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]

Thats ok seminoles,

They use a special rating table for SMC..So the criteria for SMC has to be met first...so if you guys are at 70%  you may need an addition 20% iner in there some where...I was 90&IU so they maybe a difference there..? I am not sure  but if your condition is a severity condition they are suppose to take that into effect too.

I am not so sure on the 70% IU now that you mention it. for the SMC S it may not meet the rating criteria?

These type of ratings a rater is suppose to catch this and rate according to the criteria met...these raters sometimes don't do this...but if your conditions warrants a higher increase or the condition warrants the SMC -S then they are suppose to rate it correctly...usually they have to put a adding machine to it and make the adjustments accordingly to what your rated for  they have to figure it all out  counting all your past  s.c.ratings

A lot of Veterans get low balled with this. so watch it and bring it to their attention if they don't...if you think you should have SMC S and they don't give it to you...Appeal the decision......> the rating decision 

We are suppose to be given the highest rating allowed by law  if we meet the criteria.

I MIGHT ADD these ratings for SMC is used by the VBMS-R its a generated rating system that they use to determine if you meet the SMC Rating criteria...Don't ask me how they do this  I don't know?

Also if you are baseing your SMC on the LOU Criteria..and the rater can't make a decision  then he should set you up a Special C&P Exam just for this LOU. Claim...even if you had a C&P Prior.

Edited December 19, 2018 by Buck52

[Navy4life]

This is the OP and if you have your own question, it should be posted as a new thread. 

[Navy4life]

UPDATE:  I had another CnP exam with the same examiner. This time for Fibro secondary to IBS. The rater still didn’t ask about aggravation. I went to the CnP a few weeks ago and the doctor refused to look at the medical opinions I brought with me from my VA doctors. I also had clinical findings. This CnP was just as negative. The examiner continues to keep saying no causation. It’s ridiculous. We asked for either causation or aggravation. So now two negative/incomplete CnP exams and three medical opinions. 

My MH doctor write another favorable medical opinion after the first CnP was negative. The medical opinions are weak but there are three of them. 

I hope at the very least the rater takes into consideration reasonable doubt. 

Buck52 I am at 94% rounded to 90%. I only need a 10% rating to get me to 95% rounded to 100% scheduler. 

I am not confident about this claim. Might be appealing.