Citation Nr: 18157148 Decision Date: 12/13/18 Archive Date: 12/11/18 DOCKET NO. 15-03 081 DATE: December 13, 2018 REMANDED Entitlement to service connection for fibromyalgia is remanded. REASONS FOR REMAND The Veteran served on active duty from February 2001 to June 2009. The Veteran appeals a November 2012 rating decision from the Department of Veteran Affairs (VA) Regional Office (RO) from Buffalo, New York. The Veteran declined a Board hearing in her December 2014 VA Form 9. Entitlement to service connection for fibromyalgia The issue of service connection for fibromyalgia is remanded for further development. The Veteran’s service treatment records show treatments for hypothyroidism, hemorrhoids, depression, knee and joint pain, and pregnancies. However, they are silent as to a diagnosis or treatment for fibromyalgia. Notwithstanding, private medical notes observed the Veteran’s poor sleep, hoarse voice, and pain as possible hypothyroidism, and fibromyalgia shortly after separation. See September 2009 private treatment note; November 2009 private treatment note. In a February 2012 VA treatment note, the Veteran asserts that her fibromyalgia symptoms developed after a 2005 motor vehicle accident while she was on active duty. In or around 2011, the Veteran began taking Milnacipran (Savella) to treat her fibromyalgia. VA treatment records show fibromyalgia listed on the Veteran’s past medical history. The Veteran underwent a VA examination in October 2012. The VA examiner noted that the Veteran has or has been diagnosed with fibromyalgia. However, the VA examiner opined that the Veteran did not have a confirmed diagnosis of fibromyalgia. The VA examiner rationalized that the Veteran did not have a confirmed diagnosis because she did not have tender points; her clinical examination was grossly normal; lack of fibromyalgia in the service treatment records; and lack of significant complains which would link to fibromyalgia in service records. The Board finds this examination inadequate. The VA examiner’s opinion is ambiguous as to whether the Veteran has a current diagnosis, and conflates the issues of nexus (between fibromyalgia and service) and current diagnosis. Regarding ambiguity, although the VA examiner noted that the Veteran has a diagnosis of fibromyalgia as of June 2011, the VA examiner opined that the Veteran does not have a confirmed diagnosis of fibromyalgia. However, the evidence of record indicates that the Veteran is taking Savella to treat her fibromyalgia. Further, VA treatment records show fibromyalgia in the Veteran’s medical history. A critical issue in this case is whether the Veteran has this disability, or does not. Regarding conflating nexus with current diagnosis, the Board observes that the VA examiner tried to pinpoint when the Veteran was diagnosed with fibromyalgia, and used the lack of a diagnosis to determine whether the Veteran has a current diagnosis. For example, the VA examiner speculates that the fibromyalgia diagnosis was continued in the Veteran’s medical history simply because the Veteran gave it as part of her history, and thus there is no current diagnosis. Yet, the Board notes that if the fibromyalgia diagnosis continued only because the Veteran mentioned she had fibromyalgia, the VA examiner’s reasoning does not explain why she was, and is still taking Savella (which is used to manage fibromyalgia). In short, the Board finds a new VA examination is necessary, and remand is warranted. The matter is REMANDED for the following action: 1. Obtain and associate with the record all VA and private treatment records for the Veteran. All actions to obtain the requested records should be fully documented in the record. If they cannot be located or no such records exist, the Veteran and her representative should be so notified in writing. If possible, the Veteran and her representative are asked to submit these records themselves. 2. Then, afford the Veteran appropriate VA examinations so as to determine the nature and etiology of her claimed fibromyalgia. The record, to include a complete copy of this remand, must be made available to the examiner, and all indicated tests and studies should be accomplished. The record, to include a complete copy of this remand, must be made available to the examiner, and all indicated tests and studies should be accomplished. (A) The examiner should identify whether the Veteran has or had (at least as likely as not has) fibromyalgia, even if currently asymptomatic or resolved. The key issue in this case is whether the Veteran has this disability, or does not. (B) If the disability is found, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that fibromyalgia had its onset during, or is otherwise related to, the Veteran’s military service, to include the aforementioned documented in-service complaints, treatment, and diagnoses. Particularly, is the Veteran’s fibromyalgia (if found) related to the 2005 motor vehicle accident? A rationale should be provided for any opinion offered. 3. Then, readjudicate the issues on appeal. If any benefit sought on appeal remains denied, provide the Veteran and his representative with a supplemental statement of the case and afford them the requisite opportunity to respond before the case is returned to the Board for further appellate action. John Crowley Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Timothy A. Campbell, Associate Counsel