September 4, 2025 • 54 mins
We draw a sharp line between feeling tired and a true Chronic Fatigue Syndrome diagnosis, then show how to build a VA-ready record with testing, coding, and a precise DBQ.
• symptom fatigue versus CFS syndrome and six-month persistence
• why ICD-10 G93.32 matters
• diagnosis of exclusion and the lab, sleep, and cardio workup
• DBQ structure, activity restriction tiers, and functional impact
• filing order strategy and when to protect your effective date
• pyramiding risks with sleep apnea and cancer ratings
• residuals versus primary ratings and case study insights
• Gulf War presumptive criteria and compensable thresholds
• mental health factors and documenting post-exertional malaise
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Visit J Basser's Exposed Vet Productions (Formerly Exposed Vet Radioshow) YouTube page by clicking here.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
J Basser (00:07):
Welcome folks to another distance of Colette
Productions weekly broadcast.
My name is John.
They call me Jay Bassers.
Today is September the 4th,2025.
Can you believe it's Septemberalready?
Today's co-host is the one andonly Mr.
Barry Freddy, down there in theclose to Alabama, but he's
still in Tennessee.
(00:28):
How are you doing, Barry?
I'm good.
How are you, John?
That's good.
And today, in the uh firstThursday of the month, we've got
Bethy Spangenberg on.
She is going to discuss uh theissue of chronic fatigue
syndrome.
And she's got a whole setup forus, so she's going to discuss
(00:51):
the DBQ and the legal factorsinvolved.
Bethy, how are you doing?
Bethanie Spangenberg (00:55):
I'm doing great.
I've been busy and had a littlebit of technology troubles
because it's not my thing, buthere we are.
I'm ready to go.
J Basser (01:05):
Okay.
Well, I'll turn this over toyou.
You go ahead and get startedand get us get us in the right
direction, anyway.
Bethanie Spangenberg (01:12):
So as John, you know, and Barry, you
know, I am Valid for Vet.
I am a former compensation andpension examiner.
I'm a physician assistant.
Medicine is my thing.
I love it.
Um, I fell into VA disabilitybecause my first job was at the
VA.
And when my husband wasdeployed, I didn't mind working
(01:34):
like 60 hours a week in primarycare.
But when he came home, I didn'twant that life anymore.
So I transitioned to thespecialty clinic where I was the
only full-time compensation andpension examiner.
And I learned a lot.
I, from the very beginning,when things came off the printer
or the request came from theregional office, I was the
(01:56):
person that picked them up offthe printer, read them, decided
where they went, like whatprovider they went to.
And so I was very heavilyinvolved in that process and I
learned a lot.
And then Secretary Shinsekidecided he was going to close
all these two year old two-yearor older claims out.
And my husband fell into that.
So here he got out in 2011.
(02:18):
He had his disabilitycompensation exam within a month
of his discharge, and two yearslater, he got denied for
everything that he applied for.
So at that point, my passiontransitioned into advocating for
the veteran rather than being agreat and great government
employee.
Because when I'm an employee, Itry to be the best employee
(02:41):
there is.
And I really found that myvalue was elsewhere and not
within the government system.
So I say that to say that I'vebeen in this a while now, since
formally since 2015, as Valorfor Vet or as the company, but
we do a lot of disabilityclaims.
(03:02):
And chronic fatigue is one ofthose.
We offer DBQs where the veterancan register and complete a
DBQ.
And what I am finding recentlyis a lot of confusion around
chronic fatigue syndrome.
We offer the DBQ for veteranswho are seeking service
connection for it.
(03:24):
And I find that between mecompleting the questionnaire and
what the what information theveteran provides, there's a big
disconnect.
And I feel like this has a lotof value for a lot of veterans,
especially those that fallunderneath the presumptive for
(03:46):
chronic fatigue syndrome.
Any questions before I dive in?
Any comments before I dive in?
Believe it or not, this DVQ isonly five pages, but there's a
lot of information that goeswith it.
(04:07):
So I want to first start withthe medical understanding of
chronic fatigue.
When we look at fatigue,fatigue can fall into a symptom
or a syndrome.
Okay, and those are two verydistinct definitions or words
(04:31):
when it comes to chronicfatigue.
So when I as a clinician thinkof chronic fatigue as a symptom,
okay, that is a report that thepatient is giving me.
Okay, so they come into myclinic and they're saying, you
know, I've been really fatigued,I've been really tired lately.
And so that is something that Idocument in their history.
(04:52):
It's not something I'm gonnasay, oh, you have fatigue,
chronic fatigue syndrome.
It's not, it's not that way,it's a symptom.
Um, similarly, we have othersubjective symptoms such as
pain, shortness of breath,nausea, or dizziness.
And I provide those examples upthere so that you can see, you
(05:13):
know, what the symptom is.
Like what, you know, I tell youthat fatigue is a symptom, and
so is pain.
Pain is a symptom.
These are things that Idocument, these are things that
the patient is telling me.
I put it into their chartingsystem, and these are little
things that I put together informulating a diagnosis to
understand what is going on withmy patient.
(05:33):
When it comes to syndrome,okay, this is different than
symptom, but we are looking at acollection of symptoms or
clinical signs, things that Ifind on exam, maybe some lab
testing, but more data thatconsistently occurs together and
(05:55):
characterize a condition.
So this is where your chronicfatigue syndrome falls into.
Okay.
And if we look at it side byside, okay, look at symptom of
fatigue versus chronic fatiguesyndrome.
The duration of a symptom canbe variable or short, short
(06:17):
term.
When those symptoms cometogether to make a syndrome,
they typically persist for sixmonths or more.
Okay.
The cause, a symptom of fatiguecan be caused by a lot of
diseases, sleep apnea, diabetes,heart failure, coronary artery
(06:39):
disease.
Those diseases can create asymptom of fatigue.
In the rating schedule, we seefatigue captured in Met's
testing for coronary arterydisease.
So when the examiner is askingif the veteran gets short of
(07:00):
breath or has chest pain withmowing the lawn, push mowing the
lawn, sitting watching TV, allthose scenarios are put together
or all those symptoms are puttogether to capture the fatigue
for the rating schedule.
Okay, so that's a symptom.
Now, when we look at the causeof fatigue, it is unexplained
(07:23):
after we've ruled out everyother possible disease.
The symptom of fatigue oftenimproves with sleep.
Maybe that individual's notgetting enough sleep, they get
you know a few good nights ofrest and quality nights, and
that fatigue may get better.
For chronic fatigue syndrome,it does not approve in Peruve,
(07:47):
no matter how much sleep theyget.
Post-exertional weakness.
So if they go and they decidethat they're going to load the
dishwasher or try to dosomething productive because
they're wanting to be active.
For this symptom of fatigue,they have some of it.
They do experience some of thatpost-exertional tiredness or
(08:09):
fatigue.
For chronic fatigue syndrome,it is persistent, it is a
hallmark sign.
Fatigue.
Fatigue can mess with your youryour thought process.
If you've ever gone a longnight where you haven't got much
rest, you can experience, youknow, where your words jumble,
(08:32):
or you say something you didn'tmean to say, or you stutter, or
you may have troubles, you know,getting your thoughts out
there.
And it's temporary.
For chronic fatigue syndrome,it's usually a persistent
impaired thought process.
When it comes to function withfatigue symptom, you uh have
(08:56):
slow activity, but it'smanageable.
So you know, like, oh myfatigue is worse in the
afternoon, so I do X, Y, and Zin order to get what I need
done.
For chronic fatigue syndrome,there's a significant reduction
in your daily activity.
So it doesn't matter what timeof the day that you're trying to
get the dishes done, it's it'sgoing to be bothersome or
(09:17):
troublesome any time of the day.
Again, sleep, we kind of talkedabout this already, improves
the sleep, does not, um, orchronic fatigue syndrome, you
often have non-restorativesleep.
This is important when it comesto the, and this is this is why
(09:37):
I wanted to do thispresentation.
We preach in this show a lotabout having a diagnosis, okay.
But you can't just have anydiagnosis, you have to have the
diagnosis for chronic fatiguesyndrome.
So if you look here at thebottom, for the symptom of
(10:01):
fatigue, the medical clinician,the medical examiner, may put in
a medical ICD code.
Okay, that is for insurancebilling purposes.
That is not a VA legal code,that is a billing code for
insurance purposes and forMedicaid and Medicare, things
(10:23):
like that.
So when the clinician types inother fatigue, and it's a code
R53.83, that is a symptom.
That is not a that is not asyndrome, that is a symptom.
They may put in other malaiseand fatigue because it pops up
quicker in their charting systemwhen they type in fatigue that
(10:46):
that may pop up first.
So like eh, they stick it inthere and they don't care.
It's billing code, it's forinsurance purposes, their
clinical documents supportstheir um their diagnosis of a
symptom, right?
That is not these two codes arenot the same as chronic fatigue
syndrome.
Chronic fatigue syndrome is aset of criteria that has to be
(11:11):
met.
And when they meet thatcriteria, they get the R,
actually, this is supposed to beG, it's supposed to be G93.32.
And we'll see that pop upcorrectly later in the in the
thing.
I must have fat-fingered thatone, but that's a G code.
And that is important.
So if you're a veteran seekingbenefits for chronic fatigue
syndrome, you're looking atgetting a medical opinion, you
(11:35):
need to make sure that thatG93.32 code is in your medical
record.
Okay, it needs to say chronicfatigue syndrome, and I will
show you why that's important.
This is the rating schedule forchronic fatigue syndrome.
This is something that the VAhas posted in their their
schedule, their rating schedule,and it defines exactly what
(11:57):
they expect from chronicfatigue.
Now, what's also important toknow about this definition is
it's a 1994 Center of DiseaseControl definition of chronic
fatigue.
So we are using this definitionthat is not up to date, where
medicine has changed over theyears.
This is not how we look atchronic fatigue today.
(12:18):
Okay.
Good news is I will tell youthat if you get a diagnosis of
chronic fatigue today, majorityof these uh facets or these
points are here.
So you shouldn't have to worryabout meeting the criteria for
the VA.
Okay.
Um, so the criteria, I'llbriefly read it just because I
think it's important to hear it.
(12:39):
For VA purposes, the diagnosisof chronic fatigue syndrome
requires one, a new onset ofdebilitating fatigue, severe
enough to reduce daily activityto less than 50% of the usual
level for at least six months.
And the exclusion by history,physical examination, and
laboratory test of all otherclinical conditions that may
(13:02):
produce similar symptoms.
