CHRONIC FATIGUE SYNDROME

Summary

The veteran, who served honorably in the U.S. Marine Corps from July 2002 to July 2006, appealed the denial of service connection for chronic fatigue syndrome (CFS), migraines, respiratory insufficiency (dyspnea), chronic sinusitis, bilateral hearing loss (BHL), and an increased rating for allergic rhinitis. The Board denied CFS, migraines, dyspnea, chronic sinusitis, and BHL, finding the veteran did not meet the criteria for these diagnoses or that the evidence did not establish a service connection. For CFS, the Board found the private opinion unpersuasive due to reliance on a self-diagnosis without medical competency, contrasting it with a VA examiner's finding of no CFS pathology. For migraines, the Board found the evidence weighed against service connection, noting the lack of contemporaneous headache complaints in service treatment records and giving greater weight to the VA examiner's opinion, which considered medical research and found the condition less likely than not related to service, citing age and PTSD as greater risk factors than TERA. For dyspnea and chronic sinusitis, the Board denied claims due to lack of a present diagnosis, finding the VA examiner's findings more probative than the private opinions, which were based on lay statements and lacked specialized training. For BHL, the Board denied service connection as the audiometric testing did not meet VA criteria for disability. The claim for an increased rating for allergic rhinitis was denied as the evidence supported a 10% rating but not the 30% criteria for polyps, and the Board declined to remand for further opinion on medication effects, citing potential speculation and ethical concerns. The Board remanded claims for acquired psychiatric disorders (PTSD, alcohol use disorder) and gastrointestinal disabilities (functional abdominal pain syndrome, IBS) due to inadequate VA examinations and duty to assist errors.

Rationale

Private opinion based on self-diagnosis without medical competency; VA examiner found no CFS pathology; Persuasive weight of evidence against present diagnosis

Full Decision Text

Citation Nr: A26034414
Decision Date: 04/14/26	Archive Date: 04/14/26

DOCKET NO. 250610-553446
DATE: April 14, 2026

ORDER

Service connection for chronic fatigue syndrome (CFS) is denied.

Service connection for migraines is denied.

Service connection for respiratory insufficiency (dyspnea) is denied.

Service connection for chronic sinusitis is denied.

Service connection for bilateral hearing loss (BHL) is denied.

A rating greater than 10 percent for allergic rhinitis is denied.

REMANDED

Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and alcohol use disorder is remanded.

Service connection for functional abdominal pain syndrome/abdominal pain and bloating is remanded.

Service connection for irritable bowel syndrome (IBS) is remanded.

FINDINGS OF FACT

1. The Veteran does not have a diagnosis for CFS. 

2. The Veteran's migraines are not related to his military service. 

3. The Veteran does not have respiratory insufficiency.

4. The Veteran does not have a diagnosis for chronic sinusitis.

5. The Veteran does not have BHL for VA purposes.

6. The Veteran's chronic rhinitis manifests as greater than 50 percent obstruction on both sides without polyps.

CONCLUSIONS OF LAW

1. The criteria for CFS have not been met.  38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for service connection for migraines have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

3. The criteria for service connection for dyspnea have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

4. The criteria for service connection for chronic sinusitis have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

5. The criteria for service connection for BHL have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3.385.

The criteria for a rating greater than 10 percent for allergic rhinitis have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.97, Diagnostic Code (DC) 6522.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran honorably served in the U.S. Marine Corps from July 2002 to July 2006. 

This appeal comes to the Board of Veterans' Appeals (Board) from an April 2025 Department of Veterans Affairs (VA) Regional Office (RO) rating decision.  

In the June 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the April 2025 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not
, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 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. 

However, because the Board is remanding the claims of service connection for an acquired psychiatric disorder and gastrointestinal disabilities, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in, cause by, or aggravated by service. 38 C.F.R. § 3.303(a). To establish service connection or service-connected aggravation for a present disability, the Veteran must show: (1) the existence of a present 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 or aggravated during service.  Shedden v. Principi, 381 F.3d 1166, 1167 (2004).

The requirement of a current disability is satisfied when the Veteran has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim.  McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).  If a current disability existed at the time a claim was filed, or at any time during the pendency of the claim but resolved prior to the VA adjudicating the claim, service connection may still be warranted if the additional elements are satisfied.  Id.

A present disability is not limited to a formal diagnosis, but includes "manifestations of a condition ... that results in 'functional impairment of earning capacity.'"  Martinez-Bodon v. Wilkie, 32 Vet. App. 393, 398 (2020), citing Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018).  

