Citation Nr: 21009749 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 17-26 014 DATE: February 23, 2021 ORDER Service connection for chronic fatigue syndrome is granted. FINDING OF FACT The competent and probative evidence supports a finding that the Veteran has a current diagnosis of chronic fatigue syndrome that was incurred coincident with her active military service. CONCLUSION OF LAW The criteria for service connection for chronic fatigue syndrome are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1992 to June 2002. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2021, the Veteran testified before the undersigned at a Board video-conference hearing and a transcript of that proceeding is of record. Service connection for chronic fatigue syndrome is granted. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. That determination requires a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). The Veteran is competent to report symptoms and experiences observable by her senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009). The standard of proof to be applied in decisions on claims for Veterans' benefits is set forth at 38 U.S.C. § 5107. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). The Board has reviewed all the evidence in the Veteran's claims file, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim decided herein. *** The Veteran seeks service connection for chronic fatigue syndrome. 07/02/2015 VA 21-526EZ, Veteran’s Fully Developed Claim. Regarding the first element of service connection, current disability, the Board observes that there is conflicting evidence as to whether the Veteran has a current diagnosis of chronic fatigue syndrome. The Veteran was afforded a VA examination in February 2016, where the examiner opined that the Veteran did not have a current diagnosis of chronic fatigue syndrome, as there was no evidence of a past diagnosis of chronic fatigue syndrome either in service or after discharge. See 02/23/2016 C&P Exam. A February 2017 VA examiner similarly opined that the Veteran did not have a current diagnosis of chronic fatigue syndrome and that there was insufficient medical evidence to render such a diagnosis. See 02/20/2017 C&P Exam. In contrast, an October 2016 private Chronic Fatigue Syndrome Disability Benefits Questionnaire (DBQ) prepared by Dr. S.E.R. contains his assessment that the Veteran has a current diagnosis of chronic fatigue syndrome. See 10/12/2016 Disability Benefits Questionnaire (DBQ) at 1. Dr. S.E.R. indicated that this diagnosis was based on an in-person examination of the Veteran and a review of her medical history, to include service treatment records (STRs) and her lay statements. Furthermore, a review of the Veteran’s VA treatment records reveal that she was first diagnosed with chronic fatigue syndrome in October 2015, for which she has continued to receive treatment for ever since. See 01/11/2017 CAPRI at 41; see also 04/21/2018 CAPRI at 11, 73, 74. Here, the Board finds that the competent evidence is at least in equipoise as to whether the Veteran has a current diagnosis of chronic fatigue syndrome; accordingly, the first element of service connection, current disability, is satisfied. Regarding the second element, in-service incurrence, the Veteran contends that she began to experience symptoms of chronic fatigue syndrome while on active duty in Okinawa, Japan from 2000-2001. See 10/12/2016 Correspondence; see also 01/06/2021 Hearing Transcript. She testified that symptoms of her chronic fatigue syndrome, to include dizziness, fatigue, and pain, began while she was on active duty from 2000-2001 and steadily worsened until she was forced to accept a medical discharge. The record contains numerous lay statements which confirm the Veteran’s reports of an in-service onset of symptoms of chronic fatigue, dizziness, and pain. In an October 2016 lay statement, the Veteran’s mother stated that she traveled to Okinawa, Japan in 2001 to be with her daughter and assist her with daily tasks due to the onset of symptoms of extreme fatigue, pain, and cognitive problems that left her unable to drive or care for herself. See 10/12/2016 Disability Benefits Questionnaire (DBQ) at 4. The Veteran’s ex-husband, D.M., submitted a lay statement in January 2021, in which he reported that the Veteran began to experience symptoms of fatigue, pain, dizziness, and cognitive problems. See 01/06/2021 Buddy/Lay Statement. He detailed that while on active duty in Okinawa, Japan, he had to drive the Veteran because she began falling asleep while driving. He further reported that the Veteran began to experience difficulties performing her military duties, to include lying on the ground to sleep while running due to intense fatigue, which led to a medical discharge in 2002. See id. In a January 2021 lay statement, G.W. (a fellow Marine) reported that she served at Camp Foster in Okinawa, Japan with the Veteran from 1999-2001. G.W. stated that halfway through her tour, she began to notice a sudden decline in the Veteran’s mental acuity, to include difficulty focusing and chronic fatigue, as well as problems performing physical duties at work on base. G.W. further reported that the Veteran sought treatment for her symptoms, but she never received a diagnosis that covered all of the symptoms she experienced while on active duty. G.W. also indicated that the Veteran’s symptoms continued to worsen until her discharge, which resulted from a medical board evaluation recommended by her Captain. See 01/06/2021 Buddy/Lay Statement. Finally, the Veteran’s STRs contain numerous complaints of symptoms of chronic fatigue, pain, and dizziness. See 07/23/2015 STR – Medical – Photocopy. The Veteran’s STRs also contain a February 2001 Chronological Record of Medical Care which includes a possible diagnosis of chronic fatigue syndrome. See id. at 94. As such, the Board finds that the second element of service connection, in-service incurrence, is established. See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Finally, turning to the final element of a claim of entitlement to service connection, nexus, the Veteran underwent VA examinations in connection with her claim in February 2016 and February 2017. See 02/23/2016 C&P Exam and 02/20/2017 C&P Exam. However, as noted above, neither the February 2016 nor the February 2017 rendered a diagnosis of chronic fatigue syndrome, citing insufficient medical evidence to support such an assessment. See id. In light of the Board’s finding above that the evidence of record, to include the Veteran’s STRs, VA treatment records, lay statements, and the October 2016 private Chronic Fatigue Syndrome DBQ, support a finding that the Veteran has a current diagnosis of chronic fatigue syndrome, the February 2016 and February 2017 VA examinations and medical opinions are inadequate due to the examiners’ failure to consider this relevant evidence of record, and are entitled to limited probative weight. Given the fact that there is no adequate nexus opinion of record, the Board finds that the evidence of record, including STRs which show complaints of chronic fatigue syndrome symptoms and a provisional diagnosis of the same, and the Veteran’s lay reports of an in-service onset of symptoms, supports a finding that the Veteran's chronic fatigue syndrome was incurred during service. See 38 C.F.R. § 3.303(a) (stating that service connection must be considered on the basis of the places, types, and circumstances of the Veteran's service as shown by service records, the official history of each organization in which she served, her medical records, and all pertinent medical and lay evidence).   Based on the foregoing, the Board finds that the competent and probative evidence of record is at least in equipoise as to whether the Veteran's current chronic fatigue syndrome was incurred coincident with her active military service. 38 C.F.R. § 3.102, 3.303(a). Accordingly, and resolving all reasonable doubt in favor of the Veteran, the Board finds that service connection for a chronic fatigue syndrome is warranted. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Tremont 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.