Citation Nr: 20003829 Decision Date: 01/16/20 Archive Date: 01/15/20 DOCKET NO. 19-03 332A DATE: January 16, 2020 REMANDED Entitlement to service connection for a disability manifested by fatigue, claimed as chronic fatigue syndrome (CFS), to include as due to an undiagnosed illness or medically unexplained chronic multisymptom illness (MUCMI), is remanded. REASONS FOR REMAND The Veteran served in the U.S. Army Reserves. He had periods of active duty from January 1990 to May 1990, and from December 1990 to July 1991. The Veteran is a Persian Gulf War veteran as he served in Southwest Asia, specifically in Kuwait and Saudi Arabia, as a Petroleum Supply Specialist between February 1991 and June 1991. This matter comes before the Board of Veterans Appeals (Board) on appeal from an August 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for chronic fatigue syndrome is remanded. The Veteran contends that he has a disability manifested by fatigue, claimed as CFS. He theorizes that it is related to his Gulf War service, and possibly anti-nerve agent pills; or insecticides/pesticides sprayed in Kuwait; or having oil rained on him for many days; or spray painting vehicles with “CARC paint.” See Correspondence (February 2016). In support of his claim, the Veteran submitted a buddy statement from a fellow soldier who reported that he and the Veteran had worked with equipment exposed to sarin and mustard gas; were exposed to oil fires without oxygen masks; and lived in the area constantly sprayed with pesticides and insecticides. See Buddy/Lay Statement (December 2001). To ensure that VA has met its duty to assist, remand is necessary for the following reasons. First, service treatment records (STRs) are incomplete. Although the record shows that the RO requested STRs from the Veteran and National Personnel Records Center (NPRC), the record reflects that NPRC provided only service personnel records. The record reflects no request from the Veteran’s Reserves unit or other potential repositories. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). Second, a VA medical opinion has not been obtained addressing whether the Veteran, a Gulf War veteran, has CFS attributable to his active duty service, to include environmental factors; or whether the Veteran has he has a disability manifested by fatigue that is a disability consistent with (1) an undiagnosed illness; (2) a diagnosable but medically unexplained chronic multisymptom illness; (3) a diagnosable chronic multisymptom illness with a partially explained etiology and pathophysiology; or (4) a disease with a clear and specific diagnosis, etiology, and pathophysiology. See Stewart v. Wilkie, 30 Vet. App. 383 (2018). Third, a VA medical opinion has not been obtained to address whether the Veteran has a disability manifested by fatigue that is at least as likely as not secondary to service-connected disability. It is noted that a November 1999 private treatment note reflects complaints of fatigue; that, in May 2001, the Veteran underwent a brain MRI due to symptoms of fatigue; and that a February 2016 VA treatment note suggested a possible link between the Veteran’s symptoms of fatigue and his service-connected sleep apnea. See CAPRI (July 2016). The matter is REMANDED for the following action: 1. Obtain the Veteran’s complete STRs. Document all requests and responses from official sources/repositories in the claims file along with a request to the Reserves unit. Contact the Veteran is further information is required. If records are unavailable, a formal finding of unavailability outlining the documented efforts taken should be prepared and associated with the claims file. 2. Obtain the Veteran’s complete VA treatment records dated prior to March 2015 and from November 2019 to the Present. 3. Ask the Veteran to complete a VA Form 21-4142 for all non-VA medical providers seen for his symptoms of fatigue. Make two requests for the authorized records from all identified sources, unless it is clear after the first request that a second request would be futile. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any disability manifested by fatigue. The examiner must opine on the following: (a.) whether it is at least as likely as not that the Veteran has a disability manifested by fatigue that had its onset in service or is otherwise related to in-service injury or disease to include environmental conditions in SWA; (b.) whether it is at least as likely as not that the Veteran has a disability manifested by fatigue that is (1) proximately due to service-connected disability, or (2) aggravated beyond its natural progression by service-connected disability. Consider specifically service-connected sleep apnea. (c.) Whether it is at least as likely as not that the Veteran’s symptoms of fatigue represent a disability pattern consistent with (1) an undiagnosed illness; (2) a diagnosable but medically unexplained chronic multisymptom illness; (3) a diagnosable chronic multisymptom illness with a partially explained etiology and pathophysiology; or (4) a disease with a clear and specific diagnosis, etiology, and pathophysiology. • The term medically unexplained chronic multisymptom illness means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. 5. Ensure that the VA medical opinion obtained includes a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. (COTINUED ON THE NEXT PAGE) 6. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. M. Pesin The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.