Citation Nr: 21066646 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 16-59 081 DATE: November 1, 2021 REMANDED Entitlement to service connection for fibromyalgia is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1989 to February 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2019, the Veteran presented testimony at a video conference hearing before the undersigned Veterans Law Judge. A transcript is on record. When the appeal was last before the Board in February 2020, it included claims for service connection for right and left knee disabilities, irritable bowel syndrome (IBS), sleep apnea, and fibromyalgia. The Board reopened the Veteran's claim for right and left knee disabilities, then remanded all the claims for further development. In September 2020, the RO granted the Veteran's claim for service connection for IBS. In November 2020, the RO granted the Veteran's claims for service connection for obstructive sleep apnea and right and left knee disabilities. As such, these claims are no longer before the Board. Notably, the Veteran has an Appeals Modernization Act (AMA) appeal filed regarding a claim for an earlier effective date for his 100 percent disability rating for service-connected hepatitis C. The Veteran presented testimony on this issue at a Board hearing in June 2021. This issue will be addressed in a separate Board decision. Entitlement to service connection for fibromyalgia is remanded. The claim must be remanded, as the question of whether the Veteran has a current diagnosis of fibromyalgia or a medically unexplained chronic multi-symptom illness has not been adequately answered. Per the Board's February 2020 remand, the Veteran was afforded a VA examination to diagnosis the presence of fibromyalgia or a medically unexplained chronic multi-symptom illness in March 2020. At the time, the examiner diagnosed the Veteran with fibromyalgia and attributed the Veteran's muscle stiffness, muscle weakness, fatigue, sleep disturbances, headaches, depression, anxiety, and IBS to the condition. However, in October 2020, the RO contacted the examiner to request a clinical basis for this finding, highlighting the fatigue found in March 2020 to be attributed to fibromyalgia is encompassed and etiologically related to the Veteran's service-connected hepatitis C. Unfortunately, the examiner simply responded, "upon further review, I agree that Fibromyalgia diagnosis is not supported." This conclusory statement with supporting rationale is insufficient. The Board is cognizant that many of the symptoms noted by the March 2020 examiner as evidence of fibromyalgia have been attributed and are encompassed by the Veteran's other service-connected disabilitiesi.e., his hepatitis C, persistent depressive disorder, obstructive sleep apnea with persistent depressive disorder, IBS associated with persistent depressive disorder, chronic headaches associated with tinnitus, and right and left knee osteoarthritis. However, the determination as to whether certain symptoms constitute a diagnosis of fibromyalgia or another medically unexplained chronic multi-symptom illness is a medical determination outside of the Board's competency. Colvin v. Derwinski, 1 Vet. App. 171 (1991). As such, a remand is warranted for the examiner to provide a clinical, medical basis for their finding as to whether the Veteran suffers from fibromyalgia or another medically unexplained chronic multi-symptom illness. In finding that further development is necessary to adjudicate the claim, the Board acknowledges the U.S. Court of Appeals for Veterans Claims (Court) decision in Mariano v. Principi, 17 Vet. App. 305 (2003). In this regard, the Board notes that although Mariano states it "would not be permissible for VA to undertake such additional development if a purpose was to obtain evidence against an appellant's case," the Court has held that VA may undertake the development of additional evidence if, as here, it is necessary to render an informed decision on the claim. See Douglas v. Shinseki, 23 Vet. App. 19 (2009) (distinguishing Mariano, 17 Vet App. at 312). The matter is REMANDED for the following actions: 1. Obtain an addendum opinion from the same March 2020 and October 2020 examiner, if possible to determine the nature and etiology of his condition. The claims file and a copy of this remand must be made available to the examiner and be reviewed in conjunction with providing the addendum opinion. The examiner is invited to comment on the studies discussed and cited in the Appellate Brief received on September 13, 2021. After a thorough review of the claims file, the examiner is asked to determine whether the Veteran's symptoms at least as likely as not (50 percent probability or greater) substantiate a diagnosis of fibromyalgia or another medically unexplained chronic multi-symptom illness (MUCMI). Notably, an illness is a MUCMI where either the etiology or pathophysiology of the illness is inconclusive. Conversely, an illness is not a MUCMI where both the etiology and the pathophysiology of the illness are partially understood. Stewart v. Wilkie, 30 Vet. App. 383, 389-90 (2018). 2. Then, readjudicate the claim. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.A. Infante, Associate 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.