CFS

The Veteran contends he has CFS caused by his service in Southwest Asia (SWA).  

In December 2024, the Veteran submitted a private medical opinion.  In pertinent part, the opinion states "[the Veteran reports] he has suffered with [CFS] since active duty.  Diagnosis: [CFS]."

In May 2026, the Veteran attended a VA examination for his CFS claim.  After a review of the Veteran's e-file and an in-person examination, the examiner concluded the Veteran does not meet the criteria for a CFS diagnosis.  

The Veteran reported he began experiencing the symptoms approximately in 2000, manifesting as lack of sleep, difficulty breathing, and anxiety.  Of note, this reported onset is prior to his military service.  

In the associated disability benefits questionnaire (DBQ), the examiner stated that "[n]o CFS pathology [is present] to render a diagnosis. Reported fatigue is due to [psychiatric symptoms].  CFS criteria not met.  No official CFS diagnosis by physician.  Not on medication for [this] condition."

Here, the persuasive weight of the evidence is against finding the Veteran has a present diagnosis for CFS. 

The private opinion is not assigned probative weight.  The clinician's positive findings are wholly reliant on the Veteran reporting he has a diagnosis.  However, service treatment records are silent to any formal diagnosis, and no other medical records with a diagnosis have been provided or identified.  The examiner failed to discuss this discrepancy. 

Further, the opinion appears to be based on the Veteran's self-diagnosis.  However, he has not been shown to have the required competency necessary to self-diagnose.  

Competency is a legal determination as to whether a witness is qualified to make a statement, thereby allowing for the testimony to be heard and considered by
 weight of the evidence is against finding the Veteran has a present diagnosis for CFS. 

The private opinion is not assigned probative weight.  The clinician's positive findings are wholly reliant on the Veteran reporting he has a diagnosis.  However, service treatment records are silent to any formal diagnosis, and no other medical records with a diagnosis have been provided or identified.  The examiner failed to discuss this discrepancy. 

Further, the opinion appears to be based on the Veteran's self-diagnosis.  However, he has not been shown to have the required competency necessary to self-diagnose.  

Competency is a legal determination as to whether a witness is qualified to make a statement, thereby allowing for the testimony to be heard and considered by the trier-of-fact. 38 C.F.R. § 3.159 (a)(1) (defining competent medical evidence), (a)(2) (defining competent lay evidence).  Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions.  38 C.F.R. § 3.159(a).  

Because the Veteran has not been shown to have specialized medical education, training, or experience, the private examiner's conclusion based on the self-diagnosis is not probative.  

In contrast, the VA examiner's findings are assigned probative weight.  They conducted a thorough review of the Veteran's available records and the opinion is based on sound medical reasoning.

Because the persuasive weight is against finding the Veteran has a present CFS diagnosis, the first element of service connection is not met.  The claim is, therefore, denied. 

Migraines

The Veteran contends he experiences migraine headaches related to SWA service. 

Preliminarily, the AOJ found the Veteran has a present diagnosis for migraine headaches and participated in a toxic exposure risk activity (TERA) during service.  These favorable findings are binding on the Board and satisfy the first two elements of service connection.  Therefore, the remaining question is whether the disability and in-service TERA are related.    

A review of the Veteran's service treatment records reveals that they are silent to any complaints of chronic or ongoing headaches.  

In the December 2024 private medical opinion, the examiner documented that the Veteran reported experiencing headaches since active duty.  Based on these statements, they diagnosed him which chronic headaches, and found they had their initial onset during service, and are therefore related to his military service.  

In May 2025, the Veteran attended a VA examination for his migraine headaches claim.  The Veteran reported to the examiner that he began experiencing sharp, throbbing pain after being exposed to burn pits while deployed to Iraq and continues to do so a few times per month.  Currently, he experiences pulsating or throbbing head pain on both sides of the head and sensitivity to light.  When the migraines begin, he will stop what he is doing and lie down in a dark room.  Based on the Veteran's reports and a review of his records, the examiner diagnosed him with migraine headaches.  

In the associated DBQ, the examiner found the Veteran's migraines are less likely than not related to his military service after consideration of all total potential exposures through all deployments and the synergistic, combined effects.  Specifically, after conducting significant research, they found "Migraines are thought to occur when blood flow in the brain is altered and certain nerves in the brain send abnormal pain signals throughout the head. These signals trigger the release of various brain chemicals (neurotransmitters) in the brain, which leads to inflammation, particularly of blood vessels and the membrane that covers the brain and spinal cord (meninges). This inflammation causes many of the signs and symptoms of a migraine, including the throbbing pain, nausea, and sensory sensitivities. However, it is unclear what leads to the abnormal nerve signaling. ... there is no medical or scientific evidence available that provides any indication of a relationship between the development of the condition(s) at issue and the TERA.  Veteran's age and PTSD are risk factors that far outweigh the factors identified in the TERA."

