Citation Nr: 21067796 Decision Date: 11/05/21 Archive Date: 11/05/21 DOCKET NO. 19-02 191 DATE: November 5, 2021 REMANDED Entitlement to service connection for chronic fatigue syndrome (CFS) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1990 through April 1991 and January 2003 through June 2003, which includes active service in Operation Desert Shield in Southwest Asia. The Veteran had additional service in the Army National Guard. This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from November 2017 and January 2018 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In a May 2020 decision, the Board, in relevant part, denied entitlement to service connection for CFS. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In a May 2021 Joint Motion for Partial Remand (JMPR), the parties agreed to vacate the May 2020 Board decision and remand the issue of service connection for CFS back to the Board for further consideration as consistent with the JMPR. The appeal has since returned to the Board. Entitlement to service connection for CFS is remanded. The Veteran contends that he has a CFS disability that is related to his service. In a January 2018 VA examination, the Veteran reported that he has symptoms of nervousness, night sweats, headaches, and fatigue. He also endorsed that he had not been diagnosed with CFS. The VA examiner determined that the Veteran did not have a diagnosis of CFS. Rather, his complaint of fatigue is more consistent with his diagnosis of PTSD, major depressive disorder, and obstructive sleep apnea (OSA). The Board relied on the January 2018 VA examiner's opinion in denying the Veteran's claim for service connection for CFS, to include entitlement to presumptive service connection under 38 C.F.R. § 3.317, on the basis that the Veteran did not have a qualifying disability. Rather, the Board accorded probative value to the January 2018 VA examiner finding that the Veteran did not have a diagnosis of CFS, and his symptom of fatigue was attributable to his diagnosed PTSD, major depressive disorder, and OSA. In the May 2021 JMPR, the parties agreed that the Board erred by failing to address the Veteran's symptoms other than fatigue, as they have not been attributable to a known cause in determining the applicability of 38 C.F.R. § 3.317. After further review of the existing record, the Board has determined that an addendum medical opinion is necessary to determine whether the Veteran's symptoms of nervousness, headaches, and night sweats are signs or symptoms of an "undiagnosed illness" as defined by 38 C.F.R. § 3.317 or related to an unexplained multi-chronic illness. The Board takes note that the Veteran's representative submitted a September 2021 argument requesting that the Board consider an analysis of the case that includes an increased rating evaluation for PTSD based on the Veteran's fatigue symptoms. As there is no pending appeal before the Board for an increased rating claim for PTSD, the Board does not currently have jurisdiction to review the issue of entitlement to an increased rating for PTSD. If the Veteran wishes to claim an increased rating for his service-connected PTSD, he must file a separate claim to do so. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate examiner to consider the Veteran's reports of nervousness, night sweats, and headaches. a. The examiner is requested to state whether the Veteran's complaints related to nervousness, night sweats, and headaches are attributable to (1) a diagnosed disease, (2) an undiagnosed illness, or (3) a diagnosable but medically unexplained chronic multi symptom illness (MUCMI), in that either the etiology or pathophysiology is unknown or inconclusive. A condition is not a MUCMI where both the etiology and pathophysiology are partially understood. The examiner should consider the evidence for the Veteran's particular circumstances in determining if there is MUCMI. b. If the Veteran's symptoms of nervousness, night sweats, and headaches are attributable a diagnosed disease or a diagnosable chronic multi-symptom illness with a partially understood etiology and pathophysiology, the examiner should opine whether such disability is at least as likely as not related to the Veteran's active service. The examiner is asked to provide the underlying reasons for all opinions expressed, and is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N.B. Mmeje, 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.