And six or more of thefollowing acute onset of the
condition, low grade fever,non-exudative pharyngitis, so
that means that you have anirritated throat without like
pus or drainage, palpable ortender cervical or axillary
(13:23):
lymph nodes, that's lymph nodesin your neck and under your
armpit, generalized muscle achesor weakness, fatigue lasting 24
hours or longer after exercise,headaches, migratory joint
pains, neuropsychologicsymptoms, those are those
cognitive symptoms we weretalking about, the thought
process kind of kind of deal,and then sleep disturbances.
(13:46):
The reason why I think it's soimportant to hear that is if you
look at the bullet point two, alot of veterans miss the
exclusion by history, physicalexamination, and laboratory
tests of all other clinicalconditions that may produce
similar symptoms.
That is so important forchronic fatigue syndrome, both
(14:07):
legally and in the clinic.
In the clinic, if we are tryingto investigate someone's
complaint of fatigue, there is alaundry list of testing that
needs to be done.
That testing is not availableto a CNP examiner.
You are not going to get a Cand P examiner to order all the
(14:27):
tests that are necessary to giveyou a diagnosis of chronic
fatigue.
The other part is you may havehad these tests, but sometimes
they're done in 2016.
And then in 2018, you may haveone or two tests, and then 2021,
you have another test.
And so here we have a five-yeargap of all this testing, and
(14:50):
none of it is really capturingthis new onset, this new
symptom, this new complaint, orit's not capturing when you said
that you were developing this.
So if you're trying to say thatfor your claim that you started
to have fatigue symptoms in1996, and we have absolutely no
workup for it, we see we have adiagnosis, but we have no
(15:14):
workup, then you may have tostart from from scratch and
start over and capture all thosetests in order to support that
diagnosis and that claim.
Any questions there?
Beri (15:29):
If you have those tests run, I mean, how close together
would all because you know ifyou go to the doctor, they're
going to try to eliminate onething at a time.
So does all those tests need tobe within like a six-month
period?
Bethanie Spangenberg (15:42):
Well, it may take you six months to get
those tests.
Beri (15:46):
I was gonna say because if you start scheduling one,
that's that's a year's worth oftests, don't you?
Bethanie Spangenberg (15:51):
It really is.
Um, especially through the VAsystem because of how
frustrating their obstacles areto even get some of these tests.
Um yeah, it's typically morethan six months to even get
these tests done.
So and I actually have a bulletpoint on here to talk about
that later, about um how wepreach, you know, don't file a
(16:14):
claim unless you have adiagnosis.
Well, in this case, it may takeyou forever to get a diagnosis.
So you you kind of want to putthe the horse before the cart on
this one.
Beri (16:25):
Well, you know, and that's like Alex says a lot of times,
you know, you you if you, youknow, for example, I've got
CITER, you really would have togo do your own C and Ps and get
all that knocked out on yourown, really.
Yeah.
J Basser (16:46):
You know, if you want to claim it and uh you know you
have it, then uh let somebody uhlet a good examiner look over
the results and uh give anopinion as to their opinion, and
uh maybe call you up and do avideo opinion or whatever, like
uh IME, which is independentmedical examination, and uh you
know person to call to do it,send them a little bit of salad
(17:09):
and you're ready to go.
Bethanie Spangenberg (17:13):
That's exactly it.
So for this next slide, um, youknow, I want to talk about why,
you know, I've talked a lotabout why it's important, but I
kind of want to dig a little bitmore into it.
Um let's see, I'm looking at mynotes here.
We've already talked about theoh, this is where we talk about
(17:35):
the formal diagnosis.
Oh my gosh.
Okay, so 99% of the time, Itypically recommend that you
have a formal diagnosis beforeyou file your claim.
Only because of my experienceas a CMP examiner and what I
(17:59):
have experienced over the last15 years of watching veterans
get denied.
It is my role as a medicalexpert with my understanding to
preach to veterans and advocateswhat I think will be in the
best interest of the veteranmajority of the time.
Do I understand that there arecases where they don't need a
(18:22):
diagnosis?
Absolutely.
Are there cases where theyshould file the claim and then
chase the diagnosis?
Absolutely.
But from everything that I'veexperienced, my passion is
veterans do yourself a favor, goget the diagnosis.
Don't allow your money to sitwith somebody else who is going
(18:44):
to represent you when you can bedoing the work yourself.
And half the battle is gettingthat diagnosis.
So that is why I I preach that.
And that's why I've kind ofthat's been my soapbox.
And um, but I do understand andI appreciate that that's not
the case for for everything.
And this is one of them thatthat can be, you know, where
(19:05):
where it's kind of you know, putthe put the horse before the
cart kind of thing.
And whether it's the intent tofile, whether you file the
fatigue, and then you get theworkup.
But um the reason why, let melook at my notes here.
The DVQ that we complete, thethe hurdle that I see is that
(19:30):
the veterans are wanting me toclick that they have a chronic
fatigue syndrome diagnosis whenit is not documented in the
chart.
And I cannot do that.
They may have uh sleep apneawith hypersondolence documented
in the chart, they may have COPDdocumented in the chart, they
may have asthma, those are notdiagnoses for chronic fatigue
(19:53):
syndrome.
The other part is as themedical examiner specifically
related to chronic fatiguesyndrome or chronic fatigue
symptoms, either one, whateveryou're claiming, I cannot be
that legal person for you.
So if you tell me that you'refiling for chronic fatigue
(20:15):
symptoms related to your cancer,then my job is to document in
the DBQ your symptoms, yourtesting results, um, your
limitations in employment.
It is not my job to say, oh no,no, no, you should be filing
for chronic fatigue syndromeversus the chronic fatigue
(20:37):
symptoms.
And veterans get very lost inwhat they're filing and what
their goals are.
Let me give this other exampleso you can kind of follow the
difference.
A disability is anything thatcan impair functional employment
(21:01):
or functional gain orfunctional limitations, um,
there's a definition for that.
Look it up.
But fatigue can fall into thatcategory, just like pain.
That's where that case, like 10years ago, came out, and
they're like, oh, pain can be adisability now, pain can be a
disability now, I'm gonna filefor chronic pain.
That is similar in thisscenario when it comes to
(21:23):
fatigue.
So if we look at the claim orthe treatment for chronic
lymphocytic leukemia or evenCML, if your cancer is active
and you're undergoing treatment,then you're 100%, you're
supposed to be 100%.
Well, we've had cases wherebecause their cancer is now
(21:50):
controlled, but they're onactive chemotherapy, the VA is
proposing to reduce theirbenefits.
So another alternate route issay, okay, okay, you're gonna
say that this veteran no longerhas active cancer, active
treatment, but then you need torate him for his residuals.
(22:12):
And one of those residuals ishis fatigue, and his symptom of
fatigue puts him at 100%disability.
So either way, the VA wants tospin it, you still owe this
veteran and this man a hundredpercent disability.
So that is one tool that youcan use.
Is it always successful?
No.
(22:33):
But it's still an avenue forthe veteran to advocate for
their percentage and theirdisability if they're going to
try to say, well, your cancer iscontrolled with your treatment.
I've I've had a veteran, John,I've talked to you about this
veteran.
This veteran has had activecancer since 2016.
He's still an active treatment.
(22:53):
He takes medicine every day.
That medicine makes him sosick.
Part of that 100% disabilityrating is understood that active
cancer under active treatmentwith a anti-neoplastic
chemotherapy per rating scheduleis disabling to the 100% degree
(23:13):
level.
And that incorporates the sideeffects of the disease, the side
effects of the medication, thedisability that it that it
causes that individual.
That 100% is incorporated orencaptures all those limitations
that that cancer, that act ofcancer causes.
So for this particular veteran,we did the DBQ and we showed
(23:38):
the DBQ is causing disablingfatigue, and he's warranted
100%.
Now that is before the VA, andthe VA has to decide how are
they going to rate thisindividual.
So we have all the evidence onthe table that this individual
will get 100% for his CLL or hiscancer.
The VA won't give him both.
(24:00):
The VA won't give him bothfatigue and the 100% for CLL
because that would bepyramiding.
But in this scenario, he'sfiling for fatigue as a symptom
of his cancer without having achronic fatigue syndrome
diagnosis.
Are you following me on that?
Any questions about that?
J Basser (24:30):
I just think what they're doing is kind of
criminal themselves.
Um it's like I don'tunderstand, but they do
understand, and it's just it'sjust a waiting amount.
I think uh a lot of timesthey'll get a sick patient like
that that's really sick, andthey'll wait about until they
kick the bucket.
Bethanie Spangenberg (24:50):
Well, you know, I've tried to talk to this
veteran.
This veteran is very worriedabout his benefits because it's
not just him, but it's his wife,and he's worried about caring
for his wife.
And as much as I say, you know,like hold your horses, like I
don't know what my deal is withthe horse and the all these
horse preferences today, butokay.
(25:11):
Um I said just hold yourhorses, let's wait till this
date.
Once this date hits, then we'regonna start to get our ducks in
a row financially on your end,because you know, I don't know
what the VA is gonna do.
But you know what I think hedid, and he he won't admit it,
but I think he stopped hischemotherapy because this last
month he had abnormal labs andhit it shows that his cancer is
(25:35):
active, like the medicine's notsuppressing it.
So I think that in all of thischaos that the VA has has caused
him and all the stress that hascaused him, he's like, you know
what?
I'm just not taking it anymore.
And so just that quickly,within a matter of three to four
weeks, he stopped taking thatanti-neoplastic chemotherapy and
his his leukemia numbers areare back up.
(25:58):
So then again, there's evidencethat he has active cancer, but
I mean, it's ridiculous thatveterans have to sacrifice their
own health in order to get whatthey're legally entitled to and
what's in front of the VA.
J Basser (26:14):
They're conducted for mental health.
Bethanie Spangenberg (26:16):
No, he's not, but I'm I'm really that
should be a secondary.
Yeah.
J Basser (26:24):
Because it tells me that he's affected by that and
he could take him to his chemobecause the VA keeps denying him
or whatever it is, then thatneeds to be added addressed too.
Bethanie Spangenberg (26:33):
Well, they came out and they did a couple
wellness checks on him becausehe's uh threatened, you know,
self-harm.
Um which I'm not in hisposition, but from what you know
what I've seen him like throughthe medical record part of it,
you know, since 2016, he's beenthrough a lot.
I mean he's lucky to even behere.
J Basser (26:53):
So help we can get, but I mean it's gonna help
veterans get better, guys, andthey've got cancer or some kind
of disease that can be cured.
You know, the best thing to dois make sure that you know that
if service connected issue,which it should be, they need to
go ahead and do it.
(27:14):
Instead of waiting around andplaying games.
It's all a big game to them.
I'm sad that's true, you know,it's a game.
