Citation Nr: 20006594 Decision Date: 01/27/20 Archive Date: 01/27/20 DOCKET NO. 07-30 067 DATE: January 27, 2020 REMANDED Entitlement to service connection for fibromyalgia is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served in the United States Army Reserves from 1981 to approximately 1997 and had verified active military service from October 1990 to July 1991. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a December 2006 rating decision by the Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran presented testimony at a Board hearing in June 2014. A transcript of the hearing is associated with the Veteran’s claims folder. The case was previously before the Board in August 2014, at which time the claims for entitlement to service connection for fibromyalgia and a TDIU were remanded to the RO for further adjudication. In February 2018 the claims were returned to the Board, at which time the claims were denied. The Veteran appealed the Board’s denial of her claims to the United States Court of Appeals for Veterans Claims (Court). In September 2018 the Court granted a Joint Motion for Remand (JMR), vacating the Board’s decision. Subsequently, the claim was remanded to the Board for further adjudication in compliance with the orders set out in the JMR. In June 2019 the Board remanded the claims to the RO for further development. The issues are now returned to the Board. 1. Entitlement to service connection for fibromyalgia is remanded. In the Board’s June 2019 decision, a claim for entitlement to service connection for fibromyalgia was remanded so that a VA examiner could opine on whether the Veteran’s in-service treatment for fibrositis was related to her current diagnosis of fibromyalgia. In July 2019, in compliance with the Board’s remand instructions, the Veteran was afforded a VA fibromyalgia examination wherein the examiner explained the differences between fibrositis and fibromyalgia. The examiner indicated that fibromyalgia is a disorder associated with abnormalities within the pain processing areas of the brain, while fibrositis is inflammation of the fibrous tissue that surrounds muscles. The examiner noted that the disorders cause similar symptoms, but indicated that there is no identifiable inflammation in patients with fibromyalgia. The examiner conceded, however, that while the disorders are physiologically different, fibrositis was previously used to describe fibromyalgia. (7/29/2019, C&P Exam, p. 5). After describing the differences between fibrositis and fibromyalgia, the examiner opined that the Veteran’s symptoms during service were not representative of fibromyalgia as “[t]he remand letter notation of the claimant’s symptoms during service do not describe widespread musculoskeletal symptoms that wax and wane over time, nor are trigger point pain locations noted.” (7/29/2019, C&P Exam, p. 5). The Board finds that the July 2019 examination is inadequate. In this regard, the examiner indicated that fibrositis was previously used to describe fibromyalgia, but provided no information on what point in time the terms ceased to be synonymous. Further, the examiner indicated that the Board’s remand letter did not describe symptoms representative of fibromyalgia during service. The examiner’s reliance on the Board’s remand letter to describe in-service symptoms suggest that the examiner failed to review and consider the Veteran’s service treatment records. A review of the Veteran’s service treatment records does in fact reveal evidence of widespread musculoskeletal symptoms. In December 1990 she complained of “body aches all over.” The examiner indicated that she had a history of cataplexy and fibrositis. (9/21/2015, STR – Medical, p. 45). In April 1991 the Veteran was placed on a physical profile for left elbow and right ankle pain. (9/21/2015, STR – Medical, p. 27). In June 1991 she complained of tight hamstrings and abdominal weakness. (9/21/2015, STR – Medical, p. 2). In February 1992 she was placed on a physical profile for bilateral tennis elbow. (9/21/2015, STR – Medical, p. 12). As the examiner failed to fully consider the Veteran’s service treatment records and did not provide sufficient details on the differences between fibrositis and fibromyalgia, the Board finds that the opinion is inadequate. Therefore, an addendum opinion is needed. 2. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. Because a decision on the remanded issue of entitlement to service connection for fibromyalgia could significantly impact a decision on the issue of entitlement to a TDIU, the issues are inextricably intertwined. Thus, a remand of the claim for entitlement to a TDIU is required. The matters are REMANDED for the following action: 1. The AOJ should obtain copies of VA treatment records for the Veteran’s disabilities from December 2019 to the present. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s fibromyalgia is at least as likely as not related to an in-service injury, event, or disease. In rendering an opinion, the examiner should address the following: (a.) The Veteran’s in-service treatment for fibrositis. (b.) The July 2019 examiner’s statement that fibrositis was previously used to describe fibromyalgia. (Continued on the next page)   (c.) The Veteran’s in-service history of widespread musculoskeletal symptoms, including a December 1990 complaint of “body aches all over;” an April 1991 complaint of left elbow and right ankle pain; June 1991 complaint of muscular weakness and tight hamstrings and abdominal weakness; and a February 1992 complaint of bilateral tennis elbow. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to a TDIU. If the benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and her representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Glenn, 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.