Fibro

Fibro

scoopfrank
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Joined: 31 Mar 2015, 00:31

09 Oct 2017, 20:06 #1

Good afternoon to all:

Quick question: I filed for Fibro back around this time last year. My C&P examiner stated that I did not have it (Fibro) however, the Rheumatologist at the VA stated I do have it and treating me for it. I filed as Fibro and not under the guidelines of the Gulf War Illness.

Since this denial I am seeing the Rheumatologist for Fibro at the VA. The C&P Examiner stated the following on her DBQ:

C&P: NOTES from C&P Examiner
1. Diagnosis - Does the Veteran no have or has he/she ever been diagnosed with fibromyalgia? No

What is the proper filing for Fibro is I do not have to prove service connection?

At the end of her report she stated the following:

The patient does not have a disorder that would otherwise explain the pain.

That sounds like an undiagnosed illness. Am I correct?
Reply

talexan150
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Joined: 10 Oct 2011, 16:04

11 Oct 2017, 20:42 #2

You said that Rheumatology at the VA stated that you have Fibro. Do you actually have a diagnoses of Fibromyalgia or are they just thinking / saying that you do?  It appears from the C&P notes that you posted that you have not been diagnosed with Fibro, which makes a big difference. I was going to Rheumatology for a long time and they kept mentioning it, I filed and was denied. After more tests / lab work that I can remember and a referral to the WRIISC in New Jersey I was officially diagnosed with Fibro by Rheumatology / WRIISC submitted a claim and was granted 40% service connection. 

When you filed your claim how did you file the condition? If you filed it as direct service connection, or just service connection then it will be denied unless you were diagnosed with Fibro in service. To file a claim for a diagnosed condition related to your service in the Gulf it needs to be listed on VA Form 21-526EZ as follows: 

Fibromyalgia: Environmental Hazard in the Gulf War per CFR 38, 3.317

Hope this helps, trust me it can be, and usually is a long battle, just don’t give up. Care and treatment is the most important part of all of it. Hopefully they can find something to make your symptoms a little more tolerable to live with. I haven’t found anything as of yet, but I’m still trying and not giving up. 
Never Give Up Fighting For What you Earned
Never Take No For An Answer
U.S. Army 1989-2007 (Medically Retired)
Gulf War 1990-1991
OEF / OIF 2002-2007
Reply

scoopfrank
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Joined: 31 Mar 2015, 00:31

11 Oct 2017, 22:45 #3

talexan150 wrote: You said that Rheumatology at the VA stated that you have Fibro. Do you actually have a diagnoses of Fibromyalgia or are they just thinking / saying that you do?  It appears from the C&P notes that you posted that you have not been diagnosed with Fibro, which makes a big difference. I was going to Rheumatology for a long time and they kept mentioning it, I filed and was denied. After more tests / lab work that I can remember and a referral to the WRIISC in New Jersey I was officially diagnosed with Fibro by Rheumatology / WRIISC submitted a claim and was granted 40% service connection. 

When you filed your claim how did you file the condition? If you filed it as direct service connection, or just service connection then it will be denied unless you were diagnosed with Fibro in service. To file a claim for a diagnosed condition related to your service in the Gulf it needs to be listed on VA Form 21-526EZ as follows: 

Fibromyalgia: Environmental Hazard in the Gulf War per CFR 38, 3.317

Hope this helps, trust me it can be, and usually is a long battle, just don’t give up. Care and treatment is the most important part of all of it. Hopefully they can find something to make your symptoms a little more tolerable to live with. I haven’t found anything as of yet, but I’m still trying and not giving up. 
talexan150,

Thanks for your reply. I was diagnosed actually diagnosed by a non-VA Rheumatologist prior to my C&P exam but was not being treat at the time. Then I had my C&P by someone from the VA Medical Center in Houston. In her report she stated I did not have it although I was a copy of the DBQ Paperwork from private Rheumatologist. She also recorded in her report that my pain is from DJD. For the past year I am being treated for and was diagnosed from the Rheumatologist form the VA Medical Center as having Fibro. I have all the documentation.

On another note, I initially file for lower back pain back in Aug 2014. I was denied for service connection. I went through my medical records page by page and pull all the document relating to my back. This was over a 26 year time period. I only receive quarters and injection. No MRI. Since retiring I have been having some severe lower back pain. I requested an MRI and come to find out I have a list of things wrong with my back. The MRI revealed the following: L2-L3  there is mild disc desiccation and broad-based bulging, L3-L4 there is a central to right lateral disc protrusion, mild right lateral recess stenosis and moderate to severe right foraminal stenosis, L4-L5 there is a broad-based protrusion, a facet hypertrophy particularly on the left, mild canal stenosis with moderate left recess stenosis, severe left foriminal stenosis with nerve root impingement.

