Splitting out conditions subsumed under fibromyalgia and confusing neck/shoulder pain issue

[Goonie]

I'm struggling to wrap my head around this, so many confusing factors in how conditions are related and even more so with how the VA relates them.

First question, trying to understand combined/subsumed, can you tell by my decision letter if conditions were combined to rate me at 40% for fibromyalgia? For example, could they have considered my IBS/neck condition as 10% disabling or some number and combined that to raise my rating for fibromyalgia to 40%?

2012 Decision Letter on fibromyalgia:

Evaluation of fibromyalgia (to include claim of neck condition with diagnosis of cervicalmialgia and intermittent right upper extremity radiculopathy) currently evaluated as 40 percent disabling.

We have assigned a 40 percent evaluation for your fibromyalgia base on widespread musculoskeletal pain and tender points that:

• Are constant
• Are near constant

Additional symptom(s) include:

• Headache
• Irritable Bowel symptoms
• Stiffness

Next question, how can I get them to rate neck and pain radiating down my arm separately? In 2011, they subsumed it under fibromyalgia. In 2019, they acknowledged a non-service connected neck condition and the C&P examiner said it was more likely a separate etiology (less likely than not secondary to fibromyalgia) and made a lot of comments about my shoulder being involved. This seems really screwed up, because I saw a military chiropractor on active duty for the neck issues AND I have a service connected issue in the shoulder on the same side as the pain. Can I or should I submit a supplemental claim or HLR requesting they reconsider the neck condition as direct service connection based on treatment records? Or should I ask them to reconsider the issue as secondary to my shoulder?

I think the shoulder relation might actually make more sense medically. A neck specialist back in 2015 called the neck pain facetogenic and also called it more of a muscular issue. The C&P examiner noted the shoulder multiple times. I had never thought of it as a shoulder problem because my neck hurts, but apparently it's super common to conflate the two sources of pain because of how shoulder muscles and neck muscles, nerves etc. are interconnected. The right arm/neck pain has gotten a lot worse since I separated but my MRIs have consistently showed no direct nerve involvement in my neck.

 

[oddpedestrian]

Yes its possible you would have to file a Supplemental claim first with new and relevant evidence, I am also concerned over the IBS being grouped in. One issue is if its separated it still needs to meet all the requirements for direct service connection meaning a diagnosis which you have, evidence that it occurred in service and a nexus that the current condition is related to service. The rater tends to have some discretion in which way they service connect the condition but combining them like this was kinda odd. It is important to read why they did it in your initial grant and why the C&P examiner claimed they all fall under Fibro and not separately. Since you already have one exam supporting the separate etiology its time to gather information to file. I strongly advise you to seek the assistance of a VSO for a claim like this to avoid unnecessary appeals lasting longer than they should. DAV, AMVETS, American Legion, VFW, or your county VSO should review your findings first before submission.

 

[Goonie]

It seems like the C&P exam probably initiated the letter with "we invite you to claim". I can probably just submit a statement in support of claim saying, "the VA invited me to claim cubital and carpal tunnel in my right arm presumably based on my C&P exam dated xx June 2019," right? And also, I could add "has the VA considered that the pain in the right side of my neck, which is often much worse than the average, constant pain all over my body from fibromyalgia, is due to strain from the instability in my right shoulder impingement?" That's the gist anyway, there are a lot more symptoms with this right should, right arm, right neck, hand/wrist pain deal.

I get kind of nervous when you say "new and relevant evidence." In the past, I had a lawyer that was supposedly helping me but I don't think he was taking the time to really go over this stuff (hired him mainly for BCMR, Medical discharge -> PDRL as of 2015). Now that I'm mentally at a point where I can deal with the VA stuff myself, what I'm learning makes me think I should have been 100% back to 2013 or 2014 after a weird flare made a bunch of stuff way worse. He kept telling me I needed to get this or that statement from a physician and ROMs, etc. and I was so depressed and anxious I just got discouraged and never finished filing. It's really hard to get doctors to write detailed notes with regard to the VA because they want to treat conditions, not lawyer write for VA disability. So many physicians practically shut you out the minute you say disability even if it's preceded by VA.

 

[oddpedestrian]

You already had an examiner support splitting them you probably dont need more just review your records their might be more evidence in their to support your theory take those out highlight them and submit with the claim. A VSO is free they are not paid attorneys.

 

[Fibrogirl]

My fibromyalgia was rated at 40% by itself...however, my IBS claim was denied due to lack to evidence, even though my PCM and my GI doc both diagnosed it post-colonoscopy/endoscopy...oh well, I still got 100% P&T VA, so I'm not going to fight it. The way the VA rates completely boggles my mind.

 

[Goonie]

My fibromyalgia was rated at 40% by itself...however, my IBS claim was denied due to lack to evidence, even though my PCM and my GI doc both diagnosed it post-colonoscopy/endoscopy...oh well, I still got 100% P&T VA, so I'm not going to fight it. The way the VA rates completely boggles my mind.

Was the lack of evidence for service connection or for diagnosing a disability? I think my decision stated they found I had a disability but they didn't service connect it because I put it down as secondary to GERD. In my mind all stomach things go together but medically, they do not. It's killing me waiting on the decision because I'm probably going to stop working very soon. The IBS could be the thing that bumps me to 100%.

 

[Fibrogirl]

it was for diagnosing a disability. The GI nor PCM had no notes included to defend the IBS diagnosis, even though I had practically every symptom.

 

[Goonie]

it was for diagnosing a disability. The GI nor PCM had no notes included to defend the IBS diagnosis, even though I had practically every symptom.

That's frustrating. I was back in a military clinic with Tricare Prime so that might have helped me out since the active duty GI doc understood dealing with the VA. I had to press him to write an actual diagnosis vs noting symptoms after my first C&P examiner told me there was no actual diagnosis but a bunch of notes of consistent symptoms.

 

[Cassdw70]

Good luck Goonie. I'm 40% for fibromyalgia and have been fighting for 19 years to get the IBS, Migraines, and Cervical/arm/shoulder issues separated out. I FINALLY got my migraines service-connected in November. The problem is the definition of fibromyalgia that the VA uses allows them to subsume other (separately disabling issues) if the person just feels like it. Mine (5 separately disqualifying conditions) actually got thrown under fibromyalgia during my PEB and I'm doing my PDBR application now. I'm saying all that to let you know that it CAN be done, but getting a doctor that's familiar with your medical issues to write a Nexus stating they're separate issues was key for mine. (I still got underrated for the migraines, but one step at a time, I guess). If I showed you my medical records from my last 2 years of service and my exit physical you (like my most recent C&P examiner) would say WTH?

 

[HLHL]

My fibromyalgia was rated at 40% by itself...however, my IBS claim was denied due to lack to evidence, even though my PCM and my GI doc both diagnosed it post-colonoscopy/endoscopy...oh well, I still got 100% P&T VA, so I'm not going to fight it. The way the VA rates completely boggles my mind.

What were the ratings for your conditions? Could you provide a list?