Non-service connected Fibro secondary to either PTSD or IBS

[Navy4life]

I am beyond frustrated right now!!!!  My claim is now preparation for decision and my fear is that it will be denied and I will have to appeal.  I filed for my non-service connected Fibro as caused or aggravated by the service connected IBS and/or service connected PTSD on an as likely as not basis.  See my screen shot attached of my original claim in July 2018.  I had my first C&P exam in September 2018 and it was negative based on the examiner stated there was no causation of my s/c PTSD to my Fibro.  See the screen shot below. I will note that he did a separate C&P exam for Fibro and agreed I had Fibro. Never looked at aggravation and never looked at the possibility of IBS.  I sent a statement in support of claim pointing this out to the rater.  I get another C&P exam in December 2018 BUT by now I have THREE positive medical opinions from BOTH my RA and MH doctor.  Both state my Fibro is aggravated by my PTSD and my MH doctor also states my Fibro is aggravated by my IBS.  SEE ATTACHED 2 of the 3 letters. 

When I went to the second C&P exam, it was with the same doctor and he refused to look at the medical opinions.  He also once again did not look at aggravation.  Again a negative C&P exam. 

Then the rater asked for clarification/review of conflicting medical opinions.  Here is what the rater asked, Per III.iv.3.D.3.a. and III.iv.3.D.3.d. We need clarification/review and reconciliation of conflicting evidence for claim for fibromyalgia secondary to SC PTSD. Negative MO received on 09/28/2018 (TAB A) stated that fibromyalgia was not secondary to PTSD. Received positive MO on 12/05/2018 (TAB B) relating fibromyalgia as secondary to SC PTSD and IBS. Negative MO received on 12/05/2018 (TAB D) stated that fibromyalgia was not secondary to IBS. Examination dated 12/05/2018 (TAB C) shows a diagnosis for fibromyalgia. Per reference please request clarification of conflicting MO for fibromyalgia as secondary to PTSD and IBS with rationale. 

This medical opinion was done last week w/o me present and once again the medical opinion was negative and doesn't address anything the rater asked.  In fact, his statement is laughable.  While he states he reviewed conflicting medical evidence, he sites PT notes and doesn't refute the positive medical opinions.

Here is what it says: I HAVE REVIEWED THE CONFLICTING MEDICAL EVIDENCE AND AM PROVIDING THE FOLLOWING OPINION:
All medical records were reviewed. Physical therapy note on 8/15/2018 by XXXXX documents diagnosis of fibromyalgia and PTSD. The exact cause of fibromyalgia is
unknown but has associations with IBS, temporomandibular joint disorder, interstitial cystitis, vulvodynia, and tension headaches. Literature review reveals fibromyalgia along with
its associated pain syndromes are clearly different and separable from depression and anxiety. The claimant's fibromyalgia is not secondary to the claimant's claimed PTSD
condition.

The VA continues to miss the fact that I asked in my original claim either causation or aggravation.  So on Monday, when I went to PFD, I sent the attached statement and uploaded in Ebenefits pointing out once again they are not looking at aggravation.

My rep said if it comes back denied, which I am sure it will, we will file an NOD pointing out the fact that they are missing aggravation.

MH positive opinion.pdf

RA positive medical opinion.pdf

[Unique11128]

Unfortunate it appears to be a development to deny.

[Navy4life]

20 minutes ago, Unique11128 said:

Unfortunate it appears to be a development to deny.

I think it will too but if they do not address a denial taking into factor Aggravation there is a CUE here. I’m sure it will be denied based on no causation. So frustrating. 

[Oceanbound]

Fibromyalgia, medically speaking, because I have read over several thousands of medical publications and papers since joining this site and continue to read them everyday, does not come from IBS or PTSD. This is why its denied.

And because they denied it, does not mean it has the merits of being a "CUE" in this particular case.

[Navy4life]

9 minutes ago, Oceanbound said:

Fibromyalgia, medically speaking, because I have read over several thousands of medical publications and papers since joining this site and continue to read them everyday, does not come from IBS or PTSD. This is why its denied.

And because they denied it, does not mean it has the merits of being a "CUE" in this particular case.

Never said Fibro "comes" from either IBS or PTSD.  There is known facts of aggravation which is why both my RA and MH doctors wrote their medical opinions on my behalf.  And yes, if they fail to not look at aggravation and in the denial make no mention of denying due to aggravation, that is a CUE because my claim asked for them to consider either causation or aggravation.

There is a lot of medical literature and other veteran claims at the BVA that have in fact service connected a non-service connected Fibro to PTSD, as well as other contentions.  

 

[Oceanbound]

I'm not arguing with you but trying to assist you, in having you see that your claim will be denied and that there is no CUE for what you're seeking or that they didn't do what you asked of them.  But medically speaking and with legal speaking from the Black Law's Dictionary 4th edition, or from VA Law, your claim does not met the merits of a CUE. Because you have not exhausted all available options.

As a few have said here on the forum, once you claim and go CUE, going through the RO and making it to the BVA, those judges are very literate and will say that this claim is not a CUE and your case is over. Which is why lawyers don't go the CUE route. For that a CUE is basically the "nuclear option" and that you claim you have exhausted all available options and fully understand what a CUE is under VA law.

 

15 minutes ago, Navy4life said:

Never said Fibro "comes" from either IBS or PTSD. 

 

Not from what I have read. IBS does not aggregate Fibro . PTSD does not aggregate Fibro. 

 

6 hours ago, Navy4life said:

 

 

cau·sa·tion

Dictionary result for causation

/kôˈzāSH(ə)n/

noun

1. the action of causing something.

   "investigating the role of nitrate in the causation of cancer"

   • the relationship between cause and effect; causality.

---

ag·gra·va·tion

Dictionary result for aggravation

/ˌaɡrəˈvāSH(ə)n/

noun

 

1. 1.

   an intensification of a negative quality or aspect.

   "Negotiators were optimistic despite the aggravation of the standoff caused by the press release"

    
2. 2.

   the state of being aggravated.

[Navy4life]

I am agreeing I am going to be denied but if they do not address the aggravation in the denial then they have not done their job and failed to do my claim in a complete fashion.  Most likely I will file an NOD under the RAMP HLR with my rep.  A CUE while tough to get approved, goes back to the same folks that did the denial and I don't want to do that.

You are mistaken about aggravation.  I have my VA Mental Health Doctor and VA RA doctor both stating aggravation for Fibro/PTSD.  There is a lot of literature out there but it means nothing if it doesn't pertain to me.  

The point I am trying to make is that the VA is only considering causation and not refuting the aggravation medical opinions that were positive and provided and the rater specifically asked for review/clarification and the most recent medical opinion overlooked aggravation yet again.

Thanks for the dictionary terms of causation/aggravation but I know what they mean.  Medically speaking, Fibro has been s/c as secondary to PTSD, especially women with MST, which I am also diagnosed with.