IPEB rated Fibromyalgia and did not include Sleep Apnea / GAD. Appeal?

Discussion in 'Informal Physical Evaluation Board' started by Goonie, May 5, 2011.

  1. Goonie

    Goonie PEB Forum Veteran

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    Mike,

    Thanks. From the excerpt E7.1.2. it sounds like they should have given me a combine rating since the GAD and OSA contribute to my fibromyalgia.

    I'd still love to have some information on outcomes in cases similar to mine but its sounding like I should appeal for a combined rating.
     
  2. Amygal82

    Amygal82 PEB Forum Veteran

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    Did you see Deebo77 at the bottom of the page?? They received 70% for Sleep apnea and Fibro. I don't get how people with the same illness get such different ratings....
     
  3. Jason Perry

    Jason Perry Benevolent Leader Site Founder Staff Member PEB Forum Veteran

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    This used to be the situation, more or less, in the time frame before 2008. Remember, the DoD was using an "alternate" schedule before then that rated OSA on social and industrial impairment rather than the VA criteria of 50% with CPAP. So, you would see all the time members found unfit, but with 0% awarded even though they used CPAP. In 2008, it became clear that DoD had to use the VASRD and, [sarcasm] amazingly [/sarcasm], members were suddenly being found not unfit due to sleep apnea. Now, they say that CPAP use is waiverable. The guidance on this changes (I mean the specific guidance, the principle pretty much remains the same), and if you think your circumstances are unique where you have to deploy to remote locations, then I think it is worth hunting down specific service guidance, like CENTAF, on this issue.

    That guy should get to work on preparing his case- either for a retirement finding, but perhaps for a continuation on active duty/LAS application.
     
  4. Amygal82

    Amygal82 PEB Forum Veteran

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    My psychatrist wants to add an addendum for PTSD causing the Fibromyalgia for me. What does that mean?
     
  5. Goonie

    Goonie PEB Forum Veteran

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    I would think that is a good thing rating wise, but I would obviously bow to the experience of Jason or maparker. I'm thinking you would get a combined rating that way, because both the PTSD and Fibromyalgia would be considered unfitting.

    Also, I was just scouring the forums for information and I think combat related PTSD is an automatic 50%.
     
  6. Amygal82

    Amygal82 PEB Forum Veteran

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    It's not combat related, but it is duty related... I'm just scared they will TDRL me and then do what they seem to do a lot and give me 20% later and say I don't have it anymore...
     
  7. Goonie

    Goonie PEB Forum Veteran

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    I'm still considering whether or not to appeal. I've gathered a fair amount of information but I'm still feeling somewhat torn.

    After reading up on being considered unfit for sleep apnea with CPAP, I'm thinking my case for that isn't good. I tolerate my CPAP generally well, barring any issues with allergic rhinitis. Basically if my sinuses are acting up or I get a sinus infection, which usually happens a couple times a year, I can't sleep with my CPAP. When I can't sleep with my CPAP for a few days I'm finding I usually will have an increase in fibromyalgia pain. Same thing happens with a cold or flu, just makes being sick a little worse than it should be.

    Am I right that this isn't good grounds for considering sleep apnea unfit? Allergic rhinitis is in my records but not submitted to the MEB/IPEB, however I just looked at the ratings (6522) and I doubt I would qualify for even a 10% rating for allergic rhinitis.

    The only angle that seems legitimate to me is that my generalized anxiety disorder (GAD) aggravates my fibromyalgia. Under the general ratings for mental disorders I think I would fall under the 10% bracket.

    Occupational and social impairment due to mild or transient symptoms
    which decrease work efficiency and ability to perform occupational
    tasks only during periods of significant stress, or; symptoms controlled
    by continuous medication .................................................................................. 10

    The "only during periods of significant stress" is the reason I consider myself 10%. What I think wasn't factored into my rating is that during periods of significant stress my fibromyalgia will also "flare up". It seems to me that this would be good justification to be rated for the generalized anxiety disorder (GAD).

    If they did include my wouldn't my rating be 28%? 20% fibro + 10% GAD(80%) = 28%? or in this situation would the "fuzzy math" not apply?

    Thanks in advance for any advice,
    Josh
     
  8. maparker

    maparker Staff Member PEB Forum Veteran

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    Josh,

    If in doubt appeal and ask for a formal board. You can always turn down the formal board up until the gavel drops to start the board. How confident are you that your 20% rating for fibro is correct?
     
