Citation Nr: 21021023 Decision Date: 04/09/21 Archive Date: 04/09/21 DOCKET NO. 12-33 538 DATE: April 9, 2021 ORDER Entitlement to service connection for chronic fatigue syndrome is denied. Entitlement to service connection for headaches is denied. Entitlement to service connection for a cognitive disorder is denied. Entitlement to service connection for hair loss is denied. Entitlement to service connection for sterility is denied. Entitlement to service connection for cholecystitis is denied. Entitlement to service connection for a gastrointestinal disorder is denied. Entitlement to service connection for fibromyalgia is denied. Entitlement to service connection for myalgia of the bilateral biceps, triceps, and quadriceps is denied. FINDINGS OF FACT 1. The evidence does not show that the Veteran had a diagnosis of chronic fatigue syndrome during the appeal period or that his subjective complaints of fatigue result in functional impairment. 2. The evidence does not show that the Veteran had a chronic headache condition during the appeal period. 3. The evidence does not show that the Veteran had a cognitive disorder manifesting in impairment of memory or concentration during the appeal period. 4. The evidence does not show that the Veteran’s hair loss is related to service. 5. The evidence does not show that the Veteran’s sterility is related to service. 6. The evidence does not show that the Veteran’s cholecystitis is related to service. 7. The evidence does not show that the Veteran’s gastrointestinal disorder is related to service. 8. The evidence does not show that the Veteran had a diagnosis of fibromyalgia due the appeal period. 9. The evidence does not show a current diagnosis of myalgia of the bilateral biceps, triceps, and quadriceps or pain resulting in functional impairment during the appeal period. CONCLUSIONS OF LAW 1. The criteria for service connection for chronic fatigue syndrome have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. 2. The criteria for service connection for headaches have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. 3. The criteria for service connection for a cognitive disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. 4. The criteria for service connection for hair loss have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. 5. The criteria for service connection for sterility have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. 6. The criteria for service connection for cholecystitis have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. 7. The criteria for service connection for a gastrointestinal disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. 8. The criteria for service connection for fibromyalgia have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. 9. The criteria for service connection for myalgia of the bilateral biceps, triceps, and quadriceps have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from June 1986 to March 1990 and from December 1990 to May 1991. Service Connection To establish service connection for a disability, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may also be established on a presumptive basis for a Persian Gulf Veteran who exhibits objective indications of chronic disability resulting from an undiagnosed illness that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021, and which by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1). In claims based on undiagnosed illness, unlike those for “direct service connection,” there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004). Notably, laypersons are competent to report objective signs of illness. Id. A “qualifying chronic disability” for purposes of 38 U.S.C. § 1117 is a chronic disability resulting from (A) an undiagnosed illness, (B) a medically unexplained chronic multi-symptom illness (such as chronic fatigue syndrome, fibromyalgia, or a functional gastrointestinal disorder) that is defined by a cluster of signs or symptoms, or (C) any diagnosed illness that the Secretary determines in regulation prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection. 38 U.S.C. § 1117(a)(2); 38 C.F.R. § 3.317(a)(2)(i)(B). Irritable bowel syndrome is a qualifying chronic disability for purposes of 38 U.S.C. § 1117. See 38 C.F.R. § 3.317 (a)(2)(i)(B)(3). The term medically unexplained chronic multi-symptom illness (MUCMI) means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, or disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. 38 C.F.R. § 3.317 (a)(2)(ii); Stewart v. Wilkie, 30 Vet. App. 383, 391 (2018) (holding that an illness is a medically unexplained chronic multi-symptom illness where either the etiology or the pathophysiology of the illness is inconclusive). Therefore, even if a multi-symptom illness has a diagnosis, consideration should still be given as to whether the disability has no known etiology, or has a known, partially understood etiology. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology, such as diabetes and multiple sclerosis, will not be considered medically unexplained. Id. The determination of whether a condition is an MUCMI must be based on an individual Veteran’s circumstances rather than the illness as it is understood in the general public. Stewart, 30 Vet. App. at 391. “Objective indications of chronic disability” include both “signs,” in the medical sense of objective evidence perceptible to a physician, and other, non-medical indicators that are capable of independent verification. To fulfill the requirement of chronicity, the illness must have persisted for a period of six months. 