Citation Nr: 21077210 Decision Date: 12/29/21 Archive Date: 12/28/21 DOCKET NO. 14-24 206A DATE: December 29, 2021 REMANDED Entitlement to service connection for chronic fatigue syndrome (CFS), to include as due to an undiagnosed illness and/or medically unexplained chronic multisymptom illnesses due to Persian Gulf War service is remanded. REASONS FOR REMAND The Veteran had active-duty service from November 1982 to February 2005. This matter comes before the Board of Veterans' Appeals (Board) from a September 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). Upon remand, the Veteran's claim for migraine headaches was fully granted by the RO, and is therefore no longer before the Board on appeal. See December 2020 rating decision. 1. Entitlement to service connection for chronic fatigue syndrome (CFS), to include as due to an undiagnosed illness and/or medically unexplained chronic multisymptom illnesses due to Persian Gulf War service is remanded. Per the January 2020 remand, the Board requested a new VA medical examination and opinion addressing all of the Veteran's symptoms, namely fatigue, skin rash, headaches, joint pain, and sleep disturbances relative to his Persian Gulf War service. Subsequently, the November 2020 VA examiner opined that the Veteran's service-connected hypertension and obstructive sleep apnea accounted for his fatigue symptomatology, and while the record indicates that the Veteran's service-connected acquired psychiatric disorder manifests with sleep disturbances, there is no opinion of record addressing the Veteran's symptoms of chronic joint pain and skin rash and whether those symptoms are evidence of an undiagnosed illness or a medically unexplained chronic multi symptom illness (MUCMI). See, e.g. VA treatment records dated July 26, 2016 and May 30, 2017 (indicating that the Veteran suffers from a skin rash on his back); VA treatment records dated October 29, 2018 ("Chronic joint pain all over"), January 23, 2017 (indicating chronic pain in joints and muscles), and November 28, 2016 (indicating chronic pain in all of the Veteran's joints). Thus, as the November 2020 VA examiner did not address the aforesaid symptomatology relative to the Veteran's alleged theory of entitlement, specifically as due to his Persian Gulf War service, the Board finds that an additional remand is needed here. The matters are REMANDED for the following action: Obtain an addendum medical opinion from the November 2020 VA examiner, or another appropriate clinician if deemed unavailable, addressing the Veteran's chronic joint pain and skin rash symptomatology relative to his Persian Gulf War service theory of entitlement. Upon review of the record, to include this remand, and as indicated below, the VA examiner is requested to opine as to the following: Skin rash... Whether it is at least as likely as not (50 percent probability or greater) that the Veteran's skin rash disability pattern is consistent with: (1) a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology, (2) a diagnosable chronic multisymptom illness with a partially explained etiology, or (3) a disease with a clear and specific etiology and diagnosis. If the Veteran's skin rash is not directly related to a Gulf War illness, then the examiner must opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran's skin rash is (1) proximately due to a service-connected disability, or (2) is aggravated beyond its natural progression by any of his service-connected disabilities. The Board directs the VA examiner's attention to the record evidencing symptoms of a skin rash. See VBMS, document titled "CAPRI," receipt dated September 4, 2019 (VA treatment records dated July 26, 2016 and May 30, 2017 therein). Chronic joint pain... Whether it is at least as likely as not (50 percent probability or greater) that the Veteran's chronic joint pain disability pattern is consistent with: (1) a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology, (2) a diagnosable chronic multisymptom illness with a partially explained etiology, or (3) a disease with a clear and specific etiology and diagnosis. If the Veteran's chronic joint pain is not directly related to a Gulf War illness, the examiner must then opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran's chronic joint pain is (1) proximately due to a service-connected disability, or (2) is aggravated beyond its natural progression by any of his service-connected disabilities. The Board directs the VA examiner's attention to the record evidencing symptoms of chronic joint pain. See VBMS, document titled "CAPRI," receipt dated September 4, 2019 (VA treatment records dated October 29, 2018, January 23, 2017, and November 28, 2016 therein). Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.R. Fey, 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.