submitted a presumtive CFS claim but I have questions in Gulf War Illness Forum

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submitted a presumtive CFS claim but I have questions

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beaurrr	submitted a presumtive CFS claim but I have questions		Lead	[-]
Posts: 60 Jul 15 12 8:25 AM	This past May, I submitted a claim for CFS through Vonapp. I was in the Gulf during '90-'91, so it would be presumptive. I've seen where some vets added in some verbiage on such claims to request that VBA process these claims under the presumptive condition authority. My question is this: should I submit an additional statement to the RO to be added to my claim that tells them I wish for this to be evaluated as being presumptive, or will it matter if I don't? I don't want to muck up the claim by adding unnecessary things. My second question is directed to those who have filed for this. Even though I have 13 or so years of VA progress notes showing that I have complaints of at least 6 of the required symptoms, I've never been formally diagnosed as having CFS. Generally, the doctor diagnosed the symptoms individually, instead of looking at the 'bigger picture', which I strongly believe supports a diagnosis of CFS. I've had two 'gulf war registry' exams, and will be scheduling a third very soon. I do sense from other posters, that many doctors are reluctant to diagnose CFS, despite symptomotolgy, so I'm wondering if when VA conducts a c&p exam, will the examiner render a medical opinion at that time? Or, will they even conduct a c&p exam in the absence of a current CFS diagnosis?
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byrddog		#1	[url]	[-]
Posts: 2610 Jul 15 12 10:38 AM	Question 1 Yes Question 2 No diagnosis = denial The C&P doc will not give you a diagnosis. They follow a checklist of symptoms. And you are correct many doctors VA or not are reluctant to diagnose CFS since the symptoms could have another origan. You best bet is to file under undiagnosed illness 3.317 for your symptoms. Since you have medical documentation of treatment it could be the route of least restiance.
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beaurrr		#2	[url]	[-]
Posts: 60 Jul 15 12 12:04 PM	byrddog, even though respect your answer, the DBQ for CFS would seem to contradict this, as it lists this question under the 'Diagnosis' section, 'DOES THE VETERAN NOW HAVE OR HAS HE/SHE EVER BEEN DIAGNOSED WITH CHRONIC FATIGUE SYNDROME?'. The more I look into this, the more contradictory the evidence. I am just trying to make sure that I don't complicate this by submitting extraneous information that may result in a needless delay or denial of benefits....
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beaurrr		#3	[url]	[-]
Posts: 60 Jul 15 12 12:22 PM	You said, 'Your best bet is to file under undiagnosed illness 3.317 for your symptoms'. Are you saying I should file again, (since I already have filed), or, should I submit some form to the VA to change the character of the claim?
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byrddog		#4	[url]	[-]
Posts: 2610 Jul 15 12 1:19 PM	CFS, FIBRO and IBS are diagnosised by eliminating all other possibalities. Just because they are presumptive this does not mean they are an easy service connection. DBQ, C&P no matter what you are going to have to have a diagnosis with supporting documentation. I offered my opinion of how to get some of your conditions service connected thru the undiagnosed illness route. It is your decision what to do with your claim. My personal experience has been. Diagnosis of CFS in 92 by VA but was denied service connection. Treated by private doctors thru the years filed again in 2010 denied once again due to the symptoms being related to other service connected conditions. http://www.vba.va.gov/bln...efits/exams/disexm08.pdf This is the worksheet used in my case. You will notice a number of the 10 criteria are vague. This allows the examiner to make a determination with your medical history for each item. There are multiple things that can cause any of the 10 items. 5 of which can be attributed to many mental health issues. Is it impossible to be connected for CFS no. It is very difficult in most instances. And with no written diagnosis it will not happen. I was granted service connection for IBS after fighting it for 20 years and having half the colon removed due to secondary issues from IBS. It is just not a simple thing to file and get done. If it were there would be thousands of people with this service connection already.
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beaurrr		#5	[url]	[-]
Posts: 60 Jul 15 12 1:20 PM	VA has done extensive testing over the years, with little or no true diagnoses. I guess what I'm trying figure out here is whether or not I should leave my claim as it is (for CFS- without a diagnosis), OR, should I change it to claim the symptoms rather than the syndrome, as byrddog suggests? If so, which form do I use? I understand it's complex. I've been through a bazillion labs, x-rays, ct scans, blood draws, EKG, ECG, colonoscopy, stress test, etc. and I'll do it all over, if they want. I need to know if my claim, AS SUBMITTED, is sufficient to trigger a c&p, a review of my records, and additional testing to confirm or deny a CFS diagnosis? In other words, what does it take to get VA to take the many steps necessary to confirm, or deny, a CFS diagnosis? Since the vast majority of my care has been through VA, will I need to comb through my old progress notes and pull out things that show treatment for the symptoms?
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kronan		#6	[url]	[-]
Posts: 47 Jul 15 12 1:20 PM	I was diagnosed by a C&P Dr. I was diagnosed for CFS, IBS and prostrating migrane headachs at my C&P exam and the date of diagnosis is listed as the date of the C&P exam.. I was awarded 80% and then IU...I had not seen a VA Dr. before the exam. I go on a regular basis now.
