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

[ShrekTheTank]

So navy I have a few questions. Did you serve during oif/oef?  Did you receive the anthrax vaccine?  Is your fibro joint related or your entire body?  

[doc25]

4 hours ago, Navy4life said:

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.

You have two positive medical opinions that's the good news. The  not so good news is that the nexus of opinions are absent of a rationale (A medical study, article, etc). Therefore, the rater "might" use that technicality to deny your claim.

I have taken the liberty to provide you with the necessary rationale that links Fibromyalgia to PTSD/MST below.  I do hope this helps  your claim/appeal. 

The Gerber Study was done by VA Dr. Megan Gerber and some other researchers.

GerberMRFibromyalgiaWVJGIM2018.pdf

PTSD and Fibromyalgia Syndrome.pdf

[Navy4life]

9 hours ago, shrekthetank1 said:

So navy I have a few questions. Did you serve during oif/oef?  Did you receive the anthrax vaccine?  Is your fibro joint related or your entire body?  

NO, NO, and Yes

[Navy4life]

8 hours ago, doc25 said:

You have two positive medical opinions that's the good news. The  not so good news is that the nexus of opinions are absent of a rationale (A medical study, article, etc). Therefore, the rater "might" use that technicality to deny your claim.

I have taken the liberty to provide you with the necessary rationale that links Fibromyalgia to PTSD/MST below.  I do hope this helps  your claim/appeal. 

The Gerber Study was done by VA Dr. Megan Gerber and some other researchers.

GerberMRFibromyalgiaWVJGIM2018.pdf

PTSD and Fibromyalgia Syndrome.pdf

Here is the issue with the second article.  I have read that one but it is a study of patients who suffer with FMS and looking at PTSD not the other way around.  "The article presents an overview of the study results available on the prevalence of PTSD in FMS patients, the known and proposed mechanisms of their association, and the impact of PTSD on FMS outcomes"

I need to prove the opposite.....

Now the other article is of some interest since it is talking about MST/Fibro....

Edited February 8, 2019 by Navy4life

[ShrekTheTank]

5 minutes ago, Navy4life said:

NO, NO, and Yes

have you submitted a Lay statement from yourself and someone who knows you to support how your Fibro is aggravated by your service connected disabilities?  I know this sounds like ah they won't look at those, but I got diagnosed with Fibro with no in-service evidence, some medical opinions and my own statements.  It was one of the fastest to be rated for me.

Hope this helps

[Navy4life]

Just now, shrekthetank1 said:

have you submitted a Lay statement from yourself and someone who knows you to support how your Fibro is aggravated by your service connected disabilities?  I know this sounds like ah they won't look at those, but I got diagnosed with Fibro with no in-service evidence, some medical opinions and my own statements.  It was one of the fastest to be rated for me.

Hope this helps

Did you get Fibro as primary service connected?