Citation Nr: 21065408 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 10-44 387A DATE: October 26, 2021 REMANDED Entitlement to service connection for disability manifested by fatigue, to include chronic fatigue syndrome (CFS), is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1971 to March 1974. This matter is on appeal before the Board of Veterans Appeals (Board) from a February 2009 rating decision of a Department of Veterans Affairs Regional Office (RO). The Veteran testified before a Veterans Law Judge (VLJ) at an August 2017 Board hearing. Since then, the presiding VLJ has retired. The Veteran was notified of the VLJ's retirement in a March 2021 correspondence, in which she was given 30 days to respond as to whether she desired another Board hearing. As no response was provided by the Veteran within the stated period, the Board is proceeding to adjudicate the Veteran's appeal without holding an additional hearing. In January 2018, July 2018, June 2020 and June 2021, the case was remanded for further development. Entitlement to service connection for disability manifested by fatigue, to include CFS, is remanded. In the most recent June 2021 remand, the Board instructed the agency of original jurisdiction (AOJ) to obtain an addendum opinion concerning the likely etiology of any current disability manifested by fatigue. The examiner ultimately concluded that the Veteran did not have a standalone diagnosis of fatigue and that any current fatigue was less likely than not due to the Veteran's service-connected PTSD. In so doing, the examiner reasoned in part that a complaint of fatigue may be related to many different medical and non-medical conditions; review of the Veteran's medical history reflected multiple potential causes of a complaint of fatigue and the Veteran had not undergone an evaluation to determine the etiology of fatigue. This rationale for the addendum opinion suggests that a sufficient examination to assess the likely etiology of any current fatigue has not been completed. Accordingly, a further remand is necessary so that such an examination can be conducted. The matter is REMANDED for the following action: 1. Obtain updated VA treatment records dated from September 2018 to the present. 2. Thereafter, schedule the Veteran for a VA examination by a qualified medical professional. Any necessary testing should be conducted. The examiner must review the claims file in conjunction with the examination. This review should include the Veteran's service treatment records, including the documentation of numerous medical visits during service for viral pathology, viral symptoms, flu-like symptoms, and other generalized symptoms; the October 1973 report of medical examination, including the notation of possible thyroid disease; the October 1973 report of medical history; and any other service treatment records deemed pertinent. The review should also include any pertinent post-service VA and non-VA medical records (including records from Dr. Eric Smith in Scranton, PA from May 2019 to January 2020, which include a diagnosis of hypothyroidism); the March 2018 VA examination pertaining to fatigue with accompanying medical opinion; the May 2019 addendum opinion by the March 2018 VA examiner; the January 2021 VA contract tele-health fatigue examination with accompanying medical opinions; the June 2021 addendum opinions from the January 2021 VA contract examiner; March 2018 and August 2018 VA psychological evaluations; and any other documentation of record deemed pertinent. Based on the current examination findings and review of the claims file, the examiner should provide medical opinions in answer to the following questions: A) In your medical opinion, does the Veteran have a current, independent disability manifested by fatigue, such as chronic fatigue syndrome, or is current fatigue a symptom of an underlying disability (e.g. PTSD, sleep apnea, thyroid disorder, and/or other underlying disability)? The examiner should explain the basis for this opinion. B) If the Veteran does have an independent disability manifested by fatigue, is this disability at least as likely as not (i.e. a 50 percent chance or greater) directly related to the Veteran's military service, including her frequent medical visits shown therein and/or the possible thyroid disease noted on her October 1973 separation examination? C) If the Veteran does have an independent disability manifested by fatigue, is it at least likely as not that this disability has been caused by the Veteran's service-connected PTSD? D) If the Veteran does have an independent disability manifested by fatigue, is it at least as likely as not that this disability has been aggravated by the Veteran's service-connected PTSD? The examiner should explain the rationale for each opinion provided. S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Dan Brook, 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.