Agree with unfit finding, disagree with how IPEB changed unfitting conditions.

BLUF: I am unfit. Dx ME/CFS, which is the unfitting condition that sent me to the MEB. Form 356 rated fibro as unfitting and rolled up ME/CFS into it for a total of 40%. Will an FPEB address this?

Background: USAF O5, 17 years, previously deployed to gulf war region, unfitting for ME/CFS (dx May 2017). Have a list of other conditions. Thanks to everyone for your participation here and invaluable info. Thanks to Jason and other PEBForum vets for guiding us through the process. I've been lurking for quite awhile, but now is the time for action. I also plan to give more detail about ME/CFS, as the forum on this subject is a little bare.

Details: After I entered the IDES process in May 2017 for Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS), I completed exams in June. The general exam did not address ME/CFS at all, even though that was my unfitting condition. I filed a VBA 21-4138, noting this and requesting an exam and DBQ for ME/CFS, once I received all the results in July. VA scheduled me for another exam in October, which was only an addendum exam for fibromyalgia and muscle injury. They did not address ME/CFS at that exam, even though I requested the nurse practitioner for that exam before and during the exam. I asked to speak with the supervisor, but she was out on leave. Apparently the examiner was on strict orders from DVA to do the fibro and muscle exam only, and he rushed through it. I got the exam results back and the details in there were completely incorrect. The nurse stated I had a dx for fibro, which is incorrect (I still don't have a dx from rheumatology).
The 356 listed CFS as my main unfitting condition, but also stated "DVA rated as fibromyalgia to include chronic fatigue syndrome and myofascial pain syndrome." Rated at 40% with VASRD 6354-5025, and not combat related (which I do not agree with, since I was definitely in a combat zone and can prove it with a medal and photos in country). Also, I have a dx of obstructive sleep apnea, been on a APAP/CPAP for three years, and the VA rated me at 0%. The reason: "higher rating not warranted for sleep apnea symptoms unless the evidence shows: persistent day-time hypersomnolence." My sleep study and dx, by the sleep doc, as well as my NARSUM, states: "active duty male with a history of severe daytime somnolence for the past 4 to 5 years." This is stated numerous times in several records by my sleep doc. The VA report has incorrect dates, incorrect diagnoses, and did not use my medical records in full.

The Issue: Already contacted OAC and my lawyer will call in the next few days to get my details. Will an FPEB fix the issue with my unfitting conditions? I have dx for CFS, no dx for fibro -- yet, they rated me under fibro. I believe the percentage should also be 60% for CFS -- it would be the case if the VA gave me a CFS exam/DBQ, but most the info they put in the exam was incorrect. I asked several times, in writing, for a CFS exam and DBQ, which they did not give me.

I have until 13 NOV to sign and turn in my 1180, asking for an FPEB. Thoughts, everyone?
 
stractman,

New or not, lurker or not, welcome! Hope you get some helpful info here and get your desired result!

Thanks to Jason and other PEBForum vets for guiding us through the process. I've been lurking for quite awhile, but now is the time for action. I also plan to give more detail about ME/CFS, as the forum on this subject is a little bare.
Glad to help where I can and I hope the forum is a good resource for you!


After I entered the IDES process in May 2017 for Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS), I completed exams in June. The general exam did not address ME/CFS at all, even though that was my unfitting condition. I filed a VBA 21-4138, noting this and requesting an exam and DBQ for ME/CFS, once I received all the results in July. VA scheduled me for another exam in October, which was only an addendum exam for fibromyalgia and muscle injury. They did not address ME/CFS at that exam, even though I requested the nurse practitioner for that exam before and during the exam. I asked to speak with the supervisor, but she was out on leave. Apparently the examiner was on strict orders from DVA to do the fibro and muscle exam only, and he rushed through it. I got the exam results back and the details in there were completely incorrect. The nurse stated I had a dx for fibro, which is incorrect (I still don't have a dx from rheumatology).
Not unusual to not get a full or accurate exam from the VA. This, unfortunately, happens way too often. I wouldn't necessarily think it is something personal to you or your case. My hunch is that the original VA forms were acted upon and they only input/scheduled whatever the person thought you would need. (Garbage In, Garbage Out).
Still, sounds like you did you best to try to get things fixed at that point. It may be that you need to continue with this issue down the road, however, depending on your PEB results this might be something that is "fixed" along the way.

