Citation Nr: 18158930 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 10-48 937 DATE: December 18, 2018 ORDER Service connection for an undiagnosed illness manifested by left calf pain and cramps is granted. Service connection for an undiagnosed illness manifested by right calf pain and cramps is granted. FINDINGS OF FACT 1. The Veteran served in Southwest Asia theater of operations during the Persian Gulf War. 2. Resolving all doubt in his favor, the Veteran has an undiagnosed illness manifested by left calf pain and cramps that had its onset in service. 3. Resolving all doubt in his favor, the Veteran has an undiagnosed illness manifested by right calf pain and cramps that had its onset in service. CONCLUSIONS OF LAW 1. The criteria for service connection for an undiagnosed illness manifested by left calf pain and cramps have been met. 38 U.S.C. §§ 1110, 1117, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. 2. The criteria for service connection for an undiagnosed illness manifested by right calf pain and cramps have been met. 38 U.S.C. §§ 1110, 1117, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1984 to January 1987; September 1988 to September 1981; September 1995 to September 1998; and November 2002 to July 2009. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a November 2009 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. The Veteran and his spouse testified at a Board hearing before the undersigned Veterans Law Judge in April 2012. A transcript of the hearing has been associated with the record. The Board remanded this matter in June 2015 and June 2017, and it now returns for further appellate review. 1. Entitlement to service connection for a left calf disorder. 2. Entitlement to service connection for a right calf disorder. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). As pertinent to the instant appeal, VA will pay compensation to a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability, provided that such disability became manifest either during active military, naval, or air service in the Southwest Asia theater of operations, or to a degree of 10 percent or more not later than December 31, 2021, and by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. A qualifying chronic disability means a chronic disability resulting from an undiagnosed illness or a medical unexplained chronic multisymptom illness that is defined by a cluster of signs or symptoms, to include chronic fatigue syndrome and fibromyalgia. Id. Notably, signs or symptoms of a medically unexplained chronic multisymptom illness include, but are not limited to, fatigue, joint pain, muscle pain, neurological signs, neuropsychological signs, and sleep disturbances. Additionally, a medically unexplained chronic multisymptom illness means a diagnosed illness without conclusive pathophysiology or etiology. Id. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). At the outset, the Board notes that during his final period of service from November 2002 to July 2009, the Veteran served in the Southwest Asia Theater of operations during the Persian Gulf War. Furthermore, as will be discussed below, he has an undiagnosed illness manifested by left and right calf pain and cramps that had its onset during such period of service. In this regard, the Veteran’s service treatment records reflect that he was treated for bilateral calf pain on an ongoing basis since 2002. At a pre-discharge VA examination conducted in July 2009, the Veteran reported a 6 year history of cramps of the left and right calf muscles, which occurred due to running during service. He further indicated that he currently experienced pain in the bilateral calves. However, the examiner concluded that there was no diagnosis of bilateral calf conditions with chronic pain because there was no pathology to render a diagnosis. Similarly, a July 2015 VA examination revealed no current disorder of the bilateral calves and, in February 2016, a VA examiner found that the Veteran had exercise-associated muscle cramps of the calves, which were a symptom rather than a diagnosis. However, as the Veteran served in Southwest Asia theater of operations during the Persian Gulf War, the Board found that a remand was necessary in order to determine whether he had an undiagnosed illness or a medically unexplained chronic multisymptom illness related to his calf symptomatology. In July 2017, a VA examiner found that there was no objective evidence of a chronic disability resulting from an undiagnosed illness or a medically unexplained chronic multisymptom illness based primarily on the lack of complaints referable to his bilateral calves since 2008. However, as it was unclear whether the examiner reviewed the complete record in rendering such opinion, he offered an addendum opinion in November 2017. At such time, he noted that a review of the record revealed continued complaints referable to the Veteran’s calves without a diagnosis, and opined that his claimed bilateral calf disorder most likely represents an undiagnosed illness based on the fact that, despite repeated efforts to determine the underlying etiology and establish a diagnosis for his symptoms, no current diagnosis is established. Therefore, the Board resolves all doubt in the Veteran’s favor and finds that Veteran has an undiagnosed illness manifested by left and right calf pain and cramps that had its onset in service. Consequently, service connection for such disorders is warranted. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Koria B. Stanton, Associate Counsel