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CFS/Fibro Denial thoughts


wood78221
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Looking for opinions on this one. I applied for CFS/Fibro presumptively and was denied (Shocker I know). This letter is so comical. Basically they are denying me for not being diagnosed at the VA? They also mention the conditions are not chronic but I have sent them private treatment records that were treatment records for 10 months? I attached it for review. What is interesting is how can I be connected for IBS presumptively and not this? I have a diagnosis for all these conditions. Obviously, I am going to submit the claim for an HLR. They beat around the bush but never mentioned I DONT have a diagnosis. Thoughts?Mail_Redacted.pdf

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  • HadIt.com Elder

SO, your DBQ examinier didnt follow direction first off. Had she put that she actually examined you physically it would have been more probative according to the CFR's listed. It would have at least been in equipose with the physical examination by QTC. You don' t have to have an in-service diagnosis for a presumptive, but the diagnosis that you DO have has to be based on sound evidence and supplied rationale and not subjective statements. Absent a diagnosis in your records already, a review of your records with no  prior in service history, and a subjective assessment of you (the NP) is not an objective finding. A pratitioner can't do a DBQ on you from a few states away for a new condition with no history. Why didn't you have the local doctor do the DBQ- that would satisfy the requirement for physical examination. 

Other than diagnosing- what medical rationale did your doctor in Alabama use to say that you A. have chronic fatique/fibro, and B. to say that its military related? From the sounds of it you have 1 PA that filled out the DBQ based on the notes from another doctor only, and nowhere in there other than QTC did you have a physical exam. That is not an objective examination, its only subjective, and that is why the QTC person's opinion outweighed it. 

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This is a recent decision. It’s looks like the VA is really going to start policing these DBQs that are performed by out of state doctors with no evidence of an in person exam. Did you DBQ examiner examine you in person?

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  • HadIt.com Elder

No, they didnt (its in the decision letter), and that is part of why they denied it. The only people that can do non-contact/non-present or telehealth exams for DBQs are VA or contractors. 

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  • Financial Contributor

IMO the HLR is a waste of time.  You can request for them to take another look, but It would not be a bad idea to be seen at the VA for your Fibro.  Then it is in your record and they can't refute that.

I was given Fibro, because I had already been see at the VA.  It was one of the fastest ones I have ever gotten.   Without that diagnosis and an in person review then they will continue to deny you.

I know the VA can screw around a lot, but our job is to give them less ammo to use against us.  

 

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26 minutes ago, deedub75 said:

This is a recent decision. It’s looks like the VA is really going to start policing these DBQs that are performed by out of state doctors with no evidence of an in person exam. Did you DBQ examiner examine you in person?

Yes the Fibro and foot increase was in person. Interesting enough, the feet increase DBQ was enough for them to give me an increase without an exam? 

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17 minutes ago, shrekthetank1 said:

IMO the HLR is a waste of time.  You can request for them to take another look, but It would not be a bad idea to be seen at the VA for your Fibro.  Then it is in your record and they can't refute that.

I was given Fibro, because I had already been see at the VA.  It was one of the fastest ones I have ever gotten.   Without that diagnosis and an in person review then they will continue to deny you.

I know the VA can screw around a lot, but our job is to give them less ammo to use against us.  

 

I’ve sent all my private medical records to the VA a few days ago. But the kicker is the diagnosis outside the VA doesn’t matter. It’s a diagnosis. 

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4 minutes ago, wood78221 said:

Yes the Fibro and foot increase was in person. Interesting enough, the feet increase DBQ was enough for them to give me an increase without an exam? 

Post the page for the foot increase.  

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27 minutes ago, wood78221 said:

I’ve sent all my private medical records to the VA a few days ago. But the kicker is the diagnosis outside the VA doesn’t matter. It’s a diagnosis. 

for the purpose of an EED then yes.  As to get them to SC your condition it might be faster to be seen at the VA for them to say yep he has Fibro.  You can keep fighting them to the BVA and will could get them to change it there, but the RO has already set the precedence for the next RO to follow and to give you another denial.

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I had an in person exam and got diagnosis for IBS, Fibro, and CFS (all presumptive).  I got approved for Fibro 40%, 0% IBS (which isn't correct according to the 3 Dr's diagnosis notes), and denied CFS.  The CFS denial was based on other symptoms causing it (PTSD/MDD).  Not sure I want to contest the IBS.  I'm 100% P&T with SMC-S.

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