UNDIAGNOSED ILLNESSES

Summary

The veteran, who served in the Army from October 2003 to April 2005, January 2008 to February 2009, and December 2016 to December 2017, appeals the denial of service connection for chronic fatigue syndrome (CFS), cervical strain, and bilateral upper extremity radiculopathy. The veteran asserted that the radiculopathy was secondary to a service-connected lumbosacral strain. The Board denied service connection for CFS, finding no current diagnosis of CFS in the record. While the veteran reported intermittent fatigue, service treatment records and periodic health assessments did not document chronic fatigue. A VA examination in June 2024 also found no current CFS diagnosis, attributing the veteran's fatigue to other diagnosed conditions like IBS and anxiety. The Board found the VA opinion dispositive, denying CFS due to lack of diagnosis and insufficient evidence of an undiagnosed illness. For cervical strain, the Board denied service connection, noting only a single, generalized in-service complaint of arm/leg pain without subsequent treatment or diagnosis of a neck condition. The Board found no current diagnosis or functional impairment related to the neck, and the evidence did not trigger VA's duty to provide an examination. For bilateral upper extremity radiculopathy, the Board denied service connection, finding no current diagnosis or credible evidence of persistent symptoms in the upper extremities. While the veteran reported numbness/tingling in hands/feet in-service, subsequent records and a VA examination did not corroborate ongoing upper extremity issues. The Board found no medical evidence of a chronic upper-extremity nerve condition, and the veteran's lay assertions were not corroborated.

Rationale

No current diagnosis of CFS in the record; Service treatment records and periodic health assessments did not document chronic fatigue; VA examination found no CFS diagnosis and attributed fatigue to other conditions; VA opinion was dispositive and afforded weight

Full Decision Text

Citation Nr: A25103390
Decision Date: 12/02/25	Archive Date: 12/02/25

DOCKET NO. 250820-576215
DATE: December 2, 2025

ORDER

Entitlement to service connection for chronic fatigue syndrome is denied.

Entitlement to service connection for cervical strain is denied.

Entitlement to service connection for right upper extremity radiculopathy, to include as secondary to lumbosacral strain, is denied.

Entitlement to service connection for left upper extremity radiculopathy, to include as secondary to lumbosacral strain, is denied.

FINDING OF FACT

The persuasive evidence does not show a finding that the Veteran has current diagnoses for chronic fatigue syndrome, cervical strain or a neck disability, left upper extremity radiculopathy, or right upper extremity radiculopathy, to include functional impairment of earning capacity, at any time during or approximate to the pendency of the claim. 

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for chronic fatigue syndrome have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310, 3.317.

2. The criteria for entitlement to service connection for a neck disability, to include cervical strain, have not been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

3. The criteria for entitlement to service connection for right upper extremity radiculopathy, to include as secondary to lumbosacral strain, have not been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

4. The criteria for entitlement to service connection for left upper extremity radiculopathy, to include as secondary to lumbosacral strain, have not been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSIONS

The Veteran served on active duty from October 2003 to April 2005, January 2008 to February 2009, and December 2016 to December 2017.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a September 2024 rating decision from a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ).

In the August 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the September 2024 AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim(s), considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish entitlement to service connection, there must be (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) a causal connection between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

Service connection may also be established on a secondary basis for a disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury.
.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish entitlement to service connection, there must be (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) a causal connection between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

Service connection may also be established on a secondary basis for a disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a), (b). Establishing service connection on a secondary basis requires competent and credible evidence demonstrating (1) the existence of a current disability; (2) a service-connected disability; and (3) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a), (b); see also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter (which includes but is not limited to equipoise), VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see Lynch v. McDonough, 21 F.4th 776, 778 (Fed. Cir. 2021).

Entitlement to service connection for chronic fatigue syndrome is denied.

The Veteran seeks entitlement to service connection for chronic fatigue syndrome (CFS), which he asserts is related to his military service. 

As a preliminary matter, the Board notes that the AOJ made a favorable finding that the Veteran performed service in Southwest Asia and was exposed to environmental hazards during military service. See September 2024 Rating Decision.

Service connection may also be established on a presumptive basis for a Persian Gulf Veteran who exhibits objective indications of chronic disability resulting from undiagnosed illness that 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, 2026, and which 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). For claims based on undiagnosed illness, unlike those for "direct service connection," there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. 1, 89 (2004).

