Case 25015319

CAROLINE FLEMING · 2025 · Case ID: 25015319

DENIED

Summary

The veteran, who served in the U.S. Army from August 1977 to August 1997, including service in the Southwest Asia theater of operations during the Persian Gulf War, appeals the denial of service connection for chronic fatigue syndrome. The veteran also appealed the moot dismissal of claims for special monthly compensation (SMC) based on housebound status and total disability based on individual unemployability (TDIU), as these benefits had already been granted. The Board found the TDIU and SMC claims moot because the veteran was already receiving a 100% rating and SMCs for the entire appeal period. Regarding chronic fatigue syndrome, the veteran contended it was related to service, including Persian Gulf War environmental hazards and toxic exposure risk activity (TERA). Multiple VA examinations were conducted. The January 2015, December 2020, and January 2025 examinations all concluded the veteran did not have a diagnosis of chronic fatigue syndrome. Examiners attributed the veteran's fatigue symptoms to his service-connected psychiatric and musculoskeletal disabilities, medications, and non-service-connected diabetes. The Board found these opinions persuasive and conclusive, noting the lack of competent medical evidence supporting a chronic fatigue syndrome diagnosis. The veteran's own reports of fatigue were considered lay evidence, not competent medical evidence for diagnosis. The Board denied service connection for chronic fatigue syndrome, finding the weight of the evidence against the claim.

Service Branch

ARMY

Special Benefit

SMC - HOUSEBOUND; TDIU

Docket No.

17-00 041

Full Decision Text

Citation Nr: 25015319
Decision Date: 12/30/25 Archive Date: 12/30/25

DOCKET NO. 17-00 041
DATE: December 30, 2025

ORDER

Entitlement to special monthly compensation (SMC) based on housebound status under 38 U.S.C. § 1114(s) prior to April 20, 2023, is dismissed as moot.

Entitlement to a total disability rating based on individual unemployability (TDIU), to include as due to a single service-connected disability, is dismissed as moot.

Entitlement to service connection for chronic fatigue syndrome, to include as due to Persian Gulf War environmental hazards and/or toxic exposure risk activity (TERA), is denied.

FINDINGS OF FACT

1. There is currently no case or controversy for active consideration by the Board on the issue of SMC based on housebound status under 38 U.S.C. § 1114(s) prior to April 20, 2023, as the claim was granted from December 3, 2013, the entire appeal period.

2. There is currently no case or controversy for active consideration by the Board on the issue of TDIU because the Veteran is in receipt of 100 total percent rating and SMC(s) for the entire appeal period from December 3, 2013.

3. The Veteran does not have a current diagnosis of chronic fatigue syndrome.

CONCLUSIONS OF LAW

1. The criteria for dismissal of the claim for SMC based on housebound status under 38 U.S.C. § 1114(s) have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55.

2. The criteria for dismissal of the claim for TDIU have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55.

3. The criteria for service connection for chronic fatigue syndrome have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served in the United States Army from August 1977 to August 1997, including service in the Southwest Asia theater of operations during the Persian Gulf War.

This matter is before the Board of Veterans' Appeals (Board) on appeal from an

April 2015 rating decision issued by a Department of Veterans Affairs (VA) agency

of original jurisdiction (AOJ). In January 2019, the Veteran testified before the

undersigned Veterans Law Judge; a copy of the transcript has been associated with

the electronic claims file.

