Citation Nr: 21040883 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 15-16 387 ORDER Entitlement to service connection for joint pains, claimed as fibromyalgia, to include an undiagnosed illness or medically unexplained chronic multi-symptom illness (MUCMI) is denied. FINDING OF FACT The weight of the evidence supports a finding that the Veteran's joint pains are a symptom of his service-connected chronic fatigue syndrome and not a separately diagnosed disability. CONCLUSION OF LAW The criteria for entitlement to service connection for joint pains, claimed as fibromyalgia, to include an undiagnosed illness or medically unexplained chronic multi-symptom illness (MUCMI) have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.317, 4.14. REASONS AND BASES FOR FINDING AND CONCLUSION Entitlement to service connection for joint pains, claimed as fibromyalgia, to include and undiagnosed illness or medically unexplained chronic multi-symptom illness (MUCMI) The Veteran served on active duty from March 2004 to March 2009 and had active service in Kuwait and Iraq from October 2006 to January 2008. This matter originates from a Department of Veterans Affairs (VA) Regional Office (RO) August 2012 rating decision denying service connection for joint pains, claimed as fibromyalgia, and fatigue, claimed as chronic fatigue syndrome (CFS). This matter was most recently before the Board of Veterans' Appeals in November 2020, at which time it was remanded for further development. A remand by the Board confers on the Veteran, as a matter of law, the right to substantial compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). As discussed further below, the Board finds that there has been substantial compliance with its remand directives. In November 2020 the Board directed that the Veteran be afforded a VA examination to determine, to the extent possible, the nature and etiology of his joint pain and chronic fatigue. The examiner was directed to provide an opinion as to whether it was at least as likely as not that the Veteran's joint pain and fatigue were the result of his active service, to include any relationship to his in-service complaints of fatigue and joint pain. The Veteran was afforded a VA examination in March 2021. On the basis of the March 2021 VA medical opinion, in March 2021 the RO granted the Veteran entitlement to service connection for chronic fatigue syndrome. As reflected in a March 2021 supplemental statement of the case (SSOC) the RO again denied service connection for a joint pain disability, to include fibromyalgia or an undiagnosed illness or medically unexplained chronic multi-symptom illness (MUCMI). Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. In the absence of proof of a present disability due to disease or injury, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. An October 2007 Report of Medical History in the service treatment records (STRs) reflects the Veteran's report of painful joints. A March 2014 note in the Veteran's STRs reflects complaints of pain in the shoulders, elbows, wrist, knees, lower back, and ankles; providers characterized the Veteran's reported pain as "chronic polyarthralgia." An April 2014 VA treatment note reflects complains of symmetrical hand pain and swelling, as well as low back pain. In the Veteran's May 2015 Form 9, he reported having developed symptoms of widespread pain throughout his body during his active service. In March 2021 the VA examiner characterized the Veteran's joint pain as "migratory" and stated that "migratory joint pain is a sign/symptom of chronic fatigue syndrome"; the examiner further stated that no additional joint-related diagnosis was indicated. 38 C.F.R. § 4.88a requires a finding of six or more symptoms, from a list of enumerated symptoms, to render a diagnosis of CFS for VA purposes; migratory joint pains are included on that list. 38 C.F.R. § 4.88a(a)(3)(vii). In a separate March 2021 opinion, the examiner relied on the finding of migratory joint pain to render the diagnosis of CFS. Joint pain is contemplated by the applicable rating criteria in that CFS is rated according to the frequency and duration of symptoms (including joint pain), and to the extent that symptoms (including joint pain), restrict routine daily activities and/or incapacitate the Veteran. 38 C.F.R. § 4.88b. The Board finds that the weight of the evidence is against a finding that the Veteran's joint pains are a manifestation of a disability separate and distinct from his service connected CFS. The Veteran's joint pains have served as the basis for a diagnosis of CFS, and are contemplated Accordingly, the criteria for entitlement to service connection for joint pains, claimed as fibromyalgia, to include an undiagnosed illness or medically unexplained chronic multi-symptom illness (MUCMI) have not been met, and the same is hereby denied. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.317, 4.14. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sametshaw, Eric C. 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.