New diagnosis's and fighting my first diagnosis

H

HICE33

PEB Forum Regular Member
Registered Member
hey yal,
i just signed for my formal board, anything i need to bring i have addendums two (Kerititis in right eye/ two cornia transplant and another personal) of them with the appeal and the other two in the process to be finished, do i need anything besides maybe AHLTA notes the addendums to be my evidence? And for my new diagnosis's (fibromyalgia and PTSD) do i need a disability evaluation form filled out and completed with the VA for them to be consittered unfitting? or will the NAVY doctors addendums good enough? and any advice where to stay where i dont have to walk very far or can we even rent a car? THANKS!!!
ABH3 Hice
 
From SECNAVINST 1850.4e Enclosure 9 "special instructions and explanatory notes" Here is the opening and sub paragraphs in regards to Fibro and other DoDi instructions, VASRD and American College of Rheumatology.

SECNAVINST 1850.4E 30 APRIL 2002
ENCLOSURE 9: SPECIAL INSTRUCTIONS AND EXPLANATORY NOTES
9001 General
a. This enclosure is a supplement to the VASRD and contains principles for rating disabilities where additional guidance or clarification is needed for processing active duty and Reserve military disability cases. Portions requiring special comment, or that have been the cause of misunderstanding in the past, are included. Comments and rating instructions also supplement the VASRD in those instances in which recent medical advances are inadequately covered. Supplements to the VASRD published by the DVA following the effective date of this Instruction shall take precedence unless the changes included in the supplement are identified by the Assistant Secretary of Defense for Health Affairs through a published interim change to this Instruction to be inappropriate to military requirements.
b. In adjudicating cases, the VASRD is the starting point and initial guidance for an impairment rating. Because this enclosure modifies selected VASRD ratings, it is the final reference for impairment adjudication.
c. Unless otherwise directed, separate disability ratings are combined rather than mathematically summed.

9009 Fibromyalgia [see VASRD code 5025, enclosure (8), and paragraph 9011a(5)]
a. This condition shall be evaluated by a rheumatologist and meet the requirements of paragraph A5 (b), under paragraph 9011.
b. The diagnostic criteria put forth by the American College of Rheumatology must be met . Current standards shall be used for making the diagnosis.
c. If the MEB report contains fibromyalgia as a diagnosis and is not written by a rheumatologist, there must be a report of recent consultation by rheumatology.
d.Any case with a diagnosis of fibromyalgia must have a psychiatry addendum submitted with the MEB.​
SECNAVINST 1850.4E Enclosure 8​
l. Fibromyalgia. This condition must meet the criteria as put forth by the American College of Rheumatology (current edition). The diagnosis must be made by a rheumatologist and it is preferable that the MEB report be dictated by a rheumatologist when Fibromyalgia is the diagnosis. A psychiatry addendum must accompany any MEB submitted for fibromyalgia.​
​
SECNAVINST 1850.4E Enclosure 9​
(5) 5025 - Fibromyalgia
(a) Fibromyalgia (also called fibrositis, myofascial pain syndrome, or primary fibromyalgia syndrome), is a syndrome of chronic, and widespread musculoskeletal pain associated with multiple tender or "trigger" points, and is often accompanied by multiple somatic complaints. It is a condition for which diagnostic criteria were formally established in 1990 (and have subsequently been revised - see the VASRD for specific guidance as it describes the specific criteria).
(b) Diagnostic criteria include the following: 1. A history of widespread pain that has been present for at least 3
months. There must be both axial skeletal pain and peripheral pain. 2. The presence of pain on digital palpation at 11 of 18 tender point sites. 3. The presence of a second clinical disorder does not exclude the diagnosis. 4. That diagnosis should have been made by or with the consultation of a rheumatologist, who will either be a signatory of the MEB report (with recent
consultation report included when sent to the Informal PEB) or the author of a typed addendum.
(c) A psychiatry addendum will be included.

From current VASRD:

5025 Fibromyalgia (fibrositis, primary fibromyalgia syndrome)

With widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud’s-like symptoms:
That are constant, or nearly so, and refractory to therapy......................................... 40
That are episodic, with exacerbations often precipitated by
environmental or emotional stress or by overexertion, but that
are present more than one-third of the time................................................................... 20
That require continuous medication for control.................................................................. 10
Note: Widespread pain means pain in both the left and right sides of the body, that is both above and below the waist, and that affects both the axial skeleton (i.e., cervical spine, anterior chest, thoracic spine, or low back) and the extremities.

The VASRD is very vague with Fibro so it's going to be scrutinized. This is what the American College of Rheumatology recommends as diagnostic criteria. First web address is patient info. Second is diagnostic info (full article). Third is excerpt of full article.
http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/fibromyalgia.asp​
​
DoDi 1332.38 ENCLOSURE 4
GUIDELINES REGARDING MEDICAL CONDITIONS AND PHYSICAL DEFECTS THAT ARE CAUSE FOR REFERRAL INTO THE DISABILITY EVALUATION SYSTEM
E4.2.9. Fibromyalgia. This condition must meet the definition as put forth by the American College of Rheumatology in 1990.


*****Keep in mind over the last few years the American College of Rheumatology changed the recommended diagnostic criteria(2010), but SECNAVINST 1850.4E hasn't been updated to reflect the changes, except to say they should follow the current American College of Rheumatology diagnostic criteria and defer to VASRD. DoDi 1332.38 states the condition must meet the definition according to American College of Rheumatology in 1990, not the 2010 revised criteria. In the past a minimum # of trigger points were required. That is no longer the case. I have been hearing that the Military and VA doctors are still performing these trigger point assessments and if you don't have the minmum of 11 of 18 spots they will rule out Fibro. Well, that's wrong. Click on the links above and read the new standards. Then determine whether the Military/VA evaluated you correctly per the regulations cited above. If you have not been seen by rheumetology and a psychologist/psychiatrist they may not have enough evidence to support the claim. If they have not done it correctly if might be in your best interest to have the FPEB retracted to the MTF so that it can be done properly. Hopefully they already have done it correctly.
 
is that close to the area i meet with my attourney as well?
and thank you for this information, very informative.
 
By chance is there a cab service that goes on base maybe a number I could call? And or can we get a rent a car?
 
The hotel will have the cab info for you. I don't have it. The reason I would shy away from renting a car is because of traffic in the DC area. Parking is bad as well.
 
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