Citation Nr: 21041915 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 18-52 564 DATE: July 10, 2021 REMANDED Entitlement to service connection for a disability manifested by pain in the legs, arms, hands, neck, and head, to include fibromyalgia and myofascial pain syndrome, is remanded. Entitlement to service connection for abdominal gastric GIST tumor is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1974 to May 1983. In May 2020, the Board denied the Veteran's claims for service connection for fibromyalgia and service connection for abdominal gastric GIST tumor. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (CAVC). In March 2021 Order, the CAVC granted a Joint Motion for Remand (JMR), which vacated and remanded the May 2020 Board decision. The case has been returned to the Board for further adjudication. 1. Entitlement to service connection for a disability manifested by pain in the legs, arms, hands, neck, and head, to include fibromyalgia and myofascial pain syndrome, is remanded. The Veteran contends that she developed fibromyalgia, manifested by pain in the legs, arms, hands, neck, and head, and throughout her entire body, due to the many surgeries she has undergone and prescribed medications she has taken due to service-connected disabilities. See October 2018 VA Form 9. She reported that she was actually diagnosed with fibromyalgia in the 2000's by a private physician, but she is not able to retrieve the treatment records showing this diagnosis. See id. Fibromyalgia is manifested by symptoms that the Veteran is competent to report. However, as a layperson lacking in medical training and expertise, she cannot provide a competent opinion on matters as complex as the diagnosis and etiology of her symptoms. As such, her lay assertions regarding a diagnosis and causation are of no probative value. To determine the cause of such symptoms requires medical training and expertise that the Veteran does not possess. 38 C.F.R. § 3.159 (a)(1), (2) (2019). Furthermore, the Veteran is competent to report that she was diagnosed with fibromyalgia in the past. However, the medical evidence of record, including the July 2019 VA examination, does not show that the Veteran has a current diagnosis of fibromyalgia or that she has ever had a confirmed diagnosis of fibromyalgia. Therefore, with no evidence of a diagnosis of fibromyalgia during active duty or at discharge, and no probative evidence of a current diagnosis of fibromyalgia post-service, the Board does not find the Veteran's reports of being diagnosed with fibromyalgia in the 2000's to be credible. Although the record does not show that the Veteran has a current diagnosis of fibromyalgia, the parties to the Joint Motion agree that the Board failed to address service connection for myofascial pain syndrome while adjudicating the claim for fibromyalgia. In this regard, the parties to the Joint Motion agree that the issue of entitlement to service connection for myofascial pain syndrome was reasonably raised by the record because the July 2019 VA examiner distinguished symptoms of myofascial pain for the Veteran from symptoms of fibromyalgia, and identified myofascial pain as the cause of the Veteran's symptoms. See July 2019 VA examination report and July 2019 VA medical opinion for fibromyalgia. The Board notes that although the July 2019 VA examiner identified the source of the Veteran's muscle pains as myofascial pain syndrome, the examiner did not give an opinion as to whether the diagnosed myofascial pain syndrome is related to the Veteran's active military service. As such, a remand for a new examination and medical opinion as to the etiology of any currently diagnosed myofascial pain syndrome is necessary. 2. Entitlement to service connection for abdominal gastric GIST tumor is remanded. The Veteran contends that her GIST tumor is related to abdominal complaints she had in service. She also contends that that her prescribed medication, ampicillin, caused her GIST problems. See October 2018 VA Form 9. The Veteran was afforded a VA examination to determine the nature and etiology of her claimed abdominal gastric GIST tumor in July 2019. The VA examiner noted that the Veteran had pelvic inflammatory disease (PID) with associated abdominal pain in the service and subsequent salpingo-oophorectomy and hysterectomy. The examiner opined that the Veteran's abdominal gastric (GIST) tumor is less likely than not incurred in or caused by treatment for complaints of abdominal pain in service. The examiner noted that the medical literature does not support pelvic inflammatory disease (PID) associated abdominal pain or her subsequent GYN surgeries as a cause of GIST. The examiner concluded that the Veteran's GIST is a gastric (stomach) tumor related to gene mutations, and in contrast, her service-related abdominal pain was of gynecological/pelvic origin. The parties to the Joint Motion agree that as the July 2019 examiner cited only general articles, without discussing any facts pertaining to the Veteran's condition, she failed to provide an adequate rationale specific to the Veteran's condition or individual circumstances. The parties to the Joint Motion also agree that the July 2019 examiner failed to address the Veteran's contention that her prescribed medication, ampicillin, caused her GIST problems. For these reasons, the Board finds that the July 2019 VA examiner's opinion is inadequate for evaluation purposes, and another VA medical opinion is necessary to determine the etiology of the Veteran's GIST tumor. The matters are REMANDED for the following action: 1. Updated treatment records should be obtained and added to the claims file/e-folder. 2. Then, schedule the Veteran for an examination to determine the nature and etiology of any current myofascial pain syndrome. The examiner must be provided access to the electronic claims file and indicate review of the claims file in the examination report. All necessary testing should be completed. The examiner should identify all areas of joint and muscle pain and indicate any associated diagnoses. The examiner must specifically state whether the Veteran has a current diagnosis of myofascial pain syndrome. The examiner should provide an opinion indicating whether any currently diagnosed myofascial pain syndrome is at least as likely as not (50 percent or greater probability) related to any period of active service. A complete rationale should be given for all opinions and conclusions reached. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. 3. Then, schedule the Veteran for an examination to determine the nature and etiology of her GIST tumor. The examiner must be provided access to the electronic claims file and indicate review of the claims file in the examination report. All necessary testing should be completed. The examiner should provide an opinion indicating whether any currently diagnosed GIST tumor is at least as likely as not (50 percent or greater probability) related to any period of active service. The examiner's opinion must specifically address facts pertaining to the Veteran's condition and provide an adequate rationale specific to the Veteran's condition or individual circumstances. The examiner must also specifically address the Veteran's contention that her prescribed medication, ampicillin, caused her GIST problems. A complete rationale should be given for all opinions and conclusions reached. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. 4. Then readjudicate the claims. If the benefits sought on appeal remain denied, furnish the Veteran and her representative a supplemental statement of the case and allow an appropriate period for response. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board F. Yankey, 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.