And the BDA is the reason thatthat's the end point of the
game, is going to the Board ofVegetable Pills.
Because they're playing games.
Bethanie Spangenberg (27:37):
So I guess the takeaway for this here is
to understand, you know, my roleas a medical examiner is not to
say you have chronic fatigue orto say that you have a
qualifying condition for aclaim.
(27:58):
It's my role to document yoursymptoms, your treatment, what
the testing shows.
And so when you come to me fora DBQ and you kind of don't know
what you're doing, you you maywant to talk to a representative
before you dive in and go thewrong direction because I I
really can't help you on that.
(28:18):
Um when I do sit down to do thechronic fatigue DBQ, the first
thing that I look for is I lookfor that G code.
Let's see if it's gonna let meclick this.
So I look for that G code, it'sG93.32.
Earlier I had it as an R, butit is a G93.32.
(28:41):
And I look for it because thattells me, yes, they have the
diagnosis, and this is what myfocus is going to be for this
DBQ when I write this historyand the testing results.
I want to emphasize that in thephysical DBQ, it also has
(29:01):
listed at the top of page twothe criteria that needs to be
met.
So the veteran, again, needs tounderstand this is the criteria
that they need to meet for theVA's 1994 definition of chronic
fatigue syndrome.
So, what does it mean whenchronic fatigue syndrome is an
(29:27):
unexplained cause after rollingout other causes?
Or unlike we really can't findout the cause of why they're
having these chronic fatigueissues.
What we call that in themedical world is we call it a
diagnosis of exclusion.
Okay, so basically, we aregoing to make the diagnosis of
chronic fatigue syndrome afterwe've investigated everything
(29:50):
else.
So it's by process ofelimination that you don't have
all these other conditions, andso it must be chronic fatigue.
Syndrome.
When we work up chronic fatiguesyndrome, it is a lot of labs.
We are going to look for yourblood count, your kidney
(30:12):
function, your liver function,your thyroid function, your
blood sugar, your blood sugarover 90 days.
We're going to look at youriron level, your vitamin B, your
vitamin D.
We're going to look atinflammatory markers.
We're going to look atautoimmune markers.
We're going to look at allthese different viral panels.
There is a ton of lab work thatis tied to this.
Luckily, most of those labs canbe captured in one setting.
(30:37):
You don't have to make severaltrips for it, but there's going
to be a lot there.
There's a lot of work, workupthat comes with that complaint
of fatigue.
Sleep evaluation.
Especially now, sleep apnea,that's going to be at the top of
our list.
You're telling me you havechronic fatigue.
I'm going to go ahead and orderyou a sleep study.
If you meet, you know, even ifthey don't meet risk risk
factors, if they're telling methey have fatigue, they should
(30:59):
really have a sleep studyanyway.
Because you can have centralsleep issues where your brain's
not telling your body to sleepwell, or it's malfunctioning
centrally in the brain to nothit those sleep cycles.
In addition to the obstructivesleep apnea, you're going to
have an EKG, maybe an ultrasoundof your heart, a chest x-ray.
(31:22):
We're going to look at yourheart and lungs and make sure
they're functioningappropriately and they're not
causing some form of fatigue.
Sometimes, if there'sindications there, we may refer
you for a mental healthevaluation.
A lot of times, especially withdepression or, you know, some
of the downer type mental healthissues, they can cause fatigue,
(31:45):
or you can actually have theflip.
You can even have ADHD whereyou're spinning all the time and
you end up crashing and havingfatigue as well.
So that's part of some cases,it's it's mental health is part
of that workup of chronicfatigue.
Any questions about that?
I think Barry, that was one ofthe questions that you kind of
were leaning into.
Beri (32:06):
Well, and you know, it's interesting, all those symptoms
that you listed.
I was thinking about if you'veever been on a long deployment,
you know, for after two or threemonths of most fleet, you have
all those symptoms, but they goaway eventually with the rest.
So it was just it's veryinteresting reading that list
(32:27):
and thinking that's how you feelif you're really exhausted over
a few months period of time.
Bethanie Spangenberg (32:33):
Yeah.
I think that's why they setthat limitation on there for the
six months, is because umbecause of things like that,
especially with the military.
The the other component, otherthing that they're finding, is
there it's kind of like were youwere you do you understand the
(32:53):
timeline of like hepatitis B andwhen that came around?
Beri (32:57):
Yes, yes.
Bethanie Spangenberg (32:59):
So we really didn't know what it was
when it first came about, right?
And so they called it um, wasit non-hepatitis something or
other or something, I can'tremember what they called it, to
be honest.
Beri (33:13):
They had another name for it, yeah.
Bethanie Spangenberg (33:15):
Um, yeah, they had another name for it,
but that was in the nine uh theeighties or nineties.
Now I'm missing my timeline,but you know, we didn't know
what it was, so we called itsomething.
Okay, we gave it a name and weheld on to that name for a while
until we really couldn't do thescience behind it.
They're finding that a lot ofour military members, and that's
why they've the tag theSoutheast Um Asia, the Gulf War
(33:39):
veterans, they're findingbecause there's different bugs
and bacteria and viruses inthose countries, that they are
catching them, and there it's itends up causing a lot of these
unknown symptoms.
So maybe in 10, 20, 30 yearsfrom now, we're gonna say, oh,
well, that's that that diseasenow.
(33:59):
We didn't know what it was 30years ago, but now we know what
it is.
And so I see this Gulf Warsyndrome following the same
pattern of the the hepatitispattern.
J Basser (34:10):
Um I think any questions about that, guys.
Probably better.
I mean, we can ask Alex.
He read it firsthand, and um sowe've got a cure for that now,
supposedly.
Which is good and uh he's gotthere's more than just hepatitis
(34:34):
involved with that.
You're looking at uh porfuriaand all kind of crazy stuff,
yeah.
So uh I mean I've had him onthe in the past for shows and we
discussed every issue, and it'sknown to the son, and he's had
it.
Bethanie Spangenberg (34:49):
So and now that you mention that, it's
hepatitis C, and they used tocall it non-A, non-B hepatitis.
Yep.
And so, and and we didn't know,you know, that it was even like
a bloodborne pathogen.
So these air gun injectors thatwe were given to our veterans,
that's how some of them gothepatitis C.
(35:11):
And you know, there is a therewas a study out of California in
the 90s that actually likethrew those air gun injectors in
the trash because they tied anoutbreak of hepatitis C to those
air gun injectors in Californiain the early 90s, and so that
(35:31):
is a lot of the research that weuse when we talk about
hepatitis C.
J Basser (35:35):
So 20 years ago, back when I was doing the moderation
for uh the Hadit site, we had aguy named Alan, and uh he was a
bowl tech in the Navy and a realnice guy, and he contracted
different stuff and he blamedeverything on those jet guns.
And he filed and filed andfiled and did this and that, and
(35:56):
they denied him every time hewent in.
Because the you know, the jetguns didn't cause that, you
know, but we knew it did, but Imean there's nothing we could do
about it, and I don't know whathappened if he got it to the
board or what, but uh I don'tknow if he was still with us or
not, he disappeared off theside.
We're sad.
Bethanie Spangenberg (36:18):
Another thing since I we're talking a
little bit about Gulf War, uhthis is this is totally off
topic, but it's just triggersand something actually comes up
quite a bit in my memory.
But several years ago, I had uma patient come in and I was
doing a work assessment on him,and he had a history of some
(36:39):
type of foot issue that thatmangled his foot, and you could
see all the the tendons in hisfoot.
He had very little fat, lots ofscarring on his foot.
And part of like the workevaluation is I need to
understand, you know, what hecan physically do.
And so in obtaining his historyfor that foot injury, it was
(37:01):
the craziest thing, and I itstuck with me obviously this
long.
But what happened when he wasyounger?
His brother was deployedoverseas somewhere in the
desert.
And when he came home, he wassupposed to like get rid of his
boots, decommission his boots,get rid of everything.
(37:21):
But instead, he gave them tohis his brother, this patient in
front of me.
So this patient in front of mehad these military boots on, and
while he had his military bootson, he was working in them and
he stepped on a nail, and thatnail went through the shoe,
through the bottom of the shoe,and to his foot and punctured
his foot.
(37:42):
And he ended up almost losinghis foot because infection
control, they had all thesespecialists, could not figure
out the type of bacteria thatwas in his foot.
And here it was because thoseboots that he wore that his
(38:03):
brother had overseas carried amuch like a foreign bacteria to
us in the states.
And so they had to do a lot ofwork to figure out what
antibiotics to use, how to treatthis bug because of the
different bugs.
And I say that because thattells me that that's probably
(38:24):
where this Gulf War syndrome isgoing.
Knowing the history of thenon-N, non-B hepatitis, seeing
this these foreign bugs comingover and affecting our but uh
just our population here, andeven the veterans here, we don't
know what they're carrying.
Why are so many uh of theseGulf War veterans, why are so
(38:46):
many of them having sleep apneawhen they don't have all the
risk factors?
Why are they having all thesedifferent symptoms, these
chronic fatigue syndromes, theseundiagnosed illnesses?
What is it?
We haven't figured it out, andwe I think we will, but that's
one of those things that youknow I'm foretelling the future.
But anyways, that's a lot.
(39:08):
I'm gonna get back to thepresentation.
Okay.
Um I've already talked aboutall that, so let's go on to the
next one.
By the way, this guy is anangry VA compensation a pension
worker, just so you know.
He's he's not part of our teamat Ballot for Bet.
(39:30):
He's just the angry guy at theVA.
Um, so now I just want to goover the DBQ.
This is what we've all beenwaiting for.
Um, five pages.
Uh this can actually be doneover the phone as long as you
have the proper paperwork, theproper testing.
All those tests that you getfor the workup of your chronic
fatigue syndrome, I want them.
I want them when I'm completingthis DBQ.
(39:52):
This DBQ takes me about 45minutes to an hour because a lot
of it is reviewing the medicalrecord.
I have to literally copy andpaste what is in your record,
was it what is important tosupport that diagnosis of
chronic fatigue and dates andtypes of images and things like
(40:12):
that, types of lab work.
Um, I have to carry that or putthat all into this chronic
fatigue syndrome DBQ.
Um, the DBQ itself, like Isaid, it's five pages, very
simple.
It specifically asks for thecriteria of meeting the chronic
(40:36):
fatigue diagnosis.
So um, question two C haveother clinical conditions that
may produce similar symptomsbeen excluded by history,
physical examination, andorlaboratory test to the extent
possible?
If a veteran does not provideme their workup, I have to say
no.
