Tips To Help Strengthen Your VA C&P Claim For Service Connection for Fibromyalgia and/or Increasing your rating for Fibromyalgia. Please Note: This blog consists of tips to strengthen your VA claim for Fibromyalgia. Due to individual circumstances the outlined recommendations does not guarantee your VA Claim would be awarded.
Often Veterans living with Fibromyalgia wonder how the VA reviews and determines the percentage rating for service connection for Fibromyalgia. Below is an overview of how the VA determines services connection, the designated ratings and guideline on how to strengthen your claim for Fibromyalgia. First, here is the percentage ratings for Fibromyalgia per VA regulations: HOW DOES THE VA RATE FIBROMYALGIA? 38 C.F.R. 4.71(a) diagnostic code 5025 lists the VA’s rating criteria for fibromyalgia and includes ratings from 10% to 40% disabling. Each rating begins with the prerequisite that there be “widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbances, stiffness, paresthesia, headache, irritable bowel syndrome, depression, anxiety, or Raynaud’s-like syndrome.” From there, each rating has its own requirements.
• The lowest rating, 10%, requires that the veteran take continuous medication for the control of their fibromyalgia. • For the 20% rating, the VA requires that the symptoms listed above be “episodic, with exacerbation's often precipitated by environmental or emotional stress or by overexertion, but that are present more than one-third of the time.” • Finally, for the 40% rating, the highest VA rating for this condition, the veteran’s symptoms must be “constant, or nearly so, and refractory to therapy.” 1) If you are diagnosed with Gulf War Illness or have served in the Southwest Asia Theater, and you developed Fibromyalgia, this is then considered a "presumptive condition." It is recommended you provide either medical evidence of being diagnosed with Gulf War Illness or military documents that you were in theater in Southwest Asia with your VA C&P Claim. What’s included in the Southwest Asia theater of military operations: Iraq, Kuwait, Saudi Arabia. The neutral zone between Iraq and Saudi Arabia. Bahrain, Qatar, and the United Arab Emirates (U.A.E.) Oman. The Gulf of Aden and the Gulf of Oman. The waters of the Persian Gulf, the Arabian Sea, and the Red Sea. If you are already service connected for Fibromyalgia, In order to receive a higher percentage rating for Fibromyalgia, you will have to claim an increase due to your Fibromyalgia has worsened, that you experience Headaches/Migraines, have Chronic Fatigue, worsening of depression and worsening of chronic pain. Example, if you were rated at 10% the C&P Examiner did not think your Fibromyalgia was that bad and you were stable taking your prescribed medications. With that said, if you had to change medications, increase dosages of medications, discontinue medications due to side effects or add any new medications for either your Fibromyalgia, depression or migraines, then you will want to relay this in your claim. I also recommend printing your history of medications prescribed by the VA. If you receive medical care outside the VA for Fibromyalgia, Depression, Migraines etc. you will want to obtain those clinical medical notes AND go to the local pharmacy and ask them to print off your medication list for the past 2 years. If you go to a private doctor and use Private Health Insurance or Medicare, and use it for any non-VA medications, then you can usually go online, create an account for your Medicare insurance and print your history of medications filled. ALSO, if you went to the emergency room, urgent care or were hospitalized due to Fibromyalgia, Depression, Migraines etc., you will want to obtain copies of those notes as well. Also note that if you are diagnosed with Anxiety, Irritable Bowel Syndrome (IBS), Raynaud's Syndrome, sleep disturbance/insomnia, chronic fatigue etc., you will want to include those in your claim for an increase for Fibromyalgia. 2) When applying for an increase for Fibromyalgia you will want to request an increase due to worsening of fibromyalgia and it's symptoms of chronic pain and fatigue, worsening of depression, and include chronic fatigue and migraines in your claim, secondary to your Fibromyalgia. 3) Get copies of ALL your medical records, diagnostic tests, blood tests, MRI's x-rays etc. that are related to your Fibromyalgia Treatment/Appointments, Depression, Chronic Fatigue, Chronic Pain, Migraines, IBS, Raynaud's Syndrome etc. This would include your medical records from your psychiatrist (depression) and therapist (counseling) if applicable, primary care doctor, pain management doctor. and any other doctor/specialist you saw for treatment of Fibromyalgia, Depression, Chronic Fatigue and Migraines. You can print 2 years worth of your Medical records on my health vet. 4) If you received treatment from private doctors for Fibromyalgia, you will need to obtain those records to submit with your claim. Simply show them a copy of your VA claim (after you submit it) or print your claim status from eBenefits and show this to your doctors/medical records to obtain your private physician health records. * Side Note: Private medical providers can NOT charge you for obtaining copies of your medical records if it is for a VA Compensation/Pension claim or SSDI. All you have to do is show them your application for VA compensation, and if they give you a hard time, you simply tell them that per law, they HAVE to give you a copy of your medical records within 30 days. If you are able to create an account with your private medical health provider and print your private provider medical records, that is the easiest and fastest way to obtain your private medical records. ALSO: It is recommended you obtain at least the past 5 years of ALL your medical records, if possible, to submit WITH your C&P claim. At the VA, you can go to medical records, request your medical records in writing for the past 5 years for for Psychiatry, Counseling, Primary Care, Pain Management, Physical therapy and/or Chiropractic care (if applicable) and they can send you a CD Disc in the mail with your medical records that you can pull up on your computer and print. If you do not have a computer or printer, then ask for the past 5 years of records as paper records and just tell them you do not have a computer or printer.
