Citation Nr: 21075604 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 17-05 674 DATE: December 21, 2021 REMANDED Entitlement to service connection for chronic fatigue syndrome, including as secondary to the service-connected cardiovascular disabilities, is remanded. REASONS FOR REMAND The Veteran, who is the Appellant in this case, had active service from April 1982 to April 1985. This matter comes before the Board of Veterans' Appeals (BVA or Board) from an August 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran provided testimony at a February 2021 virtual hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims folder. The Board notes that the cover page to the hearing transcript indicates that "Jim Jones" was the presiding Veterans Law Judge; however, the transcription itself clearly and correctly sets forth that the undersigned Veterans Law Judge presided over the February 2021 Board hearing. In June 2021, the Board remanded this case for further development. Specifically, the Board directed that private treatment records from the Drake Center located at the University of Cincinnati's West Chester facility be obtained, as the Veteran testified that he received treatment at that facility for his chronic fatigue syndrome and service-connected cardiovascular conditions. Treatment records from this facility were received in October 2021, subsequent to issuance of the September 2021 supplemental statement of the case (SSOC) and prior to transfer of the Veteran's records to the Board. These records are relevant to the Veteran's service connection claim. While the Board regrets the additional delay, a remand is necessary to allow the RO to review these records. 38 C.F.R. § 19.37(a). In addition, the Board finds that a new VA opinion, or examination if deemed necessary, should be obtained in light of receipt of the Drake Center treatment records. The Veteran was afforded a VA examination regarding the nature and etiology of his claimed chronic fatigue syndrome in July 2014; however, as the Drake Center treatment records were not available to the examiner at that time, the examiner relied solely on VA treatment records in providing their opinion. A new VA opinion should be obtained which takes these records into consideration. The matters are REMANDED for the following action: Obtain a VA opinion, or examination if deemed necessary by the examiner, from an appropriate specialist regarding the nature and etiology of his chronic fatigue syndrome. Any and all indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished, and a rationale for any opinion expressed should be provided. The claims file, including a copy of this decision, must be made available to the examiner for review of the history in conjunction with the examination, and the examination report should reflect that such review was accomplished. (a.) The examiner should first discuss whether the criteria for a diagnosis of chronic fatigue syndrome are met. The examiner should review the recently obtained treatment records from the Drake Center in providing this opinion and should provide a thorough rationale. (b.) Next, the examiner should offer the following opinion: Is it at least as likely as not (i.e., to at least a 50/50 degree of probability) that the Veteran's chronic fatigue syndrome was caused or aggravated by any of his service-connected disabilities, to include his cardiovascular and psychiatric disabilities and/or as a result of medication taken for those disabilities? The examiner must review and discuss the treatment records from the Drake Center in providing their opinion. Note: The term "at least as likely as not" does not mean merely within the realm of medical possibility, but rather that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of causation as it is to find against it. Note: The term "aggravated" in the above context refers to a worsening of the pre-existing or underlying condition, as contrasted to temporary or intermittent flare-ups of symptoms which resolve with return to the previous baseline level of disability. [CONTINUED ON NEXT PAGE] All opinions are to be accompanied by a rationale consistent with the evidence of record. A discussion of the pertinent evidence, relevant medical treatises, and generally accepted medical principles is requested. If the examiner cannot provide an opinion without resorting to speculation, he or she shall provide complete explanations stating why this is so. In so doing, the examiner shall explain whether any inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. Cynthia M. Bruce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Sherrard, 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.