Again, I have documents in me medical records addressing my back although I was not diagnosed. I only received shots and motrin for the pain.

What should be my next steps? Your response is greatly appreciated.

v/r

Scoopfrank
Reply

talexan150
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Joined: 10 Oct 2011, 16:04

12 Oct 2017, 13:31 #4

scoopfrank wrote:
talexan150 wrote: You said that Rheumatology at the VA stated that you have Fibro. Do you actually have a diagnoses of Fibromyalgia or are they just thinking / saying that you do?  It appears from the C&P notes that you posted that you have not been diagnosed with Fibro, which makes a big difference. I was going to Rheumatology for a long time and they kept mentioning it, I filed and was denied. After more tests / lab work that I can remember and a referral to the WRIISC in New Jersey I was officially diagnosed with Fibro by Rheumatology / WRIISC submitted a claim and was granted 40% service connection. 

When you filed your claim how did you file the condition? If you filed it as direct service connection, or just service connection then it will be denied unless you were diagnosed with Fibro in service. To file a claim for a diagnosed condition related to your service in the Gulf it needs to be listed on VA Form 21-526EZ as follows: 

Fibromyalgia: Environmental Hazard in the Gulf War per CFR 38, 3.317

Hope this helps, trust me it can be, and usually is a long battle, just don’t give up. Care and treatment is the most important part of all of it. Hopefully they can find something to make your symptoms a little more tolerable to live with. I haven’t found anything as of yet, but I’m still trying and not giving up. 
talexan150,

Thanks for your reply. I was diagnosed actually diagnosed by a non-VA Rheumatologist prior to my C&P exam but was not being treat at the time. Then I had my C&P by someone from the VA Medical Center in Houston. In her report she stated I did not have it although I was a copy of the DBQ Paperwork from private Rheumatologist. She also recorded in her report that my pain is from DJD. For the past year I am being treated for and was diagnosed from the Rheumatologist form the VA Medical Center as having Fibro. I have all the documentation.

On another note, I initially file for lower back pain back in Aug 2014. I was denied for service connection. I went through my medical records page by page and pull all the document relating to my back. This was over a 26 year time period. I only receive quarters and injection. No MRI. Since retiring I have been having some severe lower back pain. I requested an MRI and come to find out I have a list of things wrong with my back. The MRI revealed the following: L2-L3  there is mild disc desiccation and broad-based bulging, L3-L4 there is a central to right lateral disc protrusion, mild right lateral recess stenosis and moderate to severe right foraminal stenosis, L4-L5 there is a broad-based protrusion, a facet hypertrophy particularly on the left, mild canal stenosis with moderate left recess stenosis, severe left foriminal stenosis with nerve root impingement.

Again, I have documents in me medical records addressing my back although I was not diagnosed. I only received shots and motrin for the pain.

What should be my next steps? Your response is greatly appreciated.

v/r

Scoopfrank
Are you working with a Veterans Service Officer (VSO) on your claim? If not I would suggest that you seek the assistance of a VSO in your local area. Without seeing the exact wording in your denial letter for the Fibro I could only speculate as to why you were denied.  If you could post the reason for the denial I would be willing to take a look at it, and give you my opinion. But again I would highly recommend that you seek the assistance of a VSO in your area so they can review all of your records and go from there.  

As far as your back goes from what you stated in your post you were never diagnosed with a back condition while in service. In order to potentially be awarded service connection you have to have three things:

1.    Either have a diagnosis while in service or have a doctor after he / she reviews all of your Service Treatment Records (STR’s) provide a Nexus statement linking your current condition to your service.
2.    Evidence that the disability still exists.
3.    Continuity of Care, meaning that you are still actively seeking care and treatment for the condition.

If I’m missing anything I’m sure someone else will hop onboard and fill in any gaps that I might have missed. Hope this helps.

Tim   
Never Give Up Fighting For What you Earned
Never Take No For An Answer
U.S. Army 1989-2007 (Medically Retired)
Gulf War 1990-1991
OEF / OIF 2002-2007
Reply

scoopfrank
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Joined: 31 Mar 2015, 00:31

12 Oct 2017, 16:27 #5

talexan150 wrote:
scoopfrank wrote:
talexan150 wrote: You said that Rheumatology at the VA stated that you have Fibro. Do you actually have a diagnoses of Fibromyalgia or are they just thinking / saying that you do?  It appears from the C&P notes that you posted that you have not been diagnosed with Fibro, which makes a big difference. I was going to Rheumatology for a long time and they kept mentioning it, I filed and was denied. After more tests / lab work that I can remember and a referral to the WRIISC in New Jersey I was officially diagnosed with Fibro by Rheumatology / WRIISC submitted a claim and was granted 40% service connection. 