The Veteran qualifies as a Persian Gulf Veteran under 38 C.F.R. § 3.317(e) because he served on active military service in Kuwait and Iraq and his certificate of release or discharge from active duty shows an award for Iraq Campaign medal. See DPRIS - DD214 Certified Original Certificate of Release; January 2023 VA Memo. Under 38 U.S.C. § 1117(a)(1), compensation is warranted for a Persian Gulf veteran who exhibits objective indications of a "qualifying chronic disability" that became manifest during service on active duty in the Armed Forces in the Southwest Asia Theater of Operations during the Persian Gulf War, or to a degree of 10 percent during the presumptive period prescribed by the Secretary. Furthermore, the chronic disability must not be attributed to any known clinical disease by history, physical examination, or laboratory tests. 38 C.F.R. § 3.317(a)(1)(ii). The definition of "qualifying chronic disability" includes (a) undiagnosed illness; (b) a medically unexplained chronic multi-symptom illness (MUCMI) (including, but not limited to, chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders) that is defined by a cluster of signs or symptoms; or (c) any diagnosed illness that the Secretary determines, in regulations, warrants a presumption of service connection. 38 C.F.R. § 3.317(a)(2).

As a MUCMI, CFS is specifically defined as new onset of debilitating fatigue severe enough to reduce daily activity to less than 50 percent of the usual level for at least six months; the exclusion by history, physical examination, and laboratory tests of all other clinical conditions that may produce similar symptoms; and six or more of: acute onset of condition, low grade fever, nonexudative pharyngitis, palpable or tender
 fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders) that is defined by a cluster of signs or symptoms; or (c) any diagnosed illness that the Secretary determines, in regulations, warrants a presumption of service connection. 38 C.F.R. § 3.317(a)(2).

As a MUCMI, CFS is specifically defined as new onset of debilitating fatigue severe enough to reduce daily activity to less than 50 percent of the usual level for at least six months; the exclusion by history, physical examination, and laboratory tests of all other clinical conditions that may produce similar symptoms; and six or more of: acute onset of condition, low grade fever, nonexudative pharyngitis, palpable or tender cervical or axillary lymph nodes, generalized muscle aches or weakness, fatigue lasting 24 hours or longer after exercise, headaches, migratory joint pains, neuropsychologic symptoms, and sleep disturbance. 38 C.F.R. § 4.88a.

For each theory of service connection, the existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. §§ 1110, 1131; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of section 1110 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

For reasons set forth below, the evidence is not evenly balanced, nor approximately so, that the Veteran has a current diagnosis of CFS or that his symptoms of fatigue are due to an undiagnosed illness; thus, entitlement to service connection for CFS is not warranted.

Here, there is no diagnosis of CFS of record contained in the service treatment records (STRs) or in any subsequent medical records. Although STRs show intermittent reports of tiredness, these entries demonstrate isolated reports of fatigue, which the Veteran endorsed in the context of general health questionnaires. Additionally, in multiple periodic health assessments completed during his subsequent Army National Guard service (e.g., December 2014, November 2018, December 2021), the Veteran did not report fatigue, suggesting no chronic or ongoing fatigue symptoms during that period. See March 2023 STR. 

The claims file contains no private treatment records and no VA treatment records diagnosing CFS, recommending evaluation for CFS, or documenting persistent or recurrent fatigue consistent with Gulf War-related undiagnosed illness. Although the Veteran reports constant fatigue, the record does not show that he has submitted or identified competent evidence establishing a current diagnosis.

The Veteran was afforded a VA examination for CFS in June 2024. At the examination, the Veteran reported experiencing constant fatigue but acknowledged that he has never been evaluated or treated for CFS. He identified other diagnosed conditions such as IBS, migraines, adjustment disorder, depression, and anxiety. Notably, the examiner reported that the Veteran does not have a current diagnosis of CFS. The examiner noted that there is no evidence of persistent or recurrent symptoms or concerns for chronic fatigue. She further explains that the Veteran's subjective fatigue is better explained by his other conditions, including service-connected irritable bowel syndrome (IBS), migraines, adjustment disorder, anxiety, and depression-all of which are known to produce fatigue. See June 2024 C&P Exam.  

On review, there is no conflicting competent evidence of record, and significant weight must be afforded this medical opinion. The record does not reflect that the Veteran possesses the requisite expertise to provide any medical diagnosis or opinion on etiology, and his lay assertions, insofar as they are intended as such, are given no weight. See Jandreau v. Nicholson, 492 F.3d at 1374 (affirming that lay evidence is generally not competent to establish medical diagnosis or etiology).

As there is no diagnosed disability that is related to an in-service incurrence, direct service connection under 38 C.F.R. § 3.303 or presumptive service connection under 38 C.F.R. § 3.309 is not warranted.

