Citation Nr: 18159763 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 17-08 617 DATE: December 20, 2018 REMANDED Service connection for fibromyalgia (to include complaints of myalgia, arthralgia and generalized weakness) as due to an undiagnosed illness is remanded. Service connection for anemia (previously adjudicated as a blood disorder) as due to an undiagnosed illness is remanded. REASONS FOR REMAND The Veteran served in the U.S. Army Reserve from May 1988 to May 1996, to include active duty for training from October 11, 1988, to May 4, 1989. As will be discussed below, the record appears to indicate that the Veteran had active duty for training in Saudi Arabia in 1991; and orders dated in 1992 for “Active Duty Special Work” (ADSW) Training Days in South West Asia that occurred in 1993. The record is unclear as to whether the Veteran served on active duty or active duty for training from September 1, 1992 to July 1, 1994; and if so, whether this duty was performed in the U.S. or overseas in the Persian Gulf. The Veteran testified at a BVA Travel Board hearing in New Orleans, Louisiana on November 27, 2018. For the record, the Veteran’s anemia claim was previously adjudicated in August 2007 as a claim to service connection for a blood disorder as due to an undiagnosed illness. A notification letter of the claim’s denial was provided to the Veteran. The August 2007 rating decision became final in August 2008. In a November 2016 statement of the case, the RO determined that evidence submitted after August 2008 related to unestablished facts necessary to substantiate the Veteran’s anemia/blood disorder service connection claim. It reopened and adjudicated the claim on its merits. The Board agrees with the RO’s determination to reopen the previously denied claim and proceeds with a merits review. Service connection for anemia and fibromyalgia as due to undiagnosed illness are remanded. The Veteran’s claims must be remanded for clarification of the Veteran’s periods of active duty and active duty for training, especially related to her U.S. Army Reserve service from September 1, 1992, to July 1, 1994. Additional information is also needed to determine whether the Veteran served overseas in the Persian Gulf from September 1, 1992, to July 1, 1994. In a March 2006 compensation application, the Veteran reported that she served on active duty from September 1, 1992, to July 1, 1994 in Saudi Arabia. She contends that she was exposed to some type of chemical or gas during service that affected her blood. She states that her blood disorder began in 1994; was treated in 1994 by Dr. G.R., Hematology of Baton Rouge; and that treatment ended in 2006. The Veteran also reports being deployed to Kuwait. She essentially contends that she developed symptoms akin to fibromyalgia after she left Desert Storm; and that she believes her medical condition was caused by her exposure to explosives, tear gas, dead animals and all types of chemicals that were mixed in the air that she inhaled while on active duty. For the record, the Board observes that evidence in the claims file confirms that the Veteran served overseas in November 1991, as she received an Operation Desert Storm - Army Reserve Components Overseas Training Ribbon for service from November 10, 1991, to November 21, 1991. However, the Veteran has not contended that she developed a medical condition related to her training overseas in 1991. Rather, she reports her anemia and fibromyalgia developed as a result of service she had in Saudi Arabia from September 1, 1992, to July 1, 1994. Unfortunately, despite numerous attempts, the RO has been unable to verify that the Veteran served overseas during this pertinent time frame. The RO has requested copies of the Veteran’s DD-Form 214 and/or other separation papers for all periods of service on several different occasions from PIES, the VA Records Management Center and from the Veteran herself. It also attempted to obtain records from the Army Reserve Unit 321st MMC, the Reserve Unit the Veteran reported she was still active with, without success. The claims file contains a memorandum dated in July 2007 setting forth a Formal Finding of the Unavailability of Service Medical Records for Army Reserve service from September 1, 1992, to July 1, 1994. Subsequent unsuccessful record searches are documented in 2014, 2015, and 2016. Service treatment records dated in 1988 and 1989; immunization records dated in 1990 and dental records dated in 1991 are contained in the claims file. A “record of assignments” sheet dated from September 1988 to July 1992 reveals that the Veteran’s primary duties while with the Army Reserve were as an executive administrative assistant, clerk, and/or clerk typist. Information provided by the Defense Personnel Records Information Retrieval System (DPRIS) reveals that the Veteran was assigned to the 321 MMC TAACOM (WVK1AA) in June 1991, when she had orders for 12 days of Annual Training to commence on July 1, 1991. July 1991 records reveal that the Veteran was ordered 12 Annual Training (AT) days and 2 “Active Duty Special Work” (ADSW) Training Days for Desert Storm Support. On September 26, 1991, the Veteran underwent 22 Annual Training Days that were to commence on November 2, 1991. On November 21, 1991, she received Operation Desert Storm - Army Reserve Components Overseas Training Ribbon for service from November 10, 1991, to November 21, 1991. February 1992 Orders reveal that the Veteran was called to perform 17 ADSW Training Days and 22 AT days beginning on March 10, 1993 for the purpose of providing support in Southwest Asia Overseas Deployment Training (“SWA ODT Line # 97588L”). Notably, however, beginning in April 1992, the Veteran began missing her scheduled unit training assemblies. In July 1992, she was assigned as a Clerk Typist for the 321st Material Management Center (MMC), Baton Rouge, LA (WVK1AA). After a September 1992 unexcused absence (a time when she reports being in Saudi Arabia), the Veteran was reduced in grade of rank for inefficiency. Thereafter, in January 8, 1993, (a time when she reports being in Saudi Arabia), she was reassigned to the “U.S. Army Reserve Control Group” that only required an annual training (AT) commitment because she accrued nine unexcused absences from unit training assemblies within a 12-month period. The Veteran was discharged from the U.S. Army Reserves on May 7, 1996, while still assigned to the U.S. Army Reserve Control Group. Interestingly, the claims file also contains an “Information Report” dated in June 2016 that