Citation Nr: 21076890 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 18-07 425 DATE: December 28, 2021 ORDER New and material evidence having been received, the claim of entitlement to service connection for a chronic cough/breathing-related condition is reopened; the appeal is granted to this extent only. New and material evidence having been received, the claim of entitlement to service connection for a chronic fatigue condition is reopened; the appeal is granted to this extent only. New and material evidence having been received, the claim of entitlement to service connection for a gastrointestinal condition (claimed as abdominal pain) is reopened; the appeal is granted to this extent only. REMANDED Entitlement to service connection for a chronic cough/breathing-related condition is remanded. Entitlement to service connection for a chronic fatigue condition is remanded. Entitlement to service connection for a gastrointestinal condition is remanded. FINDINGS OF FACT 1. In a final decision issued in June 2014, the Agency of Original Jurisdiction (AOJ) denied service connection for a chronic cough/breathing-related condition, a chronic fatigue condition, and a gastrointestinal condition (claimed as abdominal pain). 2. Evidence associated with the record since the final June 2014 denial is not cumulative or redundant of the evidence of record at the time of the decision and raises a reasonable possibility of substantiating the claims of entitlement to service for a chronic cough/breathing-related condition, a chronic fatigue condition, and a gastrointestinal condition. CONCLUSION OF LAW New and material evidence has been received to reopen the claims for service connection for a chronic cough/breathing-related condition, a chronic fatigue condition, and a gastrointestinal condition. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. § 3.156. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from November 1981 to March 1982, and from November 1990 to June 1991. This matter comes before the Board of Veterans' Appeals (Board) from October 2016 (chronic cough/breathing-related condition) and December 2016 (chronic fatigue and a gastrointestinal condition) rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) during a hearing in August 2021. New and Material Evidence The Board must address the question of whether new and material evidence has been received since the noted June 2014 rating decision, which was unappealed and is final. Barnett v. Brown, 83 F.3d 1380, 1383-84 (Fed. Cir. 1996); 38 U.S.C. § 5108; 38 C.F.R. § 3.156. The June 2014 rating decision found that the evidence did not show the Veteran's chronic cough/breathing problems, fatigue, and gastrointestinal conditions had an onset during service, nor did the evidence show a link between the Veteran's complaints of symptoms and service. Since the issuance of the June 2014 rating decision, the Veteran has submitted evidence that shows his conditions could be related to the environmental exposures while serving in the Persian Gulf and may fall under 38 C.F.R. § 3.317 as an undiagnosed illness or a medically unexplained chronic multi-symptom illness (MUCMI). Regarding his chronic cough/breathing-related condition, the Veteran testified before the Board in August 2021 and stated that his chronic cough and breathing issues began during and have continued since service. He further testified that he has had breathing tests conducted and doctors have not been able to identify an etiology for his cough or breathing-related issues. The Board notes that recent medical records from October 2020 show the Veteran had a septoplasty to address breathing-related issues and nasal blockages, in addition to a diagnosis of allergic rhinitis. Regarding the Veteran's chronic fatigue and gastrointestinal/abdominal pain, the Veteran was provided VA examinations in November 2016 that indicate the etiology of the Veteran's gastrointestinal and fatigue-related symptoms are "unknown." The examiner did not diagnose the Veteran with chronic fatigue syndrome and stated that his abdominal pain could not be diagnosed. In addition, a statement by a gastroenterologist from July 2018 suggests the etiology of the Veteran's gastrointestinal symptoms could be "multifactorial" and related to his service in Desert Storm. The Board finds that the foregoing evidence raises a reasonable possibility of substantiating the Veteran's claims by showing that the Veteran's conditions could be related to his service in the Persian Gulf, may be classified as undiagnosed illnesses or MUCMIs per 38 C.F.R. § 3.317, and entitled to presumptive service connection. Consequently, the Board finds that the evidence associated with the record since the final June 2014 denial is neither cumulative nor redundant of the evidence of record at the time of the decision and raises a reasonable possibility of substantiating the claims of entitlement to service connection for a chronic cough/breathing-related condition, a chronic fatigue condition, and a gastrointestinal condition. As such, new and material evidence has been received, and the claims are reopened. REASONS FOR REMAND 1. Entitlement to service connection for a chronic cough/breathing-related condition is remanded. 2. Entitlement to service connection for a chronic fatigue condition is remanded. 3. Entitlement to service connection for a gastrointestinal condition (claimed as abdominal pain) is remanded. In this case, the Veteran asserts that issues 1-3 listed above are related to his environmental exposures while serving in the Persian Gulf or had an onset in service and have continued since. The Board finds that the evidence of record and November 2016 VA examinations do not provide sufficient information to adequately address 38 C.F.R. § 3.317 regarding a chronic disability due to undiagnosed illness or a medically unexplained chronic multi-symptom illness (MUCMI), or otherwise present medical findings in a manner that permits the Board to make the requisite determinations under 38 C.F.R. § 3.317. See Stewart v. Wilkie, 30 Vet. App. 383 (2018) (clarifying that under 38 C.F.R. § 3.317, an illness is a MUCMI where either etiology or pathophysiology of the illness is inconclusive). In addition, testimony provided by the Veteran and medical records submitted in September 2018 and August 2021 suggest the Veteran's symptoms may be related to later diagnoses such as a deviated septum or allergic rhinitis, gastroenteritis/gastritis, or sleep apnea. Accordingly, the Board finds that a remand is warranted for new VA medical opinions and examinations. The matters are REMANDED for the following action: Schedule the Veteran VA examinations regarding his service connection claims for (1) a chronic cough/breathing-related condition, (2) chronic fatigue, and (3) a gastrointestinal condition. The examiner(s) must review the claims file in conjunction with the examination(s). Each examiner must specifically address whether the claimed symptoms are attributable to a known clinical diagnosis. If the symptoms are attributable to a known clinical diagnosis, the examiner must then discuss both the etiology and pathophysiology of the condition to which the Veteran's reported symptoms have been attributed with emphasis on whether both the etiology and pathophysiology of the condition is understood or at least partially understood in the context of his unique circumstances. If not, the examiner should so explain with specificity. If any of the claimed symptoms are attributable to a known clinical diagnosis with both an etiology and pathophysiology that are at least partially understood in the context of the Veteran's unique circumstances, the examiner must then address whether the condition is at least as likely as not (50 percent probability or greater) the result of disease or injury in active service, to include exposure to environmental hazards, including oil fires and burn pits, while deployed in Southwest Asia/Persian Gulf. The examiner is advised the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide a reason for doing so. All opinions must be supported by a rationale. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Ariasaif, Mary 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.