Received IPEB Results

First time post, long time student of Peb Forum.

Received IPEB results for Fibromyalgia and Obstructive Sleep Apnea (OSA). Board found Fibromyalgia unffitting and rated it 40 percent. As suspected, the board did not find OSA unfitting.

Potential FPEB argument:

Fibro folks sleep poorly because of high pain levels. High pain prevents restorative sleep. Non restorative sleep causes fatigue and more pain. Fatigue and pain cause depression. A vicious cycle. This same cycle can be seen in patients who have a sleep disorder. However, when treated with CPAP these symptions can be managed. Not so with fibro folks because of underlying condition.

As for determing service member fitness, it medically impossible, in my opinion, to distinguish between the negative impacts of poor sleep hygiene when it comes to those who have both fibro and an associated sleep disorder. Therefore, in cases where fibro and a sleep disorder have been medically determined, both conditions must be deemed unfitting and rated accordingly using VASRD standards.

Any thoughts??

 

[Chinook]

Welcome,

I like the way it sounds-and it fits back injuries too. Thanks for the input, sorry I don't have any for you.

Glad to hear you got the 40% on the one thing....others with more experience will help on the other...but I did want to thank you because its things/comments like you just posted that help us all-and its a very accurate description of what we go through...

 

[robs42]

congrats on your rating. remeber that you still can get rated through the VA and w/all the other service conected stuff like the SA w/CPAP. just file the claims and see what come out of it and just in general, always keep filing for an appeal for an increase. then when you get another rating file again, until you get a rating that you feel is just. get yourself a good VSO for that. good luck.

 

[Jason Perry]

MajMustang,

Welcome! As far as thoughts, the first thing I would advise is getting a handle on what is your ultimate goal. Do you have 20 or more years of service? Before getting into the merits, I think it is important to try to figure out at what point do you no longer do better with a higher rating, taking into account some likely outcomes at the VA.

As a practical matter, since the 2008 NDAA, I have not seen a single case of unfitness due to OSA. I don't think that the argument you asked about, that in patients with both conditions, they must both be unfitting, is going to work. I think you have to address the impact of the limitations on duty performance in every case. Then, I think that even if difficult, the PEB is required to make some findings about what they are rating the limitation under. I do think there is an argument that if it truly is impossible to determine what is causing the limitation, they have to assign the more advantageous rating to the member.

Many of the arguments about OSA center on use of CPAP. While I think that the PEBs are wrongly rejecting CPAP use as not unfitting in too many cases, it seems to me that the PEBs, by and large, are also focusing too much on CPAP. I think CPAP use as unfitting should be raised when appropriate, but I think it is important to raise residual functional impact (day time sleepiness, high blood pressure, weight gain, hormonal disturbances, as appropriate) when arguing OSA cases.

The issues you raise are pretty complex and I have kept this as short as possible (after writing a lengthier reply). The questions bear on legal conclusions, presumptions, evidentiary rules, basis for ratings, and application of the VASRD. There are probably more issues. So, it is a complicated issue. My instinct is that in arguing the case, it is best to focus on the limitations (fitness question) and the rating criteria.

I think the PEBs often make errors in OSA cases, ones that can be fought out on appeal. However, before going down that road, it is necessary to assess one's goals and what is the point at which you do no better with a higher rating. This is true in every case.

Please let us know any questions.

First time post, long time student of Peb Forum.

Received IPEB results for Fibromyalgia and Obstructive Sleep Apnea (OSA). Board found Fibromyalgia unffitting and rated it 40 percent. As suspected, the board did not find OSA unfitting.

Potential FPEB argument:

Fibro folks sleep poorly because of high pain levels. High pain prevents restorative sleep. Non restorative sleep causes fatigue and more pain. Fatigue and pain cause depression. A vicious cycle. This same cycle can be seen in patients who have a sleep disorder. However, when treated with CPAP these symptions can be managed. Not so with fibro folks because of underlying condition.

As for determing service member fitness, it medically impossible, in my opinion, to distinguish between the negative impacts of poor sleep hygiene when it comes to those who have both fibro and an associated sleep disorder. Therefore, in cases where fibro and a sleep disorder have been medically determined, both conditions must be deemed unfitting and rated accordingly using VASRD standards.

Any thoughts??