Regarding the claim for chronic fatigue syndrome, when this matter was initially before the Board in April 2023, the Board denied service connection for chronic fatigue syndrome. The Veteran appealed the Board's April 2023 decision to the United States Court of Appeals for Veterans Claims (Court), which in a January 2024 Order granted the parties' joint motion for remand, vacating the Board's April 2023 decision and remanding the case for compliance with the terms of the joint motion. In the April 2023 joint motion for remand, the parties determined that the Board relied on an inadequate VA examination report. In December 2024, the Board remanded the claim for the AOJ to obtain mental health treatment records containing a diagnosis of chronic fatigue syndrome from the Veteran's mental health provider from approximately 2005 and a new VA medical opinion, to include a toxic exposure risk activity (TERA) examination. A remand by the Board confers on the claimant a legal right to compliance with the remand order. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Compliance with a remand is not discretionary, and failure to comply with the terms of a remand necessitates another remand for corrective action. See id. However, substantial compliance with the remand order, not strict compliance, is required. See Donnellan v. Shinseki, 24 Vet. App. 167, 176 (2010), Dyment v. West, 13 Vet. App. 141, 147 (1990). In January 2025, medical opinions pertaining to the Veteran's chronic fatigue syndrome disability were uploaded into the claims file. Further, the Veteran provided a release to provide his posttraumatic stress disorder (PTSD), knees, and back medical records from Fayetteville VAMC from August 13, 1977 to the present, which was rejected because such records are VA records and any available VA records are already
. See id. However, substantial compliance with the remand order, not strict compliance, is required. See Donnellan v. Shinseki, 24 Vet. App. 167, 176 (2010), Dyment v. West, 13 Vet. App. 141, 147 (1990). In January 2025, medical opinions pertaining to the Veteran's chronic fatigue syndrome disability were uploaded into the claims file. Further, the Veteran provided a release to provide his posttraumatic stress disorder (PTSD), knees, and back medical records from Fayetteville VAMC from August 13, 1977 to the present, which was rejected because such records are VA records and any available VA records are already in the claims file. See January 2025 Authorization to Disclose Information to the Department of Veterans Affairs (VA) and Medical Records Request Reject Notice. Further, the record does not contain evidence that the Veteran was under the care of a private medical provider. Based on the Veteran's signed release and because the records requested are already part of the record, the Board concludes that mental health treatment records from 2005 that contain a diagnosis of fatigue syndrome do not exist. Therefore, the Board finds that the AOJ has substantially complied with the December 2024 remand directives and will proceed with adjudication of the claim.

1. Entitlement to special monthly compensation (SMC) based on housebound status under 38 U.S.C. § 1114(s).

2. Entitlement to a total disability rating based on TDIU, to include as due to a single service-connected disability.

The Veteran contends that he is entitled to TDIU, to include as due to a single service-connected disability, and SMC(s), from December 3, 2013. See May 2025 VA Appeal to Board of Veterans' Appeals (VA Form 9); July 2015 Appellate Brief.

Here, the Veteran is in receipt of a single 100 percent rating for an acquired psychiatric disability for the entire appeal period, from December 3, 2013. See November 2025 Board Decision; December 2025 Rating Decision. In addition, SMC has also been granted for the entire period on appeal based upon that 100 percent disability rating and separate individually rated service-connected disabilities rated at 60 percent or more. Id. Therefore, as there remains no case or controversy concerning whether the Veteran is entitled to the benefit sought, the appeal of the claims for TDIU and SMC are moot. 38 U.S.C. § 7105; Grantham v. Brown, 114 F.3d. 1156 (Fed. Cir. 1997); see also Shoen v. Brown, 6 Vet. App. 456, 457 (1994); Sabonis v. Brown, 6 Vet. App. 426 (1994).

Service Connection

Service connection may be established 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. Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999).

Under legislation specific to Persian Gulf War veterans, service connection may be established on a presumptive basis for a qualifying chronic disability that became manifest during active service in the Southwest Asia theater of operations during the Persian Gulf War or to a degree of 10 percent or more no later than December 31, 2026. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1). Such chronic disability must not be attributed to any known clinical diagnosis by history, physical examination, or laboratory tests. 38 C.F.R. § 3.317(a)(1).

The term "qualifying chronic disability" means a chronic disability resulting from any of the following (or any combination of any of the following): (A) an undiagnosed illness; (B) a medically unexplained chronic multi-symptom illness that is defined by a cluster of signs or symptoms, such as chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders; or (C) any diagnosed illness that the Secretary determines in regulations prescribed under subsection (d) warrants presumptive service-connection. 38 U.S.C. § 111
Such chronic disability must not be attributed to any known clinical diagnosis by history, physical examination, or laboratory tests. 38 C.F.R. § 3.317(a)(1).

Objective indications of a 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. 38 C.F.R. § 3.317(a)(3). Disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a six-month period will be considered chronic. 38 C.F.R. § 3.317(a)(4). Manifestations of an undiagnosed illness may include, among other things, sleep disturbances and fatigue. 38 C.F.R. § 3.317(b).

Service personnel records confirm that the Veteran served in the Southwest Asia theater of operations during the Persian Gulf War. See 38 C.F.R. § 3.317(e) (defining the Southwest Asia theater of operations); see also 38 U.S.C. § 101(33) (2012) (defining the Persian Gulf War as beginning on August 2, 1990, and ending on a date thereafter to be prescribed by Presidential proclamation or law). Therefore, he qualifies for consideration of presumptive service connection for disabilities resulting from an undiagnosed illness or medically unexplained chronic multi-symptom illness.

In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994).

The Board must also fully consider the lay assertions of record. Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed by a lay person, to include observable symptoms. See 38 C.F.R. § 3.159(a)(2); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Further, a lay witness may opine on questions of diagnosis and etiology, provided that such matters are amenable to a lay person's observation. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009).

