Citation Nr: 21065499 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 15-27 473A DATE: October 26, 2021 REMANDED Entitlement to a rating more than 10 percent for hypertension is remanded. Entitlement to service connection for Gulf War unexplained illness (chronic multi-symptom illness) (to include symptoms of fatigue, respiratory problems, headaches, and dizziness) as due to an undiagnosed illness is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1989 to January 1993, which included service in the Southwest Asia Theater of operations during the Persian Gulf War. This matter is before the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge (VLJ) in July 2018. A transcript of the hearing is associated with the electronic file. The issues were previously before the Board in October 2018. 1. Entitlement to a rating more than 10 percent for hypertension is remanded. In an August 2021 statement, the Veteran asserted, though an authorized representative, that the hypertension disability has increased in severity since the Veteran was last examined by VA. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of hypertension disability. 2. Entitlement to service connection for Gulf War unexplained illness (chronic multi-symptom illness) (to include symptoms of fatigue, respiratory problems, headaches, and dizziness) as due to an undiagnosed illness is remanded. Unfortunately, there has not been substantial compliance with the Board's previous remand directives regarding the issue of entitlement to service connection for Gulf War unexplained illness (chronic multi-symptom illness) (to include symptoms of fatigue, respiratory problems, headaches, and dizziness) as due to an undiagnosed illness. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). In October 2018, the Board directed the RO to obtain VA medical opinions as to whether it was it at least as likely as not that the Veteran's reported symptoms of fatigue were due to an undiagnosed illness, a chronic disability caused by a medically unexplained illness, or a diagnosable disorder. If the examiner determined that the Veteran's symptoms of fatigue were due to a diagnosable disorder or diagnosable disorders (versus undiagnosed illness), the examiner was also requested to determine whether the underlying disease or injury was incurred during service and, in the case of a disease, is linked to any incident of active duty. October 2019 VA medical opinions, however, did not answer these questions. The October 2019 VA examination report contained contradictory information about the Veteran's diagnosis. In Section I, the VA examination report noted a 2012 diagnosis of chronic fatigue syndrome (CFS), but Section II noted that the Veteran had not been diagnosed with CFS, but "has fatigue." Two VA medical opinions did not address this conflict in the report. In the first VA medical opinion, the VA examiner did opine that it was "less likely than not (50 percent probability or greater) that the Veteran's reported symptoms of CFS constitute an undiagnosed illness or a chronic disability caused by a medically unexplained illness." However, the rationale addressed symptoms of diarrhea, not fatigue. The second VA medical opinion reiterated this VA examination report note that the Veteran did not have CFS and instead "has fatigue," but offered no rationale. Neither opinion addressed whether the noted fatigue was related to Gulf War service. The matters are REMANDED for the following actions: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of service-connected hypertension. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. 2. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's claim of service connection for an undiagnosed illness, manifested by symptoms of fatigue. The electronic file, including a copy of this remand order, must be reviewed by the examiner prior to the examination. All testing deemed necessary must be conducted and results reported in detail. The examiner should provide responses to the following: 3. Is it at least as likely as not (50 percent probability or greater) that the Veteran's reported symptoms of fatigue are due to an undiagnosed illness or a chronic disability caused by a medically unexplained illness? 4. Is it at least as likely as not (50 percent probability or greater) that the Veteran's reported symptoms of fatigue are due to a diagnosable disorder or diagnosable disorders? 5. If it is determined that the Veteran's symptoms of fatigue, indigestion, a respiratory problem, muscle pain, headaches, insomnia, memory problems, diarrhea, and dizziness are due to a diagnosable disorder or diagnosable disorders (versus undiagnosed illness), the examiner is requested to determine whether the underlying disease or injury was incurred during service and, in the case of a disease, is linked to any incident of active duty. The examiner is advised that an undiagnosed illness is defined as a condition that by history, physical examination, and laboratory tests cannot be attributed to a known clinical diagnosis. In providing the above opinions, the examiner should consider the September 2014 and October 2019 VA examination reports and July 2015 private medical opinions. The examiner should comment on such reports and treatment records and reconcile any differences of opinion as necessary. A complete rationale for any opinions expressed should be set forth. If the examiner cannot provide an above opinion without resorting to speculation, then explain why an opinion cannot be provided (e.g., lack of sufficient information/evidence, the limits of medical knowledge, etc.). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James Hekel 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.