Citation Nr: 18161108 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 16-49 977 DATE: December 28, 2018 REMANDED Entitlement to service connection for chronic fatigue syndrome, claimed as chronic-multisystem illness, is remanded. Entitlement to service connection for fibromyalgia, claimed as chronic-multisystem illness, is remanded. Entitlement to service connection for irritable bowel syndrome (IBS), claimed as functional GI disorders and chronic-multisystem illness, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1990 to October 1999, including service in Saudi Arabia. In July 2017, the Veteran and his spouse testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. 1. Entitlement to service connection for chronic fatigue syndrome, claimed as chronic-multisystem illness, is remanded. 2. Entitlement to service connection for fibromyalgia, claimed as chronic-multisystem illness, is remanded. 3. Entitlement to service connection for IBS, claimed as functional GI disorders and chronic-multisystem illness, is remanded. The Board finds that additional development is needed prior to final adjudication of the issues on appeal. Specifically, the Board finds that a new VA examination is needed. At the hearing, the Veteran’s attorney requested a new examination and the Board agrees that a new examination is needed. An April 2014 VA examination report noted no diagnosis of chronic fatigue syndrome, although it did indicate that the Veteran takes continuous medication and he has findings, signs, and symptoms attributable to chronic fatigue. The April 2014 VA examiner also indicated a diagnosis of fibromyalgia and IBS, but stated that it was less likely than not that these disabilities were incurred in or caused by an in-service injury, event, or illness. Following the April 2014 examination, a June 2014 VA opinion was issued refuting the diagnoses of fibromyalgia and IBS. The examiner wrote that the IBS diagnosis was based on the subjective history provided by the Veteran and ignored the fact that 14 years of VA providers had not reached an IBS diagnosis and that the Veteran already had specific GI diagnoses to explain his GI complaints. Similarly, the examiner argued that the fibromyalgia diagnosis was without merit. The Board finds that given these contradictory opinions, a new examination is warranted. In addition, there was some indication by the April 2014 VA examiner that the Veteran’s IBS was aggravated by service. However, it is not clear to the Board that the IBS pre-existed service. Indeed, nothing regarding IBS is indicated in his January 1990 entrance examination. Accordingly, upon remand, the Board seeks clarification of whether IBS pre-existed service. The matters are REMANDED for the following action: 1. After securing any necessary consent forms from the Veteran, obtain any outstanding treatment records, to include any VA and/or private treatment records, pertaining to the issues on appeal. All efforts to obtain these records should be documented in the claim file. If any records could not be obtained, this should be noted in the claim file. 2. Upon completion of the above, schedule the Veteran for a VA examination with a new VA examiner to address the etiology of the claimed disabilities on appeal. The examiner is asked to examine and evaluate the Veteran for any chronic disability pattern. The examiner is then asked to provide a medical statement explaining whether the Veteran’s disability pattern is (a) an undiagnosed illness; (b) a diagnosable, but medically unexplained chronic multisymptom illness of unknown etiology, such as chronic fatigue syndrome, fibromyalgia, or functional gastrointestinal disorders; (c) a diagnosable chronic multisymptom illness with a partially explained etiology; or (d) a disease with a clear and specific etiology and diagnosis. For each disability pattern or diagnosed disease, the examiner is asked to address whether it is at least as likely as not (i.e., a 50 percent or greater probability) that it was caused by the Veteran’s active duty service or, if preexisting service, was aggravated therein. The Board specifically requests that the examiner address the April 2014 VA examination and June 2014 VA opinion, as well as address the contention that the Veteran’s IBS pre-existed service. For all examinations, all necessary development should be taken. The VA examiner should be given access to the claim file. The examiner should state that a review of the claim file was completed. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. A detailed rationale is requested for all opinions provided. 3. If upon completion of the above action the issues are denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Foster, Associate Counsel