Citation Nr: 21074547 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 18-49 082 DATE: December 15, 2021 REMANDED Entitlement to service connection for fibromyalgia, to include on a secondary basis, is remanded. REASONS FOR REMAND The Veteran had an initial period of active duty for training (ACDUTRA) from September 1997 to February 1998; he had additional periods of active service from November 1999 to December 2001, from July 2005 to February 2006, and from July 2006 to November 2007. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In January 2021, the Veteran testified during a hearing before the undersigned. A transcript of the hearing is of record. The Board notes that there is a separate appeal stream pending under the Appeals Modernization Act (AMA) for the issue regarding an extension of a temporary total rating. Under the law, the AMA appellate stream cannot be merged with the legacy claims. Therefore, the AMA appeal will be addressed in a separate decision. Entitlement to service connection for fibromyalgia, to include on a secondary basis, is remanded. The Veteran has raised both direct and secondary theories of entitlement for his service connection claim for fibromyalgia. At his Board hearing, when asked about the onset of his symptoms, the Veteran testified that he began to notice back pain right after a period of active service in 2007. The Veteran's primary contention, however, appears to be that his fibromyalgia is secondary to his service-connected depression and back and achilles surgeries. In this regard, the Veteran's representative pointed to medical research showing that "symptoms for fibromyalgia often begin after an event such as a physical trauma, surgery, infection or significant psychological stressor"; however, these articles were not submitted to the Board. Service treatment records reflect numerous complaints of joint pain, including back, leg, and ankle pain, beginning as early as October 1997, and the Board notes that the Veteran has been service connected for lumbosacral strain since December 2001. The Veteran is additionally service-connected for, in pertinent part, depression, bilateral ankle achilles tendonitis, and bilateral lower extremity radiculopathy. The record reflects that the Veteran has undergone several surgeries related to his service-connected disorders. The Veteran was afforded a VA examination in January 2018, which notes a current diagnosis of fibromyalgia. The Veteran reported that his fibromyalgia started in 2000, explaining that he had pain when he injured his back while on active duty. The Veteran reported that he has been unable to walk normal since November 2016 when he had his last back surgery. He indicated that he received a diagnosis of fibromyalgia in 2017. The examiner found that, while fibromyalgia is noted in the records, there is medically no pathophysiological relationship. Specifically, the examiner reasoned that fibromyalgia syndrome is defined by the American Pain Society as a common rheumatological syndrome characterized by chronic, diffused musculoskeletal pain and tenderness with a number of associated symptoms, among which sleep disturbances, fatigue, and affective dysfunction were particularly frequent. The examiner considered medical literature noting that, although the literature suggested a link between trauma of the cervical spine and neck, it had never been proven. Additionally, the examiner noted that the medical literature indicated that there was no significant difference between idiopathic fibromyalgia and posttraumatic fibromyalgia, and the research is silent regarding achilles tendonitis and peripheral neuropathy of lower extremities being linked with fibromyalgia. Therefore, the examiner opined that the Veteran's fibromyalgia was less likely than not proximately due to or the result of his service-connected disabilities. No direct service connection opinion was provided. A medical record, dated in January 2021 and authored by the Veteran's treating provider, notes that it is reasonable to consider that the Veteran's "active fibromyalgia diagnosis could be related to military service." The provider noted, however, that the formal determination was at the discretion of the VA examiner. The Board finds that, prior to adjudication, a medical opinion addressing direct service connection is warranted. In this regard, the Veteran has claimed that his fibromyalgia symptoms began during active service in the form of back pain; STRs reflect complaints of back pain, as well as other musculoskeletal pain, and the Veteran's treating provider has suggested that his fibromyalgia could be related to his active service. A VA medical opinion, however, has not been obtained addressing whether the Veteran's fibromyalgia is etiologically related to his active service, and the opinion from the Veteran's treating provider is not sufficient to render a decision in this case. Further, it is not clear whether the Veteran's in-service reports of pain are symptoms of his already service-connected back disorder, achilles disorders, and lower extremity radiculopathies, or if any of his in-service musculoskeletal pain was a symptom of his fibromyalgia. Accordingly, the Board finds that a remand for a VA opinion is warranted. The Board points out, however, that, by this remand, the Board makes no determination, expressed or implied, as to the credibility of any statements on file. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of the Veteran's fibromyalgia. The electronic claims file must be made accessible to the examiner for review in conjunction with the opinion. (a.) The examiner should opine as to whether it is it at least as likely as not (50 percent probability or more) that the Veteran's fibromyalgia was incurred in or caused by an event, injury, or disease during active service. (b.) In rendering this opinion, the examiner is asked to address whether any of the Veteran's in-service complaints of musculoskeletal pain is related to fibromyalgia or whether it is a symptom of his already service-connected back disorder, bilateral achilles tendonitis, and bilateral lower extremity radiculopathy. (c.) The examiner must provide reasons for each opinion expressed with consideration given to all evidence of record, including the January 2021 opinion from the Veteran's treating provider. Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Hite, 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.