Citation Nr: 18156915 Decision Date: 12/11/18 Archive Date: 12/11/18 DOCKET NO. 18-33 457 DATE: December 11, 2018 REMANDED Entitlement to service connection for fibromyalgia, including as due to an undiagnosed illness, is remanded. Entitlement to service connection for chronic fatigue syndrome (CFS), including as due to an undiagnosed illness, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1982 to December 1986 and from March 1987 to April 1991. These matters come before the Board of Veterans’ Appeals (Board) from a February 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for fibromyalgia and CFS, including as due to an undiagnosed illness, is remanded. The Veteran contends that he is entitled to service connection for fibromyalgia and CFS due to his exposure to oil fires, burn pits and bombings while stationed in Kuwait. See July 2015 VA Form 21-4138. The Veteran reports that he suffers from symptoms of: tenderness to touch; sleep problems; chronic fatigue and joint and body pain. See June 2018 VA Form 9. Service connection may be warranted for a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active military, naval or air service in the Southwest Asia theatre of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021. 38 C.F.R. § 3.317 (a)(1)(i). The Veteran is deemed a Persian Gulf veteran, as there is evidence that during the Persian Gulf War he served on active military service in the Southwest Asia theatre of operations. 38 C.F.R. § 3.317 (e). For purposes of section 3.317, there are three types of qualifying chronic disabilities: (1) an undiagnosed illness; (2) a medically unexplained chronic multi-symptom illness; and (3) a diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117 (d) warrants a presumption of service connection. 38 C.F.R. § 3.317 (a)(2). An undiagnosed illness is defined as a condition that by history, physical examination and laboratory tests cannot be attributed to a known clinical diagnosis. 38 C.F.R. § 3.317 (a)(1)(ii). In the case of claims based on undiagnosed illness, unlike those for direct service connection, there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Further, lay persons are competent to report objective signs of illness. June 2015 private treatment records from Dr. R.D. indicate, “As a direct call for more likely than not caused by the result of, [the Veteran] has some exposure to multiple areas of engagement in the Gulf War he has developed chronic fatigue syndrome and fibromyalgia . . . .” VA Gulf War examination reports from February 2016 and April 2018 indicate that the Veteran does not have diagnoses for either disabilities. Therefore, the Board finds that a remand is necessary to obtain a medical opinion regarding the Veteran’s objective evidence of joint and body pain; fatigue; difficulty sleeping and tenderness to touch. The examiner should also consider the private examiner’s notation of CFS and fibromyalgia. The matters are REMANDED for the following action: Obtain an addendum medical opinion from the April 2018 examiner (or a suitable medical professional) who should review the Veteran’s VA electronic claims folder, including a copy of this remand, and indicate that review in the examination report. The examiner should provide a description of all symptoms manifested by the Veteran to include, but not limited to, chronic fatigue, joint and body pain, and fibromyalgia. The examiner should provide an opinion regarding the following: (a) The examiner should provide a diagnosis of any disorder manifested or, in the case that no diagnosis can be made, opine whether it is at least as likely as not (50 percent probability or greater) the Veteran’s symptom or symptoms are related to an undiagnosed illness or related to a medically unexplained chronic multi symptom illness. (b) If the Veteran’s symptoms of chronic fatigue are related to a diagnosed disability, whether it is at least as likely as not (50 percent probability or greater) that any diagnosed disorder began in or is related to the Veteran’s active duty service; (c) If the Veteran’s symptoms joint or muscle pain are related to a diagnosed disability, whether it is at least as likely as not (50 percent probability or greater) that any diagnosed disorder began in or is related to the Veteran’s active duty service; (d) If the Veteran’s symptoms of fibromyalgia are related to a diagnosed disability, whether it is at least as likely (50 percent probability or greater) that any diagnosed disorder began in or is related to the Veteran’s active duty service. The examiner is requested to also specifically address Dr. R.D.’s June 2015 treatment note: “As a direct call for more likely than not caused by the result of, [the Veteran] has some exposure to multiple areas of engagement in the Gulf War he has developed chronic fatigue syndrome and fibromyalgia . . . .” A complete rationale is requested for all opinions. MICHAEL A PAPPAS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Baskerville