When you filed your claim how did you file the condition? If you filed it as direct service connection, or just service connection then it will be denied unless you were diagnosed with Fibro in service. To file a claim for a diagnosed condition related to your service in the Gulf it needs to be listed on VA Form 21-526EZ as follows: 

Fibromyalgia: Environmental Hazard in the Gulf War per CFR 38, 3.317

Hope this helps, trust me it can be, and usually is a long battle, just don’t give up. Care and treatment is the most important part of all of it. Hopefully they can find something to make your symptoms a little more tolerable to live with. I haven’t found anything as of yet, but I’m still trying and not giving up. 
talexan150,

Thanks for your reply. I was diagnosed actually diagnosed by a non-VA Rheumatologist prior to my C&P exam but was not being treat at the time. Then I had my C&P by someone from the VA Medical Center in Houston. In her report she stated I did not have it although I was a copy of the DBQ Paperwork from private Rheumatologist. She also recorded in her report that my pain is from DJD. For the past year I am being treated for and was diagnosed from the Rheumatologist form the VA Medical Center as having Fibro. I have all the documentation.

On another note, I initially file for lower back pain back in Aug 2014. I was denied for service connection. I went through my medical records page by page and pull all the document relating to my back. This was over a 26 year time period. I only receive quarters and injection. No MRI. Since retiring I have been having some severe lower back pain. I requested an MRI and come to find out I have a list of things wrong with my back. The MRI revealed the following: L2-L3  there is mild disc desiccation and broad-based bulging, L3-L4 there is a central to right lateral disc protrusion, mild right lateral recess stenosis and moderate to severe right foraminal stenosis, L4-L5 there is a broad-based protrusion, a facet hypertrophy particularly on the left, mild canal stenosis with moderate left recess stenosis, severe left foriminal stenosis with nerve root impingement.

Again, I have documents in me medical records addressing my back although I was not diagnosed. I only received shots and motrin for the pain.

What should be my next steps? Your response is greatly appreciated.

v/r

Scoopfrank
Are you working with a Veterans Service Officer (VSO) on your claim? If not I would suggest that you seek the assistance of a VSO in your local area. Without seeing the exact wording in your denial letter for the Fibro I could only speculate as to why you were denied.  If you could post the reason for the denial I would be willing to take a look at it, and give you my opinion. But again I would highly recommend that you seek the assistance of a VSO in your area so they can review all of your records and go from there.  

As far as your back goes from what you stated in your post you were never diagnosed with a back condition while in service. In order to potentially be awarded service connection you have to have three things:

1.    Either have a diagnosis while in service or have a doctor after he / she reviews all of your Service Treatment Records (STR’s) provide a Nexus statement linking your current condition to your service.
2.    Evidence that the disability still exists.
3.    Continuity of Care, meaning that you are still actively seeking care and treatment for the condition.

If I’m missing anything I’m sure someone else will hop onboard and fill in any gaps that I might have missed. Hope this helps.

Tim   
Here are some notes from my healtheVet file.

HISTORY OF PRESENT ILLNESS:
48 years old MALE with dx of Fibromyalgia made by a Non-VA Rheumatologist last
year through private insurance. He now sees VA Rheumatology.
He has chronic low back pain that does NOT radiate into either LE.
Low back pain has been present since the 1990's during his military service.
*** RHEUMATOLOGY NOTE Has ADDENDA ***
Rheumatology Follow Up
Reason for follow Up; fibromyalgia
Brief History: Depression, fibromyalgia and OA
Rheumatologic History:
-First seen in our clinic in 01/2016 with no evidence of inflammatory arthritis.
Got a second opinion from Dr. Malani in Humble, TX and was diagnosed with
fibromyalgia but never treated.
-06/2016 - no evidence of inflammatory arthritis.,
Assessment:
Fibromyalgia
-will increase gabapentin to 300 MG BID
-has completed PT, does exercise at home. will continue
Severe Vitamin D deficiency
-takes 50,000 units of vit D weekly, has not had vitamin D recheck
-will recheck vitamin D level today and adjust dose
osteoarthritis in bilateral knees and DJD/stenosis of the spine
-will refer to PMR given MRI findings of lower back
-recommended NSAIDs and tylenol prn

Here are the C&P Notes:

