Citation Nr: 21076713 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 18-17 715 DATE: December 27, 2021 REMANDED Entitlement to service connection for joint and muscle pain, claimed as fibromyalgia, as secondary to service-connected irritable bowel syndrome (IBS), is remanded. Entitlement to service connection for chronic fatigue syndrome, as secondary to service-connected IBS, is remanded. Entitlement to service connection for a chronic headache disability, as secondar to service-connected IBS, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1989 to August 1993. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In a May 2019 decision, the Board reopened and denied the Veteran's claims for service connection for fibromyalgia, chronic fatigue syndrome, and a chronic headache disability as secondary to service-connected IBS and based on exposures during Southwest Asia service. See BVA Decision (May 2019). The Veteran appealed the matter to the U.S. Court of Appeals for Veterans Claims (Court). In November 2020, the Court issued a Memorandum Decision setting aside that part of the Board decision that denied service connection on a secondary basis because it had relied on medical opinions that did not address aggravation. See CAVC Decision (November 2020). The Memorandum Decision also found that the theory of service connection based on exposures during service in Southwest Asia was not appealed by the Veteran and had thus been abandoned. See CAVC Decision (November 2020). That theory of service connection is thus not before the Board and is not considered herein. A March 2021 letter notified the Veteran and his representative that he had 90 days to submit additional argument and evidence. See BVA Letter (March 2021). In May 2021, the Veteran's representative submitted argument and medical articles for consideration. See Correspondence (May 2021). In June 2021, the Board remanded the issues on appeal to obtain addendum opinions addressing secondary service connection. See BVA Decision (June 2021). As is further discussed below, there has not yet been substantial compliance with the directives of that remand. See BVA Decision (June 2021). The Board initially notes that the issue on appeal is characterized as chronic fatigue syndrome and not as service connection for chronic fatigue syndrome and/or sleep apnea. Service connection for chronic fatigue syndrome was denied in 2011. See Rating Decision (May 2011). The Veteran did not appeal. Service connection for sleep apnea was denied in 2012. See Rating Decision (September 2012). The Veteran did not appeal. In 2013, the Veteran filed a claim for service connection for chronic fatigue syndrome but not sleep apnea. See Third Party Correspondence (February 2012). Although a Veteran may identify a particular disorder when he or she files a claim, the scope of the claim cannot be limited only to the disorder stated, but must be considered a claim for any disorder that may reasonably be encompassed by several factors including the description of the claim, the symptoms the claimant describes, and the information the claimant submits or that VA obtains in support of the claim. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Where there is a prior rating decision, however, VA must determine whether one claim is the same as another that was previously denied by looking to whether there are significant elements that distinguish them, Ephraim v. Brown, 82 F.3d 399 (Fed. Cir. 1996), or whether they arise from a common factual basis, Boggs v. Peake, 520 F.3d 1330 (Fed. Cir. 2008). Here, it is clear that the Veteran understood the difference between alleging claims for chronic fatigue syndrome and for sleep apnea, as indicated by filing separate claims. The Board finds that the issue on appeal is thus entitlement to service connection for chronic fatigue syndrome. Of note, an August 2021 VA examiner opined that chronic fatigue syndrome cannot be diagnosed in a person with a diagnosis of sleep apnea, which the Veteran has. See C&P Exam (August 2021). The examiner also found that the Veteran's sleep apnea was at least as likely as not aggravated by the service-connected IBS. See C&P Exam (August 2021). 1. Entitlement to service connection for joint and muscle pain, claimed as fibromyalgia, as secondary to service-connected IBS, is remanded. 2. Entitlement to service connection for a chronic headache disability, as secondary to service-connected IBS, is remanded. 3. Entitlement to service connection for chronic fatigue syndrome, as secondary to service-connected IBS, is remanded. The Veteran contends that his joint and muscle pain, chronic headache disability, and chronic fatigue are secondary to his service-connected IBS. See Third Party Correspondence (February 2013); Third Party Correspondence (December 2015). The Board finds that remand is warranted to obtain compliance with prior remand directives. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. In a June 2021 remand, the Board requested opinions regarding secondary service connection for joint and muscle pain, chronic fatigue syndrome, and a chronic headache disability. See BVA Remand (June 2021). The Board requested that the examiner expressly address medical articles submitted by the Veteran and the February and March 2018 VA examinations and opinion. See BVA Remand (June 2021). August 2021 examinations and opinions were obtained. See C&P Exam (August 2021). The examiner provided negative opinions that addressed the medical articles submitted by the Veteran. See C&P Exam (August 2021). Although the examiner noted they reviewed records, the opinions did not address the prior 2018 VA examinations. See C&P Exam (August 2021). Accordingly, remand is required for an addendum opinion that considers the prior VA examinations. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion to address whether the Veteran's chronic fatigue, headaches, and fibromyalgia, are at least as likely as not (1) proximately due to service-connected IBS, or (2) aggravated beyond natural progression by service-connected IBS. As part of this opinion, indicate whether the Veteran's chronic fatigue symptoms are due only to sleep apnea or whether there are chronic fatigue symptoms separate and apart from sleep apnea. Provide a rationale that deals with causation and aggravation as independent concepts. Consider and expressly address the February 2018 and March 2018 VA examinations and opinions and the August 2021 examinations and opinions. 2. Ensure that the medical opinions obtained includes a complete rationale for the conclusions reached. The medical opinions must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include 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. 3. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.M., 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.