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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 isunknown but has associations with IBS, temporomandibular joint disorder, interstitial cystitis, vulvodynia, and tension headaches. Literature review reveals fibromyalgia along withits associated pain syndromes are clearly different and separable from depression and anxiety. The claimant’s fibromyalgia is not secondary to the claimant’s claimed PTSDcondition.
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
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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...