The persuasive weight of the evidence is against finding the Veteran's migraine headaches are related to his military service.  

First, though the private examination found the Veteran reported the disability's symptoms began during service, no contemporaneous medical records document such.  He did not report experiencing the symptoms during any in-service annual health assessments, report of medical history at separation, or on his post-deployment questionnaire where headaches were specifically denied.  It is reasonable to conclude that, should the headaches have begun during service, the Veteran would have reported experiencing such during one of the several opportunities to do so.  

When conducting a medical examination or providing a medical opinion, an examiner must be fully cognizant of the claimant's past medical history.  Nieves
."

The persuasive weight of the evidence is against finding the Veteran's migraine headaches are related to his military service.  

First, though the private examination found the Veteran reported the disability's symptoms began during service, no contemporaneous medical records document such.  He did not report experiencing the symptoms during any in-service annual health assessments, report of medical history at separation, or on his post-deployment questionnaire where headaches were specifically denied.  It is reasonable to conclude that, should the headaches have begun during service, the Veteran would have reported experiencing such during one of the several opportunities to do so.  

When conducting a medical examination or providing a medical opinion, an examiner must be fully cognizant of the claimant's past medical history.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).  Because the examiner relied solely on the Veteran's lay statements and did not review the relevant records, they were not aware of the Veteran's full medical history.  Therefore, the opinion is not assigned probative weight.   

Second, the VA medical opinion is assigned greater probative weight.  It is based on a review of the Veteran's medical records and significant medical research in addition to the Veteran's lay statements.  It also provides a clear, well-reasoned opinion.  

Therefore, the persuasive weight of the evidence is against finding the Veteran's migraine disability is related to his military service, and the claim must be denied. 

Dyspnea

The Veteran contends he has suffered from dyspnea since his deployment to SWA. 

In the December 2024 private medical opinion, the private examiner found the Veteran has respiratory insufficiency related to his military service.  Specifically, they state the following: "[The Veteran] states he has suffered with respiratory deficiency to include dyspnea, and the volume of air on the expiratory effort is compromised. Diagnosis: Respiratory Insufficiency (dyspnea). It is as likely as not that the aforementioned is directly and causally related to Gulf War Syndrome per the presumptions (undiagnosed illnesses) published in Gulf War Winter 2016."

In May 2025, the Veteran attended a VA examination where he participated in a pulmonary system test.  The VA examiner found that the Veteran does not have lung or respiratory insufficiency pathology to render a diagnosis and the lung exam was normal.  

Here, the persuasive weight of the evidence is against finding that the Veteran has a present respiratory disability, to include dyspnea.  

The private examination is not assigned probative weight.  As noted above, though the Veteran is competent to report his experienced symptoms, he has not been shown to have the medical training or experience to diagnose pulmonary function insufficiency.  Further, the private examiner, a chiropractor, does not have the training or expertise to render a pulmonary diagnosis.  

In contrast, the VA examiner, a general medicine MD, is found to be competent to render a diagnosis, and found the Veteran does not have a diagnosable disability.  Further, this finding is based on objective pulmonary function testing, not only lay observations.  Therefore, it is assigned high probative weight.  

Because the Veteran does not have a present pulmonary disability, the first element of service connection is not met and the claim must be denied.  

Chronic Sinusitis

The Veteran contends he has chronic sinusitis which began during his deployment to SWA.  

In the December 2024 private examination, the Veteran reported suffering from congestion of the maxillary sinuses with difficulty breathing, facial pressure, and coughing.  Based on these lay statements, the clinician found the Veteran has a present diagnosis for chronic sinusitis due to his military service. 

In May 2025, the Veteran attended a VA examination.  After a review of the Veteran's e-folder and an in-person examination, the examining physician found the Veteran does not meet the criteria for a chronic sinusitis diagnosis.  Specifically, they found he does not have any symptoms or conditions required for a sinusitis diagnosis.  

Here, the persuasive weight of the evidence is against finding the Veteran has a present sinusitis diagnosis.  The private examination is assigned less probative weight because it is based only on lay statements and is made by a clinician without specialized training or knowledge.  In contrast, the VA examination is based on the Veteran's lay statements, an in-person examination, and a review of medical records.  Further, the clinician has greater training and expertise.  