Fibromyalgia
Disability Benefits Questionnaire
Name of patient/Veteran: Franklin, Steven Brian
Is this DBQ being completed in conjunction with a VA 21-2507, C&P
Examination
Request?
[X] Yes [ ] No
ACE and Evidence Review
-----------------------
Indicate method used to obtain medical information to complete this document:
[X] In-person examination
Evidence Review
---------------
Evidence reviewed (check all that apply):
[X] VA e-folder (VBMS or Virtual VA)
1. Diagnosis
------------
Does the Veteran now have or has he/she ever been diagnosed with
fibromyalgia? (This is the condition the Veteran is claiming or for which an
exam has been requested)
[ ] Yes [X] No
 
2. Medical history
------------------
a. Describe the history (including onset and course) of the Veteran's
fibromyalgia condition:
The veteran reports he had history of fibromyalgia and diagnosis was
done several months or years. He is not able to point the doctor
told
him about this conditoin and he insinuated it was diagnosed in
service. The records showed no diagnosis of fibromyalgia and Since he
had request for rheumatology in Sept 2015 because" Previously was
on
medications for fibromyalgia". No clear what medication or
diagnosis
was done outside.
He was seen in Rheumatology on Jan 13, 206 and he indicated he was
not bother by fibromyalgia and he was reevaluated in Jun 16,2016
where the pain was found due his degenerative joint disease. No
diagnosis of fibromyalgia was included in this visit since no active
condition. No evidence of fatigue was discussed in any progress note.
The veteran is being considered to be discharged from this clinic if
not evidence of any inflammatory arthritis. he has negative serology
He indicates he was seen recently by outside rheumatology and work
up was initiated.
The date of this visit is in September 2016. ( I asked him to send the
copy to Regional VA)
He is taking on meloxicam, cyclobenzaprine , tylenol for joint pain,
sertraline for depression, propanol and sumatriptan for headache
He reports he feels constantly tired, widespread pain in lower
extremities and upper extremities and on off low back. The current
available medical records are not consistent with his statement
He has sleep apnea on cpap and feels he is not sleeping well, he has
incoming sleep lab appt tomorrow, He was found with low vitamin d
6. Functional impact
---------------------
Does the Veteran's fibromyalgia impact his or her ability to work?
[ ] Yes [X] No
 
7. Remarks, if any:
-------------------
The major issue in this exam, the veteran has not been formally diagnosed
with fibromyalgia. No diagnosis done in service or the exam following discharge. seen in Oct 2015 C&P and no diagnosis of fibromyalgia was found. There is initiated rheumatology evaluation in Jan 2016 since he felt he has presumptive diagnosis and let the different services he has established fibromyalgia and med given for this. Again, no diagnosis was
done or any treatment for this condition is found in records until that time.
 
The veteran was initially evaluated for fibromyalgia by rheumatology in
Jan and reevaluated in June 2016. The evidence showed there was evidence
of any active symptom of fibromyalgia. He was seen by private
rheumatology in Sept 2016 for the presumptive fibromyalgia. He did not
bring any medical progress note .
The veteran claims active pain but he has degenerative joint disease,
fatigue related to his depression and sleep apnea on revision. He has
migraine affecting his work performance.
AS per rheumatology records, there is no active symptoms consistent with
fibromyalgia. he has no widespread pain.
He does not fit the diagnostic criteria for fibromyalgia. There is no
conclusive evidence of widespread pain in records, pain could be explained
by djd .
The 2010 ACR preliminary diagnostic criteria (2010 criteria) :
A patient satisfies diagnostic criteria for fibromyalgia if the following
three conditions are met:
1) Widespread pain index (WPI) 7 and symptom severity (SS) scale score 5
or WPI 3-6 and SS scale score 9.
2) Symptoms have been present at a similar level for at least three
months.
3) The patient does not have a disorder that would otherwise explain the
pain.
Please send new 2501 if any needed
**CLAIM TYPE: SUPPLEMENTAL
**SPECIAL CONSIDERATIONS: NOT APPLICABLE
**INSUFFICIENT EXAM: YES
ELECTRONIC CLAIMS FOLDER AVAILABLE.
CLAIMS FILE BEING SENT FOR REVIEW BY THE EXAMINER.
Veteran is claiming fibromyalgia. DBQ General Medical Gulf War exam was
completed and the Veteran has a diagnoses of fibromyalgia. DBQ GENMED
Gulf
War says "See rheumatology C&P exam;" however, there is no
rheumatology
C&P
exam of record. A Fibromyalgia DBQ needs to be completed.

I do have an appointment to see another VSO this coming Monday.