The 356 listed CFS as my main unfitting condition, but also stated "DVA rated as fibromyalgia to include chronic fatigue syndrome and myofascial pain syndrome." Rated at 40% with VASRD 6354-5025,
This is the downside of the IDES. That is, while there is generally a benefit to members being rated by the VA and having that rating applied by the military department, there is a downside. That is, in the past the PEB would have authority to fix both the disability and the rating. Now, the military departments sometimes say, "hey, we have to just apply the VA's rating decision," and the VA says, "we had to address the miitary unfitting conditions." In some cases (which may be like yours) there is a disconnect and it can be hard to get an initial just result.

and not combat related (which I do not agree with, since I was definitely in a combat zone and can prove it with a medal and photos in country).

Recheck your understanding about combat related. (There are a lot of threads and discussions on this forum about this issue). Incurred in a combat zone is not the same as "combat-related." The former is concerned with "where" the condition was incurred or aggravated. The latter is "how" the disability was incurred or agravated. Based just on what you stated, I am not sure that your condition would be considered combat-related.

Would need a lot more details to definitively weigh in, but, my instinct is that this is not likely an issue that would resolve in your favor.

Also, I have a dx of obstructive sleep apnea, been on a APAP/CPAP for three years, and the VA rated me at 0%. The reason: "higher rating not warranted for sleep apnea symptoms unless the evidence shows: persistent day-time hypersomnolence." My sleep study and dx, by the sleep doc, as well as my NARSUM, states: "active duty male with a history of severe daytime somnolence for the past 4 to 5 years." This is stated numerous times in several records by my sleep doc. The VA report has incorrect dates, incorrect diagnoses, and did not use my medical records in full.

The "history" piece might be the impediment. It is your current situation that matters. For pilots, sometimes I have seen success with less evidence. However, reality is that most cases with an unfitting finding for OSA involves a clear diagnosis, a period of treatment with both CPAP/BiPAP and prescription of a daytime stimulant (like Provigil) and still having residual sleepiness or significant sleep problems. Generally, this is a hard one to win. That said, your case might present facts that work in your favor. I just don't know enough about your situation to offer more.

Will an FPEB fix the issue with my unfitting conditions? I have dx for CFS, no dx for fibro -- yet, they rated me under fibro. I believe the percentage should also be 60% for CFS -- it would be the case if the VA gave me a CFS exam/DBQ, but most the info they put in the exam was incorrect. I asked several times, in writing, for a CFS exam and DBQ, which they did not give me.

The FPEB could fix your issue. However, as I referenced above, sometimes there is an issue with the agencies (the AF and the VA) pointing their fingers at each other and blaming each other for an inability to "fix" things. All could work out in your favor or, of course, it might not.


Update: I plan to get enough evidence to have a VA reconsideration.
Sounds like a good plan.
I'm getting a detailed CFS DBQ from my primary care physician, which explains how CFS is separate from fibro. To prevent pyramiding, the VA combined CFS under Fibro at 40%. I need evidence to show that both conditions are separate and that my life has been impacted at the 60% level for CFS. I'm also getting a detailed DBQ for fibro, from a rheumatologist, stating that it's separate from CFS. I think that's what it takes to have it reconsidered.
Sound like a sound plan. Especially as to the DBQ. Not sure how they might view all of your disabilities and constellation of symptoms. And, yes, pyramiding might be a factor in your case. Would need to know much more about your case to offer more input.

Although the OAC is quite busy handling hundreds of cases, my rep took a lot of time to help me understand this process and advocate on my behalf. He was very clear and provided detailed instruction so I would have the evidence to support the reconsideration. I'm disappointed that I have to keep fighting against the VA to fix blatant errors and omissions in my C&P exams.
Chin up, Lt Col! Sounds like you have a plan and are taking actions. Hope it all works out in your favor!

Best of luck and if you have any questions, please let us know!
 
It's been a hot minute. Just wanted to update everyone on the major timeline points (I will provide more detail later for my entire IDES process).

FPEB found me unfit - I'm fine with that. After receiving a proposed rating of 40% I filed a VA Recon with detailed DBQs from my primary doctor (for CFS) and my rheumatologist (for fibro). VA Recon was rejected and I found out this morning. They kept it at a 40% even though my CFS DBQ and lengthy medical notes stated that I should be at 60% or higher. The VA rated me based on bad information and incomplete information, opting to give me a fibro rating even though I have severe issues with post-exertion malaise (which is only CFS and not a fibro issue). I don't want anything higher than a 60%...I just feel that the VA cast me aside after lowballing me and they really don't care about what the military has done to me in about the last two decades. I love my country and our military, but I'm broken now and just looking to get some compensation for the sacrifices I made.

