Citation Nr: 22016977 Decision Date: 03/23/22 Archive Date: 03/23/22 DOCKET NO. 10-15 987 DATE: March 23, 2022 ORDER Entitlement to service connection for bilateral restless leg syndrome is granted. FINDING OF FACT It is at least as likely as not that the Veteran's current restless leg syndrome was caused by his service in Southwest Asia. CONCLUSION OF LAW The criteria for service connection for restless leg syndrome have been met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.303, 3.317 (2021). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1985 to January 1991, from November 1, 2006, to November 18, 2006, and from September 30, 2007, to October 8, 2007, including service in the Southwest Asia theater of operations. The Veteran's claim was previously before the Board in September 2019 but was remanded to the Agency of Original Jurisdiction (AOJ) for further development. Specifically, the AOJ was required to allow the Veteran to identify any outstanding medical treatment records, obtain and associate outstanding medical records, schedule the Veteran for appropriate examinations concerning his restless leg syndrome. The Veteran completed VA examinations, with subsequent medical opinions, in January 2020 and January 2021. The VA has also contacted the Veteran, and obtained, information regarding outstanding medical records concerning the Veteran's restless leg syndrome. Those records have been associated with the claims file. Accordingly, the Board finds there has been substantial compliance with the remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In February 2019, the United States Court of Appeals for Veterans Claims (Court) granted the parties' joint motion for remand (JMR) and remanded the matter to the Board for readjudication consistent with the JMR. The parties agreed that the Board failed address whether the May 2016 VA medical opinion on which the Board relied substantially complied with April 2016 remand directives. See Stegall, 11 Vet. App. at 271. Entitlement to service connection for bilateral restless leg syndrome Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. In order to prevail on the issue of service connection there must be competent evidence of a current disability; medical evidence, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be established for a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability which became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2016; and by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317 (a)(1). A "qualifying chronic disability" includes an undiagnosed illness or a medically unexplained chronic multi-symptom illness (MUCMI) that is defined by a cluster of signs or symptoms, such as chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders. 38 C.F.R. § 3.317 (a)(2)(i).The term "medically unexplained chronic multi-symptom illness" means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology, such as diabetes and multiple sclerosis, will not be considered medically unexplained. 38 C.F.R. § 3.317 (a)(2)(ii). For purposes of this section, "objective indications of chronic disability" include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. Disabilities that have existed for 6 months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. The 6-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. 38 C.F.R. § 3.317 (a)(3), (4). The Board notes that the Veteran's military personnel records note service in Southwest Asia, to include service in Operation Enduring Freedom. Accordingly, the Board finds that the Veteran is eligible for presumptive service connection under 38 C.F.R. § 3.317. The Veteran claims entitlement to service connection for restless leg syndrome. In January 2020, the Veteran completed a VA Central Nervous System and Neuromuscular Diseases examination. At examination, the Veteran was diagnosed with restless leg syndrome, with a date of onset in 1999. Accordingly, the Board finds that the Veteran does have a current disability that had its onset during the presumptive time period. At issue in the present case is if the Veteran's restless leg syndrome was caused by his period of active service. Following the January 2020 examination, the VA physician noted that the Veteran's restless leg syndrome was a diagnosed MUMCI. The VA examiner's opinion was based on an in-person examination of the Veteran and review of his VA and private medical history. The January 2020 opinion is highly probative evidence in favor of the Veteran's claim for service connection. Conversely, a January 2021 medical opinion found that it was less likely than not that the Veteran's restless leg syndrome was related to a "specific exposure event experienced by the Veteran during service in Southwest Asia." Further, the examiner noted that restless leg syndrome can be caused by age, genetics, and/or side effects of medication. The January 2021 opinion is highly probative evidence against the Veteran's claim for service connection. The Board finds that the probative medical evidence of record is in equipoise regarding the Veteran's claim for service connection for restless leg syndrome. When the evidence is in "relative equipoise, the law dictates that the Veteran prevails." Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, entitlement to service connection for bilateral restless leg syndrome is warranted. K. MILLIKAN Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Riordan, 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.