Therefore, because the weight of the evidence is against finding the Veteran has a present sinusitis disability, the first element of service connection is not met and the claim must be denied.  

BHL

The Veteran contends he experiences bilateral hearing loss related to his military service. 

Preliminarily, the Veteran's December 2024 private examination diagnoses him with hearing loss
 sinusitis diagnosis.  The private examination is assigned less probative weight because it is based only on lay statements and is made by a clinician without specialized training or knowledge.  In contrast, the VA examination is based on the Veteran's lay statements, an in-person examination, and a review of medical records.  Further, the clinician has greater training and expertise.  

Therefore, because the weight of the evidence is against finding the Veteran has a present sinusitis disability, the first element of service connection is not met and the claim must be denied.  

BHL

The Veteran contends he experiences bilateral hearing loss related to his military service. 

Preliminarily, the Veteran's December 2024 private examination diagnoses him with hearing loss.  However, because the examination does not include audiometric testing, and the opining clinician is not shown to have the necessary medical training or experience to make that determination, it is not assigned any probative weight and will not be considered. 

For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent.  38 C.F.R. § 3.385.  

Regarding the first element of service connection, the Veteran attended a VA examination for his hearing loss claim in July 2024. Audiometric findings were: 

		HERTZ

 	500	1000	2000	3000	4000

RIGHT	20	15	20	25	20

LEFT	25	15	20	20	15

Speech recognition was 98% in the right ear and 98% in the left ear. 

The examiner, an audiologist, did not diagnose the Veteran hearing loss.  Rather, the examiner found the Veteran did not meet the criteria for a hearing loss disability.

The audiometric test of record does not show results qualifying as a disability under 38 C.F.R. § 3.385, either by Puretone threshold or speech recognition. In this regard, the January 2025 audiological examination does not show that the Veteran has hearing loss for VA purposes.      

Accordingly, as the Veteran does not have a current hearing loss disability for VA purposes, service connection cannot be granted. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

Increased Rating

Allergic Rhinitis

Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity caused by the given disability.  Separate diagnostic codes identify the various disabilities.  38 U.S.C. § 1155; 38 C.F.R. Part 4.

When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating.  38 C.F.R. § 4.7.  After careful consideration of the evidence, any reasonable doubt remaining, including degree of disability, is to be resolved in favor of the Veteran.  38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Lynch v. McDonough, 21 F.4th 776 (2021).  Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern.  Francisco v. Brown, 7 Vet. App. 55, 58 (1994).

Allergic Rhinitis is rated under Diagnostic Code (DC) 6522.  Under DC 6522, a 10 percent rating is assigned when the allergic or vasomotor rhinitis manifests without polyps, but with greater than 50 percent obstruction of nasal passage on both sides or complete obstruction on one side; a 30 percent rating is assigned when it manifests with polyps.  38 C.F.R. § 4.97.

In May 2025, the Veteran attended a VA examination for his chronic rhinitis.  He reported to the examiner that the symptoms began as congestion/stuffy nose, red and itchy eyes, and headaches.  He treats the disability with over-the-counter medications.  

After a review of the Veteran's records and an
 (DC) 6522.  Under DC 6522, a 10 percent rating is assigned when the allergic or vasomotor rhinitis manifests without polyps, but with greater than 50 percent obstruction of nasal passage on both sides or complete obstruction on one side; a 30 percent rating is assigned when it manifests with polyps.  38 C.F.R. § 4.97.

In May 2025, the Veteran attended a VA examination for his chronic rhinitis.  He reported to the examiner that the symptoms began as congestion/stuffy nose, red and itchy eyes, and headaches.  He treats the disability with over-the-counter medications.  

After a review of the Veteran's records and an in-person examination, the examiner concluded the Veteran's rhinitis causes greater than 50 percent obstruction on both sides of his nasal passage but does not cause complete obstruction or polyps.  No other relevant evidence is of record.  

Therefore, the available medical evidence establishes the Veteran's disability meets the 10 percent rating criteria because it causes greater than 50% obstruction bilaterally.  However, because it does not manifest with polyps, the criteria for a 30 percent rating are not met.  Therefore, because the Veteran's disability is currently rated at 10 percent disabling, he is appropriately rated and a rating greater than 10 percent, to include 30 percent, is not warranted.  The claim must be denied. 

