Citation Nr: 18160750 Decision Date: 12/28/18 Archive Date: 12/27/18 DOCKET NO. 15-35 139 DATE: December 28, 2018 ORDER Entitlement to service connection for fibromyalgia is granted. FINDING OF FACT The Veteran has fibromyalgia that is related to her military service. CONCLUSION OF LAW Fibromyalgia was incurred in active service. 38 U.S.C. §§ 1101, 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1983 to November 2003. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge in August 2017. A transcript is of record. In September 2018, the Board requested a Veterans Health Administration (VHA) opinion regarding the issue on appeal, which was later received in November 2018. The VHA opinion is favorable to the Veteran. Accordingly, the Board finds that it can adjudicate the claim without providing the Veteran notice as required by 38 C.F.R. § 20.903, as there is no prejudice to the Veteran in light of the grant of the full benefits sought. Law and Analysis Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is entitled to service connection for fibromyalgia. The Veteran has claimed that her symptoms began in service, including burning and fatigue, but that she did not know that the condition was fibromyalgia at the time. Similarly, her representative has asserted that her condition was treated as general muscle fatigue, cramps, and pain and that her symptoms remained undiagnosed at the time. The Veteran has also asserted that the disorder is secondary to her service-connected cervical spine disability. She has stated that she was told that there was a possibility that her strained neck nerves affected her brain’s sensation of pain. See August 2017 hearing transcript. The Veteran’s service treatment records do not include a diagnosis of fibromyalgia. However, they do document various complaints and evaluations for pain and other symptoms, such as foot swelling in February 1989; treatment for patellofemoral pain syndrome in 1995 and 1996, including a March 1996 assessment of malicious malalignment syndrome and temporary profiles due to knee pain beginning in April 1996; polyarthritis of the hips in December 1998; chronic knee pain in June 1999; numbness in the legs in March 2003; sciatica in April 2003; lumbar radiculopathy in May 2003; and foot pain and swelling, retropatellar pain syndrome, knee pain and swelling, toe swelling, seronegative inflammatory arthritis, leg/hip piriformis muscle spasm, low back pain, upper back pain, and wrist pain in August 2003. Dr. F. (initials used to protect privacy) provided a September 2013 disability benefits questionnaire (DBQ) in which she stated that the Veteran’s fibromyalgia was more likely than not caused by her service-connected neck, tendon, and arthritic conditions. However, she did not provide any rationale for that opinion. A VA medical opinion was obtained March 2014 in connection with the claim. The examiner opined that it was not at least as likely as not that her fibromyalgia was caused by or aggravated by her service-connected cervical strain. However, the examiner’s rationale was unclear and inadequate. She simply stated that there was no information in the file regarding outside rheumatology evaluation and explained that fibromyalgia is systemic chronic pain disorder felt to be mediated by impaired pain receptors and also genetically mediated. The examiner also did not provide an opinion regarding direct service connection. In April 2014, a VA examiner opined that the claimed condition is less likely than not proximately due to or the result of the Veteran’s service-connected disability. He explained that fibromyalgia is considered to be due to or affect the way the brain perceives pain. Thus, the change occurs in the brain. The examiner indicated that a cervical strain is not known to cause the brain to alter the way it perceives pain. He also opined that it was not at least as likely as not that the Veteran’s fibromyalgia was aggravated beyond its natural progression by the cervical strain, as a cervical strain is not known to aggravate the way that the brain perceives pain. However, the examiner did not address whether the disorder could be directly related to the Veteran’s military service, including any symptomatology therein. The Veteran submitted an August 2017 private medical opinion in which M.E.D., a physician assistant, stated that she agreed with the assessment that the Veteran’s cervical spine condition was a likely initiating factor for her fibromyalgia. She also cited to medical literature. However, despite her noting a study indicating that fibromyalgia was 13 more times frequent following a neck injury than following a lower extremity injury, she did not address whether there is actual causation or aggravation, which is particularly significant given the April 2014 VA medical opinion explaining that the spine does not affect the brain. As previously noted, the Board requested a VHA medical opinion in September 2018 to specifically address direct and secondary service connection. In November 2018, a VHA physician provided a medical opinion in response to a request by the Board. In pertinent part, the examiner opined that it is at least as likely as not that the Veteran currently has fibromyalgia that manifested during her military service. In this regard, he stated that it is likely that her fibromyalgia symptoms started during her military service and that there was a delay in the diagnosis of this condition. In light of the Veteran’s reports that she has had continuous symptoms associated with fibromyalgia since service, the service treatment records reflecting symptomology, and the favorable opinion from the November 2018 VHA examiner, the Board finds that the Veteran has current fibromyalgia that is related t her military service. Notably, the prior VA examiners did not address direct service connection. Accordingly, the Board concludes that service connection is warranted for fibromyalgia. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Kuczynski