5) When submitting your claim to apply for service connection or increase your percentage for Fibromyalgia, it is recommended you go through a VSO (Veteran Service Organization) such as the DAV (Disabled American Veterans), American Legion, AM Vets or the VSC (Veteran Service Commission) so they can assist you with your claim. They provide these services free of charge and they usually have offices at most VA facilities. You can look up if they have offices at your local VA or google your local DAV, American Legion, AM Vets or VSC for the contact number. When you go to meet with a VSO to assist with your claim, you will want to make copies of ALL relevant medical documents and submit those documents with your claim. HOWEVER, before turning over the copies you receive, make sure you make a 2 sets of copies. 1 set for your records AND an additional set of copies to give to the C&P Examiner if the VA sets up a Compensation & Pension Medical Evaluation appointment for your request of increase for Fibromyalgia. 6) Personal Statement Letter: It's highly recommend you write a personal statement letter outlining how your Fibromyalgia, Depression, Chronic Fatigue, Chronic Pain and Migraines etc. inhibit you, not only from working, but inhibits you from completing daily tasks. Further, in your personal statement letter, also write HOW each medical condition inhibits you from completing Activities of daily living. Example: The Fibromyalgia Chronic Pain routinely interferes with your ability to do daily tasks such as cooking and cleaning. Your Chronic Fatigue and Brain Fog inhibits you from driving most days. Your Migraines inhibit you from functioning or doing anything and you have to sleep through the Migraine. FURTHER, in your personal statement letter, you will want to outline how often you have migraines/headaches in a given month and how many days it causes you to be bed ridden. In addition, if your Fibromyalgia and chronic fatigue causes you to be bed ridden, you will want to outline that as well and how many days it causes you to be bed ridden. You will also want to write out how your depression affects you from day to day. The key here is writing about how your symptoms are on your WORST days. Further, if you are scheduled for a C&P examine, you also want to relay what your Fibromyalgia, Migraines/Headaches, Depression, Chronic Fatigue and Brain Fog are like on your WORST days. The point is to relay how bad your medical conditions affect you on your worst days and inhibits you from completing daily tasks or activities of daily living including social activities. Also, albeit it is a sensitive area, if your Fibromyalgia and its' symptoms have interfered with having a healthy sex life due to fatigue, chronic pain, depression, etc. you also want to outline that in your personal statement letter. Finally, you will want to write out how much your Fibromyalgia and related symptoms interfere with your daily functioning and/or home-bound. The more often your medical condition keeps you home-bound, the worse they will determine your Fibromyalgia and symptoms are. Example Of What To Write In Your Personal Statement Letter:
"My chronic pain from Fibromyalgia interferes with my mobility and reduces the time I am able to stand which interferes with my ability to do grocery shopping. My depression is so bad on some days, that inhibits me from accessing public places, further, going to public places also increase my depression and exacerbates my chronic pain and chronic fatigue. Due to chronic fatigue and brain fog, I am unable to concentrate and compete simple tasks. In addition, my brain fog makes it difficult to navigate public places such as the grocery store. Thus, I often have to order food and basic needs online and have them shipped to me. Due to chronic pain and chronic fatigue, I am often unable to complete simple chores such as dusting and vacuuming, and I have friends and family who come over to my home and do these chores for me. Due to severe migraines, I am unable to do anything other than sleep through the migraine until it goes away and I spend many days in bed until my migraines pass. My migraines, chronic fatigue and chronic pain are so bad some days that I can barely move and often keeps me home bound. Further, my chronic fatigue and chronic pain interferes with my ability to do self care and I sometimes can not shower due to chronic pain and chronic fatigue. Also, my depression is so bad some days that I have no interest in doing any activities, socializing with others nor engage in hobbies. I often have difficulty simply watching TV due to lack of interest and concentration as a result of my depression, brain fog, chronic fatigue and chronic pain from fibromyalgia. Finally, Due to my Fibromyalgia, Depression, Migraines, Chronic Fatigue and Brain Fog being so disabling, the Social Security Administration (SSA) determined I was disabled as a result and I was awarded SSDI."
