Citation Nr: 21072715 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 15-23 364A DATE: December 6, 2021 REMANDED Entitlement to service connection for a fatigue disability, to include chronic fatigue syndrome (CFS) and as fatigue due to an undiagnosed illness, is remanded. REASONS FOR REMAND The Veteran had active military service from May 1988 to July 1998, with a tour of duty in the Persian Gulf from August 1990 to April 1991. In May 2021, this matter was previously remanded the Board for additional development. Entitlement to service connection for a fatigue disability is remanded. In the May 2021 remand, the Board directed the Regional Office (RO) to obtain a VA medical opinion to address the Veteran's diagnosis/etiology of his claimed CFS, to include if the symptoms of fatigue were accounted for in the Veteran's service-connected sleep apnea. In July 2021, the RO procured a VA medical opinion from an appropriate VA examiner and the examiner provided a negative nexus opinion finding that the Veteran did not have a current diagnosis of CFS. In making that determination, the examiner noted that VA treatment record show that the Veteran was diagnosed with chronic fatigue syndrome in April 2001 and that this was erroneous. The examiner explained further that, for VA claims purposes, subjective symptoms of fatigue do not constitute a diagnosis of chronic fatigue syndrome. By the VA's own explicit diagnostic criteria, the diagnosis of Chronic Fatigue Syndrome requires the exclusion by history, physical examination, and laboratory tests, all other clinical conditions that may produce similar symptoms and explain fatigue. In this Veteran's case, his subjective symptoms of fatigue are definitively explained by his morbidly obese body habitus. The examiner also stated that the Veteran's obesity caused the Veteran's diabetes mellitus and sleep apnea, both of which the Veteran is service connected. The examiner also stated that the Veteran's complaints of chronic fatigue are not indicative of any undiagnosed illness or any chronic multi-symptom illness. In spite of the RO's attempt at obtaining an adequate VA medical opinion, the Board finds that the May 2021 VA medical opinion is insufficient for rating purposes. Notably, while the VA examiner concluded that the Veteran's fatigue was due to his obesity, the examiner did not otherwise consider or discuss the Veteran's reports that his chronic fatigue developed in 1994 following his deployment to the Persian Gulf. The evidence of record suggests that the Veteran's in-service weight gain was due to deconditioning after an ankle injury he sustained in 1995. This evidence contradicts the July 2021 VA examiner's findings and was not otherwise considered or discussed by the examiner. Additionally, the examiner did not address the Veteran's October 1997 service treatment records and April 1999 treatment records that indicate the Veteran's chronic fatigue has been present for several years. Accordingly, as the May 2021 VA medical opinion is insufficient for adjudication purposes, the Board finds that remand is warranted for additional development to adequately adjudicate the Veteran's claim. The Board also notes that the Veteran's representative has raised a theory of entitlement to service connection on a secondary basis, asserting the Veteran's chronic fatigue syndrome is related to sleep apnea. Accordingly, this theory of entitlement should be address by the VA examiner. The matter is REMANDED for the following action: Obtain a VA medical opinion from an appropriate examiner to determine the nature and etiology of the Veteran's claimed fatigue disorder (a physical examination may be conducted, if deemed necessary). The claims file, including a copy of this remand, must be made available to be reviewed by the examiner. a) The examiner must provide a diagnosis for any current fatigue disability present during the appeal period. In rendering a diagnosis, the examiner should consider and discuss the Veteran's the July 2012 VA treatment record indicated that the Veteran was diagnosed with chronic fatigue syndrome in April 2001 and was diagnosed with fatigue in January 1999 and the treatment records that suggest onset for his fatigue disorder was in 1994. b) For any diagnosed fatigue disability, the examiner is asked to address whether it is at least as likely as not (a 50 percent or greater probability) that the diagnosed disability was: i) incurred in service, or is otherwise etiologically related to service, ii) is caused by a service-connected disability, iii) is aggravated by a service-connected disability, or iv) if a related to a service-connected disability (to include his service-connected ankle disorder) caused him to become obese; and if so, whether the obesity was a substantial factor in causing the Veteran's fatigue disability. A full and complete rationale for all opinions expressed must be provided. If the examiner is unable to offer any of the requested opinions, a rationale should be provided for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. PAUL E. METZNER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lent, Edward 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.