Citation Nr: 21015460 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 17-04 591 DATE: March 17, 2021 REMANDED Entitlement to service connection for chronic Fatigue Syndrome (CFS) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 2009 to November 2009, September 2011 to January 2012, March 2012 to August 2012, and June 2013 to September 2013, to include service in the Southwest Asia theater of operations, and on active duty for training (ACDUTRA) from July 15, 2010, to September 30, 2010. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a from a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran presented sworn testimony at a videoconference hearing before the undersigned Veteran’s Law Judge (VLJ) in December 2019. Entitlement to service connection for chronic Fatigue Syndrome (CFS) is remanded. The Veteran seeks service connection for CFS, which he relates to excessive fatigue. The Board remanded the claim in a June 2020 decision, so that the Veteran could be afforded a VA examination to clarify the nature and etiology of the Veteran’s symptoms. The Board noted that excessive daytime fatigue is may be a symptom of the Veteran’s sleep apnea, and it was unclear whether his fatigue represented a separate disorder. Although the Board sincerely regrets the additional delay, a remand is required, as the October 2020 VA examination was inadequate. Specifically, the examiner offered contradictory opinions and suggested that the Veteran should be evaluated further in order to assess his claim. The October 2020 VA examiner filed four different opinion documents dated October 22, 2020. In one document, at Section III regarding direct service connection, the examiner reported that the claimed condition was at least as likely as not incurred in or caused by the claimed in service injury, event, or illness. In that document, the examiner noted “the Veteran has not had an extended medical work up to meet the criteria or rule out a condition for Gulf War syndrome. Claims file shows objective evidence of complaints of fatigue, headaches and generalized muscle joint pain which resolved with treatment for obstructive sleep apnea.” In another document, at Section III regarding direct service connection, in contradiction to the document just referenced, the examiner opined that the claimed condition was less likely than not incurred or caused by the claimed in service injury, event or illness. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). For the foregoing reasons, the Board finds that the October 2020 examination and opinions are inadequate and an additional medical opinion is necessary. See 38 U.S.C.A. § 5103A ; 38 C.F.R. § 3.159 ; McLendon, 20 Vet. App. at 79. The matters are REMANDED for the following action: 1. Schedule the Veteran for appropriate VA examinations with a different examiner who possesses appropriate expertise to determine the nature and etiology of the Veteran’s symptoms of fatigue. 2. The examiner is asked to review the pertinent evidence, including the Veteran’s lay assertions regarding his symptomatology. It is specifically noted that the Veteran has reported fatigue, headaches and generalized muscle joint pain. The examiner is asked to undertake any indicated studies or further actions in order to render a complete opinion. It is specifically noted that a VA examiner identified that the Veteran has not had an extended medical work up to meet the criteria or rule out a condition for Gulf War syndrome, and the examiner should take appropriate action consistent with this observation. Then, the examiner is asked to address each of the following questions: 1. Please state whether the symptoms of fatigue are attributable to a known clinical diagnosis, to include his service-connected sleep apnea. If the Veteran does not now have a disability manifested by complaints of fatigue, but previously had any such condition, when did that condition resolve? 2. Is the Veteran’s disability pattern and complaints of fatigue consistent with: (1) a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology, (2) a diagnosable chronic multi-symptom illness with a partially explained etiology, or (3) a disease with a clear and specific etiology and diagnosis. 3. If, after examining the Veteran and reviewing the claims file, you determine that the Veteran’s disability pattern is either a diagnosable chronic multi-symptom illness with a partially explained etiology, or a disease with a clear and specific etiology and diagnosis, then please provide an expert opinion as to whether it is related to a presumed environmental exposure experienced by the Veteran during service in Southwest Asia. 4. Is it at least as likely as not that any current diagnosed disorder manifested by fatigue had its onset directly during the Veteran’s service or is otherwise causally related to any event or circumstance of his service, including environmental exposures during service in Southwest Asia during the Persian Gulf War? 5. If not directly related to service on the basis of the above questions, is any medical condition manifested by fatigue proximately due to, the result of, or caused by any service-connected disability? 6. If not caused by another medical condition, has any disorder manifested by fatigue been aggravated (made permanently worse or increased in severity) by any service connected disability? In answering all questions, please clearly identify the facts and information underpinning your conclusions. 3. The RO must ensure that all examination reports and opinions requested above are in compliance with the directives of this remand. If any report or opinion is   deficient in any manner, the RO must implement corrective action. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.M. Schneider 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.