The above are simply examples of what to write in a personal statement letter and you can tailor it to your specific medical conditions. Also, the more informative the Personal Statement Letter is, the better. Finally, turn in your original and signed personal statement letter but make sure you make copies, 1 for your records and 1 to give to the C&P examiner. Make sure to sign and date your personal statement letter.
7) Buddy Statement Letters: The "Buddy Statement Letter" is a letter you obtain from friends, family, colleagues and military members you served with, corroborating your Fibromyalgia illness along with their observations of how your medical condition of Fibromyalgia and subsequently the secondary medical conditions of Depression, Anxiety, Migraines, Brain Fog and Chronic Fatigue affect you and your ability to work and complete daily tasks. Further, if your symptoms of Fibromyalgia started while in service, and it was observed by your military colleagues, it is helpful to ask those you served with to write you a buddy letter outlining their observations of your Fibromyalgia symptoms while in service along with identify an approximate time frame they observed your symptoms of Fibromyalgia.
The "Buddy" statement letter is similar to your "Personal Statement Letter" but written from their perspective and observations on how bad your illnesses are and how they affect your daily life/routine. You will want to submit your signed "buddy letter statements" with your claim, but again, make sure you make copies, 1 for record and 1 to give to the C&P examiner. If you are able to get a friend, family member or colleague to write you a "buddy letter" make sure they sign and date it. You may find that people do not want to take the time to type up a letter, however, often times if you offer to type a letter based on their perspective, they will usually sign and date it. 8.) If possible, try to have ALL your medical health and mental health providers fill out the DBQ form/s. ALSO NOTE: Many doctors at the VA will try to refuse to fill out any medical forms whether it is the DBQ or non-VA medical forms. However, per VA Policy they are not allowed to refuse to fill out your medical medical forms. "VA POLICY Except when specifically prohibited, it is VHA policy that providers, when requested, must assist patients in completion of VA and non-VA medical forms and provide medical statements with respect to the patient’s medical condition and functionality." 9) If you are receiving SSDI. If receiving SSDI due in part to Fibromyalgia, Depression, Anxiety, Irritable Bowel Syndrome, Migraines, Chronic Fatigue etc. If this is the case. I would submit a copy of your Social Security Letter of Disability with your claim along with bring an extra copy to your C&P examination to show the medical examiner that even Social Security Administration determined your Fibromyalgia and your symptoms of Fibromyalgia were severe and disabling. Your SSDI letter will only help determine the severity of your Fibromyalgia, it will not determine if your Fibromyalgia is service connected. That is up to the VA C&P examiner to determine, In your personal statement letter, it is recommend you outline "Due to my Fibromyalgia, Depression, Anxiety, Migraines, Irritable Bowel Syndrome, Chronic Fatigue, and Brain Fog are so disabling, Social Security Administration determined I was disabled as a result and awarded SSDI." 10) One final note of advice, from now on when you go to your doctors, inform them of your chronic fatigue and brain fog and how bad it is. You also want to discuss how your Fibromyalgia and how the symptoms, chronic pain/fatigue etc. Impacts your life. Likewise, with your depression and all other secondary conditions to Fibromyalgia. You can even speak with your psychiatrist/therapist about your fibromyalgia, its' symptoms, the chronic pain etc. and discuss with them how it is compounding your depression and interfering with your ability to complete daily tasks and diminishes your quality of life. You also want to talk with your primary care doctor and any other doctors you see for fibromyalgia treatment, and relay how bad your Fibromyalgia is and how it's compounding your depression because your illness and symptoms are decreasing your quality of life. The key here is to talk about your medical issues/concerns across the board with every last provider you see, and get it documented by several medical providers, because it will show consistency of your medical concerns, symptom severity and and how it is affecting your life as a whole.