Will not pursue combat-related. You're right, Jason. I won't win that argument.

Next steps - what do I need to do to appeal this VA Recon decision? My VA MSC told me that I should contact the IG, legal, and my congresspeople. I called IG and they told me it was a VBA issue. I contacted my senators, Ted Cruz and John Cornyn (Texas, yeeehaaawwww!!!!). I also contacted the President, through the White House website. I know people are sending them loads of requests for help, so I don't have much hope in those avenues. However, any help from my politicians in order to get the VA to actually read my files and treat me like a human being (instead of a number on a piece of paper) is great.
The OAC can't help me from this point. VSO cannot help me until I'm completely retired and out. IG keeps sending me back to VBA, but who at the VBA can help me with this? Can anything be done at this point before I am force to retire from active duty this summer?

Any help is appreciated.
 
2017

MAY – diagnosed with ME/CFS. Tested for all other conditions and excluded them, other than ME/CFS and fibro.
MAY 22 – NARSUM signed
MAY 23 – initial MEB appt with PEBLO
MAY 25 – meet with MSC, all conditions, fill out paperwork
MAY 26 – make all VA appts
JUN 2 – behavioral health (report complete JUN 6)
JUN 5 – neurology (report complete JUN 7)
JUN 6 – audiology
JUN 16 – dental (report complete JUN 18)
JUN 19 – general exam, did not address ME/CFS (report “complete” JUL 3)
JUN 27 – sent to VA for x-ray on both shoulders and R elbow, reviewed VA exam results
JUL 3 – VA diagnosed bilateral acromial clavicular separation, L shoulder labrum tear with scar, GERD, right elbow tendonitis, allergic rhinitis, nasal septal defect, bilateral pelvis pain (secondary to lumbar), rotator cuff tendonitis, R shoulder impingement
JUL 7 – PEBLO, received MEB package for signature, have 10 days (asked for extension)
JUL 14 – signed and submitted LOE, VBA 21-4138 (noting discrepancies and asking specifically for CFS exam), CC impact letter, MEB package
JUL 28 – audiology, get hearing aids for tinnitus
AUG 2 – ortho, wrist exam
AUG 9 – pain clinic, back shots; audiology
SEP 6 – ortho, shoulder shots
SEP 18 – torn hand tendon check; MRI shoulder
OCT 4 – hand tendon surgery
OCT 5 – notified of new C&P for ME/CFS, scheduled for 19 OCT (4 months after general)
OCT 19 – new C&P exam for Fibro, again did not address ME/CFS, got duped. Requested referral from PCM, to rheumatology for fibro diagnosis. Email to MSC and PEBLO regarding Fibro and ME/CFS followups, VA general practitioner requested I get it officially diagnosed with rheumatologist.
OCT 25 – home call regarding fibro and ME/CFS. Dr. put in blood lab work.
NOV 2 – Received 1180 and AF Form 356. 40% DoD, 80% VA. Contacted OAC, requesting Formal PEB. Clerical errors, inconsistent ratings. Diagnosed with CFS, but not rated. Not diagnosed with fibromyalgia, but rated 40%.
NOV 13 – turned in 1180 and OAC forms, asked for formal board (FPEB).
NOV 14 – got an actual DBQ for CFS, signed by a real doctor not just the VA nurse (doc who diagnosed me).
NOV 15 – turned in CFS DBQ to PEBLO and MSC.
NOV 28 – notified of FPEB date (3JAN18)

2018

JAN 3 – checked with OAC to waive FPEB and get more data for VA Recon.
JAN 5 – Met with Dr. (PCM), called to request earlier appointment for rheumatologist. Got appointment with them for 12JAN.
JAN 12 – Diagnosed with fibro. Turned in medical notes to OAC for the VA recon. Deadline is 16th, Tuesday, since Monday is a holiday.
JAN 18 – OAC forwarded VA Reconsideration
JAN 19 – Government shutdown
FEB 13 – VA Recon rejected. Still at 40%. Contacted both senators from TX and the President at the White House. Wrote these last two posts.
 
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