Citation Nr: 21002135 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 10-20 166 DATE: January 12, 2021 ORDER Entitlement to service connection for insomnia disorder is granted. Entitlement to service connection for chronic fatigue syndrome is denied. FINDINGS OF FACT 1. The Veteran did not serve in Southwest Asia during the Persian Gulf War. 2. The Veteran’s sleep disturbance (diagnosed as insomnia disorder) has been attributed to his service-connected gout of various joints. 3. The Veteran’s chronic fatigue is a symptom that has been attributed to his service-connected insomnia disorder and nonservice-connected sleep apnea. CONCLUSIONS OF LAW 1. The criteria for service connection for insomnia disorder are met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2019). 2. The criteria for service connection for chronic fatigue syndrome have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from September 1985 to September 1993. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an October 2009 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the Veteran’s claims for additional development in December 2013, June 2016, July 2018, and November 2019. The case has now been returned to the Board for further appellate action. Service Connection – Sleep Disturbance and Chronic Fatigue Syndrome The Veteran maintains that he has sleep disturbance and chronic fatigue syndrome related to Gulf War illness. Initially, the Board will address the applicability of the laws and regulations related to service connection for “undiagnosed illness” related to service in Southwest Asia during the Persian Gulf War. See 38 C.F.R. § 3.317. As noted, the Veteran served on active duty from September 1985 to September 1993. The Persian Gulf War period began on August 2, 1990. 38 C.F.R. § 3.2(i). The Board acknowledges that a February 2014 VA examiner remarked that “Service in SW Asia is confirmed, and the Veteran spent 116 days in country,” and that the Veteran has asserted such service. However, the Board does not find any such evidence in the Veteran’s personnel records and the evidence does not establish that he had service in Southwest Asia. The Veteran’s DD Form 214 shows 3 years, 2 months and 22 days of foreign service. However, no achievement or award on the Veteran’s DD Form 214, such as the Kuwait Liberation Medal indicates any service in Southwest Asia. Moreover, the Veteran’s personnel and treatment records show that the Veteran’s foreign service consisted of service in Bamberg, Germany. No personnel or treatment record documents any service in Southwest Asia. Under those circumstances, the Board concludes that the laws and regulations pertaining to service connection for “undiagnosed illness” for service in Southwest Asia are not applicable. VA treatment reports reflect that the Veteran denied unusual fatigue in March 2009, but reported that he got tired easily in June 2009. In March 2011, the Veteran reported that his pain affected his sleep. In September 2011, the Veteran reported sleep disturbance due to pain. In February 2012, he reported sleep disturbance at a mental health evaluation. In August 2017, he reported an inability to walk secondary to fatigue. During a March 2012 VA Gulf War examination, the Veteran reported fatigue. In April 2017, a VA addendum opinion was obtained from a VA clinician who reported that there was no evidence that the Veteran was treated for chronic fatigue syndrome or any other diagnosis similar to chronic fatigue syndrome or Gulf War Syndrome or Illness. During a January 2020 VA psychiatric examination, the Veteran was diagnosed with insomnia disorder. The examiner opined that the Veteran’s insomnia disorder was due to his service-connected gout of various joints which causes significant disruption in his ability to fall asleep and stay asleep (early awakening with difficulties returning to sleep). The examiner noted that the Veteran was unable to sustain sleep after prolonged fatigue. During a VA examination in April 2020, the examiner diagnosed the Veteran with sleep apnea based on the results of a polysomnography report. The examiner indicated that a diagnosis of chronic fatigue syndrome was not appropriate and indicated that the Veteran’s sleep disturbances are not related to gout but were due to severe obstructive sleep apnea. The examiner indicated that sleep apnea was less likely than not due to service. During an April 2020 VA chronic fatigue syndrome examination, the examiner indicated that a diagnosis of chronic fatigue syndrome was not appropriate. The examiner diagnosed sleep apnea and generalized gout disorder. The examiner indicated that the Veteran’s debilitating fatigue was due to sleep apnea. With regard to the claimed sleep disturbances, diagnosed as insomnia disorder, the evidence indicates that the Veteran’s insomnia disorder has been attributed to his service-connected gout of various joints. Therefore, the Board finds that service-connected is warranted for insomnia disorder. With regard to chronic fatigue syndrome, the Board has granted service connection for insomnia disorder which is manifested by an inability to sustain sleep after prolonged fatigue. The fatigue has also been attributed to nonservice-connected sleep apnea. The above evidence indicates that the Veteran’s symptoms of chronic fatigue are causally related to both his now service-connected insomnia disorder and to nonservice-connected sleep apnea and that he does not meet the criteria for a separate diagnosis of chronic fatigue syndrome. Therefore, service connection for chronic fatigue, as a separate disability, is not warranted. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Cryan, 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.