Citation Nr: 18149826 Decision Date: 11/13/18 Archive Date: 11/13/18 DOCKET NO. 11-30 813 DATE: November 13, 2018 REMANDED Entitlement to service connection for an undiagnosed illness or other qualifying, chronic disability pursuant to 38 U.S.C. § 1117 manifested by chronic fatigue is remanded. Entitlement to a total disability rating for compensation based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1989 to February 1990, from November 1990 to October 1992, and from January 1998 to August 2002, to include service in Southwest Asia. In June 2016, the Veteran was afforded a videoconference hearing with the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. The appeal was remanded by the Board in September 2016 for additional development. The Agency of Original Jurisdiction (AOJ) was directed to obtain an addendum VA opinion to determine if the Veteran’s claimed fatigue was attributed to a known clinical diagnosis. The additional delay of a final decision is regrettable; however, review of the record reveals that additional development is needed to ensure that due process is followed and that there is a complete record upon which to decide the Veteran’s claims so that she is afforded every possible consideration. 38 U.S.C. § 5103A (West 2012); 38 C.F.R. § 3.159 (2017). 1. Entitlement to service connection for an undiagnosed illness or other qualifying, chronic disability pursuant to 38 U.S.C. 1117 manifested by chronic fatigue is remanded. In September 2016, the Board remanded the appeal to obtain a VA addendum opinion regarding the Veteran’s claimed fatigue disability. The AOJ obtained a new VA examination and opinion on behalf of the Veteran, but the examiner did not render an opinion as to whether the Veteran’s claimed fatigue, which the examiner determined is related to known clinical diagnoses, is related to the Veteran’s military service, to include service in Southwest Asia. Stegall v. West, 11 Vet. App. 268, 271. The July 2018 examiner indicated that the Veteran does not have chronic fatigue syndrome, but has multiple medical conditions, to include the following: Somatic Symptom disorder with predominant pain, depression, disturbances of motivation and mood, and chronic sleep disturbances; fibromyalgia in 2012; chronic pain syndrome; gout; diabetes mellitus (non-insulin dependent); arthralgia; chronic low back pain; obesity; and obstructive sleep apnea. The examiner additionally noted that any of these medical conditions, or in their combination, could potentially cause a “chronic fatigue issue”; however, medical record review and physical examination have not revealed findings of a claimed chronic fatigue syndrome condition, and no diagnosis was rendered at the time of the examination. As these fatigue complaints have been attributed to specific diagnoses, most of the associated disorders are not “undiagnosed” or “medically unexplained” for purposes of applying the Persian Gulf presumption. 38 C.F.R. § 3.317 (a)(2)(i) and (ii). However, the examiner did indicate a 2012 fibromyalgia diagnosis, which the Board notes needs clarification. On remand, new opinions must be obtained to 1) determine whether the Veteran has current fibromyalgia that is considered a medically unexplained chronic multi-symptoms illness, and 2) determine whether her medical conditions, which the July 2018 examiner indicated are associated with chronic fatigue, are related to service. 2. Entitlement to a total disability rating for compensation based on individual unemployability (TDIU) is remanded. As the resolution of the claim for service connection listed above could impact the claim for TDIU, the adjudication of this claim must be deferred pending the development requested. Harris v. Derwinski, 1 Vet. App. 80 (1991). The matters are REMANDED for the following action: 1. Obtain a new VA examination and opinion that conforms to the guidelines for conducting Gulf War examinations. The claims file should be made available for review. (a.) The examiner should note and detail all assertions as to problems associated with the Veteran’s complaints of chronic fatigue and other symptoms, current and documented. The examiner should conduct a comprehensive examination, and provide details about the onset, frequency, duration, and severity of the asserted symptoms and state what precipitates and what relieves them. (b.) The examiner should list all diagnosed disability(ies) associated with the Veteran’s chronic fatigue, if any. If all complaints are associated with a diagnosed condition(s), additional specialist examinations for diagnostic purposes are not needed and the examiner should opine whether it is at least as likely as not that the diagnosed condition was incurred in or is related to the Veteran’s active military service. (c.) If any symptoms associated with the Veteran's chronic fatigue are not determined to be associated with a known clinical diagnosis, further specialist examination(s) will be required to address these findings, and should be ordered by the primary examiner. (d.) If any specialist examination(s) is/are warranted, the primary examiner should provide the specialist with all examination reports and test results, specify the relevant symptoms that have not been attributed to a known clinical diagnosis and request that the specialist determine which of these, if any, can be attributed in this Veteran to a known clinical diagnosis and which, if any, cannot be attributed in this Veteran to a known clinical diagnosis. The examiner should specifically address the July 2018 VA examination report noting a 2012 fibromyalgia diagnosis; chronic pain syndrome; gout; diabetes mellitus; arthralgia chronic low back pain; and obstructive sleep apnea. A rationale is requested for any opinion given. (Continued on the next page)   2. Readjudicate the appeal. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD I. Warren, Associate Counsel