Citation Nr: 18161233 Decision Date: 12/31/18 Archive Date: 12/31/18 DOCKET NO. 17-05 785A DATE: December 31, 2018 REMANDED 1. Entitlement to service connection for a disability manifested by muscle pain and stiffness, to include as due to undiagnosed illness, is remanded. 2. Entitlement to service connection for headaches, to include as due to undiagnosed illness, is remanded. 3. Entitlement to service connection for chronic fatigue syndrome (CFS), or other disability manifested by fatigue, to include as due to undiagnosed illness associated with Persian Gulf service is remanded. 4. Entitlement to service connection for eczema is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from August 1989 to August 1992, including service in Southwest Asia. These matters are before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision. 1. Service connection for muscle pain and stiffness. The Veteran claims that he has a disability manifested by muscle pain related to his service in the Persian Gulf. On September 2016 VA examination for fibromyalgia, the examiner opined that the Veteran does not now have, and has not had. a diagnosis of fibromyalgia. The examiner also indicated that the Veteran has some signs and symptoms of fibromyalgia (including fatigue, sleep disturbances, headaches and depression) and has tender points in both knees. The examiner opined that lab tests suggest a possible diagnosis of systemic lupus erythematosus (and that the Veteran needed to be referred for further evaluation for such disability). Such referral does not appear to have taken place. It is not clear from the record whether the Veteran has a chronic disability (other than fibromyalgia) manifested by muscle pain. Another examination to determine whether he has such disability, and if so its etiology, is necessary. 2. Service connection for headaches. The Veteran contends that he has a headache disability related to his service in the Persian Gulf. On September 2016 VA examination, the examiner opined that the Veteran does not now have, and has not had, a diagnosis of a headache condition. However, the examiner further indicated that the Veteran has symptoms of headache pain which include pulsating and throbbing head pain, and pain localized on one side of the head in the left occiputal-parietal area. Considering the apparently conflicting opinions on September 2016 VA examination, a new medical examination to determine if the Veteran has a chronic headache disability and if so its nature and etiology is necessary. 3. Service connection for CFS. The Veteran asserts that he has daily fatigue and night terrors (See statement from May 2015). It is not clear from the record whether his symptoms are manifestations of his service-connected PTSD, or reflect a separate disability. A September 2016 VA examiner indicated that the Veteran has constant symptoms related to CFS which restrict his routine daily activities. The examiner also opined that the Veteran does not now have and has not had, a diagnosis of CFS. Considering the apparently conflicting findings/opinions on September 2016 VA examination, another examination to resolve the medical questions remaining in this matter is necessary. 4. Service connection for eczema. The Veteran also claims that he has a skin disorder (claimed as a rash) acquired during service in the Persian Gulf. His service treatment records (STRs) do not note any complaints pertaining to a skin disability/skin rashes. On June 2014 dermatology consult he reported that in 1998 he was seen at the Bronx VAMC dermatology clinic for a rash that was treated with a cream, (which did not help). Records of such treatment are not in the Veteran’s claims file and do not appear to have been specifically sought. VA treatment records are constructively of record. On September 2016 VA examination, eczema was diagnosed. The examiner did not opine whether it is related to the Veteran’s service/identify its likely etiology. An examination to confirm the nature, and ascertain the likely etiology, of the Veteran’s skin disability is necessary. The matters are REMANDED for the following: 1. Arrange for a search for the records of the Veteran’s reported treatment for a skin disability at the Bronx VAMC in 1998, and secure them for the record. If they cannot be located, the scope of the search should be noted in the record. 2. Arrange for the Veteran to be examined by an appropriate physician to determine whether he has a diagnosis of fibromyalgia, CFS (or other chronic disability manifested by fatigue and/or joint pain). The Veteran’s claims file must be reviewed by the examiner in conjunction with the examination. On examination of the Veteran and review of his claims file, the examiner should: (a) Indicate whether the Veteran has diagnoses of fibromyalgia and/or CFS, and identify the signs and symptoms that support any such diagnosis, or those necessary for such diagnoses found lacking. (b) If CFS is not found, does the Veteran have another diagnosed illness manifested by fatigue, or signs or symptoms of an undiagnosed illness manifested by chronic fatigue. (c) If fibromyalgia is not diagnosed, does the Veteran have a chronic (diagnosed or undiagnosed) illness manifested by muscle and/or joint pain. If such disorder is not diagnosed, reconcile that finding with the Veteran’s reports of muscle pain, and with the September 2016 VA examination report, which indicates he might have systemic lupus erythematosus. The examiner must include rationale with all opinions, citing to supporting factual data and/or medical literature, as deemed appropriate. 3. Also arrange for a neurological examination of the Veteran to determine if he has a chronic headache disorder, and if so its likely etiology. The claims file must be reviewed by the examiner in conjunction with the examination. On examination of the Veteran and review of his claims file the examiner should: (a) Indicate whether the Veteran has a chronic headache disorder. If not, reconcile that finding with reports of headaches noted in the record. (b) Identify the likely etiology for any headache condition diagnosed? Specifically, is it at least as likely as not (a 50% or greater probability) that it is directly related to (was incurred during) his active duty service? (c) If a diagnosed headache disorder is determined to not have been incurred in service, identify the likely etiology for the headache disability. The examiner must include rationale with all opinions, citing to supporting factual data and/or medical literature, as deemed appropriate. 4. Also arrange for a skin disorders examination of the Veteran to ascertain whether he has a chronic skin disability (manifested as skin rash), and if so, whether such disability is related to his service. The entire record, to include this remand, must be reviewed by the examiner. The examiner should provide opinions that respond to the following: (a) Identify (by diagnosis) each skin disorder found (or shown by the record during the pendency of the instant claim). If a skin disorder is not diagnosed, reconcile that finding with the report of the September 2016 VA examination which found the Veteran has eczema. (b) Identify the likely etiology for each skin disability entity diagnosed. Is it at least as likely as not (i.e. a 50% probability or greater) that it is related to an event (exposure), injury, or disease in service? (c) If a diagnosed skin disorder is found to be unrelated to service, identify the etiology considered more likely. The examiner should include rationale with all opinions, citing to supporting factual data and/or medical literature, as deemed appropriate. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Robert Cordingley, Associate Counsel