And so they they may rejectthis DBQ and say, well, they
(41:01):
don't meet the criteria forchronic fatigue syndrome.
But if the veteran is lookingat chronic fatigue as a symptom,
then that would be fine.
It asks about the onset was thechronic fatigue sudden or did
it happen gradually?
Is it debilitating?
Um, they define theincapacitation as um a
(41:27):
requirement of bed rest for fromthe physician, from the
treating physician.
They ask specifically about thesymptoms, if they're constant
or if they come and go, and howthey restrict routine daily
activity.
For example, if the symptomsdue to chronic fatigue syndrome
are nearly constant, do theyrestrict routine daily
(41:51):
activities as compared to thepre-illness level?
And then it goes through, andyou're supposed to say it
restricts routine dailyactivities almost completely
when compared to pre-illnesslevel.
And in fact, that it precludesself-care.
They're not able to do theirADLs or care for themselves.
Um daily activities to lessthan 50% of the pre-illness
(42:18):
level.
Symptoms restrict dailyactivities from 50 to 75 percent
of the pre-illness level.
Symptoms restrict routine dailyactivities by less than 25% of
pre-illness level.
Those are confusing.
I read them out to you just sothat you can understand the
criteria.
That is the rating criteriathat they're asking in those
(42:38):
little check boxes.
Okay.
The most important part, goahead.
The most important part I feelthat is in this DBQ, aside from
having your testing to supportthe diagnosis, um, is the
(42:59):
functional impact.
When I do these DBQs, I want tohear an example, a real-world
example in your life, how thischronic fatigue has impacted
you, your work, your sociallife, all of it, so that I can
emphasize that to the VA.
I will, you know, put it backinto the DVQ and emphasize just
(43:23):
how, from an occupational healthstandpoint, how these chronic
fatigue symptoms or syndromescan affect this individual's
functional employment orfunctional gain.
So there's not really anythingfancy or confusing to talk about
there on the DBQ.
Any questions about the DBQitself?
J Basser (43:49):
Is that mainly a Gulf War thing?
Bethanie Spangenberg (43:53):
Right now, yes.
Um, I see a lot of veteranstrying to do fatigue secondary
to like sleep apnea, and they'renot gonna they're not gonna get
fatigue symptoms, secondarysleep apnea.
Now, if they go on to developthe criteria for chronic fatigue
(44:15):
syndrome, then they may bebecause of the separate
diagnosis, they may be able toget it.
Um, but again, for like sleepapnea, that fatigue is
incorporated in the ratingcriteria already.
So I see a lot of errors in howveterans are pursuing the
chronic fatigue or chronicfatigue syndrome, and so that's
(44:39):
why I want to.
J Basser (44:40):
You hear that people.
Sleep apnea.
If you have daytime tiredness,it's called an insolvent or
whatever it is, and it's part ofthe sentiment of sleep apnea or
hyper what do you call it?
Bethanie Spang (44:52):
Hypersonnolence.
J Basser (44:54):
Yeah, well, if I have a teeth, I could say that word.
It's always best to get thebest information you can and uh
have it explained, you know, interms of people can understand
it, and uh that's good.
I'm glad you did this.
That's good.
Bethanie Spangenberg (45:14):
So I've only got a few more slides here.
I just want to uh listspecifically the rating
criteria.
I'm not gonna read it off.
I'm just gonna make make anemphasis about the rating
criteria because it's in theslides.
If somebody's watching YouTube,they can hit pause and they can
read through it.
Um here for 40, 20, and 10%rating.
(45:44):
Okay.
And there's a few otherimportant things.
Uh, we already talked aboutpyramiding.
You have to watch forpyramiding.
You could be spinning yourwheels and they come back and
say, No, you're pyramiding.
So if you're thinking aboutfiling for for chronic fatigue,
secondary to something, you needto sit down with the VSO,
unaccredited agent, uh, talk tosomebody that has that can kind
(46:07):
of explain the pyramiding to youand how it applies to your
disability.
Um I've already given theexample of the cancer where uh
despite the fact that theindividual is active treatment,
active cancer, they're trying togive him a zero percent because
it's it's normal, his labs arenormal.
(46:29):
Um, you know, that's that's onefancy creative way that we're
trying to push to keep that100%.
It's like fine, if you're gonnabe a jerk, then you know, rate
him on his residuals.
What's his residuals?
J Basser (46:43):
Exactly.
Does the regulation state thatI'm sorry, that if the cancer
numbers are showing different,but the cancer is still active,
does it put the difference ordoes it just say uh still active
process?
Bethanie Spangenberg (47:02):
So there's a a we call it a race aging,
and so they're like, oh, but ifthe race zero, then it's normal.
Ray zero has to do with theprogression of the disease, not
necessarily the treatment orwhether it's active.
So to try to erase the factthat the cancer is active and
that he's on activeantineoplastic chemotherapy for
(47:25):
the treatment of the conditionis is an ignorant way of trying
to say he's fine.
Um, the last thing I want toemphasize that are important is
just that Gulf War presumptive.
And I just want to lay this outthere on the criteria that are
needed for the Gulf Warpresumptive.
(47:47):
So chronic fatigue syndrome islisted as a presumptive service
connection if the followingconditions are met.
Their service occurred inSouthwest Asia Theater of
Operations.
Their symptoms began duringservice or became compensable by
greater than or equal to 10%within the next year.
(48:10):
And we're looking at 2026.
So if sometime in the next yearyou start to develop these
chronic fatigue syndromesymptoms to a 10% degree, you're
still eligible as a Gulf Warpresumptive.
And I oh it's signs andsymptoms cannot be attributed to
any known clinical diagnosisthrough history eczema lab,
which that's the criteria thatis chronic fatigue anyway.
(48:30):
But here is that 10% thatyou're trying to meet as a Gulf
War presumptive.
J Basser (48:38):
That's very similar to hypertension, 10% presumptive
test.
It's gotta be compensable,right?
Bethanie Spangenberg (48:50):
And that's all I've got for for the deep
chronic fatigue syndrome, do youthink you're good.
J Basser (49:03):
Pretty good, didn't have to rush, took the time.
Last time we had to get throughit in a hurry.
Bethanie Spangenberg (49:09):
Well, it was the back one was like 11
pages.
J Basser (49:13):
It was huge.
Bethanie Spangenberg (49:14):
Yeah.
J Basser (49:16):
It was huge, it was big.
I don't know.
I don't want what do we haveleft to do on these DVQs?
I mean, uh, we covered theback, the neck, the nerves, the
spine.
Bethanie Spangenberg (49:28):
Believe it or not, we've been doing this
for like two years, and we'restill not done.
There's like 76 DVQs.
I'm just trying to hit the topones.
We'll get to the the smallerones eventually.
Beri (49:42):
Yeah, that uh pretty interesting.
You were talking about I'veknown a two cases of people came
back from uh OIF.
I think they were both OIF.
And uh they had a family memberthat got ill or got a skin
condition from maybe washingtheir uniforms or being exposed.
(50:05):
And like you were talking aboutthat boot, I mean, because
there's some bad stuff.
You you're in a country thatstill has the plague, and uh you
don't really know what, youknow, but I've and it it's
strange that and you you can'tget it clean over there before
you come home for the job, andit's not clung.
J Basser (50:23):
Have you guys ever come across you ever come across
any Korean war vets?
A good friend of mine wasstationed over in the DMZ.
He was in a guard, but he gotactivated and went over, and uh
he's a command sergeant major.
And he got lucky because he hadhis own people to do his
laundry and stuff, you know, andthey did it, did it right.
(50:46):
But the actual active troops,they would spray those uniforms
down with some kind ofinsecticide with deep in it
because of all the mosquitoesand bugs over there.
And majority of them got reallysick in bad shape because of
the chemicals they used sprayingthe uniforms.
Beri (51:05):
That bug juice.
J Basser (51:06):
You ever heard of it?
Beri (51:08):
Go ahead.
I don't know, but I had some ofthat that ate the case in off
my watch one time, so I quitusing that old stuff.
If it'll eat the case in yourwatch, what's it doing to you?
Yeah, no, I had a G Shop placein it, so I threw that away.
The time X G Shark or theCasio?
It was the Casio G shark GShop, and it ate the case up,
(51:31):
you know.
J Basser (51:32):
Whoa.
That's pretty sad.
That's just lead acid.
So if it kills bugs andmosquitoes, is it gonna kill
you?
You get enough of it to killyou too, because you're or
you're you're an organism ororganic material just like they
are.
No, but yeah.
But Korean bests are few andfar between.
(51:55):
You know, and uh that'll bewell.
Beri (51:59):
Yeah, I think we're down like 43% Vietnam best left.
J Basser (52:04):
So if he'd have chosen to, you could actually cover
two.
You know, if you've got twosmall ones, we could probably
split it up and do one firstpart of the show and another
second part of the show.
unknown (52:14):
Okay.
Bethanie Spangenberg (52:15):
I'll take a look.
I thought I had uh wrote onedown that I wanted to do next.
I don't know.
I I try to I was gonna try todo it in order, but now I'm just
doing it into what annoys me.
So not necessarily what annoysme, but what's like, hey, you
know what?
They there needs to be moreclarification on this one.
(52:35):
So um so that's that's whatI've been the game I've been
playing lately.
Okay.
J Basser (52:43):
Well, I do appreciate everybody coming on.
Barry, thank you again.
I'm glad you made it back fromOhio and in good spirits and in
one piece.
Beri (52:53):
Well, I am too.
I it was uh you know, that'sthe first real work I've done in
a while now.
My wife's had me in there twoweekends.
So I'm back to it.
She's gonna start slappinghoneydews on the fridge again.
Bethanie Spangenberg (53:08):
Yeah.
Beri (53:09):
You know, the thing is, you know, I work, you know, I
work for and I get usually getfired about once a month, but
then I have to show back up atwork the next day.
I don't get it.
J Basser (53:21):
You say you're the CEO, you can't fire yourself,
and you don't have a board ofdirector.
You got one board of director,and that's the wire.
Beri (53:30):
That's it.
J Basser (53:31):
Yeah.
Oh you're the same situation,but you can't fire yourself
either.
My wife is fireing me in amoment.
Beri (53:40):
She's great though.
You know, I keep complaining.
Got a really great fringebenefits packaging up.
J Basser (53:49):
We're gonna shut her down.
I've uh has made the dentalwork done and I've been pretty
serious pain all day, but uhfigure I took this one out.
So uh with that, busy, thanksfor coming on.
Ray, thanks for I mean, Ray.
I'm sorry, Barry.
Uh had rail on my mind.
Thanks for coming on, weappreciate it.
We'll we'll do this again nextweek, guys.