38 C.F.R. § 3.317(a)(2), (3). Signs or symptoms that may be manifestations of undiagnosed illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders. 38 C.F.R. § 3.317 (b). In the present case, the Veteran served in the Southwest Asia Theater of Operations during the Gulf War as shown by service personnel records. Thus, the Board finds that the Veteran is a “Persian Gulf Veteran” for the purposes of 38 C.F.R. § 3.317. See 38 C.F.R. § 3.317(e)(1). 1. Entitlement to service connection for chronic fatigue syndrome. The Veteran claims entitlement to service connection for chronic fatigue syndrome to include as a manifestation of an undiagnosed, chronic multi-symptom illness due to Gulf War service. To be considered for service connection, a claimant must first have a disability. This requirement “is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim and that a claimant may be granted service connection even though the disability resolves prior to the Secretary’s adjudication of the claim.” McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In addition, symptoms such as pain alone, that do not result in functional impairment, do not constitute a disability for VA compensation purposes. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). An April 2006 private treatment note indicates the Veteran denied fatigue. During the April 2009 VA examination, the Veteran reported that his fatigue started within a couple years after service while on the police force. He reported he has never seen a provider for his symptoms. The examiner noted that although the Veteran has a current complaint of fatigue his current level of function is very high as the Veteran reported being able to mountain bike and run. In a November 2020 VA medical opinion, the examiner noted that the service treatment records and medical records show no evidence the Veteran was diagnosed, treated, or had symptoms suggestive of chronic fatigue syndrome in service or within one year of separation. In addition, a review of the medical record shows no evidence that the Veteran meets or has ever met the diagnostic criteria for chronic fatigue syndrome. The examiner explained that the Institute of Medicine diagnostic criteria provides that symptoms should be present for at least six months and have moderate, substantial, or severe intensity at least one-half of the time. In addition to fatigue, other criteria include: post-exertional malaise, unrefreshing sleep, cognitive impairment, orthostatic-related symptoms, loss of memory or concentration, sore throat, enlarged lymph nodes in neck or armpits, unexplained muscle pain, pain that moves from one joint to another without swelling or redness, headache of a new type, unrefreshing sleep, and extreme exhaustion lasting more than 24 hours after physical or mental exercise. The examiner explained that while fatigue is a very common complaint in primary care practice, patients meeting the formal case definition of chronic fatigue syndrome are rare. In a study of 1000 patients in a primary care clinic 8.5 percent had debilitating fatigue of at least 6 months duration without apparent cause; however only 15 percent of these patients satisfied the clinical definition for chronic fatigue syndrome. In sum, chronic fatigue syndrome represents a very small subset of those who complain of chronic fatigue. The examiner concluded that the Veteran’s complaints did not represented an undiagnosed illness, medically unexplained chronic multi-symptoms illness of unknown etiology, or a chronic multi-symptom illness understood with partially explained etiology. The Veteran’s complaints do not represent a disease process. The Board finds the VA examiner’s opinion adequate and probative to the question at hand. The examiner possessed the necessary education, training, and expertise to provide the requested opinions. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In addition, the VA examiner provided a detailed rationale for the opinions, which was based on the Veteran’s statements, a review of the service treatment records, post-service treatment records, and medical literature. The opinion considered an accurate history, were definitive and supported by a detailed rationale that considered the lay and medical evidence. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Significantly, the Veteran has not presented or identified any contrary medical opinion that supports the claim for service connection. VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). The evidence does not show that the Veteran’s subjective complaints of fatigue result in functional impairment. In addition, the only evidence suggesting a relationship between the Veteran’s complaints of fatigue and service are his statements, and the Veteran is not competent to provide an opinion on issues requiring medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In sum, as there is no current diagnosis or indicia of an undiagnosed illness or MUCMI, there is no basis for entitlement to service connection for chronic fatigue syndrome. As the preponderance of the evidence is against the Veteran’s claim, the doctrine of reasonable doubt does not apply. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for headaches. The Veteran claims entitlement to service connection for headaches to include as a manifestation of an undiagnosed, chronic multi-symptom illness due to Gulf War service. As an initial matter, the evidence does not show that the Veteran had a chronic headache disorder during the appeal period. Although the Veteran reports experiencing headaches since his Persian Gulf service, medical treatment records show he frequently denied headache symptoms. See March 2010 Notice of Disagreement. October 2005 and February 2008 private treatment notes indicate the Veteran denied headache. An August 2011 VA optometry note indicates the Veteran reported with headache complaints which later resolved once he received new glasses. A February 2015 VA optometry clinic notes the Veteran denied any recurrent of temporal/occipital headaches since getting bifocals years ago. During the October 2016 VA examination, the Veteran reported he had never been diagnosed or treated for a headache condition he just “sometimes gets a normal headache.” Similarly, an August 2018 VA treatment note also shows the Veteran denied headaches. In a November 2020 VA medical opinion, the examiner concluded that the Veteran’s reported headache condition was not related to service. The examiner reasoned that a review of the service treatment records, and medical records show no evidence the Veteran was diagnosed, treated, or had symptoms of suggestive of chronic recurrent or severe headaches while on active duty or within one year of separation. The examiner further noted that headache is a disease with a clear and specific etiology and diagnosis. About 70 to 80 percent of the North American population has headaches with 50 percent experiencing at least one headache per month, 15 percent experiencing at least one weekly, and 5 percent experiencing one daily. The occurrence of headaches rises sharply during the second decade of life and levels off until the age of 40 to 50 years, after which it decreases. The Board finds the examiner’s opinions probative to the question at hand. See Nieves-Rodriguez, 22 Vet. App. at 295. The Veteran has not presented or identified any contrary medical opinion that supports the claim for service connection. VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). In sum, as there is no current diagnosis or indicia of an undiagnosed illness or MUCMI, there is no basis for entitlement to service connection for headaches. See 38 C.F.R. § 3.317. In reaching the decision, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine does not apply. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to service connection for a cognitive disorder. The Veteran claims entitlement to service connection for memory loss and difficulty concentrating (hereinafter “a cognitive disorder”), to include as a manifestation of an undiagnosed, chronic multi-symptom illness due to Gulf War service. The evidence does not show that the Veteran had a cognitive disorder during the appeal period. Service treatment records are silent for complaints of or treatment for a cognitive or psychiatric disorder, to include memory or concentration problems. The Veteran was afforded a VA examination in August 1993, which showed normal neurological and psychiatric examinations. Similarly, during the May 2009 VA examination the Veteran showed normal memory and normal neurological and psychiatric examinations. The examiner noted that the Veteran’s concentration appears adequate as one of the main things he does for enjoyment is reading. In a July 2019 VA medical opinion, the examiner concluded that the VA treatment records did not show any diagnosis, significant complaints of, or treatment for any difficulty with memory or concentration. The examiner noted that during a September 2016 mental health evaluation the Veteran did not endorse memory or concentration problems. The Veteran reported that he forgets things sometimes and will write down appointments to keep track of them. He denied any concentration problems. The examiner noted that this level of occasional forgetting appears well within normal limits and does not represent any significant cognitive dysfunction or memory disorder. In an August 2019 addendum medical the examiner noted that the Veteran’s reports of memory or concentration impairment are not related to an undiagnosed illness or MUCMI. The examiner again emphasized that the record does no show impairment due to memory or concentration issues. In addition, the Veteran has functioned quite well in his life without indications of impairment regarding memory or concentration. In a July 2020 decision, the Board concluded that the opinion was not supported by a sufficient rationale and remanded for an addendum medical opinion. In a November 2020 VA medical opinion, the examiner opined that there was no diagnosis of a cognitive disorder found in the record. There was also no objective evidence of cognitive impairment found in the record. The examiner concluded that give the lack of evidence of cognitive impairment, there is no cognitive or other mental disorder that is at least as likely as not incurred in or caused by service in the Gulf War. In sum, as there is no current diagnosis or indicia of an undiagnosed illness or MUCMI, there is no basis for entitlement to service connection for a cognitive disorder manifested in impairment of memory or concentration. See 38 C.F.R. § 3.317. In reaching the decision, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine does not apply. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to service connection for hair loss. The Veteran claims entitlement to service connection for hair loss, to include as a manifestation of an undiagnosed, chronic multi-symptom illness due to Gulf War service. As the Veteran shows a current diagnosis of alopecia, the issue that remains disputed is whether the Veteran’s hair loss is related to service. The preponderance of the evidence is against the claim. During the August 1993 VA examination, the Veteran reported that he noticed hair loss for the past few years. He reported no family history of baldness on his paternal side. He denied that his hair was falling out and reported thinning. He denied any history of dandruff or inflammatory conditions of the scalp. During the April 2009 VA examination the Veteran reported that when he returned from the Gulf War in 1991, he started to have hair thinning and hair loss. He reported that two years later he essentially had complete hair loss with only hair on the temporal and occipital regions of the head. He reported that no one else in his family is bald. On physical examination, the examiner noted male pattern baldness to the scalp with no other areas of the body with hair loss. The examiner noted there were no abnormal physical findings or test results associated with his hair loss. In a November 2020 VA medical opinion, the examiner concluded that the Veteran’s hair loss was less likely as not related to service. The examiner reasoned that the Veteran has been diagnosed with male pattern baldness, which is a disease with a clear and specific etiology and diagnosis. It is also consistent with other androgen related diagnoses the Veteran has (male infertility). Androgenetic alopecia is the most common type of hair loss in men. The condition is characterized by the progressive loss of terminal hairs on the scalp in a characteristic distribution. Male androgenetic alopecia is a common postpubertal disorder that occurs worldwide and exhibits increasing prevalence with age. The Board finds the examiner’s opinions probative to the question at hand. See Nieves-Rodriguez, 22 Vet. App. at 295. The Veteran has not presented or identified any contrary medical opinion that supports the claim for service connection. VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). The only evidence suggesting a relationship between the Veteran’s hair loss and service are his statements, and the Veteran is not competent to provide an opinion on issues requiring medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In sum, as there is no competent evidence to suggest that the Veteran’s hair loss is related to service, there is no basis for entitlement to service connection for hair loss. See 38 C.F.R. § 3.317. In reaching the decision, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine does not apply. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 5. Entitlement to service connection for sterility. The Veteran asserts that his sterility is a manifestation of an undiagnosed, chronic multi-symptom illness due to Gulf War service. As the evidence shows a diagnosis of azoospermia, the issue that remains disputed is whether the Veteran’s condition is related to service. The preponderance of the evidence is against the claim. Service treatment records are silent for complaints of or treatment for sterility. During an August 1993 VA examination, the Veteran reported that he and his wife were married in December 1991 and were trying to have children. He reported that six months earlier he saw a local physician who told him he had no motile sperm. He reported that he had not attempted to have children with anyone other than his wife. In a November 2020 VA examination, the examiner opined that the Veteran’s sterility was less likely as not related to service. The examiner reasoned that the Veteran was evaluated by an endocrinologist and told he as a diagnosis of azoospermia, which is a genetic defect and has a clear and specific etiology. The examiner further noted that the diagnosis is consistent with other androgen related condition such as male pattern baldness. The examiner further noted that the majority of men with male infertility have oligozoospermia or azoospermia. The Board finds the examiner’s opinions probative to the question at hand. See Nieves-Rodriguez, 22 Vet. App. at 295. The Veteran has not presented or identified any contrary medical opinion that supports the claim for service connection. VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). The only evidence suggesting a relationship between the Veteran’s sterility and service are his statements, and the Veteran is not competent to provide an opinion on issues requiring medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). Thus, service connection for sterility is not warranted. As the preponderance of the evidence is against the Veteran’s claim, the doctrine of reasonable doubt does not apply. