Citation Nr: A25035992 Decision Date: 04/18/25 Archive Date: 04/18/25 DOCKET NO. 240904-471256 DATE: April 18, 2025 ORDER Service connection for chronic fatigue syndrome (CFS) is denied. FINDING OF FACT The Veteran has not been diagnosed with CFS. CONCLUSION OF LAW The criteria for service connection for CFS have not been met. 38?U.S.C. §§?1110, 1116, 5107; 38?C.F.R. §§?3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from September 2001 to March 2008. For her meritorious service, the Veteran was awarded (among other decorations) the Navy and Marine Corps Achievement Medal. This matter is before the Board of Veterans' Appeals (Board) on appeal of an August 2024 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). Given the date of this rating decision, the Veteran's appeal is governed by the modernized review system (known by the Board as AMA). 38 C.F.R. § 19.2. On her September 2024 VA Form 10182 to the Board, the Veteran selected direct review. Thus, the Board shall consider all evidence of record at the time of the August 2024 rating decision herein. 38 C.F.R. § 20.301. For the Veteran's own understanding, the September 2024 VA Form 10182 attempted to appeal additional determinations stemming from rating decisions issued in 2017, 2019, 2020, and 2023. However, a valid notice of disagreement (NOD) must be submitted within one year of the rating decision being appealed. 38 C.F.R. § 20.202. Thus, the September 2024 submission is only valid with respect to the pending appeal. Before turning to the merits of the decision, the Board notes that this matter is being adjudicated prior to the expiration of time for the Veteran to switch dockets. See Williams v. McDonough, 37 Vet. App. 305, 310-11 (2024); 38 C.F.R. § 20.202(c)(2). Here, however, the Board finds sufficient evidence to warrant an immediate decision rather than waiting an additional four months to allow this time to elapse. First, since submitting her notice of disagreement in September 2024, the Veteran has not submitted anything further to the Board or VA intimating at a desire to switch dockets. Second, the notification letter accompanying her August 2024 rating decision clearly explained the Veteran's review options, including noting that the Board has a goal to complete cases in "365 days on average for Direct Review (longer for the other options)." The Veteran then subsequently clearly and unambiguously selected the Direct Review docket. The Board sees no reason to presume anything other than the idea that the Veteran made a knowing decision to select the fastest review docket for her appeal to the Board. Finally, in this decision, the Board has sought to use claimant friendly language that clearly explains what elements of the service connection framework are missing, giving the Veteran clear information about what evidence is required when submitting a subsequent supplemental claim (if she so desires). Under these circumstances, the Board finds it prudent to adjudicate her claim immediately rather than waiting an additional four months to do so. Service Connection The Veteran is pursuing service connection for CFS. Service connection may be granted directly as a result of disease or injury incurred in service based on nexus using a three-element test: (1) The existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may also be warranted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Thus, the threshold inquiry for any service connection claim is whether a current disability exists. The evidence weighs against a positive finding at this time. Historically, the Veteran underwent VA CFS examination in August 2024. Upon review of the evidence and contemporaneous evaluation of the Veteran, the examiner concluded that the Veteran did not have a current diagnosis of CFS. See also August 2024 VA opinion ("the Veteran did not meet the criteria to render a diagnosis for Chronic fatigue syndrome"). In formulating this opinion, the examiner reviewed the Veteran's claims folder and accepted the Veteran's description of her medical history, but found that the Veteran did not have sufficient findings, signs, or symptoms to warrant a CFS diagnosis. The Board finds this examination and opinion to be adequate and probative. The examiner specifically noted the symptoms that the Veteran does have, but found that she did not have a sufficient number to qualify for a CFS diagnosis. Further, the examiner made this conclusion after reviewing both the Veteran's claims file and taking her medical history and a description of her claimed disability directly from her. There is no contradictory evidence in the remainder of the record, including any treatment records containing a positive diagnosis of such. See generally VA and private treatment records. Given the relationship between the two, the Board has also contemplated whether the Veteran demonstrates a current diagnosis of a qualifying chronic disability relevant to Persian Gulf veterans, such that a current disability may be found under 38 C.F.R. § 3.317. However, the Veteran's personnel records do not document any foreign service, to include in the Persian Gulf; moreover, an April 2023 VA examiner concluded that the Veteran's disability pattern did not constitute an undiagnosed illness or a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology. Thus, neither a current disability nor presumptive service connection is established in this case. The Board also acknowledges that the Veteran has historically pursued service connection for obstructive sleep apnea. While this appeal is not before the Board, there is also no basis upon which to expand the existing claim, as an April 2023 VA examiner denied a current diagnosis of sleep apnea and there is no conflicting evidence in the record. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009); see generally VA and private treatment records. In weighing the evidence, the Board further acknowledges the Veteran's competent reports of sleep impairment. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, she lacks the training and expertise to offer a competent opinion as to complex medical matters, including the existence of a current disability. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). Moreover, the record persuasively establishes that the reported sleep impairment is attributable to the Veteran's service-connected psychiatric disability, and is compensated as such. See 38 C.F.R. § 4.14 (prohibiting pyramiding of symptoms); see, e.g., January 2019 VA examination (reporting chronic sleep impairment in assessing the Veteran's psychiatric disability). In sum, the persuasive evidence of record is against the Veteran's claim; the evidence is not in approximate balance; and the benefit of the doubt rule is inapplicable. Such a finding renders further analysis into the remaining elements of service connection moot. For the above reasons, service connection for CFS is denied. Of final note, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kovarovic, Kate 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.