(54:09):
We're gonna have a new gueston.
She's a uh credit appeal.
No, she's an attorney out ofWashington, D.C.
I'm sorry.
Um I'll advertise the show upthis weekend and get out there,
and uh she's really good at whatshe does.
She's got her own office andshe does ethnic things out there
in Virginia.
So uh this will be John onbehalf of Bethany and Barry,
(54:32):
we'll be shutting her down fornow.
Welcome folks to another distance of Colette
Productions weekly broadcast.
My name is John.
They call me Jay Bassers.
Today is September the 4th,2025.
Can you believe it's Septemberalready?
Today's co-host is the one andonly Mr.
Barry Freddy, down there in theclose to Alabama, but he's
still in Tennessee.
(00:28):
How are you doing, Barry?
I'm good.
How are you, John?
That's good.
And today, in the uh firstThursday of the month, we've got
Bethy Spangenberg on.
She is going to discuss uh theissue of chronic fatigue
syndrome.
And she's got a whole setup forus, so she's going to discuss
(00:51):
the DBQ and the legal factorsinvolved.
Bethy, how are you doing?
Bethanie Spangenberg (00:55):
I'm doing great.
I've been busy and had a littlebit of technology troubles
because it's not my thing, buthere we are.
I'm ready to go.
J Basser (01:05):
Okay.
Well, I'll turn this over toyou.
You go ahead and get startedand get us get us in the right
direction, anyway.
Bethanie Spangenberg (01:12):
So as John, you know, and Barry, you
know, I am Valid for Vet.
I am a former compensation andpension examiner.
I'm a physician assistant.
Medicine is my thing.
I love it.
Um, I fell into VA disabilitybecause my first job was at the
VA.
And when my husband wasdeployed, I didn't mind working
(01:34):
like 60 hours a week in primarycare.
But when he came home, I didn'twant that life anymore.
So I transitioned to thespecialty clinic where I was the
only full-time compensation andpension examiner.
And I learned a lot.
I, from the very beginning,when things came off the printer
or the request came from theregional office, I was the
(01:56):
person that picked them up offthe printer, read them, decided
where they went, like whatprovider they went to.
And so I was very heavilyinvolved in that process and I
learned a lot.
And then Secretary Shinsekidecided he was going to close
all these two year old two-yearor older claims out.
And my husband fell into that.
So here he got out in 2011.
(02:18):
He had his disabilitycompensation exam within a month
of his discharge, and two yearslater, he got denied for
everything that he applied for.
So at that point, my passiontransitioned into advocating for
the veteran rather than being agreat and great government
employee.
Because when I'm an employee, Itry to be the best employee
(02:41):
there is.
And I really found that myvalue was elsewhere and not
within the government system.
So I say that to say that I'vebeen in this a while now, since
formally since 2015, as Valorfor Vet or as the company, but
we do a lot of disabilityclaims.
(03:02):
And chronic fatigue is one ofthose.
We offer DBQs where the veterancan register and complete a
DBQ.
And what I am finding recentlyis a lot of confusion around
chronic fatigue syndrome.
We offer the DBQ for veteranswho are seeking service
connection for it.
(03:24):
And I find that between mecompleting the questionnaire and
what the what information theveteran provides, there's a big
disconnect.
And I feel like this has a lotof value for a lot of veterans,
especially those that fallunderneath the presumptive for
(03:46):
chronic fatigue syndrome.
Any questions before I dive in?
Any comments before I dive in?
Believe it or not, this DVQ isonly five pages, but there's a
lot of information that goeswith it.
(04:07):
So I want to first start withthe medical understanding of
chronic fatigue.
When we look at fatigue,fatigue can fall into a symptom
or a syndrome.
Okay, and those are two verydistinct definitions or words
(04:31):
when it comes to chronicfatigue.
So when I as a clinician thinkof chronic fatigue as a symptom,
okay, that is a report that thepatient is giving me.
Okay, so they come into myclinic and they're saying, you
know, I've been really fatigued,I've been really tired lately.
And so that is something that Idocument in their history.
(04:52):
It's not something I'm gonnasay, oh, you have fatigue,
chronic fatigue syndrome.
It's not, it's not that way,it's a symptom.
Um, similarly, we have othersubjective symptoms such as
pain, shortness of breath,nausea, or dizziness.
And I provide those examples upthere so that you can see, you
(05:13):
know, what the symptom is.
Like what, you know, I tell youthat fatigue is a symptom, and
so is pain.
Pain is a symptom.
These are things that Idocument, these are things that
the patient is telling me.
I put it into their chartingsystem, and these are little
things that I put together informulating a diagnosis to
understand what is going on withmy patient.
(05:33):
When it comes to syndrome,okay, this is different than
symptom, but we are looking at acollection of symptoms or
clinical signs, things that Ifind on exam, maybe some lab
testing, but more data thatconsistently occurs together and
(05:55):
characterize a condition.
So this is where your chronicfatigue syndrome falls into.
Okay.
And if we look at it side byside, okay, look at symptom of
fatigue versus chronic fatiguesyndrome.
The duration of a symptom canbe variable or short, short
(06:17):
term.
When those symptoms cometogether to make a syndrome,
they typically persist for sixmonths or more.
Okay.
The cause, a symptom of fatiguecan be caused by a lot of
diseases, sleep apnea, diabetes,heart failure, coronary artery
(06:39):
disease.
Those diseases can create asymptom of fatigue.
In the rating schedule, we seefatigue captured in Met's
testing for coronary arterydisease.
So when the examiner is askingif the veteran gets short of
(07:00):
breath or has chest pain withmowing the lawn, push mowing the
lawn, sitting watching TV, allthose scenarios are put together
or all those symptoms are puttogether to capture the fatigue
for the rating schedule.
Okay, so that's a symptom.
Now, when we look at the causeof fatigue, it is unexplained
(07:23):
after we've ruled out everyother possible disease.
The symptom of fatigue oftenimproves with sleep.
Maybe that individual's notgetting enough sleep, they get
you know a few good nights ofrest and quality nights, and
that fatigue may get better.
For chronic fatigue syndrome,it does not approve in Peruve,
(07:47):
no matter how much sleep theyget.
Post-exertional weakness.
So if they go and they decidethat they're going to load the
dishwasher or try to dosomething productive because
they're wanting to be active.
For this symptom of fatigue,they have some of it.
They do experience some of thatpost-exertional tiredness or
(08:09):
fatigue.
For chronic fatigue syndrome,it is persistent, it is a
hallmark sign.
Fatigue.
Fatigue can mess with your youryour thought process.
If you've ever gone a longnight where you haven't got much
rest, you can experience, youknow, where your words jumble,
(08:32):
or you say something you didn'tmean to say, or you stutter, or
you may have troubles, you know,getting your thoughts out
there.
And it's temporary.
For chronic fatigue syndrome,it's usually a persistent
impaired thought process.
When it comes to function withfatigue symptom, you uh have
(08:56):
slow activity, but it'smanageable.
So you know, like, oh myfatigue is worse in the
afternoon, so I do X, Y, and Zin order to get what I need
done.
For chronic fatigue syndrome,there's a significant reduction
in your daily activity.
So it doesn't matter what timeof the day that you're trying to
get the dishes done, it's it'sgoing to be bothersome or
(09:17):
troublesome any time of the day.
Again, sleep, we kind of talkedabout this already, improves
the sleep, does not, um, orchronic fatigue syndrome, you
often have non-restorativesleep.
This is important when it comesto the, and this is this is why
(09:37):
I wanted to do thispresentation.
We preach in this show a lotabout having a diagnosis, okay.
But you can't just have anydiagnosis, you have to have the
diagnosis for chronic fatiguesyndrome.
So if you look here at thebottom, for the symptom of
(10:01):
fatigue, the medical clinician,the medical examiner, may put in
a medical ICD code.
Okay, that is for insurancebilling purposes.
That is not a VA legal code,that is a billing code for
insurance purposes and forMedicaid and Medicare, things
(10:23):
like that.
So when the clinician types inother fatigue, and it's a code
R53.83, that is a symptom.
That is not a that is not asyndrome, that is a symptom.
They may put in other malaiseand fatigue because it pops up
quicker in their charting systemwhen they type in fatigue that
(10:46):
that may pop up first.
So like eh, they stick it inthere and they don't care.
It's billing code, it's forinsurance purposes, their
clinical documents supportstheir um their diagnosis of a
symptom, right?
That is not these two codes arenot the same as chronic fatigue
syndrome.
Chronic fatigue syndrome is aset of criteria that has to be
(11:11):
met.
And when they meet thatcriteria, they get the R,
actually, this is supposed to beG, it's supposed to be G93.32.
And we'll see that pop upcorrectly later in the in the
thing.
I must have fat-fingered thatone, but that's a G code.
And that is important.
So if you're a veteran seekingbenefits for chronic fatigue
syndrome, you're looking atgetting a medical opinion, you
(11:35):
need to make sure that thatG93.32 code is in your medical
record.
Okay, it needs to say chronicfatigue syndrome, and I will
show you why that's important.
This is the rating schedule forchronic fatigue syndrome.
This is something that the VAhas posted in their their
schedule, their rating schedule,and it defines exactly what
(11:57):
they expect from chronicfatigue.
Now, what's also important toknow about this definition is
it's a 1994 Center of DiseaseControl definition of chronic
fatigue.
So we are using this definitionthat is not up to date, where
medicine has changed over theyears.
This is not how we look atchronic fatigue today.
(12:18):
Okay.
Good news is I will tell youthat if you get a diagnosis of
chronic fatigue today, majorityof these uh facets or these
points are here.
So you shouldn't have to worryabout meeting the criteria for
the VA.
Okay.
Um, so the criteria, I'llbriefly read it just because I
think it's important to hear it.
(12:39):
For VA purposes, the diagnosisof chronic fatigue syndrome
requires one, a new onset ofdebilitating fatigue, severe
enough to reduce daily activityto less than 50% of the usual
level for at least six months.
And the exclusion by history,physical examination, and
laboratory test of all otherclinical conditions that may
(13:02):
produce similar symptoms.
And six or more of thefollowing acute onset of the
condition, low grade fever,non-exudative pharyngitis, so
that means that you have anirritated throat without like
pus or drainage, palpable ortender cervical or axillary
(13:23):
lymph nodes, that's lymph nodesin your neck and under your
armpit, generalized muscle achesor weakness, fatigue lasting 24
hours or longer after exercise,headaches, migratory joint
pains, neuropsychologicsymptoms, those are those
cognitive symptoms we weretalking about, the thought
process kind of kind of deal,and then sleep disturbances.
