Citation Nr: 21026354 Decision Date: 04/30/21 Archive Date: 04/30/21 DOCKET NO. 16-19 432 DATE: April 30, 2021 REMANDED Entitlement to service connection for a disability manifested by chronic muscle fatigue is remanded. Entitlement to service connection for a left shoulder disability is remanded. Entitlement to service connection for a bilateral knee disability is remanded. Entitlement to service connection for a bilateral leg disability is remanded. REASONS FOR REMAND The Veteran had active duty service from October 1974 to October 1976. This matter is on appeal to the Board of Veterans’ Appeals (Board) from August 2014 and October 2014 rating decisions of a regional office of the Department of Veterans Affairs (VA). This appeal was previously remanded by the Board in October 2018 for additional evidentiary development. Entitlement to service connection for a disability manifested by chronic muscle fatigue is remanded. In the August 2014 rating decision on appeal, the Agency of Original Jurisdiction (AOJ) noted the Veteran’s STRs showed he was diagnosed with chronic muscle fatigue following his complaints of left arm weakness. However, the AOJ denied the claim on the basis that there is no permanent residual or chronic disability shown in the STRs or demonstrated by the evidence following service. The AOJ specifically noted that a current VA examination did not diagnosis a disability related to the Veteran’s complaints in service and, in this regard, the Board notes that the AOJ primarily relied upon the August 2014 VA fibromyalgia examination wherein the examiner determined the Veteran’s symptoms and complaints were not consistent with a diagnosis of fibromyalgia. Despite the foregoing, the Board finds additional development is needed for the following reasons. First, the August 2014 VA examiner did not adequately explain why the Veteran does not meet the criteria for a diagnosis of fibromyalgia. Indeed, while the examiner noted the Veteran had signs and symptoms attributable to fibromyalgia, including muscle weakness, fatigue, depression, and anxiety, the examiner merely concluded that the clinical exam was not consistent with a diagnosis of fibromyalgia without further comment or explanation, which renders his conclusion inadequate. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008) (a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two). Further, the Board notes that the evidence of record raises a question of whether the Veteran meets the criteria for a diagnosis of chronic fatigue syndrome (CFS), as he has endorsed several symptoms that are generally associated with CFS, such as joint pain, muscle weakness, neuropsychologic symptoms, and sleep disturbance. See e.g., private treatment records dated February 1990 and March 1999; VA treatment records dated November 2003, October and November 2017, February 2019, and March 2020. In this regard, the Board notes that the Veteran is not considered a Persian Gulf veteran such that the provisions of 38 U.S.C. § 1117(a)(2) and 38 C.F.R. § 3.317 apply. However, CFS is similar to fibromyalgia in that it is a multi-symptom illness to which the Veteran’s myriad symptoms may be attributed and which may be related to his period of active duty. Because the Veteran was afforded a VA fibromyalgia examination, the Board finds consideration should also be given to whether he meets the criteria for a diagnosis of CFS. See e.g., Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes the effort to provide an examination for a service connection claim, even if not statutorily obligated to do so, it must provide an adequate one). Therefore, new VA examinations and opinions are needed to clarify if the Veteran meets the criteria for a diagnosis of fibromyalgia or CFS and, if so, whether either of those diagnoses are related to his active military service. Entitlement to service connection for a left shoulder disability is remanded. Entitlement to service connection for a bilateral knee disability is remanded. Entitlement to service connection for a bilateral leg disability is remanded. The April 2016 statement of the case (SOC) lists treatment records from the Jackson, Mississippi VA Medical Center (VAMC), including the Greenville Community Based Outpatient Center (CBOC), dated from April 1992 to March 2016 among the evidence considered in conjunction with this appeal. The subsequent July 2020 supplemental SOC also considered VA treatment records dated from March 2016 to July 2020. However, the Board’s review of the claims file reveals VA treatment records dated no earlier than October 2001 with a gap in the records from April 2005 to November 2013. Notably, the VA clinician who provided the July 2019 VA opinion referred to evidence dated in January 2007 while discussing the Veteran’s current left shoulder diagnoses and the Board is otherwise unable to determine that no reasonable possibility exists that the outstanding records contain any information or evidence relevant to the other claims on appeal. Therefore, the outstanding VA treatment records must be associated with the claims file. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all of the Veteran’s VA treatment records dated from April 1992 to October 2001 and from April 2005 to November 2013. 2. Schedule the Veteran a VA examination to determine if he meets the criteria of chronic fatigue syndrome (CFS). The need for an additional fibromyalgia examination is left to the discretion of the clinician chosen to conduct the examination. A complete history of the disability should be obtained, and all studies and tests deemed appropriate to ascertain the nature of the disability should be performed. After reviewing the claims file and examination of the Veteran, the examiner is requested to address the following: (a) Is it as likely as not (50 percent probability) that the Veteran meets the criteria for a diagnosis of chronic fatigue syndrome? (b) Is it as likely as not (50 percent probability) that the Veteran meets the criteria for a diagnosis of fibromyalgia? In answering the foregoing, the examiner must consider the symptoms the Veteran has endorsed having and/or manifested on clinical evaluation since approximately April 2014. (c) If the answer to either (a) or (b) is yes, is it as likely as not (50 percent probability) that the diagnosis of chronic fatigue syndrome or fibromyalgia had its onset during or is otherwise related to the Veteran’s military service, to include the diagnosis of chronic muscle fatigue or any other complaints or diagnoses noted during service? (d) A complete rationale must be provided for each opinion offered. The examiner must consider and address all lay and medical evidence of record with respect to the onset and progression of the Veteran’s symptoms during and since service. Jenna Brant Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Turnipseed, 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.