Citation Nr: 21069739 Decision Date: 11/19/21 Archive Date: 11/19/21 DOCKET NO. 15-38 792A DATE: November 19, 2021 ORDER Service connection for a disability manifested by fatigue to include chronic fatigue syndrome (CFS) is denied. Service connection for sleep disturbance is denied. Service connection for headaches is granted. REMANDED A total disability rating due to individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. Any symptoms associated with fatigue are already being compensated for by the Veteran's disability ratings for posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA); the Veteran does not currently have a diagnosis of chronic fatigue syndrome (CFS). 2. Any symptoms associated with sleep disturbance are already being compensated for by the Veteran's disability ratings for PTSD and OSA. 3. The Veteran currently manifests headaches, and the Veteran's headaches are proximately due to the Veteran's previously service-connected OSA and hypertension. CONCLUSIONS OF LAW 1. The criteria for service connection for a disability manifested by fatigue to include CFS have not been met. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. 2. The criteria for service connection for sleep disturbance have not been met. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. 3. The criteria for service connection for headaches have been met. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Air Force from October 1979 to December 2000. These matters come to the Board of Veteran's Appeals (Board) on appeal of April 2012, January 2016, and April 2017 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). This appeal is being adjudicated under the legacy appellate framework. The Veteran did not desire a personal hearing before the Board. These matters were previously before the Board, and, in November 2018, February 2020, and in September 2020, the Board remanded these matters for further development. Further development in substantial compliance with the Board's previous remand instructions has been completed. Service Connection In seeking VA disability compensation, a Veteran generally seeks to establish that a current disability results from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131. "Service connection" basically means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303. Service connection may also be granted on a secondary basis for diseases that are proximately due to or aggravated by a previously service-connected disability. 1. Service connection for a disability manifested by fatigue to include CFS is denied. 2. Service connection for sleep disturbance is denied. At issue is whether the Veteran is entitled to service connection for chronic fatigue syndrome and sleep disturbances. The record does not show that the Veteran has been diagnosed with chronic fatigue syndrome. To the extent that the Veteran has fatigue and sleep disturbance, a VA examiner opined in June 2021 that these symptoms attributed to his service connected PTSD and OSA. The examiner opined that the Veteran did not have CFS. The Veteran has already been granted service connection for PTSD and OSA. See February 2021 Rating Decision Code Sheet. Both disabilities compensate the Veteran for symptoms associated with trouble sleeping. 38 C.F.R. §§ 4.97, Diagnostic Code 6847; 4.130, General Rating Formula for Mental Disorders. The practice of assigning multiple disabilities for the same symptomology under different diagnoses, also known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. Therefore, service connection for CFS and sleep disturbance is denied as a matter of law. 3. Service connection for headaches is granted. At issue is whether the Veteran is entitled to service connection for headaches. The Veteran underwent a VA examination in June 2021. The examiner opined that the Veteran headaches are a symptom of the Veteran's previously service-connected OSA and hypertension. The ratings currently assigned for OSA and HTN do not contemplate a rating for the severity of his headaches. Therefore, the Veteran's headaches are proximately due to the Veteran's previously service-connected disabilities and service connection must be granted. The Board notes that the examiner opines that the Veteran's headaches are not an underlying disability; but rather merely a symptoms. Nevertheless, pain is considered a disability in and of itself. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Therefore, service connection is granted. REASONS FOR REMAND TDIU is remanded. At issue is whether the Veteran is entitled to TDIU. The evidence of record is sufficient to trigger VA's duty to assist, and this matter must be remanded for a VA examination. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: Arrange to provide the Veteran with a VA examination in order to address the following: (a.) Comment on the Veteran's ability to function in an occupational environment.' (b.) Document any reported education or work experience. (c.) Describe functional impairment caused solely by the Veteran's service-connected disabilities. DAVID L. WIGHT Veterans Law Judge Board of Veterans' Appeals Attorney for the Board David R. Seaton, 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.