(13:46):
The reason why I think it's soimportant to hear that is if you
look at the bullet point two, alot of veterans miss the
exclusion by history, physicalexamination, and laboratory
tests of all other clinicalconditions that may produce
similar symptoms.
That is so important forchronic fatigue syndrome, both
(14:07):
legally and in the clinic.
In the clinic, if we are tryingto investigate someone's
complaint of fatigue, there is alaundry list of testing that
needs to be done.
That testing is not availableto a CNP examiner.
You are not going to get a Cand P examiner to order all the
(14:27):
tests that are necessary to giveyou a diagnosis of chronic
fatigue.
The other part is you may havehad these tests, but sometimes
they're done in 2016.
And then in 2018, you may haveone or two tests, and then 2021,
you have another test.
And so here we have a five-yeargap of all this testing, and
(14:50):
none of it is really capturingthis new onset, this new
symptom, this new complaint, orit's not capturing when you said
that you were developing this.
So if you're trying to say thatfor your claim that you started
to have fatigue symptoms in1996, and we have absolutely no
workup for it, we see we have adiagnosis, but we have no
(15:14):
workup, then you may have tostart from from scratch and
start over and capture all thosetests in order to support that
diagnosis and that claim.
Any questions there?
Beri (15:29):
If you have those tests run, I mean, how close together
would all because you know ifyou go to the doctor, they're
going to try to eliminate onething at a time.
So does all those tests need tobe within like a six-month
period?
Bethanie Spangenberg (15:42):
Well, it may take you six months to get
those tests.
Beri (15:46):
I was gonna say because if you start scheduling one,
that's that's a year's worth oftests, don't you?
Bethanie Spangenberg (15:51):
It really is.
Um, especially through the VAsystem because of how
frustrating their obstacles areto even get some of these tests.
Um yeah, it's typically morethan six months to even get
these tests done.
So and I actually have a bulletpoint on here to talk about
that later, about um how wepreach, you know, don't file a
(16:14):
claim unless you have adiagnosis.
Well, in this case, it may takeyou forever to get a diagnosis.
So you you kind of want to putthe the horse before the cart on
this one.
Beri (16:25):
Well, you know, and that's like Alex says a lot of times,
you know, you you if you, youknow, for example, I've got
CITER, you really would have togo do your own C and Ps and get
all that knocked out on yourown, really.
Yeah.
J Basser (16:46):
You know, if you want to claim it and uh you know you
have it, then uh let somebody uhlet a good examiner look over
the results and uh give anopinion as to their opinion, and
uh maybe call you up and do avideo opinion or whatever, like
uh IME, which is independentmedical examination, and uh you
know person to call to do it,send them a little bit of salad
(17:09):
and you're ready to go.
Bethanie Spangenberg (17:13):
That's exactly it.
So for this next slide, um, youknow, I want to talk about why,
you know, I've talked a lotabout why it's important, but I
kind of want to dig a little bitmore into it.
Um let's see, I'm looking at mynotes here.
We've already talked about theoh, this is where we talk about
(17:35):
the formal diagnosis.
Oh my gosh.
Okay, so 99% of the time, Itypically recommend that you
have a formal diagnosis beforeyou file your claim.
Only because of my experienceas a CMP examiner and what I
(17:59):
have experienced over the last15 years of watching veterans
get denied.
It is my role as a medicalexpert with my understanding to
preach to veterans and advocateswhat I think will be in the
best interest of the veteranmajority of the time.
Do I understand that there arecases where they don't need a
(18:22):
diagnosis?
Absolutely.
Are there cases where theyshould file the claim and then
chase the diagnosis?
Absolutely.
But from everything that I'veexperienced, my passion is
veterans do yourself a favor, goget the diagnosis.
Don't allow your money to sitwith somebody else who is going
(18:44):
to represent you when you can bedoing the work yourself.
And half the battle is gettingthat diagnosis.
So that is why I I preach that.
And that's why I've kind ofthat's been my soapbox.
And um, but I do understand andI appreciate that that's not
the case for for everything.
And this is one of them thatthat can be, you know, where
(19:05):
where it's kind of you know, putthe put the horse before the
cart kind of thing.
And whether it's the intent tofile, whether you file the
fatigue, and then you get theworkup.
But um the reason why, let melook at my notes here.
The DVQ that we complete, thethe hurdle that I see is that
(19:30):
the veterans are wanting me toclick that they have a chronic
fatigue syndrome diagnosis whenit is not documented in the
chart.
And I cannot do that.
They may have uh sleep apneawith hypersondolence documented
in the chart, they may have COPDdocumented in the chart, they
may have asthma, those are notdiagnoses for chronic fatigue
(19:53):
syndrome.
The other part is as themedical examiner specifically
related to chronic fatiguesyndrome or chronic fatigue
symptoms, either one, whateveryou're claiming, I cannot be
that legal person for you.
So if you tell me that you'refiling for chronic fatigue
(20:15):
symptoms related to your cancer,then my job is to document in
the DBQ your symptoms, yourtesting results, um, your
limitations in employment.
It is not my job to say, oh no,no, no, you should be filing
for chronic fatigue syndromeversus the chronic fatigue
(20:37):
symptoms.
And veterans get very lost inwhat they're filing and what
their goals are.
Let me give this other exampleso you can kind of follow the
difference.
A disability is anything thatcan impair functional employment
(21:01):
or functional gain orfunctional limitations, um,
there's a definition for that.
Look it up.
But fatigue can fall into thatcategory, just like pain.
That's where that case, like 10years ago, came out, and
they're like, oh, pain can be adisability now, pain can be a
disability now, I'm gonna filefor chronic pain.
That is similar in thisscenario when it comes to
(21:23):
fatigue.
So if we look at the claim orthe treatment for chronic
lymphocytic leukemia or evenCML, if your cancer is active
and you're undergoing treatment,then you're 100%, you're
supposed to be 100%.
Well, we've had cases wherebecause their cancer is now
(21:50):
controlled, but they're onactive chemotherapy, the VA is
proposing to reduce theirbenefits.
So another alternate route issay, okay, okay, you're gonna
say that this veteran no longerhas active cancer, active
treatment, but then you need torate him for his residuals.
(22:12):
And one of those residuals ishis fatigue, and his symptom of
fatigue puts him at 100%disability.
So either way, the VA wants tospin it, you still owe this
veteran and this man a hundredpercent disability.
So that is one tool that youcan use.
Is it always successful?
No.
(22:33):
But it's still an avenue forthe veteran to advocate for
their percentage and theirdisability if they're going to
try to say, well, your cancer iscontrolled with your treatment.
I've I've had a veteran, John,I've talked to you about this
veteran.
This veteran has had activecancer since 2016.
He's still an active treatment.
(22:53):
He takes medicine every day.
That medicine makes him sosick.
Part of that 100% disabilityrating is understood that active
cancer under active treatmentwith a anti-neoplastic
chemotherapy per rating scheduleis disabling to the 100% degree
(23:13):
level.
And that incorporates the sideeffects of the disease, the side
effects of the medication, thedisability that it that it
causes that individual.
That 100% is incorporated orencaptures all those limitations
that that cancer, that act ofcancer causes.
So for this particular veteran,we did the DBQ and we showed
(23:38):
the DBQ is causing disablingfatigue, and he's warranted
100%.
Now that is before the VA, andthe VA has to decide how are
they going to rate thisindividual.
So we have all the evidence onthe table that this individual
will get 100% for his CLL or hiscancer.
The VA won't give him both.
(24:00):
The VA won't give him bothfatigue and the 100% for CLL
because that would bepyramiding.
But in this scenario, he'sfiling for fatigue as a symptom
of his cancer without having achronic fatigue syndrome
diagnosis.
Are you following me on that?
Any questions about that?
J Basser (24:30):
I just think what they're doing is kind of
criminal themselves.
Um it's like I don'tunderstand, but they do
understand, and it's just it'sjust a waiting amount.
I think uh a lot of timesthey'll get a sick patient like
that that's really sick, andthey'll wait about until they
kick the bucket.
Bethanie Spangenberg (24:50):
Well, you know, I've tried to talk to this
veteran.
This veteran is very worriedabout his benefits because it's
not just him, but it's his wife,and he's worried about caring
for his wife.
And as much as I say, you know,like hold your horses, like I
don't know what my deal is withthe horse and the all these
horse preferences today, butokay.
(25:11):
Um I said just hold yourhorses, let's wait till this
date.
Once this date hits, then we'regonna start to get our ducks in
a row financially on your end,because you know, I don't know
what the VA is gonna do.
But you know what I think hedid, and he he won't admit it,
but I think he stopped hischemotherapy because this last
month he had abnormal labs andhit it shows that his cancer is
(25:35):
active, like the medicine's notsuppressing it.
So I think that in all of thischaos that the VA has has caused
him and all the stress that hascaused him, he's like, you know
what?
I'm just not taking it anymore.
And so just that quickly,within a matter of three to four
weeks, he stopped taking thatanti-neoplastic chemotherapy and
his his leukemia numbers areare back up.
(25:58):
So then again, there's evidencethat he has active cancer, but
I mean, it's ridiculous thatveterans have to sacrifice their
own health in order to get whatthey're legally entitled to and
what's in front of the VA.
J Basser (26:14):
They're conducted for mental health.
Bethanie Spangenberg (26:16):
No, he's not, but I'm I'm really that
should be a secondary.
Yeah.
J Basser (26:24):
Because it tells me that he's affected by that and
he could take him to his chemobecause the VA keeps denying him
or whatever it is, then thatneeds to be added addressed too.
Bethanie Spangenberg (26:33):
Well, they came out and they did a couple
wellness checks on him becausehe's uh threatened, you know,
self-harm.
Um which I'm not in hisposition, but from what you know
what I've seen him like throughthe medical record part of it,
you know, since 2016, he's beenthrough a lot.
I mean he's lucky to even behere.
J Basser (26:53):
So help we can get, but I mean it's gonna help
veterans get better, guys, andthey've got cancer or some kind
of disease that can be cured.
You know, the best thing to dois make sure that you know that
if service connected issue,which it should be, they need to
go ahead and do it.
(27:14):
Instead of waiting around andplaying games.
It's all a big game to them.
I'm sad that's true, you know,it's a game.
And the BDA is the reason thatthat's the end point of the
game, is going to the Board ofVegetable Pills.
Because they're playing games.
Bethanie Spangenberg (27:37):
So I guess the takeaway for this here is
to understand, you know, my roleas a medical examiner is not to
say you have chronic fatigue orto say that you have a
qualifying condition for aclaim.
(27:58):
It's my role to document yoursymptoms, your treatment, what
the testing shows.
