Citation Nr: 21004953 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 14-28 940A DATE: January 28, 2021 REMANDED Entitlement to service connection for chronic fatigue, to include as a component of an undiagnosed illness associated with service in Southwest Asia is remanded. Entitlement to service connection for a chronic joint condition, to include as a component of an undiagnosed illness associated with service in Southwest Asia is remanded. Entitlement to service connection for a psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1989 to March 1991. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). These matters were before the Board in May 2018, at which time they were remanded for development. They have been returned to the Board for appellate review. 1. The claims for entitlement to service connection for chronic fatigue and a chronic joint condition, to include as components of an undiagnosed illness associated with service in Southwest Asia, are remanded. Although it regrets the additional delay, the Board finds it necessary to remand the Veteran’s claims in order to afford him adequate VA examinations and medical opinions as to etiology. With respect to his claims for service connection for chronic fatigue and for a chronic joint condition, manifested chiefly as knee and ankle pain, the Board notes that the January 2020 VA medical examination yielded the opinions that the Veteran is beset by neither chronic fatigue syndrome, nor any diagnosable joint condition which might account for his symptoms, including fibromyalgia, and that the former may constitute a component of the Veteran’s diagnosed psychiatric disorder. These statements are not reconciled with the finding that the Veteran’s undiagnosed conditions are less likely than not components of an undiagnosed illness associated with service in the Southwest Asia theater of operations during the Persian Gulf War. On remand, new VA examinations must be conducted and clarity obtained as to whether the Veteran’s chronic fatigue and chronic joint pain, complaints with respect to both of which are found in plenty in VA medical treatment records, are attributable to a diagnosable medical condition, or if not, whether they constitute components of an undiagnosed illness associated with Southwest Asia service. If both questions are answered in the negative, the examiner must reconcile those assessments and explain them fully. 2. Entitlement to service connection for an acquired psychiatric disorder is remanded. The Board finds the opinion with respect to etiology rendered by the January 2020 VA psychiatric examiner inadequate. The examiner indicates that the absence of in-service mental health complaints or treatment, coupled with the emergence of the Veteran’s depression “years after his discharge,” which she attributes to “life circumstances, medical problems, substance abuse, and poor choices,” convinces her that the Veteran’s current depressive disorder is less likely than not service-related. However, the Board notes that the examiner herself concedes that the Veteran’s depression diagnosis has been warranted at least since 1993, that he has used prescription psychotropic medications “long-term,” and that his condition may owe, at least in part, to “medical problems,” to include, ostensibly, those herein on appeal, and those for which he is already service-connected, including neurodermatitis and irritable bowel syndrome. Critically, the Veteran separated from active duty service in 1991; thus, the Board finds the examiner’s emphasis on the gulf of time between separation and diagnosis in rendering her assessment problematic. To be clear, the Veteran has never explicitly conceded that he was free of psychiatric malaise during service or prior to 1993. Rather, the examiner has conceded that depression has been present since at least that date. On remand, a new VA psychiatric examination must be conducted, and an expert medical opinion as to etiology obtained, to include whether a diagnosed mental condition began in service or is otherwise related thereto, or whether it has been caused or aggravated beyond its normal course of progression by a service-connected condition. The matters are REMANDED for the following action: 1. After obtaining the necessary authorization, update the record with any as yet unsecured VA and/or private medical records relevant to the Veteran’s claims. 2. Then, schedule the Veteran for a VA examination to explore the etiology of his claimed joint disorder. All indicated tests and studies should be conducted and all clinical findings reported in detail. The entire claims file should be made available to and be reviewed by the examiner in conjunction with this request.     Please identify all current chronic joint disabilities. For each identified disability, the examiner should state whether it is at least as likely as not (e.g. at least a 50 percent probability or greater) that the condition began in service or is otherwise related to service. If no such diagnosis is appropriate, the examiner should opine as to whether the Veteran’s joint-related symptoms, including knee and ankle pain, constitute components of an undiagnosed multisymptom illness associated with service in the Southwest Asia theater of operations during the Persian Gulf War. In addressing the above opinions, the examiner should consider the Veteran’s lay statements regarding onset of symptomatology and any continuity of symptomatology since onset and/or since discharge from service. The examiner should also consider any other pertinent evidence of record, as appropriate. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. 3. Schedule the Veteran for a VA examination to explore the etiology of his claimed chronic fatigue. All indicated tests and studies should be conducted and all clinical findings reported in detail. The entire claims file should be made available to and be reviewed by the examiner in conjunction with this request.     Please identify whether the Veteran has chronic fatigue syndrome, or another disorder associated with his complaints of chronic fatigue. For each identified disability, the examiner should state whether it is at least as likely as not (e.g. at least a 50 percent probability or greater) that the condition began in service or is otherwise related to service. If no such diagnosis is appropriate, the examiner should opine as to whether the Veteran’s fatigue-related symptoms constitute components of an undiagnosed multisymptom illness associated with service in the Southwest Asia theater of operations during the Persian Gulf War. In addressing the above opinions, the examiner should consider the Veteran’s lay statements regarding onset of symptomatology and any continuity of symptomatology since onset and/or since discharge from service. The examiner should also consider any other pertinent evidence of record, as appropriate. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. 4. Schedule the Veteran for a VA examination to explore the etiology of his diagnosed psychiatric condition. All indicated tests and studies should be conducted and all clinical findings reported in detail. The entire claims file should be made available to and be reviewed by the examiner in conjunction with this request.     Please identify all current mental disorders. For each identified disability, the examiner should state whether it is at least as likely as not (e.g. at least a 50 percent probability or greater) that the condition began in service or is otherwise related to service. If it is determined that no diagnosed mental disorder is directly related to service, the examiner should opine as to whether, on an at least as likely as not basis, the disorder has been caused or aggravated beyond its normal course of progression by any service connected disability or combination of disabilities, including neurodermatitis or irritable bowel syndrome. In addressing the above opinions, the examiner should consider the Veteran’s lay statements regarding onset of symptomatology and any continuity of symptomatology since onset and/or since discharge from service. The examiner should also consider any other pertinent evidence of record, as appropriate. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. 5. Thereafter, the RO should readjudicate the claim GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Z. Sahraie, 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.