of 60% or  higher  but at least 60%  this qualifies   you for the mandatory rating for SMC S- H.B. and also a 100% final degree rating, if you get the SMC S H.B. ....>check e benefits EOB and it should tell you just how your rated,   if you get another S.C. Condition...and I think that can be a secondary condition too. (not sure on this?)

I got mine when I filed the PTSD Claim...as I was already 90%combined for the TDIU P&T  With my disability not expected to improve in my life time   and no future exams scheduled, if your P&T you should have received these letters?

When a Veteran has IU w/P&T and files for another condition totally separate from the IU ...And that condition is S.C. and given a rating at 60% or higher  then you should meet the SMC Criteria for the SMC.S.H.B. its about 360.00 extra depending on your dependents.

All SMC Payments are added to what you already get.

So if you have a new claim in I hope you get the 60% ...now if this is for an increase as long as it don't have anything to do with your IU Claim  your good to go.

Normal they give a low ball rating  like 50% so check the rating scheduled for your condition and make sure your getting a fair ratings.

 

I know I am not the original poster but I was 70% IU PT  and then was awarded additional service connections one of them was for a single 60% for a bladder condition, they did not give me SMC S.   At the end of all my added service connected issues I ended up being schedular 100% PT but they didn't give me the SMC S.   I had thought it would be an automatic as well.