And so when you come to me fora DBQ and you kind of don't know
what you're doing, you you maywant to talk to a representative
before you dive in and go thewrong direction because I I
really can't help you on that.
(28:18):
Um when I do sit down to do thechronic fatigue DBQ, the first
thing that I look for is I lookfor that G code.
Let's see if it's gonna let meclick this.
So I look for that G code, it'sG93.32.
Earlier I had it as an R, butit is a G93.32.
(28:41):
And I look for it because thattells me, yes, they have the
diagnosis, and this is what myfocus is going to be for this
DBQ when I write this historyand the testing results.
I want to emphasize that in thephysical DBQ, it also has
(29:01):
listed at the top of page twothe criteria that needs to be
met.
So the veteran, again, needs tounderstand this is the criteria
that they need to meet for theVA's 1994 definition of chronic
fatigue syndrome.
So, what does it mean whenchronic fatigue syndrome is an
(29:27):
unexplained cause after rollingout other causes?
Or unlike we really can't findout the cause of why they're
having these chronic fatigueissues.
What we call that in themedical world is we call it a
diagnosis of exclusion.
Okay, so basically, we aregoing to make the diagnosis of
chronic fatigue syndrome afterwe've investigated everything
(29:50):
else.
So it's by process ofelimination that you don't have
all these other conditions, andso it must be chronic fatigue.
Syndrome.
When we work up chronic fatiguesyndrome, it is a lot of labs.
We are going to look for yourblood count, your kidney
(30:12):
function, your liver function,your thyroid function, your
blood sugar, your blood sugarover 90 days.
We're going to look at youriron level, your vitamin B, your
vitamin D.
We're going to look atinflammatory markers.
We're going to look atautoimmune markers.
We're going to look at allthese different viral panels.
There is a ton of lab work thatis tied to this.
Luckily, most of those labs canbe captured in one setting.
(30:37):
You don't have to make severaltrips for it, but there's going
to be a lot there.
There's a lot of work, workupthat comes with that complaint
of fatigue.
Sleep evaluation.
Especially now, sleep apnea,that's going to be at the top of
our list.
You're telling me you havechronic fatigue.
I'm going to go ahead and orderyou a sleep study.
If you meet, you know, even ifthey don't meet risk risk
factors, if they're telling methey have fatigue, they should
(30:59):
really have a sleep studyanyway.
Because you can have centralsleep issues where your brain's
not telling your body to sleepwell, or it's malfunctioning
centrally in the brain to nothit those sleep cycles.
In addition to the obstructivesleep apnea, you're going to
have an EKG, maybe an ultrasoundof your heart, a chest x-ray.
(31:22):
We're going to look at yourheart and lungs and make sure
they're functioningappropriately and they're not
causing some form of fatigue.
Sometimes, if there'sindications there, we may refer
you for a mental healthevaluation.
A lot of times, especially withdepression or, you know, some
of the downer type mental healthissues, they can cause fatigue,
(31:45):
or you can actually have theflip.
You can even have ADHD whereyou're spinning all the time and
you end up crashing and havingfatigue as well.
So that's part of some cases,it's it's mental health is part
of that workup of chronicfatigue.
Any questions about that?
I think Barry, that was one ofthe questions that you kind of
were leaning into.
Beri (32:06):
Well, and you know, it's interesting, all those symptoms
that you listed.
I was thinking about if you'veever been on a long deployment,
you know, for after two or threemonths of most fleet, you have
all those symptoms, but they goaway eventually with the rest.
So it was just it's veryinteresting reading that list
(32:27):
and thinking that's how you feelif you're really exhausted over
a few months period of time.
Bethanie Spangenberg (32:33):
Yeah.
I think that's why they setthat limitation on there for the
six months, is because umbecause of things like that,
especially with the military.
The the other component, otherthing that they're finding, is
there it's kind of like were youwere you do you understand the
(32:53):
timeline of like hepatitis B andwhen that came around?
Beri (32:57):
Yes, yes.
Bethanie Spangenberg (32:59):
So we really didn't know what it was
when it first came about, right?
And so they called it um, wasit non-hepatitis something or
other or something, I can'tremember what they called it, to
be honest.
Beri (33:13):
They had another name for it, yeah.
Bethanie Spangenberg (33:15):
Um, yeah, they had another name for it,
but that was in the nine uh theeighties or nineties.
Now I'm missing my timeline,but you know, we didn't know
what it was, so we called itsomething.
Okay, we gave it a name and weheld on to that name for a while
until we really couldn't do thescience behind it.
They're finding that a lot ofour military members, and that's
why they've the tag theSoutheast Um Asia, the Gulf War
(33:39):
veterans, they're findingbecause there's different bugs
and bacteria and viruses inthose countries, that they are
catching them, and there it's itends up causing a lot of these
unknown symptoms.
So maybe in 10, 20, 30 yearsfrom now, we're gonna say, oh,
well, that's that that diseasenow.
(33:59):
We didn't know what it was 30years ago, but now we know what
it is.
And so I see this Gulf Warsyndrome following the same
pattern of the the hepatitispattern.
J Basser (34:10):
Um I think any questions about that, guys.
Probably better.
I mean, we can ask Alex.
He read it firsthand, and um sowe've got a cure for that now,
supposedly.
Which is good and uh he's gotthere's more than just hepatitis
(34:34):
involved with that.
You're looking at uh porfuriaand all kind of crazy stuff,
yeah.
So uh I mean I've had him onthe in the past for shows and we
discussed every issue, and it'sknown to the son, and he's had
it.
Bethanie Spangenberg (34:49):
So and now that you mention that, it's
hepatitis C, and they used tocall it non-A, non-B hepatitis.
Yep.
And so, and and we didn't know,you know, that it was even like
a bloodborne pathogen.
So these air gun injectors thatwe were given to our veterans,
that's how some of them gothepatitis C.
(35:11):
And you know, there is a therewas a study out of California in
the 90s that actually likethrew those air gun injectors in
the trash because they tied anoutbreak of hepatitis C to those
air gun injectors in Californiain the early 90s, and so that
(35:31):
is a lot of the research that weuse when we talk about
hepatitis C.
J Basser (35:35):
So 20 years ago, back when I was doing the moderation
for uh the Hadit site, we had aguy named Alan, and uh he was a
bowl tech in the Navy and a realnice guy, and he contracted
different stuff and he blamedeverything on those jet guns.
And he filed and filed andfiled and did this and that, and
(35:56):
they denied him every time hewent in.
Because the you know, the jetguns didn't cause that, you
know, but we knew it did, but Imean there's nothing we could do
about it, and I don't know whathappened if he got it to the
board or what, but uh I don'tknow if he was still with us or
not, he disappeared off theside.
We're sad.
Bethanie Spangenberg (36:18):
Another thing since I we're talking a
little bit about Gulf War, uhthis is this is totally off
topic, but it's just triggersand something actually comes up
quite a bit in my memory.
But several years ago, I had uma patient come in and I was
doing a work assessment on him,and he had a history of some
(36:39):
type of foot issue that thatmangled his foot, and you could
see all the the tendons in hisfoot.
He had very little fat, lots ofscarring on his foot.
And part of like the workevaluation is I need to
understand, you know, what hecan physically do.
And so in obtaining his historyfor that foot injury, it was
(37:01):
the craziest thing, and I itstuck with me obviously this
long.
But what happened when he wasyounger?
His brother was deployedoverseas somewhere in the
desert.
And when he came home, he wassupposed to like get rid of his
boots, decommission his boots,get rid of everything.
(37:21):
But instead, he gave them tohis his brother, this patient in
front of me.
So this patient in front of mehad these military boots on, and
while he had his military bootson, he was working in them and
he stepped on a nail, and thatnail went through the shoe,
through the bottom of the shoe,and to his foot and punctured
his foot.
(37:42):
And he ended up almost losinghis foot because infection
control, they had all thesespecialists, could not figure
out the type of bacteria thatwas in his foot.
And here it was because thoseboots that he wore that his
(38:03):
brother had overseas carried amuch like a foreign bacteria to
us in the states.
And so they had to do a lot ofwork to figure out what
antibiotics to use, how to treatthis bug because of the
different bugs.
And I say that because thattells me that that's probably
(38:24):
where this Gulf War syndrome isgoing.
Knowing the history of thenon-N, non-B hepatitis, seeing
this these foreign bugs comingover and affecting our but uh
just our population here, andeven the veterans here, we don't
know what they're carrying.
Why are so many uh of theseGulf War veterans, why are so
(38:46):
many of them having sleep apneawhen they don't have all the
risk factors?
Why are they having all thesedifferent symptoms, these
chronic fatigue syndromes, theseundiagnosed illnesses?
What is it?
We haven't figured it out, andwe I think we will, but that's
one of those things that youknow I'm foretelling the future.
But anyways, that's a lot.
(39:08):
I'm gonna get back to thepresentation.
Okay.
Um I've already talked aboutall that, so let's go on to the
next one.
By the way, this guy is anangry VA compensation a pension
worker, just so you know.
He's he's not part of our teamat Ballot for Bet.
(39:30):
He's just the angry guy at theVA.
Um, so now I just want to goover the DBQ.
This is what we've all beenwaiting for.
Um, five pages.
Uh this can actually be doneover the phone as long as you
have the proper paperwork, theproper testing.
All those tests that you getfor the workup of your chronic
fatigue syndrome, I want them.
I want them when I'm completingthis DBQ.
(39:52):
This DBQ takes me about 45minutes to an hour because a lot
of it is reviewing the medicalrecord.
I have to literally copy andpaste what is in your record,
was it what is important tosupport that diagnosis of
chronic fatigue and dates andtypes of images and things like
(40:12):
that, types of lab work.
Um, I have to carry that or putthat all into this chronic
fatigue syndrome DBQ.
Um, the DBQ itself, like Isaid, it's five pages, very
simple.
It specifically asks for thecriteria of meeting the chronic
(40:36):
fatigue diagnosis.
So um, question two C haveother clinical conditions that
may produce similar symptomsbeen excluded by history,
physical examination, andorlaboratory test to the extent
possible?
If a veteran does not provideme their workup, I have to say
no.
And so they they may rejectthis DBQ and say, well, they
(41:01):
don't meet the criteria forchronic fatigue syndrome.
But if the veteran is lookingat chronic fatigue as a symptom,
then that would be fine.
It asks about the onset was thechronic fatigue sudden or did
it happen gradually?
Is it debilitating?
Um, they define theincapacitation as um a
(41:27):
requirement of bed rest for fromthe physician, from the
treating physician.
