Citation Nr: 20005604 Decision Date: 01/23/20 Archive Date: 01/23/20 DOCKET NO. 19-18 263 DATE: January 23, 2020 REMANDED Entitlement to service connection for chronic fatigue syndrome, including as secondary to service-connected chronic headaches and major depressive disorder with anxious distress is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1994 to May 1998. This matter comes before the Board of Veterans’ Appeals (Board) from a July 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran contends that her chronic fatigue syndrome is secondary to her service-connected headaches and major depressive disorder. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. Service treatment records show that the Veteran sought treatment for body aches and malaise while in service. Post-service treatment records show that the Veteran complained of fatigue and was diagnosed with chronic fatigue syndrome in June 2018. The Veteran underwent a VA examination in May 2019. The examiner stated that chronic fatigue syndrome is a diagnosis of exclusion. That is, by definition, all other causes of fatigue must be ruled out before determining that a diagnosis of chronic fatigue syndrome is appropriate. Therefore, the Veteran’s chronic fatigue syndrome is less likely than not proximately due to or the result of major depressive disorder and migraine headaches. The VA examiner did not adequately discuss whether the Veteran’s service-connected disabilities aggravated (worsened) his claimed chronic fatigue syndrome. 38 C.F.R. § 3.310(b). Since this examination, the Veteran has submitted a medical article discussing the relationship between chronic fatigue and headaches and depression. She has also submitted lay statements discussing her symptoms in relation to her service-connected headaches and major depressive disorder. As this was not of record at the time of the VA examination, a new examination is needed so the VA examiner can provide an opinion considering the evidence that the Veteran has since submitted. The matters are REMANDED for the following actions: 1. Ask the Veteran to identify all outstanding treatment records relevant to treatment for chronic fatigue syndrome. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the Veteran of the unavailability of the records. 2. After records development is completed, the claims file should be sent to an appropriate examiner to offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the current chronic fatigue syndrome onset during service or is otherwise related to an in-service injury, event, or disease, to include her in-service complaints of body aches and malaise. The examiner should also address whether any current disability of chronic fatigue syndrome is at least as likely as not (a) caused by, or (b) aggravated by (worsened beyond natural progression) service-connected headaches and major depressive disorder. In offering the opinion, the examiner is asked to consider the medical article and lay statements that the Veteran has submitted since the last VA examination. The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. A. M. CLARK Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Shuster, Attorney Advisor 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.