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beaurrr		#7	[url]	[-]
Posts: 60 Jul 15 12 1:36 PM	Unfortunately, it doesn't help. Maybe I wasn't clear in my posts...
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byrddog		#8	[url]	[-]
Posts: 2610 Jul 15 12 1:42 PM	kronan wrote: I was diagnosed by a C&P Dr. I was diagnosed for CFS, IBS and prostrating migrane headachs at my C&P exam and the date of diagnosis is listed as the date of the C&P exam.. I was awarded 80% and then IU...I had not seen a VA Dr. before the exam. I go on a regular basis now. If you were diagnosed by a a C&P doctor you had to have overwhelming medical evidence for it. Having never been to a VA doc your medical bills had to be staggering. Since a C&P doc had never seen you only your evidence and about an hour face to face you were extremley lucky.
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Truckmaster		#9	[url]	[-]
Posts: 1628 Jul 15 12 6:51 PM	My experience is that if you at least have some of the symptoms, the VA will give you a C&P for what you claim. I had the usual run around with VA docs getting any type of diagnosis. I had all the symptoms, and millions of tests, but the Neurologist would say she thought I had fibromyligia, but it was up to my PCP to give a diagnosis. The formal diagnosis was at my C&P, the doc had no problem agreeing that I had fibro, and the RO went with it. CFS was another story, the initial C&P doc agreed with it while I was in the room, but when he went to write up the report, he stated that I did not have enough symptoms (He listed the joint pains under the fibro, not the CFS, otherwise I would have had enough). By the time I had another C&P through the appeal, I had a firm diagnosis and writeup of CFS from DR B. Before that second C&P, I had a runaround with the RO, because they said I claimed "Chronic Fatigue", not "Chronic Fatigue Syndrome", After I pointed out that the first C&P doc did his writeup as CFS, so it was obvious to him that my claim was for CFS, not just the fatigue, they agreed, and I got awarded the CFS back to the original claim date. So even though I did not have a firm diagnosis when I started my claim, I still got both awarded back to the claim date. In fact, all my medical records started after I started the claim, as I never knew I was eligible for the VA health care, until I started the claim. Fight for every little bit of your life back. Don't let them win.
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branman		#10	[url]	[-]
Posts: 728 Jul 16 12 1:24 PM	Beaurrr, I do believe that your going to have to have a diagnosis of CFS, this is a tough one to fight. Some do get granted for CFS, Fibro, IBS with no problems,and just move straight through the system and are granted without extensive back and forth from the RO while others are taken through the ringer to have to prove every little thing. You can see this just from this post. Byrdog fought the VA for 20 yrs while Kronan just went to a C&P and the doc there gave him the diagnosis and the rater at the RO agreed with examiner. In my own experience, I do have a diagnosis of CFS but in my C&P exam notes from the examiner he didn't agree that I had CFS I was given a firm diagnosis of CFS and was tested for all other test to rule out other things from a Gulf War Research Study in DC by Dr. Baranuik . Now take into consideration, I do have mental illnesses such as PTSD and MDD so some of the symptoms do overlap into CFS symptoms. So what I've had to do was go outside of the VA to get diagnosis from my Rheumatologist for Fibro and get a DBQ from him to help out with any confusion, it may go for a C&P but the medical evidence is there and the private doctors opinion. So if the CFS doesn't land the first time then I will lean on the Fibro to be granted while still fighting the CFS with the VA since I do have a diagnosis for this from one of the countries best Immunologist. Just like Truckmaster, the doctor agreed with my diagnosis to my face but when I got the report it was another story. Very disappointing. Also, the difference between me and Truckmaster is that we both have the same doctor diagnosis from DR. B, he was approved and mine the doc didn't agree even though the doc had the diagnosis in his face. So I will probably have to go to another C&P if they deny my original claim and file a NOD. I do believe that even though your medical records of all of those years may infer that you have CFS, the rater may not make that connection and deny it. My belief is this, if it's not spelled out to the rater in clear English with a diagnosis and medical records to back it up then it will not be granted and you won't have a chance at getting it approved or fighting it. I do know for a fact that you must be clear of filing for CFS and not chronic fatigue, that is a total different set of ratings and can be linked to something else, also I know that you can have CFS and Fibro at the same time, too many people have been granted both at the same time, you just have to fight it. So, if you feel you didn't file it right and you don't want to muck up your claim by adding unnecessary things then just send in a 21-4138 and be very clear of what your filing for to amend your claim. I put on my form "I am filing for Chronic Fatigue Syndrome -CFS due to Gulf War Illnesses as per the 38CFR section 3.317 and as presumptive of Gulf War Illness." Also, again if you don't have a diagnosis from some doctor from somewhere for CFS and medical records and notes to back it up then you will probably be denied, I don't think another Gulf War Registry Exam is going to do anything further to help, it's just basically used to collect data on those of us who went to the Gulf. Your main winning points will come from those diagnosis that your PCP, other specialist , private docs and C&P examiner gives you since this is what the examiners are mostly looking at in conjunction with their own medical team on hand at the RO to help them come to a conclusion to grant or deny your claim. SSDI awarded, 70% PTSD , 40% Fibromyalgia, 30%IBS= Total Awarded 90% Granted 100% TDIU One Does Not Have To Be Evil To Do Evil Because Good Men Only Have To Say Nothing Or Do Nothing... Peace and always much unadulterated Love Thanks For Your Service Branman
