Citation Nr: 21021178 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 14-29 213A DATE: April 12, 2021 ORDER Service connection for a migraine disability is granted. REMANDED Entitlement to a rating in excess of 10 percent for fibromyalgia is remanded. Service connection bilateral carpal tunnel syndrome is remanded. Service connection for a fatigue disability is remanded. Entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. FINDING OF FACT The Veteran’s migraine disability is caused by or related to her service-connected fibromyalgia. CONCLUSION OF LAW The criteria for service connection for a migraine disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from December 1979 to December 2003. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from April and August 2013 rating decisions from the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that the Veteran withdrew her request for a hearing in connection with this case. See January 2021 correspondence. Service Connection The Veteran seeks service connection for a headache disability. Service connection may be granted for a disability resulting in a disease or injury that is incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 U.S.C. § 3.303. To establish service connection for the claimed disorder, the following criteria must be met: (1) evidence of a current disability; (2) evidence of an in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and current disability. See 38 C.F.R. § 3.303; see also Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection may also be granted on a secondary basis for a disability if it is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). The Board finds that service connection for migraines is warranted as secondary to the Veteran’s service-connected fibromyalgia. Veteran has a diagnosis of migraine, including migraine variants. See July 2013 VA examination. In the February 2012 VA examination addressing fibromyalgia, the VA examiner noted that the Veteran has migraines that are attributable to fibromyalgia. Specifically, where asked if the Veteran currently has any findings, signs or symptoms attributable to fibromyalgia, the examiner checked a box indicating “Headaches” and where asked to add a description, the examiner added “Migraines.” Affording the Veteran the benefit of the doubt, the Board interprets this examination report as finding that the Veteran’s migraines are at least as likely as not due to her service-connected fibromyalgia disability. As such, entitlement to service connection for migraines is warranted. REASONS FOR REMAND Fibromyalgia The Veteran originally asserted clear and unmistakable error (CUE) regarding her initial rating for fibromyalgia. In an April 2013 rating decision, the RO granted service connection for fibromyalgia and assigned a 10 percent rating. Following, this rating decision, the Veteran highlighted her CUE assertions. However, the April 2013 rating decision never became final and CUE cannot be used to revise this rating decision. Instead, the Veteran’s claim should be recharacterized as entitlement to a higher initial rating for fibromyalgia. Still, the Board finds remand is warranted for a new VA examination to assess the current nature of severity of her disability. In numerous statements, the Veteran highlights her symptoms and the effect on her daily functioning. Her contentions indicate that her disability is worse than represented by her rating. As her last VA examination was in 2013, the Board finds remand is warranted. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Fatigue The Veteran seeks service connection for chronic fatigue syndrome (CFS). A February 2012 VA examination indicates that she reports being diagnosed with CFS. However, the July 2013 VA examiner addressed the findings in the February 2012 VA examination and ultimately concluded that she did not have chronic fatigue syndrome, although she does suffer from fatigue. The VA examiner opined that the Veteran’s fatigue can be explained by her fibromyalgia because moderate or severe fatigue are hallmark symptoms of the disability. The Veteran also has diagnosis of depression, chronic pain syndrome, insomnia, and posttraumatic stress disorder (PTSD) which can also explain reported fatigue. The VA examiner ultimately concluded that the Veteran does not meet the criteria for a diagnosis of chronic fatigue syndrome as her fatigue symptoms are due to depression, PTSD, chronic pain, fibromyalgia. As a result, remand is warranted for a medical opinion to determine whether the Veteran has solely fatigue symptoms as part of her service-connected disabilities or if the fatigue she experiences constitutes a separate disability caused by these disabilities. This is especially true in light of the VA examiner listing fatigue as her diagnosis. Bilateral Carpal Tunnel Syndrome The Veteran asserts that her bilateral carpal tunnel syndrome began in service and is the result of in-service operation of manual equipment: account machines, typewriters, card key punchers, magnetic tape drives, teletype machines and computers. See January 2012 correspondence. Remand is warranted for a VA examination and a medical opinion. TDIU A TDIU is part in parcel of a claim for increased rating. The increased rating fibromyalgia claim being remanded here is inextricably intertwined with the Veteran’s claim for a TDIU. See Rice v. Shinseki, 22 Vet. App. 447 (2009). She asserts that her disabilities affect her ability to work. As a result, remand is warranted for further development. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. Obtain an addendum medical opinion addressing whether the Veteran has a fatigue disability resulting from her service-connected disabilities or whether her fatigue symptoms are part of her service-connected disabilities. 3. Schedule a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) for her bilateral carpal tunnel syndrome and fibromyalgia. For her bilateral carpal tunnel syndrome, the VA examiner should opine whether any disability found to be present had its onset in service or is due to the circumstances of her service, including of in-service operation of manual equipment: account machines, typewriters, card key punchers, magnetic tape drives, teletype machines and computers. 4. Furnish the Veteran a VA Form 21-8940 and request that she complete and submit it in conjunction with the TDIU claim. TRACIE N. WESNER Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Ijitimehin, Kemi D. 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.