They ask specifically about thesymptoms, if they're constant
or if they come and go, and howthey restrict routine daily
activity.
For example, if the symptomsdue to chronic fatigue syndrome
are nearly constant, do theyrestrict routine daily
(41:51):
activities as compared to thepre-illness level?
And then it goes through, andyou're supposed to say it
restricts routine dailyactivities almost completely
when compared to pre-illnesslevel.
And in fact, that it precludesself-care.
They're not able to do theirADLs or care for themselves.
Um daily activities to lessthan 50% of the pre-illness
(42:18):
level.
Symptoms restrict dailyactivities from 50 to 75 percent
of the pre-illness level.
Symptoms restrict routine dailyactivities by less than 25% of
pre-illness level.
Those are confusing.
I read them out to you just sothat you can understand the
criteria.
That is the rating criteriathat they're asking in those
(42:38):
little check boxes.
Okay.
The most important part, goahead.
The most important part I feelthat is in this DBQ, aside from
having your testing to supportthe diagnosis, um, is the
(42:59):
functional impact.
When I do these DBQs, I want tohear an example, a real-world
example in your life, how thischronic fatigue has impacted
you, your work, your sociallife, all of it, so that I can
emphasize that to the VA.
I will, you know, put it backinto the DVQ and emphasize just
(43:23):
how, from an occupational healthstandpoint, how these chronic
fatigue symptoms or syndromescan affect this individual's
functional employment orfunctional gain.
So there's not really anythingfancy or confusing to talk about
there on the DBQ.
Any questions about the DBQitself?
J Basser (43:49):
Is that mainly a Gulf War thing?
Bethanie Spangenberg (43:53):
Right now, yes.
Um, I see a lot of veteranstrying to do fatigue secondary
to like sleep apnea, and they'renot gonna they're not gonna get
fatigue symptoms, secondarysleep apnea.
Now, if they go on to developthe criteria for chronic fatigue
(44:15):
syndrome, then they may bebecause of the separate
diagnosis, they may be able toget it.
Um, but again, for like sleepapnea, that fatigue is
incorporated in the ratingcriteria already.
So I see a lot of errors in howveterans are pursuing the
chronic fatigue or chronicfatigue syndrome, and so that's
(44:39):
why I want to.
J Basser (44:40):
You hear that people.
Sleep apnea.
If you have daytime tiredness,it's called an insolvent or
whatever it is, and it's part ofthe sentiment of sleep apnea or
hyper what do you call it?
Bethanie Spang (44:52):
Hypersonnolence.
J Basser (44:54):
Yeah, well, if I have a teeth, I could say that word.
It's always best to get thebest information you can and uh
have it explained, you know, interms of people can understand
it, and uh that's good.
I'm glad you did this.
That's good.
Bethanie Spangenberg (45:14):
So I've only got a few more slides here.
I just want to uh listspecifically the rating
criteria.
I'm not gonna read it off.
I'm just gonna make make anemphasis about the rating
criteria because it's in theslides.
If somebody's watching YouTube,they can hit pause and they can
read through it.
Um here for 40, 20, and 10%rating.
(45:44):
Okay.
And there's a few otherimportant things.
Uh, we already talked aboutpyramiding.
You have to watch forpyramiding.
You could be spinning yourwheels and they come back and
say, No, you're pyramiding.
So if you're thinking aboutfiling for for chronic fatigue,
secondary to something, you needto sit down with the VSO,
unaccredited agent, uh, talk tosomebody that has that can kind
(46:07):
of explain the pyramiding to youand how it applies to your
disability.
Um I've already given theexample of the cancer where uh
despite the fact that theindividual is active treatment,
active cancer, they're trying togive him a zero percent because
it's it's normal, his labs arenormal.
(46:29):
Um, you know, that's that's onefancy creative way that we're
trying to push to keep that100%.
It's like fine, if you're gonnabe a jerk, then you know, rate
him on his residuals.
What's his residuals?
J Basser (46:43):
Exactly.
Does the regulation state thatI'm sorry, that if the cancer
numbers are showing different,but the cancer is still active,
does it put the difference ordoes it just say uh still active
process?
Bethanie Spangenberg (47:02):
So there's a a we call it a race aging,
and so they're like, oh, but ifthe race zero, then it's normal.
Ray zero has to do with theprogression of the disease, not
necessarily the treatment orwhether it's active.
So to try to erase the factthat the cancer is active and
that he's on activeantineoplastic chemotherapy for
(47:25):
the treatment of the conditionis is an ignorant way of trying
to say he's fine.
Um, the last thing I want toemphasize that are important is
just that Gulf War presumptive.
And I just want to lay this outthere on the criteria that are
needed for the Gulf Warpresumptive.
(47:47):
So chronic fatigue syndrome islisted as a presumptive service
connection if the followingconditions are met.
Their service occurred inSouthwest Asia Theater of
Operations.
Their symptoms began duringservice or became compensable by
greater than or equal to 10%within the next year.
(48:10):
And we're looking at 2026.
So if sometime in the next yearyou start to develop these
chronic fatigue syndromesymptoms to a 10% degree, you're
still eligible as a Gulf Warpresumptive.
And I oh it's signs andsymptoms cannot be attributed to
any known clinical diagnosisthrough history eczema lab,
which that's the criteria thatis chronic fatigue anyway.
(48:30):
But here is that 10% thatyou're trying to meet as a Gulf
War presumptive.
J Basser (48:38):
That's very similar to hypertension, 10% presumptive
test.
It's gotta be compensable,right?
Bethanie Spangenberg (48:50):
And that's all I've got for for the deep
chronic fatigue syndrome, do youthink you're good.
J Basser (49:03):
Pretty good, didn't have to rush, took the time.
Last time we had to get throughit in a hurry.
Bethanie Spangenberg (49:09):
Well, it was the back one was like 11
pages.
J Basser (49:13):
It was huge.
Bethanie Spangenberg (49:14):
Yeah.
J Basser (49:16):
It was huge, it was big.
I don't know.
I don't want what do we haveleft to do on these DVQs?
I mean, uh, we covered theback, the neck, the nerves, the
spine.
Bethanie Spangenberg (49:28):
Believe it or not, we've been doing this
for like two years, and we'restill not done.
There's like 76 DVQs.
I'm just trying to hit the topones.
We'll get to the the smallerones eventually.
Beri (49:42):
Yeah, that uh pretty interesting.
You were talking about I'veknown a two cases of people came
back from uh OIF.
I think they were both OIF.
And uh they had a family memberthat got ill or got a skin
condition from maybe washingtheir uniforms or being exposed.
(50:05):
And like you were talking aboutthat boot, I mean, because
there's some bad stuff.
You you're in a country thatstill has the plague, and uh you
don't really know what, youknow, but I've and it it's
strange that and you you can'tget it clean over there before
you come home for the job, andit's not clung.
J Basser (50:23):
Have you guys ever come across you ever come across
any Korean war vets?
A good friend of mine wasstationed over in the DMZ.
He was in a guard, but he gotactivated and went over, and uh
he's a command sergeant major.
And he got lucky because he hadhis own people to do his
laundry and stuff, you know, andthey did it, did it right.
(50:46):
But the actual active troops,they would spray those uniforms
down with some kind ofinsecticide with deep in it
because of all the mosquitoesand bugs over there.
And majority of them got reallysick in bad shape because of
the chemicals they used sprayingthe uniforms.
Beri (51:05):
That bug juice.
J Basser (51:06):
You ever heard of it?
Beri (51:08):
Go ahead.
I don't know, but I had some ofthat that ate the case in off
my watch one time, so I quitusing that old stuff.
If it'll eat the case in yourwatch, what's it doing to you?
Yeah, no, I had a G Shop placein it, so I threw that away.
The time X G Shark or theCasio?
It was the Casio G shark GShop, and it ate the case up,
(51:31):
you know.
J Basser (51:32):
Whoa.
That's pretty sad.
That's just lead acid.
So if it kills bugs andmosquitoes, is it gonna kill
you?
You get enough of it to killyou too, because you're or
you're you're an organism ororganic material just like they
are.
No, but yeah.
But Korean bests are few andfar between.
(51:55):
You know, and uh that'll bewell.
Beri (51:59):
Yeah, I think we're down like 43% Vietnam best left.
J Basser (52:04):
So if he'd have chosen to, you could actually cover
two.
You know, if you've got twosmall ones, we could probably
split it up and do one firstpart of the show and another
second part of the show.
unknown (52:14):
Okay.
Bethanie Spangenberg (52:15):
I'll take a look.
I thought I had uh wrote onedown that I wanted to do next.
I don't know.
I I try to I was gonna try todo it in order, but now I'm just
doing it into what annoys me.
So not necessarily what annoysme, but what's like, hey, you
know what?
They there needs to be moreclarification on this one.
(52:35):
So um so that's that's whatI've been the game I've been
playing lately.
Okay.
J Basser (52:43):
Well, I do appreciate everybody coming on.
Barry, thank you again.
I'm glad you made it back fromOhio and in good spirits and in
one piece.
Beri (52:53):
Well, I am too.
I it was uh you know, that'sthe first real work I've done in
a while now.
My wife's had me in there twoweekends.
So I'm back to it.
She's gonna start slappinghoneydews on the fridge again.
Bethanie Spangenberg (53:08):
Yeah.
Beri (53:09):
You know, the thing is, you know, I work, you know, I
work for and I get usually getfired about once a month, but
then I have to show back up atwork the next day.
I don't get it.
J Basser (53:21):
You say you're the CEO, you can't fire yourself,
and you don't have a board ofdirector.
You got one board of director,and that's the wire.
Beri (53:30):
That's it.
J Basser (53:31):
Yeah.
Oh you're the same situation,but you can't fire yourself
either.
My wife is fireing me in amoment.
Beri (53:40):
She's great though.
You know, I keep complaining.
Got a really great fringebenefits packaging up.
J Basser (53:49):
We're gonna shut her down.
I've uh has made the dentalwork done and I've been pretty
serious pain all day, but uhfigure I took this one out.
So uh with that, busy, thanksfor coming on.
Ray, thanks for I mean, Ray.
I'm sorry, Barry.
Uh had rail on my mind.
Thanks for coming on, weappreciate it.
We'll we'll do this again nextweek, guys.
(54:09):
We're gonna have a new gueston.
She's a uh credit appeal.
No, she's an attorney out ofWashington, D.C.
I'm sorry.
Um I'll advertise the show upthis weekend and get out there,
and uh she's really good at whatshe does.
She's got her own office andshe does ethnic things out there
in Virginia.
So uh this will be John onbehalf of Bethany and Barry,
(54:32):
we'll be shutting her down fornow.
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