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pgwvet		#11	[url]	[-]
Posts: 1321 Jul 17 12 2:30 PM	PS wrote: To be diagnose with CFS, VA would put the veterans under intensive medical examination like blood work, ultrasound, catscan, MRI etc..to rule out a lot of possibilities of what causing your fatigue. CFS overlapped the symptoms of liver disease like TB, and Hepatitis and some other diagnose illnesses and diseases which involves weakening your immunes system (HIV, AIDS etc). If you come out negative with all of these diagnosis illnesses and diseases then CFS would perhaps warranted to the claimants. VA then question the degree of your disabilities. Just submit everything you have. CFS is a complex claim and it requires a lot of examination and consideration. A very expensive process in the VA part. Good luck to you. I am seeing more veterans going to a C&P with a nurse -P and beaning told they do not have CFS, FM or IBS and losing the claim. Get to your doctor get the VA webpage printout on CFS. and talk to him. ask if him if it might fit since you have most of the signs. http://www.publichealth.v...-unexplained-illness.asp one more thing, you do need to send in a 21-4138 telling them of all of the symptoms how bad they are when they started when you went to a doctor and the whole nine yards. Do not thnk the VARO will look at the full records they are over worked and will do the least amount of work they can. Edited 1 time by pgwvet Jul 17 12 2:33 PM.
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jjd		#12	[url]	[-]
Posts: 410 Aug 4 12 1:30 PM	If you want them to understand what you are claiming, just use VA Form 4138 and clarify.
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pgwvet		#13	[url]	[-]
Posts: 1321 Aug 6 12 11:15 AM	byrddog wrote: kronan wrote: I was diagnosed by a C&P Dr. I was diagnosed for CFS, IBS and prostrating migrane headachs at my C&P exam and the date of diagnosis is listed as the date of the C&P exam.. I was awarded 80% and then IU...I had not seen a VA Dr. before the exam. I go on a regular basis now. If you were diagnosed by a a C&P doctor you had to have overwhelming medical evidence for it. Having never been to a VA doc your medical bills had to be staggering. Since a C&P doc had never seen you only your evidence and about an hour face to face you were extremley lucky. there are other veterans that have been Dx in the C&P exam. byrddog if you filed for CFS in 92 it would be denied by the VA as the VA did not have a DC for it at that time. They did not start until 1994 or 95. Fibro was 96 final in 98. Edited 1 time by pgwvet Aug 6 12 11:22 AM.
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byrddog		#14	[url]	[-]
Posts: 2610 Aug 6 12 3:33 PM	I guess I was a little ahead of the curve. However I was denied again in 2010 due to not meeting the number criteria because the symptoms were connected to other service connected disabilities. A system wide determination would sure be nice and prevent alot of confusion. Now I am aware of the DBQ's and other checklists they have used, but the interpetation from clinician to clinician as it refers to each symptom is varied. The exam you get in Kansas city would likley be much different if you had it here in Nashville. The consistancy is just not there. I tend to think it is an implementation problem since there are training letters galore out there.
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pgwvet		#15	[url]	[-]
Posts: 1321 Aug 7 12 10:18 AM	byrddog wrote: I guess I was a little ahead of the curve. However I was denied again in 2010 due to not meeting the number criteria because the symptoms were connected to other service connected disabilities. A system wide determination would sure be nice and prevent alot of confusion. Now I am aware of the DBQ's and other checklists they have used, but the interpetation from clinician to clinician as it refers to each symptom is varied. The exam you get in Kansas city would likley be much different if you had it here in Nashville. The consistancy is just not there. I tend to think it is an implementation problem since there are training letters galore out there. The exam from one doctor to the next in the same hospital came very, not just one VA to the next. I forced the MO RO to bring in a CFS doctor to MO for a C&P on a vet that I was working a claim for. The first C&P was done by a Nurse-P and was done wrong. After my write-up they flew someone in to do it right. Was DX with FM and other things. got his 100%.
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razorpig	CF	#16	[url]	[-]
Posts: 61 Aug 12 12 12:22 PM	PGWVet is correct, you really need to get as much documentation about all your illnesses from outside doctors as possible. I was awarded the full amounts for fibro and CF, had years of documentation from private doctors stating that I had the two, and still had to fight for the CF portion, the VA really loves to believe they are the same for just about everyone. It was the two years plus documentation from neurologist, rheumatologist and other doctors that tipped the scales in my favor after the C&P doctor spent literally 3 minutes with me, then determined I only had fibro. When I was denied, I resubmitted all the documentation from my doctors that they (the VA) already had, and asked them to have the C&P doctor go over my diagnosis point by point. He couldn't, and about 6 months later (with several phone calls in between) I was awarded the full amount for CF, but I wouldn't have a leg to stand on without all the private doctors. Good luck.....
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submitted a presumtive CFS claim but I have questions

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