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]

Nope it was secondary  

[Navy4life]

Just now, shrekthetank1 said:

Nope it was secondary  

To what service connected issue?  

[ShrekTheTank]

When I filed I did it linked to my PTSD-IBS-Dercums disease.  After looking at what you posted I do think you are correct, the rater is not looking what can aggravate Fibro.  So our jobs as much as it sucks is to show them how it is aggravated by these other conditions.  They ultimately put it to PTSD.  

You have to think of the RO as a 5 year old and break it down to Barney level!  I go through and page number the evidence and I will bold certain words and then Highlight it so they will not miss what point I am making.  I used to submit 40 or 50 pages of evidence and that will sink your ship like no other and they can bury it.  From my recent appeal I have found fewer pages and Barney level makes it very hard to miss anything.

Edited February 8, 2019 by shrekthetank1

[Oceanbound]

On 2/7/2019 at 3:50 PM, Navy4life said:

 

You are mistaken about aggravation.  I have my VA Mental Health Doctor and VA RA doctor both stating aggravation for Fibro/PTSD.   

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.

Well you are still thinking in layman terms and not legal doctrine. You do not know what causation means because it is not in the dictionary, while aggravation means

AGGRAVATION. Any circumstance attending 
the commission of a crime or tort which increases 
its guilt, but which is above and beyond the 
essential constituents of the crime or tort itself. 

And it doesn't matter that your VA RA or shrink is saying that. Medically speaking fibro does not come from PTSD or IBS. Since you are claiming "Fibromyalgia secondary to either PTSD or IBS"

So I'm not telling you not to file that CUE and in fact insisting on you doing so.

Please post the NOD with the CUE in huge permanent marker, so that the RO can see that you are filing a CUE

[Navy4life]

1 hour ago, Oceanbound said:

Well you are still thinking in layman terms and not legal doctrine. You do not know what causation means because it is not in the dictionary, while aggravation means

AGGRAVATION. Any circumstance attending 
the commission of a crime or tort which increases 
its guilt, but which is above and beyond the 
essential constituents of the crime or tort itself. 

And it doesn't matter that your VA RA or shrink is saying that. Medically speaking fibro does not come from PTSD or IBS. Since you are claiming "Fibromyalgia secondary to either PTSD or IBS"

So I'm not telling you not to file that CUE and in fact insisting on you doing so.

Please post the NOD with the CUE in huge permanent marker, so that the RO can see that you are filing a CUE

I am not speaking in layman terms when it comes to medical opinions provided by two VA medical doctors who are knowledgeable in their fields.

You continue to say that fibro does not come from PTSD or IBS.  I know that....aggravation doesn't mean something comes from it.  It means that that contention has been aggravated by the current s/c contention.  That is plausible.  

The attached findings speak volumes with regards to MST among WOMEN VETERANS with FMS

Page 4 of 5 bottom of the page, there are two questions asked of the WOMEN VETERANS regarding MST: Question 1. When you were in the military, did you ever receive unwanted, threatening, or repeated sexual attention (for example, touching, cornering, pressure for sexual favors, or inappropriate verbal remarks)? Question 2. When you were in the military, did you have sexual contact against your will or when you were unable to say no (for example, after being forced or threatened or to avoid other consequences)? My answer is YES to both.

Page 4 of 5 - Study completed on WOMAN VETERANS and found that the majority reported MST, most screened positive for FMS. It's important to point out that this small study ONLY evaluated WOMEN accessing VA services.   In conclusion, if the VA has already evaluated WOMEN with PTSD/MST and found them to have both PTSD and FMS, how can the VA deny my claim?

MST among Women Veterans with Fibro.pdf

[Unique11128]

I am a PTSD/MST survivor and I too have FIBROMYALGIA interesting I never thought of it being connected to PTSD. I guess because FIBROMYALGIA is a nerve condition after doing research on it perhaps it can be service connected or aggravated. If I were not 100 P&T I would definitely file a claim.

 

Goodluck keep us posted