VA is responsible for determining whether the evidence supports the claim or is in relative balance, with a claimant prevailing in either event. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claimant is entitled to the benefit of the doubt when there is an "approximate" (meaning nearly equal) balance of positive and negative evidence regarding any material determination. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). If the evidence persuasively weighs against a claim, the claim is denied.

3. Entitlement to service connection for chronic fatigue syndrome, to include due to Persian Gulf War environmental hazards and/or TERA.

The Veteran contends he has a chronic fatigue syndrome disability that is related to service, to include as due to Gulf War environmental hazards and
ant is entitled to the benefit of the doubt when there is an "approximate" (meaning nearly equal) balance of positive and negative evidence regarding any material determination. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). If the evidence persuasively weighs against a claim, the claim is denied.

3. Entitlement to service connection for chronic fatigue syndrome, to include due to Persian Gulf War environmental hazards and/or TERA.

The Veteran contends he has a chronic fatigue syndrome disability that is related to service, to include as due to Gulf War environmental hazards and/or TERA. See May 2014 Informal Claim; April 2016 Notice of Disagreement (NOD); October 2022, July 2024 appellate briefs;

The Board concludes that the Veteran does not have a current diagnosis of chronic fatigue syndrome and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

The Veteran's service treatment records do not contain evidence of complaints of fatigue in service. See August 1977 Enlistment Examination; November 1996 Report of Medical History.

A VA General Medical Examination was conducted in January 2015. The examiner found that the Veteran did not have a diagnosis of chronic fatigue syndrome and explained that the Veteran did not have symptoms of chronic fatigue syndrome and attributed his fatigue to prescribed multiple medications for his service-connected psychiatric and musculoskeletal disabilities and his non-service-connected diabetes. The examiner also found that the Veteran's disability pattern was not that of an undiagnosed illness and not a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology and not a diagnosable chronic multi-symptom illness with a partially explained etiology. The examiner reiterated in that connection that the Veteran's fatigue symptoms are most likely due to multiple medications and his statement that he takes a higher dose of some of his mental health medications than prescribed.

The December 2020 VA examiner found that the Veteran did not have a diagnosis of chronic fatigue syndrome because there were no current signs and symptoms to support a diagnosis.

During an August 2022 VA examination, the Veteran reported that he was being treated for his fatigue by his mental health provider and attributed his fatigue to anxiety. He also reported symptoms of generalized muscle aches or weakness, sleep disturbance, inability to concentrate, and forgetfulness. The examiner concluded that the Veteran's symptoms did not amount to a diagnosis of chronic fatigue syndrome and attributed the fatigue symptoms to the Veteran's psychiatric disability. The examiner stated that the Veteran has other mental and physical health conditions that can cause chronic fatigue syndrome-like symptoms and it is impossible to state without speculation the source of the symptoms. In the April 2023 joint motion for remand, the parties agreed that the August 2022 VA examination report was inadequate. Specifically, the language of the examiner's rationale is vague and inconclusive as to the cause of the Veteran's fatigue symptoms.

Following the Board's December 2024 remand, another VA examination was conducted in January 2025, during which the Veteran reported he began experiencing a fast heartbeat, sweating, muscle tightness, sweaty hands, shallow breathing, and fatigue in 1987. He reported the symptoms would occur daily and would last approximately three to four hours. He described the fatigue as having to go lie down "all of a sudden" and improved after rest. He reported that these symptoms have progressively worsened since service and his mental health provider prescribed a medication used to treat depression, Fluoxetine, for his fatigue symptoms. The examiner concluded that after a review of the claims file, examination of the Veteran and the applicable medical literature, the Veteran did not have a diagnosis of chronic fatigue syndrome and explained that chronic fatigue syndrome is a diagnosis of exclusion that requires workup and testing to rule out other causes of fatigue. According to the examiner, in this case, there is no formal diagnosis in the record and no diagnosis can be provided based on the Veteran's subjective symptoms. The examiner concluded that the Veteran's fatigue is likely a symptom of his service-connected psychiatric disability.

The Board finds the January 2015, December 2020 and January 2025 VA medical opinions when combined to be complete, adequate, and highly persuasive. The opinions set forth the results of the examiners' comprehensive review of the claims file and the Veteran's lay reports, review the applicable medical literature, and provide clear and consistent rationales for the opinions. Hence, the Board finds the opinions highly probative and,
requires workup and testing to rule out other causes of fatigue. According to the examiner, in this case, there is no formal diagnosis in the record and no diagnosis can be provided based on the Veteran's subjective symptoms. The examiner concluded that the Veteran's fatigue is likely a symptom of his service-connected psychiatric disability.