In making the above findings, the Board is cognizant of the fact that the Veteran has used medication, including Claratin, to treat his rhinitis. The Court has held that in assigning a disability rating, VA may not consider the ameliorative effects of medication where such effects are not explicitly contemplated by the rating criteria. Jones v. Shinseki, 26 Vet. App. 56 (2012).  More recently, the Court stated that the "the Board [is] obligated to discount the beneficial effects of the medication taken for each disability and evaluate the baseline severity of those disabilities."  Ingram v. Shinseki, 2025 U.S. App. Vet. Claims LEXIS 327, *15-19 (March 12, 2025). 

The Board notes, however, that neither Jones nor Ingram address how the Board is to discount the beneficial effects of medication where examiners do not reasonably have the ability to severity both with and without use of medication. Remanding this appeal to order an addendum medical opinion based on Jones and Ingram, and in the lens of the rating criteria under § 4.97, would almost certainly require an examiner to engage in medical speculation and would result in a medical opinion that lacks the degree of certainty to ascertain, even under the benefit-of-the-doubt standard, the impact of the ameliorative effects of medication on the severity of a veteran's musculoskeletal disability in terms of range of motion. See, e.g., Hood v. Shinseki, 23 Vet. App. 295, 298-99 (2005) (medical opinions that are speculative have "little probative value"). Significantly, one of the judges in McCarroll, joined by another judge in concurrence, expressed the same concern as to the implications of the holding in Jones: 

The requirement that the Secretary "may not consider the relief afforded by [a veteran's] medication when" applying the rating schedule, as Jones demands...invites medical speculation in trying to guess what a veteran's symptoms might be without the medication, or medical malpractice in the cessation of medication so that the veteran's symptoms without medication might be recorded. The former invites non-helpful guesswork by medical practitioners, ... and the latter raises, at a minimum, serious ethical concerns that no court should encourage. That Jones essentially requires the Board to consider whether a medical examination is required to determine how serious a veteran's symptoms would have been in an alternate reality in which he or she was not taking his or her required medication should alone demonstrate the fallacy of the Jones holding.

McCarroll v. McDonald, 28 Vet. App. 267, 278 (2016) (internal citations omitted). Because it is highly unlikely that remand to obtain a medical opinion as to the ameliorative effects of medication on the severity of the Veteran's chronic rhinitis would result in a probative, non-speculative opinion as to such, the Board does not wish to further delay adjudication of the Veteran's appeal to engage in likely unfruitful further development pursuant to Jones and Ingram. Moreover, the Board certainly cannot - and will not - order the Veteran to stop taking medication to undergo an examination that would reflect the severity of his chronic rhinitis without the use of medication. This would not only be cruel and potentially damaging to the Veteran, but the undersigned finds it would
, 278 (2016) (internal citations omitted). Because it is highly unlikely that remand to obtain a medical opinion as to the ameliorative effects of medication on the severity of the Veteran's chronic rhinitis would result in a probative, non-speculative opinion as to such, the Board does not wish to further delay adjudication of the Veteran's appeal to engage in likely unfruitful further development pursuant to Jones and Ingram. Moreover, the Board certainly cannot - and will not - order the Veteran to stop taking medication to undergo an examination that would reflect the severity of his chronic rhinitis without the use of medication. This would not only be cruel and potentially damaging to the Veteran, but the undersigned finds it would be legally unethical to ask such.

Finally, the Board notes that VA compensation does not contemplate hypothetical symptoms or impairment. Instead, the purpose of VA benefits is to compensate for decreased earning capacity - to compensate for actual symptoms or impairment that an individual experiences in the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. The Veteran's manifestations have been considered in rating his chronic rhinitis, but it still remains the Board's obligation to rate the condition based on the application of the rating criteria found in the diagnostic codes to the objective medical evidence. 

REASONS FOR REMAND

When the Secretary provides a veteran with a VA medical examination or opinion, it must be adequate.  A medical opinion is adequate when it is based upon consideration of the veteran's prior medical history and describes the disability in detail sufficient for the Board's evaluation of the claimed disability to be fully informed.  Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); See also Martinak v. Nicholson, 21 Vet. App. 447 (2007).    

When conducting a medical examination or providing a medical opinion, an examiner must be fully cognizant of the claimant's past medical history.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).

Acquired Psychiatric Disorder

Preliminarily, the Board notes the Veteran has claimed service connection for both PTSD and alcohol use disorder.  Because more than one psychiatric disability has been claimed, the Veteran's claim will be addressed has having raised the issue of whether service connection is warranted for any acquired psychiatric disorder.  See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009).

