CHRONIC FATIGUE SYNDROME

Summary

The Veteran, a Veteran who served from December 1990 to June 1991, including service in the Southwest Asia theater of operations during the Persian Gulf War, appeals the denial of service connection for Chronic Fatigue Syndrome (CFS). The Veteran contends that his CFS was caused by his service in Southwest Asia. The Board reviewed the evidence, including a March 2021 VA examination and an April 2021 addendum opinion, both of which declined to diagnose CFS. The March 2021 VA examiner found the Veteran only exhibited four of the six required symptoms and failed to rule out other causes. The April 2021 examiner attributed some symptoms to sleep apnea, a condition the Veteran's records indicate was ruled out. The Board assigned low probative value to both VA opinions due to factual defects. However, a March 2025 private medical opinion from M.D. found the Veteran met the diagnostic criteria for CFS, citing persistent fatigue, unrefreshing sleep, cognitive difficulties, joint and muscle pain, headaches, and post-exertional malaise, while ruling out other causes. The Board found this private opinion credible and assigned it high probative value, establishing a diagnosis of CFS. Service connection for CFS is granted presumptively based on the Veteran's qualifying Persian Gulf War service.

Rationale

Veteran served in Southwest Asia during Persian Gulf War; Credible private medical opinion established CFS diagnosis; VA examinations had factual defects and low probative value

Full Decision Text

Citation Nr: A26035810
Decision Date: 04/16/26	Archive Date: 04/16/26

DOCKET NO. 210824-181389
DATE: April 16, 2026

ORDER

Entitlement to service connection for chronic fatigue syndrome (CFS) is granted.

FINDINGS OF FACT

1. The Veteran served in the Southwest Asia theater of operations during the Persian Gulf War.  

2. The credible medical evidence establishes a current diagnosis of CFS.

CONCLUSION OF LAW

The criteria for service connection for CFS have been met. 38 U.S.C. §§ 1110, 1117, 1118, 1119, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317.

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran served on active duty from December 1990 to June 1991.

This matter comes before the?Board of Veterans' Appeals?(Board) on appeal from an April 2021 rating decision issued by a Department of Veterans Affairs (VA) Regional Office.

In the August 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on March 18, 2025. A copy of the hearing transcript is associated with the claims file. Therefore, the Board may only consider the evidence of record at the time of the April 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

Entitlement to service connection for CFS.

The Veteran contends that his CFS was caused by service in Southwest Asia during the Persian Gulf War. 

Service connection, in pertinent part, may be granted on a presumptive basis for a Persian Gulf War Veteran who exhibits objective indications of a qualifying chronic disability that manifested during or after active military, naval, or air service in the Southwest Asia theater of operations.?38 U.S.C. § 1117;?38 C.F.R. 

§ 3.317. For purposes of section 3.317, there are three types of qualifying chronic disabilities: (1) an?undiagnosed illness; (2) a medically unexplained chronic multi-symptom illness (MUCMI); and (3) a diagnosed illness that the Secretary determines in regulations prescribed under?38 U.S.C. § 1117(d) warrants a presumption of service connection.?38 C.F.R. § 3.317(a)(2). 

A MUCMI is one defined by a cluster of signs or symptoms and specifically includes CFS, fibromyalgia, and irritable bowel syndrome. A MUCMI means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. 

VA rating criteria define CFS as "[d]ebilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, or confusion), or a combination of other signs and symptoms." Similarly, as stated in a March 2021 VA examination report for CFS, a diagnosis of CFS for VA purposes requires:

(1) 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; and

(2) The exclusion, by history, physical examination, and laboratory tests, of all other clinical conditions that may produce similar symptoms; and

(3) Six or more of the following ten signs or symptoms: acute onset of the condition, low-grade fever, non-exudative pharyngitis, palpable or tender cervical or axillary lymph nodes, generalized muscle aches or weakness, fatigue lasting 24 hours or longer after exercise, headaches (of a type, severity, or pattern that is different from headaches in the pre-morbid state), migratory joint pains, neuropsychologic symptoms, and sleep disturbance.