reflects a military history from the VA/DoD Identity Repository (VADIR) that the Veteran had a reserve service period from May 5, 1988, to May 31, 1996. No dates were listed under “deployment periods.” In the report, under military history from the beneficiary identification and records locator subsystem (BIRLS), the Veteran is listed as having army service from October 11, 1988, to March 4, 1989, AND from September 1, 1992, to July 1, 1994. However, BIRLS does not indicate service in the Gulf War; or reflect Gulf War service start or end dates. Although the RO sought records from the U.S. Army Reserve Unit 321st MMC, no records could be located because the unit was deactivated in September 2006. However, no records request has been made to the U.S. Army Reserve Control Group to which the Veteran was assigned from January 8, 1993, to May 7, 1996. Although the RO was informed in a November 2006 letter from the Department of the Army that any additional requests for medical records should be directed to the U.S. Army Human Resources Command (HRC) (currently located at 1600 Spearhead Division Avenue, Fort Knox, Kentucky 40121), no records request was made to this organization. Because it appears that the HRC is the commander of the Individual Ready Reserve (IRR) that includes the “Control Group Annual Training,” requests for information should be sought from them. Additionally, as it appears there are only 4-pages of post-service medical records (that are unrelated to this appeal) contained in the claims, the RO should contact the Veteran and obtain information in order to request any post-service treatment records related to the conditions on appeal, to include the records from Dr. G.R., Hematology of Baton Rouge that the Veteran reported in her initial VA application for compensation. Lastly, in terms of the VA medical opinions in the claims, the RO requested a DBQ General Medical Gulf War opinion and a fibromyalgia DBQ addressing whether the Veteran’s claimed fibromyalgia (which really consisted of the Veteran’s complaints of myalgia, arthralgia and generalized weakness) had a “chronic disability pattern”; and if so, was this disability pattern (1) an undiagnosed illness, (2) a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology, (3) a diagnosable chronic multisymptom illness with a partially explained etiology, or (4) a disease with a clear and specific etiology and diagnosis. For the record, a diagnosable chronic multisymptom illness with a partially explained etiology, such as diabetes and multiple sclerosis, will not be considered medically unexplained; and therefore, is not subject to service connection pursuant to 38 C.F.R. § 3.317. The RO subsequently requested that if the examiner opined that the Veteran’s disability pattern was either (3) a diagnosable chronic multisymptom illness with a partially explained etiology, or (4) a disease with a clear and specific etiology and diagnosis, he or she was to provide a nexus opinion with supporting rationale as to whether the Veteran’s disability pattern or diagnosed disease was related to a specific exposure event experienced by the Veteran during service in Southwest Asia. A review of the February 2015 Gulf War General Medical Examination DBQ reveals that the Veteran was diagnosed as having a chronic multisymptom illness with a partially explained etiology, but failed to provide any insight as to what the “partially explained etiology” was. Additionally, the doctor provided a medical opinion that it was less likely as not that the Veteran’s medical problems were related to a specific environmental exposure event experienced by the Veteran during her service in Southwest Asia, but he failed to provide any supporting rationale for his opinion. The February 2015 fibromyalgia DBQ report is confusing and inconsistent. The doctor who examined the Veteran found that she did not have a diagnosis of fibromyalgia, although she had “findings, signs and symptoms” that were attributable to fibromyalgia. However, when asked about the frequency of fibromyalgia symptoms, the doctor marked the answer indicating that the Veteran did not have any fibromyalgia symptoms. At the end of the report, the doctor was asked if the Veteran’s “fibromyalgia” impacted her ability to work, to which the doctor marked the answer ‘yes.” He then went on to describe the “impact of the Veteran’s fibromyalgia.” On remand, the RO should seek clarifying medical opinions after making additional attempts to verify the Veteran’s periods of service so that this additional service can be taken into consideration by the medical provider. The matters are REMANDED for the following actions: 1. After reading this remand in its entirety, the RO should undertake additional efforts to clarify the Veteran’s periods of active duty and active duty for training during her tenure with the U.S. Army Reserve, particularly for the time frame from September 1, 1992, to July 1, 1994, and determine whether that service was performed in the Southwest Asia Theater of Operations. In doing so, the RO should request information from the U.S. Army Reserve Control Group to which the Veteran was assigned from January 8, 1993 to May 7, 1996; and the U.S. Army Human Resources Command (HRC) currently located at 1600 Spearhead Division Avenue, Fort Knox, Kentucky 40121. 2. The RO should contact the Veteran and request information as to any post-service medical treatment, private or via VA, she has had that is related to her anemia and fibromyalgia conditions. Thereafter, the RO should obtain the appropriate consent forms from the Veteran and request any post- medical records that may be applicable to the Veteran’s appeal. A consent form should be obtained and records requested from Dr. G.R., Hematology of Baton Rouge, the medical provider the Veteran reported treated her for her anemia/blood disorder from 1994 to 2006. 3. After obtaining any additional available evidence confirming or rebutting the Veteran’s assertions of overseas active duty or active duty for training from September 1, 1992, to July 1, 1994, and requesting/receiving any post-service medical records identified by the Veteran, the RO should obtain clarifying addendum medical opinions from the doctor who conducted the February 2015 Gulf War General Medical Examination DBQ and February 2015 fibromyalgia DBQ in regards to the deficiencies discussed in the body of this remand. (Continued on the next page)   A detailed rationale should be provided for all opinions given. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Talpins, Patricia