Citation Nr: 21003181 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 11-14 927A DATE: January 19, 2021 ORDER Entitlement to service connection for generalized anxiety disorder and unspecified depressive disorder (claimed as undiagnosed illness related to service in the Persian Gulf) is granted. Entitlement to service connection for fibromyalgia (claimed as undiagnosed illness related to service in the Persian Gulf) is granted. Entitlement to service connection for chronic fatigue syndrome (claimed as undiagnosed illness related to service in the Persian Gulf) is granted. FINDINGS OF FACT 1. The Veteran’s diagnosed generalized anxiety disorder and unspecified depressive disorder are related to service in the Gulf War. 2. The Veteran manifests chronic fatigue syndrome and fibromyalgia. CONCLUSIONS OF LAW The criteria for service connection for generalized anxiety disorder and unspecified depressive disorder have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. § 3.303 (2020). The criteria for service connection for generalized anxiety disorder and unspecified depressive disorder have been met. 38 U.S.C. §§ 1110, 1117, 5107 (2012); 38 C.F.R. § 3.317 (2020). The criteria for service connection for chronic fatigue syndrome have been met. 38 U.S.C. §§ 1110, 1117, 5107 (2012); 38 C.F.R. § 3.317 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had a period of active duty for training from February 1988 to July 1988 and served on active duty from September 1990 to June 1991; in September 2001; in December 2001; and from June 2002 to October 2002. He also served in the National Guard. He served in the Persian Gulf from September 1990 to June 1991 and from June 2002 to October 2002. Therefore, he is considered a Persian Gulf veteran. 38 C.F.R. § 3.317(e). 1. Entitlement to service connection for generalized anxiety disorder and unspecified depressive disorder (claimed as undiagnosed illness related to service in the Persian Gulf). 2. Entitlement to service connection for fibromyalgia (claimed as undiagnosed illness related to service in the Persian Gulf). 3. Entitlement to service connection for chronic fatigue syndrome (claimed as undiagnosed illness related to service in the Persian Gulf). The Veteran has appealed a claim to the Board vaguely stylized as undiagnosed illness related to service in the Persian Gulf. As a general matter, service connection for chronic, undiagnosed illness (or a medically unexplained chronic multi-symptom illness such as fibromyalgia, chronic fatigue syndrome, or functional gastrointestinal disorders) arising from service in Southwest Asia during the Gulf War may be established under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317. For purposes of § 3.317, “objective indications of chronic disability” include both “signs,” in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). For purposes of § 3.317(a)(1), signs or symptoms which may be manifestations of undiagnosed illness or medically unexplained chronic multi-symptom illness include, but are not limited to: fatigue; signs or symptoms involving skin, headache, muscle pain, joint pain, neurological signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system, sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. 38 C.F.R. § 3.317(b). In pursuit of this claim, the Veteran has presented an October 2019 private medical statement diagnosing him with chronic fatigue syndrome with symptoms that include recurring episodes of depression, short-term memory deficit, episodes of cervical lymphadenopathy, overwhelming fatigue, arthralgias and recurring headaches. A November 2019 VA examiner diagnosed fibromyalgia and chronic fatigue syndrome. A March 2020 VA examiner found that the Veteran’s behavioral health symptoms were not caused by an undiagnosed illness or medically unexplained chronic multi-symptom illness but rather separately identified diagnoses of generalized anxiety disorder and unspecified depressive disorder related to his deployment in the Gulf War. The most recent Supplemental Statement of the Case (SSOC) dated August 2020 focused on whether the symptoms of anxiety, insomnia and fatigue were symptoms of undiagnosed illness, medically unexplained chronic multi-symptom illness, fibromyalgia or chronic fatigue syndrome. The Agency of Original Jurisdiction (AOJ) noted that symptoms of anxiety and insomnia had been linked to diagnosed generalized anxiety disorder and unspecified depressive disorder. The AOJ found no current diagnoses of fibromyalgia and chronic fatigue syndrome. When a claimant makes a claim, he/she is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. Clemons v. Shinseki, 23 Vet. App. 1 (2009). In Clemons, the United States Court of Appeals for Veterans Claims (CAVC) held that “multiple medical diagnoses or diagnoses that differ from the claimed condition do not necessarily represent wholly separate claims,” and that because a lay claimant is only competent to report symptoms and not diagnoses, VA must consider the claim for disabilities reasonably raised by the description of the claimant’s symptoms. Clemons, 23 Vet. App. at 6-7. In the context of this record, the Board finds that the Veteran’s generalized claim of service connection claim for undiagnosed illness, when considering the medical opinions describing the medical etiology for those symptoms, has reasonably raised service connection claims for the diagnoses of generalized anxiety disorder and unspecified depressive disorder, fibromyalgia and chronic fatigue syndrome as part of the undiagnosed illness claim on appeal. With respect to the diagnoses of generalized anxiety disorder and unspecified depressive disorder, the available treatment records reflect a prescription of Lexapro for depression as early as January 2004. An August 2017 opinion from a VA Director of Occupational Health stated that the Veteran manifested a generalized anxiety disorder for which there was a sufficient association between Gulf War deployment. A March 2020 VA psychologist found that the Veteran’s behavioral health symptoms were not caused by an undiagnosed illness or medically unexplained chronic multi-symptom illness, but rather generalized anxiety disorder which was at least as likely as not caused by in-service behavioral health stressors and experiences during the Gulf War. Thus, there is sufficient evidentiary support to find that the Veteran’s diagnosed generalized anxiety disorder and unspecified depressive disorder are related to service in the Gulf War. Thus, service connection on a direct basis is warranted. 38 C.F.R. § 3.303. See Wise v. Shinseki, 26 Vet. App. 517, 531 (2014) (“By requiring only an ‘approximate balance of positive and negative evidence’..., the nation, ‘in recognition of our debt to our veterans,’ has ‘taken upon itself the risk of error’ in awarding... benefits.”) With respect to the diagnoses of fibromyalgia and chronic fatigue syndrome, there is evidence for and against such diagnoses. A November 2016 private medical statement noted treatment for hypertension, anxiety, hyperlipidemia, insomnia, thyroid nodule, obstructive sleep apnea, headaches, cervicalgia and erectile dysfunction several of which fulfilled criteria for Gulf War Syndrome and more likely than not were caused by active duty. An October 2019 private medical opinion diagnosed the Veteran with chronic fatigue syndrome manifested by symptoms of recurring episodes of depression, short-term memory deficit, episodes of tender cervical lymphadenopathy, overwhelming fatigue, arthralgias and recurring headaches. A November 2019 VA examination offered diagnoses of both fibromyalgia and chronic fatigue syndrome. However, the AOJ sought another opinion in November 2019 which opined that there was no confirmed diagnosis of fibromyalgia or chronic fatigue syndrome in the medical record, and that further testing was required to rule out other medical conditions producing the symptoms. The Board notes that the private medical opinion offered a diagnosis of chronic fatigue syndrome which was not discussed. As such, the opinion is not based on a full review of the record. Furthermore, the examiner indicated that further testing was required to confirm diagnoses of chronic fatigue syndrome and fibromyalgia, but such examinations were not scheduled. As such, this examination report is inadequate. Jones (Michael) v. Shinseki, 23 Vet. App. 382, 390 (2010). In light of the above, the Board finds sufficient evidence of record that the Veteran manifests both chronic fatigue syndrome and fibromyalgia which are deemed presumptive diseases for Persian Gulf Service. 38 U.S.C. § 1117 and 38 C.F.R. § 3.317. Thus, service connection is warranted for chronic fatigue syndrome and fibromyalgia. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Patrick C. Brady, 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.