  9. Goonie

    Goonie PEB Forum Veteran

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    It is tempting to just appeal but I do want out of the Air Force, and sooner is better for me in some ways. I kind of don't want to waste my time or anyone else's time if I don't have good grounds for an appeal.

    I'm pretty confident that 20% is accurate. The "episodic" description fits me pretty much to the "T." One thing I just noticed when I reread the description below is that it describes fibromyalgia "with or without associated.. anxiety.. " Since anxiety is already in the description for fibromyalgia does that make it highly unlikely that they would rate the generalized anxiety disorder because it aggravates the fibromyalgia?

    Also, FYI, I just ran around the clinic today putting in T-CONs, or phone consults, to see if I have documentation to make a clear statement that the anxiety does aggravate the fibromyalgia. I also asked for documentation that I can't use my CPAP when I have a sinus infection, cold, etc and that not using my CPAP for several days aggravates my fibromyalgia. I should have info on the documentation before the end of the week to help decide whether or not to appeal.

    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
     
  10. Goonie

    Goonie PEB Forum Veteran

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    Does anyone have any thoughts on possibly being rated for generalized anxiety and fibromyalgia?

    In the description of fibromyalgia it says "with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud’s-like symptoms:"

    What does that mean for rating the "associated" symptoms or conditions?

    Thanks,
    Josh
     
  11. Goonie

    Goonie PEB Forum Veteran

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    I've continued doing research and at this point I'm leaning against appealling to FPEB. I would appreciate anyone weighing in on my logic / reasoning.

    With regard to rating both Generalized Anxiety Disorder (GAD) and Fibromyalgia (FMS) I'm highly doubtful I could have them both rated. This is especially true in my case because I do not have severe GAD. I would basically be pusing it to be rated 10% for GAD and that aligns very closely with the description of my severity of FMS, 20%.

    Here are some exceprts from the VASRD:

    (d) When a single disability has been diagnosed both as a physical condition and as a mental disorder, the rating agency shall evaluate it using a diagnostic code which represents the dominant (more disabling) aspect of the condition (see §4.14). (Authority: 38 U.S.C. 1155)

    The VASRD description of a general mental disability rating of 10%:

    Occupational and social impairment due to mild or transient symptoms
    which decrease work efficiency and ability to perform occupational
    tasks only during periods of significant stress, or; symptoms controlled
    by continuous medication .................................................................................. 10

    The description of fibromyalgia and a 20% rating:

    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:


    ...[left out 10 & 40% descriptions]

    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

    maparker showed me this:
    From the 14 october 2008 DTM:

    E7.1.2. The Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) shall be used in making ratings determinations for each of the medical conditions
    determined to be unfitting independently or due to combined effect, to include in combination with an independently unfitting condition. If more than 1 military unfitting condition exists, the VASRD will be used to determine a combined disability rating for each unfitting condition. For purposes of establishing a rating, the VASRD will be used in relation to the Service member's physical disability at the time of the evaluation. If use of convalescent ratings and/or other interim ratings (i.e prestabilization ratings) applies, the Service member may be placed on the Temporary Disability Retired List (TDRL) for reevaluation purposes.

    At first the paragraph E7.1.2. gave me some hope but now I'm thinking there's no way they would consider GAD an independently unfitting condition or consider it unfitting as a "combined effect" with fibromyalgia since fibromyalgia already includes/rates associated anxiety.

    Again, I would appreciate anyone weighing in on my reasoning and references. I'll make a final decision on the appeal by Friday if not sooner.

    Thanks,
    Josh
     
  12. Goonie

    Goonie PEB Forum Veteran

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    Additionally, I got a reply from a paralegal at the FPEB. Here are some exceprts from the conversation:

    [Paralegal]
    Yes, that is definitely a possibility. The board here will look at your
    entire medical records and if there is any mention of you experiencing
    symptoms as a child, which you mention one of the doctors does. Then there
    is a higher risk that the board will consider it EPTS which means they will
    offer you nothing.

    [Me]
    Is there any chance something not considered EPTS during IPEB could change
    to EPTS in the FPEB? I have never tried to conceal it from my physicians
    that I had problems in high school following a car accident. In the notes
    submitted to the IPEB from the rheumatologist, Dr Bond, he makes a brief
    note of it. Is this going to receive greater scrutiny at the FPEB? I can
    honestly admit that I probably had fibromyalgia prior to joining the Air
    Force but it was not diagnosed. However, the fibromyalgia has definitely
    gotten worse since I joined and I can honestly attribute that to some of the
    stresses of active duty.
     

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