Citation Nr: 21001498 Decision Date: 01/08/21 Archive Date: 01/08/21 DOCKET NO. 17-09 287 DATE: January 8, 2021 REMAND Entitlement to service connection for a disability manifested by chronic fatigue, to include chronic fatigue syndrome, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Marine Corps from June 1983 to December 2004, including service in the Southwest Asia theater of operations. This matter comes before the Board of Veterans’ Appeals (Board) from a September 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which denied service connection for chronic fatigue syndrome, claimed as chronic fatigue due to Gulf War exposure. The Veteran filed a timely notice of disagreement, received by VA in December 2016. In January 2017, the RO issued a statement of the case. The Veteran’s substantive appeal was received by VA in February 2017. In June 2020, the Veteran testified at a telehearing before the undersigned. A transcript is of record. 1. Entitlement to service connection for a disability manifested by chronic fatigue, to include chronic fatigue syndrome. The Veteran contends that he has experienced symptoms of chronic fatigue since his active service in the Southwest Asia theater of operations. In connection with his claim, the Veteran was afforded a VA medical examination in July 2016 at which his complaints included fatigue, multiple joint pains, and sore muscles since the Gulf War. He reported that his fatigue had been so significant that he had quit working in November 2014 as he had been unable to stay awake at work. He also reported becoming tired and having to frequently lay down with activities. He indicated that he had not undergone any testing to rule out other causes for his symptoms and had not been evaluated by a Rheumatologist. After reviewing the record and examining the Veteran, the examiner concluded that the Veteran did not meet the criteria for a diagnosis of chronic fatigue syndrome. The examiner, however, noted that the Veteran had a history of fibromyalgia “which has a component of fatigue which can cause similar symptoms.” Unfortunately, however, the examiner failed to provide any additional comment. After considering the record on appeal in light of the applicable legal criteria, the Board finds that a remand is necessary for further development of the claim. The evidence of record establishes that the Veteran has qualifying service in the Southwest Asia theater of operations. 38 C.F.R. § 3.317(e). In addition, the July 2016 VA medical examination report suggests that the Veteran’s chronic fatigue may be due to fibromyalgia, a medically unexplained chronic multisymptom illness (MUCMI) for which presumptive service connection is available. 38 C.F.R. § 3.317(2)(i)(B)(2). However, other than a February 2016 private gastroenterology treatment note reflecting a history of fibromyalgia, there are no private or VA treatment records reflecting a current diagnosis of fibromyalgia. The Board therefore finds that an examination is necessary to clarify the nature and etiology of the Veteran’s chronic fatigue, to include whether it is due to fibromyalgia. This matter is remanded for the following: 1. Schedule the Veteran for an examination to determine the nature and etiology of his chronic fatigue. The examiner must be provided access to the Veteran’s claims folder for review in connection with the examination. After reviewing the record, examining the Veteran, and performing all appropriate diagnostic testing, the examiner should then record all noted signs and reported symptoms, document all clinical findings, and provide a diagnosis if possible. The examiner is asked to provide responses to the following: A) By history, physical examination, or laboratory testing, can the Veteran’s chronic fatigue be attributed to a known clinical diagnosis? In reaching this determination, the examiner should consider the relevant evidence of record, to include the July 2016 VA medical examination report noting that the Veteran has a history of fibromyalgia “which has a component of fatigue which can cause similar symptoms.” B) If the Veteran’s chronic fatigue cannot be attributed to a known clinical diagnosis, is there affirmative evidence that the undiagnosed illness manifested by chronic fatigue was not incurred during active service during the Gulf War or that it was caused by a supervening condition or event that occurred since the Veteran’s departure from service during the Persian Gulf War? In reaching this decision, the examiner should review the relevant evidence of record, to include July 2004 service treatment records noting joint pain and fatigue, and August 2006 VA clinical records showing complaints of fatigue after the Gulf War. The examiner should note that a positive response to this question requires affirmative evidence. The mere absence of evidence is not sufficient. C) If the Veteran’s chronic fatigue can be attributed to a known clinical diagnosis, is the etiology of the Veteran’s condition (1) inconclusive, (2) partially understood, or (3) fully understood? This determination as to each must be based on the Veteran’s specific case and cannot be based on the etiology of the disease or disability population as a whole. D) If the Veteran’s chronic fatigue can be attributed to a known clinical diagnosis, is the pathophysiology of the Veteran’s condition (1) inconclusive, (2) partially understood, or (3) fully understood? This determination as to each must be based on the Veteran’s specific case and cannot be based on the pathophysiology of the disease or disability population as a whole. (Continued on the next page)   E) If both the etiology and pathophysiology are partially understood or fully understood, then is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s diagnosed condition was incurred in, or is otherwise related to, his active service? A complete rationale must be provided for all opinions expressed. K. Conner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Hillan Sosa, 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.