Citation Nr: 21004975 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 14-26 514 DATE: January 28, 2021 REMANDED Entitlement to service connection for chronic fatigue syndrome, to include as due to undiagnosed illness is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1988 to July 1994. In May 2018, the Board denied the Veteran’s claim for chronic fatigue syndrome. In January 2019, the Veteran appealed that portion of the May 2018 Board decision to the U.S. Court of Appeals for Veterans Claims (Court). In a January 2020 Panel Decision, the Court set aside that portion of the Board’s decision that denied the Veteran’s claim and remanded the issue for VA to obtain a new medical examination. In June 2020, the Board remanded the claim for additional evidentiary development. Such was accomplished, and the claim has been returned to the Board for further appellate review. Entitlement to service connection for chronic fatigue syndrome, to include as due to undiagnosed illness is remanded. In the January 2020 Panel Decision, the Court ordered that the claim of service connection for chronic fatigue syndrome be remanded to obtain a new VA examination that addressed whether the Veteran’s fatigue is a qualifying chronic disability under the provisions of 38 U.S.C. § 1117. The Court specifically noted that an opinion must be obtained that addresses whether both the etiology and pathophysiology of the Veteran’s fatigue is known or unknown such that it qualifies as chronic fatigue syndrome or some other medically unexplained chronic multi-symptom illness (MUCMI). See Stewart v. Wilkie, 30 Vet. App. 383, 392 (2018). The claim was remanded in a June 2020 decision of the Board. The Board directed the AOJ to obtain a new medical opinion. On an October 2020 VA chronic fatigue syndrome examination, the same examiner acknowledged that the Veteran had complaints of chronic fatigue syndrome, but determined that the complaints did not meet the required criteria to warrant a diagnosis at this time. Significantly, notwithstanding this determination, the examiner did not provide an adequate opinion addressing whether the Veteran’s complaints of fatigue otherwise represented a disability pattern consistent with (i) an undiagnosed illness; (ii) a diagnosable but medically unexplained chronic multisymptom illness; (iii) a diagnosable chronic multisymptom illness with a partially explained etiology and pathophysiology; or (iv) a disease with a clear and specific diagnosis, etiology, and pathophysiology. A previous remand confers on the claimant, as a matter of law, the right to substantial compliance with the remand orders. Stegall v. West, 11 Vet. App. 268 (1998). Therefore, remand is necessary in order to ensure substantial compliance with the Board's prior remand directives. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion addressing the nature and etiology of the Veteran's fatigue, to include as due to undiagnosed illness, from an appropriate clinician other than the October 2020 opinion provider. An examination should not be scheduled unless the clinician finds it necessary. The clinician must review the claims file and must note that review in the report. Following review of the record, the clinician is asked to address the following: (a) Concerning the Veteran’s fatigue, does the Veteran exhibit a disability pattern consistent with (i) an undiagnosed illness; (ii) a diagnosable but medically unexplained chronic multisymptom illness; (iii) a diagnosable chronic multisymptom illness with a partially explained etiology and pathophysiology; or (iv) a disease with a clear and specific diagnosis, etiology, and pathophysiology? (b) The term medically unexplained chronic multisymptom illness means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Examples include, but are not limited to, the following: chronic fatigue syndrome; fibromyalgia; and functional gastrointestinal disorders. (c) The response to this question should include a discussion of the pathophysiology and etiology of the Veteran’s claimed disability and/or reported symptomology. Pathophysiology is defined as the physiology of abnormal states; specifically, the functional changes that accompany a particular syndrome or disease. Consideration of pathophysiology and etiology is a veteran-specific inquiry, as opposed to an inquiry regarding the general knowledge of the medical community. (d) If the Veteran’s disability pattern is consistent with either (iii) a diagnosable chronic multisymptom illness with a partially explained etiology and pathophysiology, or (iv) a disease with a clear and specific diagnosis, etiology, and pathophysiology, opine as to whether it is at least as likely as not (a 50 percent or greater probability) that said disability incurred in, or is otherwise related to service. A complete rationale must be provided for every opinion offered. The examiner must consider the Veteran’s lay descriptions of onset and progression of fatigue. 2. Then, readjudicate the issue on appeal. If the benefit sought remains denied, send the Veteran and his representative a supplemental statement of the case. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Crohe, 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.