Citation Nr: 21067053 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 17-09 481 DATE: November 3, 2021 ORDER Service connection for chronic fatigue syndrome as secondary to service-connected lumbosacral bilateral lower peripheral neuropathy and left upper extremity peripheral neuropathy is granted. FINDING OF FACT The Veteran has a diagnosis of chronic fatigue syndrome, which is due to his service-connected bilateral lower peripheral neuropathy and left upper extremity peripheral neuropathy. CONCLUSION OF LAW The criteria for service connection for chronic fatigue syndrome as secondary to bilateral lower peripheral neuropathy and left upper extremity peripheral neuropathy are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from February 1968 to December 1971. In July 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ); a transcript of the hearing is associated with the claims file. 1. Service connection for chronic fatigue syndrome as secondary to service-connected lumbosacral bilateral lower peripheral neuropathy and left upper extremity peripheral neuropathy. The Veteran contends that his chronic fatigue syndrome is due to his service-connected bilateral lower peripheral neuropathy and left upper extremity peripheral neuropathy. The Board notes that the Veteran does not contend that his chronic fatigue syndrome is directly due to service. See July 2021 Hearing Transcript. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). A disability may be service connected on a secondary basis if it is proximately due to or the result of a service-connected disease or injury; or, if it is aggravated beyond its natural progress by a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310(a), (b). Private treatment records indicate that the Veteran has a current disability as he was diagnosed with chronic fatigue syndrome in 2010. The question for the Board is whether the Veteran's current chronic fatigue syndrome either is etiologically related to service, including as due to the service-connected bilateral lower peripheral neuropathy and left upper extremity peripheral neuropathy. The Board finds that entitlement to service connection for chronic fatigue syndrome as due to his service-connected bilateral lower peripheral neuropathy and left upper extremity peripheral neuropathy is warranted. In September 2015, the Veteran underwent a VA examination for his fatigue. The VA examiner indicated that the Veteran did not have a diagnosis for chronic fatigue syndrome. The VA examiner noted that the Veteran had "worsening fatigue." The VA examiner opined that the Veteran's fatigue was less likely than not proximately due to or the result of the Veteran's service-connected sensorimotor polyneuropathy of all extremities. However, the VA examiner also opined that the Veteran's fatigue was at least as likely as not aggravated by his service-connected sensorimotor polyneuropathy of all extremities. The VA examiner's rationale provided that the Veteran's service-connected sensorimotor polyneuropathy is not the primary cause of the fatigue but indicated that the Veteran's polyneuropathy clearly limits his physical activity which in turn contributes to weight gain and may disrupt his sleep, which all can aggravate the Veteran's fatigue. In September 2021, the Veteran was provided a private medical opinion from Doctor K.B.. Doctor K.B. noted that the Veteran has longstanding chronic fatigue syndrome dating back to 2010. Doctor K.B. indicated that it is as likely as not that the chronic fatigue syndrome is aggravated by the Veteran's bilateral lower extremity and upper extremity neuropathy. Doctor K.B.'s rationale first indicated that neuropathy causes loss of balance and strength leading to more effort and energy to accomplish daily activities and tasks. Doctor K.B. also stated that the Veteran's chronic fatigue syndrome occurred in an acute fashion and that the Veteran was investigated for a cardiac condition and subsequently had a sleep study. Further, Doctor K.B. noted that the Veteran was diagnosed with severe sleep apnea. In addition, Doctor K.B. reported that the Veteran also suffers from generalized muscle aches and weakness from neuropathy, generalized joint pain arthritis, recurrent headaches, and cognitive symptoms of lack of concentration, memory impairment and drowsiness. Notably, Doctor K.B. indicated that the Veteran's fatigue is significant and certainly lasts more than 24 hours after exercise. The Board finds the September 2021 private medical opinion to be both competent and credible, and as such, entitled to great probative weight. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). The opining physician provided the facts and rationale on which their opinion was based. See Prejean v. West, 13 Vet. App. 444 (2000) (factors for assessing the probative value of a medical opinion include the examiner's access to the claims folder and the Veteran's history, and the thoroughness and detail of the opinion). Therefore, the Board finds the September 2021 private medical opinion to be probative. Weighing the probative evidence of record, the Board finds the preponderance of the evidence supports a finding that the Veteran's chronic fatigue syndrome is aggravated by his service-connected bilateral lower peripheral neuropathy and left upper extremity peripheral neuropathy The Board finds the September 2021 private medical opinion from Doctor K.B. to be highly probative as to this assertion. The September 2015 VA examination and medical opinions did not contradict the September 2021 private medical opinion from Doctor K.B., but they did not confirm the Veteran's previously diagnosed disability of chronic fatigue syndrome. Significantly, both the September 2015 and September 2021 medical opinions both indicate that the Veteran's fatigue is aggravated by his service-connected bilateral lower peripheral neuropathy and left upper extremity peripheral neuropathy. Accordingly, the Board finds that the Veteran's chronic fatigue syndrome is aggravated by his service-connected bilateral lower peripheral neuropathy and left upper extremity peripheral neuropathy. As such, the elements of secondary service connection are established, and the claim is granted. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Dourmashkin 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.