Citation Nr: 21025325 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 14-17 113A DATE: April 27, 2021 ORDER Entitlement to service connection for chronic fatigue syndrome is denied. Entitlement to service connection for a headache disorder is denied. Entitlement to service connection for IBS is denied. REMANDED Entitlement to service connection for acquired psychiatric disorder to include posttraumatic stress disorder (PTSD) is remanded. FINDINGS OF FACT 1. The evidence of record does not reflect that the Veteran has a current diagnosis of chronic fatigue syndrome, undiagnosed illness, or medically unexplained chronic multisystem illness. 2. The evidence of record does not reflect that the Veteran has a current diagnosis of a headache disorder, undiagnosed illness, or medically unexplained chronic multisystem illness. 3. The evidence of record does not reflect that the Veteran has a current diagnosis of irritable bowel syndrome, IBS, undiagnosed illness, or medically unexplained chronic multisystem illness. CONCLUSIONS OF LAW 1. The criteria for entitlement to 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. 2. The criteria for entitlement to service connection for a headache disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for IBS have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from November 1986 to January 1992. SERVICE CONNECTION 1. Entitlement to service connection for chronic fatigue syndrome 2. Entitlement to service connection for headache disorder 3. Entitlement to service connection for IBS The Veteran contends that he has chronic fatigue syndrome, a headache disorder, and IBS related to active service. After a thorough review of the evidence, the Board finds that entitlement to service connection is not warranted. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of chronic fatigue syndrome, headache disorder, or IBS and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Furthermore, the Board notes that the Veteran served in the Southwest Asia theater of operations during the Persian Gulf War and is cognizant of the Veteran’s assertion that fatigue, irritable bowel syndrome, and headaches may be the result of an undiagnosed illness or a medically unexplained chronic multisystem illness. Unfortunately, the examination reports of record indicate that the Veteran does not have an undiagnosed illness or medically unexplained chronic multisystem illness. Since the prior Board remand, the RO verified the Veteran’s address and attempted to reach him by telephone to schedule a VA examination for these claims, but the RO was not successful in its attempts. The overall record does not support that the Veteran has a current diagnosis for these conditions, an undiagnosed illness or medically unexplained chronic multisystem illness. While there may be complaints that also can comprise symptoms of other diseases, such as February 8, 2017 CAPRI note showing complaint of headache, there are not confirmed current diagnoses for chronic fatigue syndrome, headache disorder, or IBS. While the Veteran believes he has a current diagnosis of chronic fatigue syndrome, headache disorder, IBS, an undiagnosed illness, or medically unexplained chronic multisystem illness he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Since the evidence does not show that the Veteran has any of these disabilities, the Board finds that the Veteran is not entitled to service connection for chronic fatigue syndrome, headache disorder, IBS, an undiagnosed illness, or medically unexplained chronic multisystem illness. REASONS FOR REMAND 1. Entitlement to service connection for acquired psychiatric disorder to include posttraumatic stress disorder (PTSD) is remanded. As background, the Board notes that the Veteran has been incarcerated on numerous occasions and at times for lengthy sentences, making communication and examination fulfillment challenging or impossible. The current records of the relevant state prison system note that this Veteran has entered incarceration again in February 2021 and is scheduled for release in 2023. Accordingly, the RO knows or is able to find easily where the Veteran is located, however it is unclear if an in-person psychiatric examination would be possible. Nonetheless, due to the various conflicting and previously-deemed inadequate psychiatric examinations and the fact that diagnoses of various psychiatric disorders to include PTSD are present in the record, the Board will ask the RO to determine if a new VA psychiatric examination is possible, perhaps by telecommunication while the Veteran is incarcerated. If not possible, the RO should request a medical opinion and examination based on records review only for acquired psychiatric disorders. The Veteran has a non-service-connected pension that is permanent, and total based on psychiatric disorders that render him unemployable. The evidence of record shows that qualified persons have noted a PTSD diagnosis per DSM-5 or the prior DSM-IV for the Veteran. See February 21, 2018 CAPRI note. The Veteran’s CAPRI records include “chronic PTSD” in the problem history through his medical record. The Veteran has also been diagnosed with other psychiatric disorders such as anxiety (See November 2006 psychiatric program records) and delusional parasitosis (April 20, 2017). The Veteran has a lengthy history with abuse of various substances. The Veteran’s service personnel records document multiple disciplinary issues and an Article 15 charge leading to separation. There were prior PTSD VA examinations that either the Board or the RO later deemed inadequate for various reasons. The Board remanded this issue in August 2020 to obtain a new VA examination for PTSD. The RO was unable to reach the Veteran after numerous phone calls and after identifying the Veteran’s correct current address after mail had previously been returned. In various statements (e.g. November 7, 2016 CAPRI; August 12, 1998 CAPRI), the Veteran reported an in-service stressor involving a personal assault. Specifically, sexual assault by other servicemembers on multiple occasions. 