Citation Nr: 18145253 Decision Date: 10/26/18 Archive Date: 10/26/18 DOCKET NO. 16-28 692 DATE: October 26, 2018 REMANDED Entitlement to service connection for chronic fatigue syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1992 to August 1995. He contends that he has chronic fatigue syndrome and that he either incurred it while in service in Kuwait or that it developed after service, both as due to his exposure to Gulf War environmental hazards. The Veteran has submitted treatment records dated in April 1994 that show that he was present in Kuwait at that time. A letter of commendation dated in April 1994 established that the Veteran served as a weapons custodian during an exercise known as NATIVE FURY; accordingly, the Board confirms that the Veteran had qualifying service in the Southwest Asia theater of operations during the Persian Gulf War. The Board is mindful that the Veteran’s symptom complaints, which include chronic fatigue and sleep disturbances, may warrant application of the provisions of 38 C.F.R. § 3.317 if any or all of those symptoms are not medically accounted for by the Veteran’s known medical diagnoses. He was afforded an examination in June 2015 to evaluate the nature and etiology of his claimed chronic fatigue syndrome, during which he reported a history of experiencing fatigue despite not having any sleeping problems. After reviewing the claims file, the examiner found that it was less likely than not that the Veteran had a disability pattern that was related to a specific exposure event experienced by the Veteran during service in Southwest Asia. In support thereof, the examiner noted that the Veteran had consistently reported experiencing no fatigue during routine check-ups at his local VA medical center. Furthermore, the examiner detailed that the Veteran endorsed experiencing insomnia during prior mental health evaluations. Ultimately, the examiner found that the medical history for fatigue was inconsistent, and did not endorse a diagnosis of chronic fatigue syndrome. The June 2015 examination is not sufficient, as it overlooked testimony from the Veteran that he was experiencing fatigue regularly. Moreover, the examiner did not discuss whether the Veteran’s symptomatology was chronic in nature, and if so, whether any qualifying chronic disability was affirmatively shown to have resulted from a supervening condition or was otherwise affirmatively shown to have not been incurred during active service, as would be necessary in order to evaluate whether service connection is warranted under 38 C.F.R. § 3.317. Accordingly, the Board finds that a new examination is needed to address these outstanding queries and provide a sufficient rationale for any conclusions reached. The matter is REMANDED for the following action: Schedule the Veteran for a VA medical examination to address the nature and etiology of his claimed fatigue symptoms. The examiner must review the claims file and address the following matters. All opinions must be supported by a rationale: A) First, please note whether the Veteran has a medically unexplained chronic multisymptom illness corresponding to the claimed fatigue symptoms. B) If the answer to (A) is negative, please describe whether the Veteran’s reported fatigue symptoms have at the present time or at any time during the pendency of this appeal been chronic in nature and thus would constitute a qualifying chronic disability under 38 C.F.R. § 3.317(a)(2)(i)(B). If this question is answered in the negative, an explanation for this determination is needed. C) If a chronic disability is found to correspond to the fatigue symptoms, please address the possible etiologies of such chronic disability. Of particular importance, please address the likelihood that any chemical exposures in Southwest Asia contributed to cause the onset of symptoms. If a chronic disability is found to be attributable to a supervening condition or event that occurred between the Veteran’s most recent departure from active duty in the Southwest Asia theater of operations during the Persian Gulf War and the onset of the illness, the examiner should so state. If, on the other hand, the examiner is not able to pinpoint the etiology of any such chronic symptoms based on the evidence of record, the examiner should also so state. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Christopher M. Collins, Associate Counsel