As the Veteran had qualifying service, consideration was afforded as to whether chronic fatigue was a symptom of the disabilities identified under the Gulf War provisions of 38 C.F.R. § 3.317. However, the evidence weighs against such a finding. The June 2024 VA medical opinion noted "[t]he four standard Gulf War disability patterns are not applicable for this case." The June 2024 VA opinion must be afforded weight, and as it is the only qualified opinion of record, it is dispositive. As the medical evidence weighs against a finding of an
 direct service connection under 38 C.F.R. § 3.303 or presumptive service connection under 38 C.F.R. § 3.309 is not warranted.

As the Veteran had qualifying service, consideration was afforded as to whether chronic fatigue was a symptom of the disabilities identified under the Gulf War provisions of 38 C.F.R. § 3.317. However, the evidence weighs against such a finding. The June 2024 VA medical opinion noted "[t]he four standard Gulf War disability patterns are not applicable for this case." The June 2024 VA opinion must be afforded weight, and as it is the only qualified opinion of record, it is dispositive. As the medical evidence weighs against a finding of an undiagnosed illness or a medically unexplained chronic multi symptom illness, service connection cannot be granted on this basis.

As the Board has indicated above, the first requisite element to substantiate an entitlement claim for service connection is a current disability. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a); see also Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). The persuasive evidence of record weighs against finding that the Veteran had CFS at any point during the pendency of the appeal period. As such, the claim for service connection for CFS is denied for lack of a diagnosis and because the evidence does not show such representing a qualifying disability under 38 C.F.R. § 3.317. Accordingly, the most persuasive evidence of record is against finding that service connection for CFS is warranted and the benefit of the doubt rule is inapplicable. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.303; see Lynch, 21 F.4th at 781. The claim is denied.

Entitlement to service connection for a neck disability, to include a cervical strain, is denied. 

The Veteran seeks service connection for cervical strain. See April 2024 VA 21-526EZ. 

Here, the Veteran has not been afforded a VA examination for his cervical strain claim. VA must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for VA to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 86 (2006). The threshold for determining whether the evidence "indicates" that there "may" be a nexus between a current disability and an in-service event, injury, or disease is a low one. Id. at 83.

Although the Veteran has reported that he has been "bothered a little" by pain in the arms, legs, or joints as mentioned in the service treatment record (STR) dated November 3, 2017, there are no additional notes or treatments related to this single report of generalized pain. See March 2023 STR. Additionally, in multiple periodic health assessments completed during his subsequent Army National Guard service (e.g., December 2014, November 2018, December 2021), the Veteran explicitly denied joint pain, suggesting no chronic or ongoing joint or neck conditions during that period. See March 2023 STR. 

As noted above, for each theory of service connection, the existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. §§ 1110, 1131; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of section 1110 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). 

Generally, the requirement of a "current disability" is satisfied if the disability is present at the time the claim was filed or during the pendency of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Moreover, a disability can resolve itself by the time the case is adjudicated on appeal, yet still qualify as a "current disability." Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013). Crucially, though, without competent, credible evidence of a current disability, a claim cannot proceed. Bram
 1110 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). 

Generally, the requirement of a "current disability" is satisfied if the disability is present at the time the claim was filed or during the pendency of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Moreover, a disability can resolve itself by the time the case is adjudicated on appeal, yet still qualify as a "current disability." Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013). Crucially, though, without competent, credible evidence of a current disability, a claim cannot proceed. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see Degmetich, supra.

Here, the probative evidence does not show the presence of current diagnosis of a neck disability during or approximate to the filing of the claim or the pendency of the appeal. See Romanowsky, 26 Vet. App. at 294; McClain, 21 Vet. App. at 321.

There is likewise no post-service medical evidence demonstrating that the Veteran has been diagnosed with or treated for a neck condition. The Board notes that there are no private medical records associated with the claims file and the record does not show that he has submitted or identified competent evidence establishing a current diagnosis or functional impairment attributable to his symptoms. 

The Board notes that the Veteran identified cervical strain as a current disability on his April 2024 VA Form 21-526EZ; however, the record does not reflect that the Veteran possesses the requisite expertise to provide any medical diagnosis or opinion on etiology, and his lay assertions, insofar as they are intended as such, are given no weight. See Jandreau , 492 F.3d at 1374 (affirming that lay evidence is generally not competent to establish medical diagnosis or etiology). While the Veteran is competent to report observable symptoms such as pain and the circumstances of his in-service injury, he is not competent to provide a diagnosis of a neck disability under VA regulations, such a diagnosis requires specialized medical knowledge and testing.

The Board notes that the Court of Appeals for the Federal Circuit (Federal Court) holds that pain alone may constitute a disability when it results in functional impairment. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018); cf. Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999).