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 6. Entitlement to service connection for cholecystitis. The Veteran claims entitlement to service connection for cholecystitis (gallbladder information), to include as a manifestation of an undiagnosed, chronic multi-symptom illness due to Gulf War service. As the Veteran shows a current diagnosis of cholecystitis, the issue that remains disputed is whether the Veteran’s condition is related to service. The preponderance of the evidence is against the claim. Service treatment record are silent for complaints of or treatment for a gallbladder disorder. The Veteran was afforded a VA examination in August 1993. The examiner noted that the Veteran had elevated bilirubin in the blood with a finding of a positive HEP-B, surface AB, which means that that the Veteran is immune to hepatitis B, and the elevated bilirubin could be from liver or gallbladder problems. The examiner called the Veteran to tell him about the positive findings and encouraged the Veteran to his physician about the matter as soon as possible. An April 2006 private treatment record indicates the Veteran underwent a laparoscopic cholecystectomy. It was noted that the Veteran was seen in February for abdominal pain and was diagnosed with Gilbert’s disease in April 2003. The Veteran was asymptomatic since up until approximately 1 week. In a November 2020 VA medical opinion, the examiner opined that the Veteran’s cholecystitis was less likely as not related to service. The examiner noted that service treatment records show no evidence that the Veteran was diagnosed, treated, or had symptoms of cholecystitis while in active duty or within one year of separation. The Veteran was diagnosed with cholecystitis in 2006 and underwent a cholecystectomy several years after separation. In addition, the disease has a clear and specific etiology. The Board finds the examiner’s opinions probative to the question at hand. See Nieves-Rodriguez, 22 Vet. App. at 295. The Veteran has not presented or identified any contrary medical opinion that supports the claim for service connection. VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). The only evidence suggesting a relationship between the Veteran’s current cholecystis is disability and service are his statements, and the Veteran is not competent to provide an opinion on issues requiring medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). As the preponderance of the evidence is against the Veteran’s claim, the doctrine of reasonable doubt does not apply. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 7. Entitlement to service connection for a gastrointestinal disorder. The Veteran claims entitlement to service connection for a gastrointestinal disorder manifesting in periodic diarrhea, to include as a manifestation of an undiagnosed, chronic multi-symptom illness due to Gulf War service. As the records show general complaints of diarrhea, the Veteran has a current diagnosis. The issue that remains disputed is whether the Veteran’s condition is related to service. The preponderance of the evidence is against the claim. Service treatment records are silent for complaints of or treatment for a gastrointestinal disorder. During the August 1993 VA examination, the Veteran reported that since returning from Gulf War service he began to experience period diarrhea which occurs more approximately once a week. During the examination he denied any history of diarrhea while in service, but in a March 2009 statement, the Veteran reported that after Meal, Ready to Eats (MREs) in service, he began to notice severe diarrhea every day. A May 2017 VA gastroenterology note indicates the Veteran reported that he had his gallbladder removed and shortly thereafter he began having diarrhea. He reported that at one time he was taking cholestyramine but once it ran out his diarrhea returned. The diagnostic assessment was “post cholecystectomy diarrhea.” In a November 2020 VA medical examination, the examiner opined that the Veteran that the Veteran’s gastrointestinal disability was less likely as not related to service. The examiner reasoned that the Veteran experienced intermittent diarrhea which is consistent with postcholecystectomy syndrome (PCS). The examiner noted that PCS is a complex of heterogenous symptoms, including persistent abdominal pain, diarrhea, and dyspepsia that recur and persist after a cholecystectomy. The Veteran underwent a laparoscopic cholecystectomy in 2006. Complaints of intermittent diarrhea is a disease with a clear and specific etiology and diagnosis. The Board finds the examiner’s opinions probative to the question at hand. See Nieves-Rodriguez, 22 Vet. App. at 295. The Veteran has not presented or identified any contrary medical opinion that supports the claim for service connection. VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). The only evidence suggesting a relationship between the Veteran’s diarrhea is disability and service are his statements, and the Veteran is not competent to provide an opinion on issues requiring medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In sum, service connection for a gastrointestinal condition is not warranted. As the preponderance of the evidence is against the Veteran’s claim, the doctrine of reasonable doubt does not apply. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 8. Entitlement to service connection for fibromyalgia. The Veteran claims entitlement to service connection for fibromyalgia, to include as a manifestation of an undiagnosed, chronic multi-symptom illness due to Gulf War service. The evidence does not show that the Veteran had fibromyalgia during the appeal period. In order to be considered for service connection, a claimant must first have a disability. Brammer, 3 Vet. App. at 225. In addition, symptoms such as pain alone which do not result in functional impairment do not constitute a disability for VA compensation purposes. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Service treatment record are silent for complaints of or treatment for symptoms consistent with fibromyalgia. The August 1993 VA examination showed no evidence of joint or musculoskeletal abnormalities. Similarly, the April 2009 VA examination was negative for muscle or joint symptoms. A February 2011 private medical treatment note indicates that the Veteran complained of muscle and joint pain and was evaluated for possible fibromyalgia. VA treatment records are silent for a diagnosis of fibromyalgia, and the October 2016 VA examiner also concluded that the Veteran did not have a diagnosis of fibromyalgia. In a November 2020 VA medical opinion, the examiner concluded that the Veteran did not have a diagnosis of fibromyalgia during the appeal period. The examiner noted that service treatment records show no evidence that the Veteran was treated for symptoms suggestive of fibromyalgia while on active duty or within one year of separation. A review of the medical records shows no evidence the Veteran meets or has ever met the diagnostic criteria for fibromyalgia. In sum the most probative evidence of record indicates there is no current diagnosis or indicia of an undiagnosed illness or MUCMI. Thus, there is no basis for entitlement to service connection for fibromyalgia. See 38 C.F.R. § 3.317. In reaching the decision, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine does not apply. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 9. Entitlement to service connection for myalgia of the bilateral biceps, triceps, and quadriceps. The Veteran claims entitlement to service connection for myalgia of the bilateral biceps, triceps to include as a manifestation of an undiagnosed, chronic multi-symptom illness due to Gulf War service. The evidence does not show a current diagnosis or pain resulting in functional impairment. In order to be considered for service connection, a claimant must first have a disability. Brammer, 3 Vet. App. at 225. In addition, symptoms such as pain alone which do not result in functional impairment do not constitute a disability for VA compensation purposes. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In a January 2011 statement the Veteran reported that his myalgias began in service however service treatment records are negative for any complaints of muscle pain in the bilateral upper extremities. The August 1993 VA examination showed no evidence of abnormalities of the upper extremities. The April 2009 VA examination showed the Veteran had full muscle strength in the upper extremity. There were no muscle atrophy, spasms, or other muscle abnormalities shown. A September 2010 VA treatment note indicates the Veteran complained of diffuse muscle aches mostly in the extremities. He reported pain was intermittent with remissions. The Veteran showed full muscle strength. There was no atrophy, spasm, or other muscle abnormality. In addition, VA treatment records show some reports of low back pain but are negative for specific complaints of upper extremity pain. A December 2018 VA treatment note indicates the Veteran denied musculoskeletal pain. In the November 2020 VA examination, the examiner concluded that the Veteran’s reported myalgia was not related to service. The examiner noted that the service treatment records and medical records show no evidence that the Veteran was diagnosed, treated, or had symptoms suggestive of myalgia while on active duty or within one year of separation. The examiner noted that while the medical records shows the Veteran has complained of subjective muscle ache of the bilateral biceps, triceps, deltoids, and quadriceps, objective physical examinations and laboratory results have not substantiated these symptoms. The examiner noted that subjective complaints that are inconsistent and show no physical or pathological component do not represent an undiagnosed illness, a medically unexplained chronic multi-symptoms illness of unknown etiology, or chronic multi-symptoms illness with a partially explained etiology. They are perceived symptoms that vary and change and do not represent a disease process. The preponderance of the evidence shows that the Veteran does not have a current diagnosis or indicia of an undiagnosed illness or MUCMI. In addition, even accepting the Veteran’s complaints of pain as true, the evidence does not show that the Veteran’s pain resulted in functional impairment. The Veteran consistently showed full strength and there is no evidence of incapacitation due to myalgias of the upper extremities. Thus, service connection for myalgia of the bilateral biceps, triceps is denied. As the preponderance of the evidence is against the Veteran’s claim, the doctrine of reasonable doubt does not apply. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.A. Williams, 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.