Citation Nr: 20004846 Decision Date: 01/22/20 Archive Date: 01/21/20 DOCKET NO. 12-03 151 DATE: January 22, 2020 REMANDED Entitlement to service connection for chronic fatigue syndrome (CFS) is remanded. Entitlement to service connection for multiple joint pain, to include a bilateral hand disorder, is remanded. REASONS AND BASES FOR REMAND The Veteran served on active duty from August 1987 to August 1991 and March 1993 to July 1995, to include service in Southwest Asia during the Persian Gulf War. He is the recipient of numerous awards and decorations, to include the Combat Action Ribbon. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In October 2016, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In June 2017, the Board remanded the claims on appeal, as well as a claim for service connection for a skin disorder. While on remand, a June 2018 rating decision granted service connection for tinea versicolor. As such represents a full grant of the benefits sought with respect to the issue of entitlement to service connection for a skin disorder, it is no longer before the Board. Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). Additionally, with regard to the Veteran’s claim for service connection for multiple joint pain, to include a bilateral hand disorder, a February 2019 rating decision awarded service connection for right lateral epicondylitis (elbow), left trochanteric (hip) pain syndrome, and right trochanteric (hip) pain syndrome, which the Agency of Original Jurisdiction (AOJ) appears to have concluded was a full grant of benefits sought on appeal with regard to such claim. However, as noted in the June 2017 remand, the Veteran had documented joint pain involving his hands, elbows, shoulders, and knees. Consequently, as such award does not include his hands, left elbow, shoulders, or knees, it is not a full grant of the benefit sought on appeal. Consequently, such remains on appeal and it, as well as the claim for service connection for CFS, now returns to the Board for further appellate review. REASONS FOR REMAND 1. Entitlement to service connection for multiple joint pain, to include a bilateral hand disorder. 2. Entitlement to service connection for CFS. As noted in the June 2017 remand, the Veteran has documented joint pain involving his hands, left elbow, shoulders, and knees, fatigue, and trouble sleeping, which he claims are related to his military service, to include as due to an undiagnosed illness or medically unexplained chronic multisymptom illness, to include CFS. In this regard, his service treatment records reflect complaints of joint pain, fatigue, and trouble sleeping in a March 1995 Persian Gulf Illness Screen and a May 1995 Report of Medical History, an indication of diffuse arthralgias with an unclear etiology noted in a March 1995 consultation, and an abnormal clinical evaluation of the upper extremities involving range of motion of the bilateral shoulders, knees, and elbows in a May 1995 Report of Physical Examination. However, August 2010 and October 2017 VA examinations revealed that the Veteran did not have diagnoses of bilateral hand, left elbow, bilateral shoulder, and bilateral knee disorders and his subjective complaints of pain did not result in any functional impairment. Similarly, August 2010 and October 2017 VA examinations likewise failed to reveal a diagnosis of CFS and, in a May 2019 addendum, a VA examiner found that the Veteran’s fatigue was due to normal life stressors and long hours at work. However, despite the Board’s directive for the examiner to address whether the Veteran’s joint pain and chronic fatigue were objective indications of a chronic disability resulting from an undiagnosed illness or representative of a “medically unexplained chronic multi-symptom illness,” such opinion was not provided. Therefore, a remand is necessary in order to obtain an addendum opinion addressing such inquiries. Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: Return the record to the October 2017/May 2019 VA examiner. The record and a copy of this Remand must be made available to the examiner. If the October 2017/May 2019 VA examiner is not available, the record should be provided to an appropriate medical professional so as to render the requested opinion. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. Following a review of the record, the examiner should address the following inquiries: (A) As the Veteran’s symptoms of multiple joint pain, to include of the bilateral hands, left elbow, bilateral shoulders, and bilateral knees, and chronic fatigue have not been associated with a known clinical diagnosis, the examiner should indicate whether he has objective indications of a chronic disability resulting from an undiagnosed illness, as established by history, physical examination, and laboratory tests, that has either (1) existed for 6 months or more, or (2) exhibited intermittent episodes of improvement and worsening over a 6-month period. (B) The examiner should offer an opinion as to whether it is at least as likely as not that the Veteran’s symptoms of multiple joint pain, to include bilateral hands, left elbow, bilateral shoulders, and bilateral knees, and/or chronic fatigue represent a “medically unexplained chronic multi-symptom illness.” Such is defined as 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. In offering such opinions, the examiner should consider the Veteran’s in-service complaints of joint pain, fatigue, and trouble sleeping in a March 1995 Persian Gulf Illness Screen and a May 1995 Report of Medical History; an indication of diffuse arthralgias with an unclear etiology noted in a March 1995 consultation; an abnormal clinical evaluation of the upper extremities involving range of motion of the bilateral shoulders, knees, and elbows in a May 1995 Report of Physical Examination; and his report that he experienced multiple joint pain and chronic fatigue since his military service. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. M. Kelly, Associate Counsel 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.