The Board considered Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) and other relevant authorities. Here, there is no indication-medical or lay-that pain have caused functional impairment affecting his ability to work or perform daily activities. Saunders does not stand for the proposition that "a veteran could demonstrate service connection simply by asserting subjective pain" because "to establish a disability, the veteran's pain must amount to a functional impairment." Saunders, 886 F.3d at 1367. "Functional impairment" is defined as "the ability of the body or a constituent part of it to function under the ordinary conditions of daily life including employment." Id. at 1363 (quoting 38 C.F.R. § 4.10). In other words, as the CAVC observed "if pain doesn't cause impairment, it doesn't qualify as a disability."  Here, the medical and lay evidence does not show such functional impairment.

Thus, the threshold for obtaining a VA examination under McLendon is not met. Although the record contains evidence of an isolated in-service complaint, there is no indication that any current symptoms-if present-are related to that event. The documented in-service finding reflect temporary musculoskeletal strains or illness that resolved without residuals. Absent competent evidence of a chronic disability or a nexus to service, VA's duty to obtain an examination is not triggered. 

In sum, the evidence does not establish that the Veteran currently has a cervical strain or any neck disability that began in or is otherwise related to service. As the evidence weighs against the claim (that is to say, is neither in approximate balance nor nearly equal), the benefit-of-the-doubt rule is inapplicable and service connection is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, 21 F. 4th at 781-82.

Entitlement to service connection for right upper extremity radiculopathy, to include as secondary to lumbosacral strain, is denied.

Entitlement to service connection for left upper extremity radiculopathy, to include as secondary to lumbosacral strain, is denied
 neck disability that began in or is otherwise related to service. As the evidence weighs against the claim (that is to say, is neither in approximate balance nor nearly equal), the benefit-of-the-doubt rule is inapplicable and service connection is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, 21 F. 4th at 781-82.

Entitlement to service connection for right upper extremity radiculopathy, to include as secondary to lumbosacral strain, is denied.

Entitlement to service connection for left upper extremity radiculopathy, to include as secondary to lumbosacral strain, is denied.

The Veteran seeks service connection for bilateral upper extremity radiculopathy. See April 2024 VA 21-526EZ. He asserts that his right and left upper extremity radiculopathy are secondary to his service-connected lumbosacral strain. Id.

As discussed above, for each theory of service connection, the existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. §§ 1110, 1131; see Degmetich, 104 F.3d at 1332. Here, the Veteran was afforded a VA examination in May 2024 for peripheral nerves conditions. The examiner documented the Veteran's history of daily pain, paresthesia, and spasm in both legs extending to the ankles, but there were no complaints, findings, or  diagnoses involving either upper extremity. Specifically, the examiner marked "None" for constant pain, intermittent pain, paresthesias and/or dysesthesias, and numbness affecting the right and left upper extremities, while noting mild to moderate symptoms limited to the lower extremities. See May 2024 C&P Exam.

Service treatment records reflect a single notation dated November 18, 2008, where the Veteran endorsed being "bothered by numbness or tingling in hands or feet." However, subsequent records, including a March 2009 health assessment, specifically reflect no concerns for numbness or tingling in hands or feet. Later periodic post-deployment assessments through 2017 similarly do not document ongoing complaints or findings involving the upper extremities. See March 2023 STR. The documented single in-service report of numbness and tingling is generalized and does not indicate whether the symptoms involved the hands or feet. 

Furthermore, no private treatment records were identified or submitted by the Veteran to substantiate a chronic upper-extremity nerve condition, and VA treatment records are silent for any diagnosis or treatment of a peripheral nerve or radicular disorder affecting the upper extremities. The record also contains no lay statements describing persistent upper-extremity pain, sensory disturbance, or functional impairment. The only mention of such condition appears in the Veteran's April 2024 VA Form 21-526EZ, which is listed as sciatic radiculopathy RUE and LUE secondary to lumbosacral strain. However, this assertion is not corroborated by any medical evidence or symptom reports. 

Moreover, the Board notes that the record does not reflect that the Veteran possesses the requisite expertise to provide any medical diagnosis or opinion on etiology, and his lay assertions, insofar as they are intended as such, are given no weight. See Jandreau, 492 F.3d at 1374 (affirming that lay evidence is generally not competent to establish medical diagnosis or etiology).

Given the lack of objective findings or credible evidence of persistent symptoms, the Board finds that the Veteran does not have a diagnosed disability that is related to an in-service incurrence. Thus, direct service connection under 38 C.F.R. § 3.303 or secondary service connection under 38 C.F.R. § 3.310 is not warranted. Accordingly, the claim for service connection for right and left upper extremity radiculopathy is denied. 

 

 

Jenna Brant

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Gaviola, Associate 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.