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

Goonie

PEB Forum Veteran
Registered Member
#21
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.
 

Amygal82

PEB Forum Veteran
#22
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....
 

Jason Perry

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#23
Sleep Apnea with a machine is non-deployable due to possible lack of needed voltage, etc. I have seen guys get medically retired at 50% disability for this in the past(2005-2006 timeframe).
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.

A guy I work with has 18 yrs and 11 months of service, over 10 of those as an enlisted aviator in special operations, and he was just offered 10% and severence (no retirement) for a serious spinal 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.
 

Goonie

PEB Forum Veteran
Registered Member
#25
My psychatrist wants to add an addendum for PTSD causing the Fibromyalgia for me. What does that mean?
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%.
 

Amygal82

PEB Forum Veteran
#26
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...
 

Goonie

PEB Forum Veteran
Registered Member
#27
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
 

maparker

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#28
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?
 

Goonie

PEB Forum Veteran
Registered Member
#29
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.

How confident are you that your 20% rating for fibro is correct?
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
 

Goonie

PEB Forum Veteran
Registered Member
#30
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
 

Goonie

PEB Forum Veteran
Registered Member
#31
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
 

Goonie

PEB Forum Veteran
Registered Member
#32
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.
 

Goonie

PEB Forum Veteran
Registered Member
#33
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.
I wish I had taken this advice. There's so much I did wrong when I was going through the MEB/IPEB process. I should have let it drag so I hit 8 years, for one thing. I should have appealed the IPEB, because they should have rated me higher for FMS and I actually was not tolerating the CPAP. If I hadn't been so paranoid I'd get screwed somehow by the changing PT standards, that it would wind up EPTS, or that I'd miss my window of opportunity of a job on the outside I might have played my cards more wisely. I let my fear rule me.

I'm doing much, much worse now. I'm still working but it's becoming more and more of a struggle, even though my newest job is a bit lower stress and the environment is much better. It now looks like I have rheumatoid arthritis/sjogren's or both and I think that my problems in service were just the early signs of it. I have carpal and cubital tunnel in both arms, much worse on the right arm and my wrist has what amounts to a permanent sprain as far as function. I'm also getting numbness and tingling in my feet now and when I flare all my joints get stiff and pop. I had to have my gallbladder removed, which was basically just chronically inflamed (no stones), and now I have nearly chronic diarrhea or just nasty craps in general. Stomach gets upset all the time. I get sick all the time too, just general colds and fllus. If my family gets a bug when I get it is twice as bad.

I got too stressed trying to deal with VA appeals and BCMR and I finally ponied up the cash for a lawyer about a year ago. Not sure if it will help yet. Everything is so slow. I think about just quitting my job and applying for full disability probably on a weekly basis, depends how bad my pain is at the time.
 

Warrior644

PEB Forum Veteran
Registered Member
#34
I wish I had taken this advice. There's so much I did wrong when I was going through the MEB/IPEB process. I should have let it drag so I hit 8 years, for one thing. I should have appealed the IPEB, because they should have rated me higher for FMS and I actually was not tolerating the CPAP. If I hadn't been so paranoid I'd get screwed somehow by the changing PT standards, that it would wind up EPTS, or that I'd miss my window of opportunity of a job on the outside I might have played my cards more wisely. I let my fear rule me.

I'm doing much, much worse now. I'm still working but it's becoming more and more of a struggle, even though my newest job is a bit lower stress and the environment is much better. It now looks like I have rheumatoid arthritis/sjogren's or both and I think that my problems in service were just the early signs of it. I have carpal and cubital tunnel in both arms, much worse on the right arm and my wrist has what amounts to a permanent sprain as far as function. I'm also getting numbness and tingling in my feet now and when I flare all my joints get stiff and pop. I had to have my gallbladder removed, which was basically just chronically inflamed (no stones), and now I have nearly chronic diarrhea or just nasty craps in general. Stomach gets upset all the time. I get sick all the time too, just general colds and fllus. If my family gets a bug when I get it is twice as bad.

I got too stressed trying to deal with VA appeals and BCMR and I finally ponied up the cash for a lawyer about a year ago. Not sure if it will help yet. Everything is so slow. I think about just quitting my job and applying for full disability probably on a weekly basis, depends how bad my pain is at the time.
Indeed, thank you for sharing your post DoD IDES MEB/PEB process experiences! Sometimes, performing certain activities in an effort to wanting the IDES process to "end" quickly is necessarily not the best course of action for sure at the end of the day (e.g., end of the IDES process).

As such, I hope that all goes well for you and your family, and you can continue to get well. Take care!

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
 

tony292

PEB Forum Veteran
#35
Generalized anxiety disorder at zero percent and fitting is bullshit. My GAd is unfitting and 50% and I'm doing a VARR to raise it to 70%. Find and if you have to pay for a civilian mental health doc to examine you.
 

tony292

PEB Forum Veteran
#36
I'll give you some examples of unfitting anxiety:

Suicidal ideations
Inability to establish/maintain work and social relationships. I've severed/ended several long term relationships, with my own mother and best friend from high school. When my anxiety levels peak, I shut and lock my door to my office at work, or in my bedroom at home. I cannot tolerate loud noises, I've had to walk out of the last 4 of 5 of the last movies I've tried to watch in theaters, because I cannot control the volume there. The MH term for this is hyperacusis.
Near continuous depression or panic. This is me except for the last hour of my day (4 prescription sleep meds relax me the last hour) and the first 2-3 hours in the morning (-hangover effect of said 4 sleep meds).

My point is, military and VA docs are completely biased, they work for and get a paycheck from the government... And so where do you think thier loyalty lies? Go get second opinions from civilian docs!

Zero percent and fitting for anxiety is very suspicious to me! My first "telephonic" mental health Army interview was with a LCSW (social worker, lowest form of MH provider) and she found me fit for mental health. I first had to convince my commander that he should write about my MH issues in hi s DA 7652 commanders performance and functional statement... That was the first step in turning anxiety from "fitting" to "unfitting". From there one out, I appealed and fought and asked for an IMR, numerous appeals etc.... Now anxiety is my greatest asset, because it was the first diagnosed, written about by my commander, and I had around two years of history with it. I was diagnosed extremely late in the IDES game with myasthenia gravis, which is truthfully very much more disabling than my anxiety is, but IDES is like being on a treadmill of time.... A late breaking diagnosis won't get you very far because you won't have the luxury of time to further develop it... The military will want to get you out very quickly,nbefore you have had time to fully develop your case! Be warned!!!
 
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