Citation Nr: 22038303 Decision Date: 07/05/22 Archive Date: 07/05/22 DOCKET NO. 15-01 092 DATE: July 5, 2022 REMANDED Entitlement to service connection for a chronic undiagnosed illness or a medically unexplained multi-symptom illness, claimed as fibromyalgia, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1990 to July 1994 with confirmed service in Southwest Asia. This appeal comes before the Board of Veterans' Appeals (Board) on appeal from January 2014 rating decision of the Department of Veterans' Affairs (VA) Regional Office (RO). This matter was previously before the Board in April 2021 and was denied. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (CAVC) and a Joint Motion for Remand (JMR) was granted by CAVC in February 2022. In granting the JMR, CAVC effectively vacated and remanded the claim. Accordingly, the matter returns to the Board for further action consistent with the JMR. Entitlement to service connection for a chronic undiagnosed illness or a medically unexplained multi-symptom illness, claimed as fibromyalgia, is remanded. The Veteran is seeking service connection for an undiagnosed illness or medically unexplained multi-symptom illness, including fibromyalgia, due to his Gulf War service. Specific to the April 2022 Board decision, the JMR noted that the Board failed to ensure that VA satisfied its duty to assist. Specifically, the parties agree that the Board relied on the inadequate July 2019 VA Environmental Exposure Gulf War examination opinion to deny service connection for a chronic undiagnosed illness or a medically unexplained multi-symptom illness, claimed as fibromyalgia. The opinion was deemed inadequate due to (i) its failure to address the pathophysiology of the Veteran's conditions, and (ii) its failure to account for the Veteran's lay statements of reflux symptoms. The parties report that the Court in Stewart v. Wilkie, 30 Vet.App. 383 (2018), explained that a multi-symptom illness is a medically unexplained chronic multi-symptom illness "if either the etiology or the pathophysiology of the illness is inconclusive." The Court found the examination at issue in that case inadequate because the VA examiner failed to address the etiology and pathophysiology of the claimant's condition. Id. at 392. Here, the parties conclude that while the July 2019 examiner explained that the Veteran's conditions have a clear and specific etiology and diagnosis, such explanation failed to address whether the pathophysiology of Appellant's muscle spasms with paresthesia or OSA was inconclusive or partially understood, pursuant to Stewart, 30 Vet.App. at 389-92. The JMR further stated that the July 2019 VA Environmental Exposure Gulf War examination opinion is inadequate because it failed to account for the Veteran's description of reflux and adequately explain if such symptom is indicative of an undiagnosed illness or a medically unexplained chronic multi-symptom illness. Specifically, the examiner found "insufficient evidence to warrant or confirm a diagnosis of an acute or chronic GERD condition or its residuals at this time" and that "no medical opinion can be rendered as no condition is diagnosed." The parties contend, however, that such opinion does not explain how the examiner considered the Veteran's report of reflux and whether such symptom was indicative of either an undiagnosed illness or a medically unexplained chronic multi-symptom illness. In compliance with the JMR, the Board finds that reconsideration of the service connection claim is warranted and remanded for additional development and a new VA examination is necessary. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the same VA examiner who conducted the July 2019 Environmental Exposure Gulf War examination, if available. If the same examiner is unavailable, request an addendum opinion from an appropriately qualified VA clinician. Access to the Veteran's electronic claims file, which shall include a copy of this Remand, must be made available to the examiner for review, and be reviewed, in connection with the examination. Following a complete review of the Veteran's claims file the examiner should address the following: (a) Are the Veteran's symptoms of hiatal hernia, muscle spasms, pain, burning sensations, vibration in his legs, sleeping disturbances, poor concentration, breathing difficulties, and a possible psychiatric condition consistent with: (1) an undiagnosed illness; (2) a diagnosable but medically unexplained chronic multi-symptom illness (MUCMI) of unknown etiology or pathophysiology, (3) a diagnosable chronic multi-symptom illness with a partially explained etiology and pathophysiology, or (4) a disease with a clear and specific etiology and diagnosis. *The examiner's review of the body of this Remand is recommended to assist in avoiding errors that have resulted in deficiencies in the July 2019 opinion. *The need for another examination(s) is left to the discretion of the medical professional offering the addendum opinion. Should an examination(s) be necessary, all indicated studies, tests, and evaluations must be conducted, and all findings reported in detail. *The examiner should address each symptom reported by the Veteran in providing an opinion. The examiner must provide a complete rationale for all opinions provided. If any requested opinion(s) cannot be provided without resorting to speculation, then the clinician should explain why this is so. 2. Thereafter, ensure that the examiner has substantially responded to the questions posed by the Board, and if not, take corrective action. 3. Then, readjudicate the remanded claim. Cynthia M. Bruce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Russell, Tangela 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.