The Board finds the January 2015, December 2020 and January 2025 VA medical opinions when combined to be complete, adequate, and highly persuasive. The opinions set forth the results of the examiners' comprehensive review of the claims file and the Veteran's lay reports, review the applicable medical literature, and provide clear and consistent rationales for the opinions. Hence, the Board finds the opinions highly probative and, taken in conjunction with the lay and medical evidence of record, attaches significant weight to the opinions on the matter of a current diagnosis. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

Here, the January 2015, December 2020, and January 2025 examiners all concluded that the Veteran did not have a diagnosis of chronic fatigue syndrome and instead attributed his symptoms to his service connected psychiatric disability and medications taken to treat it, and pain medications taken for his service connected musculoskeletal disabilities and his non-service connected diabetes. Their combined rationales are adequate and probative. Furthermore, the Veteran reported that his mental health practitioner prescribed a medication for depression to treat his fatigue symptoms, suggesting that his fatigue was attributed to his service-connected psychiatric disability.

The Board acknowledges the Veteran's reports that he began feeling tired, low energy, and sleepy during the daytime in 1980 while on active duty and treated his symptoms with vitamin supplements including B12 and D3 and that he has a diagnosis of chronic fatigue syndrome. See December 2020 VA Examination. The Veteran is competent to report observable symptoms, such as fatigue; however, the diagnosis of chronic fatigue syndrome requires medical expertise to determine. Thus, the opinion of the Veteran regarding the diagnosis of chronic fatigue syndrome is not competent medical evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this case, there is no competent evidence of record showing that the Veteran has a diagnosis of chronic fatigue syndrome. To the contrary, as discussed above, multiple VA examiners have concluded that the Veteran does not have a diagnosis of chronic fatigue syndrome after examination of the Veteran and thorough consideration of his medical records and history.

Therefore, upon consideration of the above, the Board concludes that service connection for chronic fatigue syndrome is not warranted. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (holding that "[i]n the absence of proof of a present disability, there can be no valid claim"); Degmetich v. Brown, 104 F.3d 1328, 1333 (1997) (holding that the existence of a current disability is the cornerstone of a claim for VA disability compensation).

The Board has also considered whether the Veteran's claimed fatigue is a symptom of an undiagnosed illness or medically unexplained chronic multi-symptom illnesses. However, as noted above, VA examiners have attributed the Veteran's fatigue to service-connected psychiatric, back, neck, and knee disabilities and medications taken to treat his non-service-connected diabetes, not to any undiagnosed illness or medically unexplained chronic multi-symptom illness. Accordingly, the Board concludes that service connection is not warranted for an undiagnosed illness or medically unexplained chronic multi-symptom illnesses manifested by fatigue.

The Veteran submitted a March 2014 VA medical article regarding the effects of the Gulf War on veterans. But because this article does not make such an association based on the Veteran's particular factual history, this article cannot, alone, serve to support the Veteran's claim. The Court has held that "generally, an attempt to establish a medical nexus to a disease or injury solely by generic information in a medical journal or treatise is too general and inconclusive." Mattern v. West, 12 Vet. App. 222, 228 (1999). However, it has some probative value when considered along with a competent medical nexus opinion. Sacks v. West, 11 Vet. App. 314, 317 (1998) (medical articles and treatises can provide important support for a claim when combined with an opinion of a medical professional). But in this case, as discussed above, there is simply no medical nexus opinion or other medical evidence of record to support a finding that the Veteran has been diagnosed with chronic fatigue syndrome. Thus, the article submitted by the Veteran does not
or injury solely by generic information in a medical journal or treatise is too general and inconclusive." Mattern v. West, 12 Vet. App. 222, 228 (1999). However, it has some probative value when considered along with a competent medical nexus opinion. Sacks v. West, 11 Vet. App. 314, 317 (1998) (medical articles and treatises can provide important support for a claim when combined with an opinion of a medical professional). But in this case, as discussed above, there is simply no medical nexus opinion or other medical evidence of record to support a finding that the Veteran has been diagnosed with chronic fatigue syndrome. Thus, the article submitted by the Veteran does not, by itself, support a finding of service connection in this case.

As the weight of the competent and probative evidence is against the claim, service connection for chronic fatigue syndrome is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Lynch, 21 F.4th at 776.

Caroline B. Fleming

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Michel-Rossi, Mayerline

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.

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