Gain, thanks
Reply

talexan150
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Joined: 10 Oct 2011, 16:04

13 Oct 2017, 13:10 #6

I hate to say this… but from reading the C&P notes that you posted this is a mess, I say this because of the following statements:  

1.   “insinuated it was diagnosed in service. The records showed no diagnosis of fibromyalgia”.    Unless you were diagnosed with Fibro while in service the condition on VA Form 21-526EZ should have been   Fibromyalgia: Environmental Hazard in the Gulf War per CFR 38, 3.317.
2.   “He indicates he was seen recently by outside rheumatology and workup was initiated. The date of this visit is in September 2016. (I asked him to send the copy to Regional VA)”. This report from the outside Rheumatologist should have been submitted with your claim when it was sent to the VA in order to keep it a Fully Developed Claim (FDC). If the VA has not seen this report please take it with you when you meet with the VSO next week.
3.   The current available medical records are not consistent with his statement. Again this sounds like the C&P examiner did not see the diagnosis / reports from the outside Rheumatologist.
4.   The major issue in this exam, the veteran has not been formally diagnosed with fibromyalgia. Again this sounds like the C&P examiner did not see the diagnosis / reports from the outside Rheumatologist.
5.   He did not bring any medical progress note "See rheumatology C&P exam;" however, there is no rheumatology C&P exam of record. A Fibromyalgia DBQ needs to be completed. Just going off what you’ve posted this statement seems to indicate that the rater at the VARO only requested a DBQ General Medical Gulf War exam and did not also request a Fibromyalgia DBQ.
As I have stated in previous posts I can only speculate based off of the information that you have provided. But it sounds to me even though you are being treated by the VA for Fibro they are unaware if the formal diagnosis from the outside Rheumatologist. I would recommend taking that paperwork and any other records that are not part of your VA file with you when you meet with the VSO on Monday. Let him or her review everything and go from there as to whether to file for reconsideration with the “new and material evidence” the reports from the outside Rheumatologist or file an NOD and request a DRO review. Again it all depends if the VA has the report from the outside Rheumatologist. If your VSO has access to VBMS he or she will be able to see everything in your c-file, what is in there and what has or has not been done.
Hope all of this helps, I am going at this blind since I can only go off of the information that you have provided in your posts.

Tim     
Never Give Up Fighting For What you Earned
Never Take No For An Answer
U.S. Army 1989-2007 (Medically Retired)
Gulf War 1990-1991
OEF / OIF 2002-2007
Reply

scoopfrank
.
.
Joined: 31 Mar 2015, 00:31

13 Oct 2017, 13:24 #7

talexan150 wrote: I hate to say this… but from reading the C&P notes that you posted this is a mess, I say this because of the following statements:  

1.   “insinuated it was diagnosed in service. The records showed no diagnosis of fibromyalgia”.    Unless you were diagnosed with Fibro while in service the condition on VA Form 21-526EZ should have been   Fibromyalgia: Environmental Hazard in the Gulf War per CFR 38, 3.317.
2.   “He indicates he was seen recently by outside rheumatology and workup was initiated. The date of this visit is in September 2016. (I asked him to send the copy to Regional VA)”. This report from the outside Rheumatologist should have been submitted with your claim when it was sent to the VA in order to keep it a Fully Developed Claim (FDC). If the VA has not seen this report please take it with you when you meet with the VSO next week.
3.   The current available medical records are not consistent with his statement. Again this sounds like the C&P examiner did not see the diagnosis / reports from the outside Rheumatologist.
4.   The major issue in this exam, the veteran has not been formally diagnosed with fibromyalgia. Again this sounds like the C&P examiner did not see the diagnosis / reports from the outside Rheumatologist.
5.   He did not bring any medical progress note "See rheumatology C&P exam;" however, there is no rheumatology C&P exam of record. A Fibromyalgia DBQ needs to be completed. Just going off what you’ve posted this statement seems to indicate that the rater at the VARO only requested a DBQ General Medical Gulf War exam and did not also request a Fibromyalgia DBQ.
As I have stated in previous posts I can only speculate based off of the information that you have provided. But it sounds to me even though you are being treated by the VA for Fibro they are unaware if the formal diagnosis from the outside Rheumatologist. I would recommend taking that paperwork and any other records that are not part of your VA file with you when you meet with the VSO on Monday. Let him or her review everything and go from there as to whether to file for reconsideration with the “new and material evidence” the reports from the outside Rheumatologist or file an NOD and request a DRO review. Again it all depends if the VA has the report from the outside Rheumatologist. If your VSO has access to VBMS he or she will be able to see everything in your c-file, what is in there and what has or has not been done.
Hope all of this helps, I am going at this blind since I can only go off of the information that you have provided in your posts.

Tim     
Thanks for your feedback TIm.

v/r

Steven
Reply