38 C.F.R. § 3.304(f)(5) states that “VA will not deny a posttraumatic stress disorder claim that is based on in-service personal assault without first advising the claimant that evidence from sources other than the veteran’s service records or evidence of behaviour changes may constitute credible supporting evidence of the stressor and allowing him to the opportunity to furnish his type of evidence or advise VA of potential sources of evidence.” The RO should send the Veteran the notice of development specific to military sexual assault claims. The Veteran also has a diagnosis of delusional parasitosis. The Veteran has stated in various documents that he was exposed to black flies in Maine and Panama during active service and that those biting flies contribute to his current condition. In one instance in April 2017, the Veteran was treated for skin lesions related to picking his skin due to perceived insects biting him. The medical provider diagnosed delusional parasitosis. A remand is required to allow VA to attempt to corroborate the Veteran’s reported stressors and send the Veteran notification as required under 38 C.F.R. § 3.304(f)(5) and to obtain a VA medical opinion or examination. The matters are REMANDED for the following actions: 1. Confirm if the Veteran is currently incarcerated as shown by state prison system. If so, ensure mailing address and other contact information on file reflects the appropriate prison mailing address and details for the Veteran. 2. Send the Veteran notice required for PTSD claims based on personal assaults and allow time for a response. Then, attempt to corroborate the Veteran’s in-service stressors based on personal assault, including sexual assault on separate occasions. If more details are needed, contact the Veteran to request the information. 3. After the Veteran’s reported stressors have been developed, schedule the Veteran for a psychiatric examination to determine the nature and etiology of any acquired psychiatric disorder including, but not limited to, posttraumatic stress disorder (PTSD), delusional parasitosis, anxiety, depression or substance use disorder. If the Veteran is incarcerated, attempt to schedule an in-person VA psychiatric examination if allowed under prison guidelines or other considerations. If an in-person examination is not possible, determine if a telephone or video VA psychiatric examination is possible. If in-person, telephone, or video examinations are not possible, request a VA psychiatric examination based on record review only. The examiner should first state in the examination which, if any, confirmed psychiatric disorders apply to the Veteran, including but not limited to PTSD, delusional parasitosis, anxiety, depression, or substance use disorder. The examiner should disregard prior VA psychiatric examinations that have been deemed inadequate (March 2015 and August 2013) but review all other relevant medical records, lay statements, personnel and service treatment records, and any other records in the claims file. If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not related to a verified in-service stressor. If the Veteran is diagnosed with a personality disorder and PTSD - The examiner must opine whether the PTSD was at least as likely as not superimposed on a personality disorder during active service and resulted in additional disability. If the Veteran’s stressor is based on an in-service personal assault - The examiner must opine whether the evidence of record, including the Veteran’s lay statements, statements made by others, and the Veteran’s service and personnel records, corroborate the claim that a personal assault occurred in service (38 C.F.R. § 3.304(f)(5)). If the examiner finds that evidence indicates that a personal assault occurred during the Veteran’s active service, the examiner must opine whether any PTSD is at least as likely as not related to the in-service personal assault. If any other acquired psychiatric disorders are diagnosed, the examiner must opine whether each diagnosed disorder is at least as likely as not related to an in-service injury, event, or disease, to include personal assault, and claimed exposure to biting black flies, or other claims by Veteran of in-service injury, event, or disease. The examiner must comment on whether the Veteran’s psychiatric conditions existed prior to active service. The Veteran’s service entrance examination in 1986 does not note psychiatric problems. However, the Veteran’s medical records document alcohol use and sexual abuse prior to active service. The examiner should answer the following: Did any of the Veteran’s diagnosed psychiatric disorders clearly and unmistakably exist prior to active service based on evidence? The examiner should opine on the following: If the diagnosed psychiatric disorders clearly and unmistakably existed prior to active service, were these psychiatric disorders aggravated beyond a natural progression during active service? (Continued on the next page)   4. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If the benefits sought are not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. R.R. WATKINS Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Miller, 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.