In January 2025, the Veteran attended a VA examination for his psychiatric disability claim.  After a review of the Veteran's records and an approved telehealth examination, the examiner diagnosed the Veteran with alcohol use disorder, but found it was not related to his military service.  Specifically, they found: "Rationale is while veteran submitted a claim for PTSD, he was not diagnosed with PTSD during C&P exam and there is no evidence of mental disorder during service. A search of STRs was negative for mental health issues and in fact veteran denied all mental health screening questions during service. VA instructions has instructed examiners that 'PTSD is the only mental health condition that can be service connected solely based on circumstantial marker evidence' ...  There is thus no evidence of a service nexus"

Because the examiner did not discuss whether the Veteran's alcohol use disorder is caused or aggravated by his military service, to include incidents observed as a firefighter, it is inadequate for adjudicatory purposes.  Further, the examiner appears to implicitly reject the Veteran's lay statements made outside of the private examination, to include the February 2025 Statement in Support of Claimed Mental Health Disorders and February 2025 Lay Witness Statement, without explanation.  Because a veteran or lay person is generally competent to report their observed events, experiences, and symptoms, the implicit rejection without explanation also renders the opinion inadequate for adjudicatory purposes.  

Therefore, because the examination is inadequate for adjudicatory purposes, remand is required to correct this predecisional duty to assist error.  38 C.F.R. § 20.802.  

The Board does note the Veteran provided a private examination which found he does meet the criteria for PTSD and alcohol use disorder, and found those are at least as likely as not due to his military service.  However, the examiner based their findings primarily on the Veteran's lay statements which were found to likely be subject to exaggeration and conflation.  Therefore, because the opinion is based on non-credible statements, it is not assigned any probative value.  

Functional Abdominal Pain Syndrome

IBS

Remand is required to correct predecisional duty to assist errors.  38 C.F.R. § 20.802.  

In May 2025, the Veteran attended a VA examination for his gastrointestinal disability claims.  The examiner found he does not meet
 a private examination which found he does meet the criteria for PTSD and alcohol use disorder, and found those are at least as likely as not due to his military service.  However, the examiner based their findings primarily on the Veteran's lay statements which were found to likely be subject to exaggeration and conflation.  Therefore, because the opinion is based on non-credible statements, it is not assigned any probative value.  

Functional Abdominal Pain Syndrome

IBS

Remand is required to correct predecisional duty to assist errors.  38 C.F.R. § 20.802.  

In May 2025, the Veteran attended a VA examination for his gastrointestinal disability claims.  The examiner found he does not meet the criteria for a diagnosis because the Veteran was not previously diagnosed with an intestinal or digestive disability, has not had a "GI work up," and is not currently on medication to treat any such disability.  However, while acknowledging the Veteran reported experiencing symptoms, the examiner failed to consider them in their opinion as a possible present diagnosis.  Therefore, the opinion is inadequate for adjudicatory purposes.  

Further, when the Secretary's duty to provide a medical examination is triggered, this duty includes the requirement that the Secretary provide reasonable tests and other examinations necessary to render a meaningful medical opinion.  See Green v. Derwinski, 1 Vet. App. 121, 123-124 (1991).  Here, because the examiner found testing necessary to possibly establish a diagnosis was not performed, but did not either attempt to perform necessary non-invasive tests or explain why testing is contraindicated, a second predecisional duty to assist error occurred. 

Remand is required to correct these errors. 

The matters are REMANDED for the following action:

1. Obtain a supplemental medical opinion which discusses whether the Veteran's acquired psychiatric disability is at least as likely as not (likelihood in approximate balance, or greater) caused or aggravated by the Veteran's military service.  As part of this opinion, the clinician is requested to include discussion of the February 2025 lay statements.  If that evidence is not probative or credible, the examiner must explain why they made such findings.  

2. Obtain a new medical examination for the Veteran's gastrointestinal disability claims.  As part of the examination, the examiner is to conduct any appropriate and necessary testing to determine if they Veteran has a present diagnosis.  If testing cannot or should not be performed, they must provide a rationale for that determination.  After conducting such testing, they are requested to discuss whether any diagnosed disability is at least as likely as not (likelihood in approximate balance, or greater) caused or aggravated by the Veteran's military service.

A complete rationale must be given for all opinions and conclusions expressed. If it is not possible to provide an opinion without resorting to mere speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training).

 

 

JOHN Z. JONES

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	N. Guarnieri

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.