As the Veteran's Department of Defense Form 214 indicates that he served in Southwest Asia from January 1991 to May 1991, he is a Persian Gulf War Veteran within the meaning of the applicable statute. 38 U.S.C. § 1117
3) Six or more of the following ten signs or symptoms: acute onset of the condition, low-grade fever, non-exudative pharyngitis, palpable or tender cervical or axillary lymph nodes, generalized muscle aches or weakness, fatigue lasting 24 hours or longer after exercise, headaches (of a type, severity, or pattern that is different from headaches in the pre-morbid state), migratory joint pains, neuropsychologic symptoms, and sleep disturbance.

As the Veteran's Department of Defense Form 214 indicates that he served in Southwest Asia from January 1991 to May 1991, he is a Persian Gulf War Veteran within the meaning of the applicable statute. 38 U.S.C. § 1117(f).

During a March 2021 VA examination, the Veteran reported that his condition had its onset in either 2000 or 2001. His symptoms initially consisted of body aches. These aches progressed, and around 2015 they became constant during waking hours. He tried to work out, but on some days he was too sore to do so. Body aches also affected his sleep. At the time of the appointment, the Veteran had soreness everywhere in his body, pain in joints and muscles, difficulty falling asleep, and forgetfulness. 

The March 2021 VA examiner declined to diagnose CFS. The Veteran's symptoms consisted solely of generalized muscle aches or weakness, migratory joint pains, neuropsychologic symptoms, and sleep disturbance, all of which had a gradual onset. These constituted four of the six symptoms required for a diagnosis of CFS. The examiner noted that other conditions had not been ruled out by history, physical examination, or laboratory tests. The examiner accordingly rendered a negative opinion regarding whether the Veteran's CFS was related to his service. 

The March 2021 VA examiner's lack of diagnosis appears to be based, at least in part, on a faulty factual premise. The examiner did not address headaches as one of the Veteran's symptoms; however, the Veteran's VA treatment records include numerous complaints related to headaches. Additionally, during the examination, the Veteran reported that some days he was too sore to work out. The Veteran's VA treatment records also indicate that the Veteran's headaches occurred after exercise. The examiner did not address whether these exercise-related symptoms constituted "fatigue lasting 24 hours or longer after exercise" for the purpose of VA's CFS diagnostic criteria. The Board, therefore, assigns low probative value to the March 2021 VA examiner's conclusion regarding whether the Veteran has a diagnosis of CFS. 

In April 2021, VA obtained an addendum opinion. The examiner explained that the Veteran's symptoms had clear and specific etiologies and diagnoses. Joint pain was attributed to poor sleep and a history of neuropathy and right knee effusion, as well as his age. The examiner attributed the Veteran's sleep disturbance to sleep apnea. Forgetfulness was characterized as transient global amnesia, which could also be attributed to sleep apnea. The examiner noted that CFS required six symptoms for diagnosis, and the Veteran only exhibited four. The April 2021 opinion accepts the premise of the March 2021 examiner that the Veteran has only four of the symptoms of CFS. As discussed above, this premise is at least partially defective. Additionally, the examiner attributed some of the Veteran's symptoms to sleep apnea. The Veteran's VA treatment records do not include a diagnosis of sleep apnea. In fact, sleep apnea was specifically ruled out by a December 2003 VA sleep study. As a result, the Board finds the April 2021 examiner's opinion does not deserve significant probative value. 

In a March 2025 letter accompanied by private treatment records, M.D., a private clinician submitted an opinion that the Veteran met the Centers for Disease Control and Prevention and VA guidelines for a diagnosis of CFS. M.D. specifically noted symptoms of persistent fatigue lasting longer than six months, unrefreshing sleep, cognitive difficulties, joint and muscle pain, headaches, and post-exertional malaise. The Veteran was unable to maintain a healthy lifestyle and perform day-to-day activities as a result. M.D. ruled out other causes of these symptoms, including fibromyalgia, sleep apnea, low testosterone, and thyroid issues. In M.D.'s opinion, there was no alternative medical explanation for the Veteran's condition. M.D. is competent to offer the opinion provided. The opinion is credible because it is based on a full review of the Veteran's medical records and symptoms. As a result, the Board assigns high probative value to the opinion. 

Accordingly, the probative evidence of record establishes a diagnosis of CFS.  Therefore, service connection for CFS is warranted as presumptively related to the Veteran's qualifying service during the Persian Gulf War. ?38 C.F.R. §
 activities as a result. M.D. ruled out other causes of these symptoms, including fibromyalgia, sleep apnea, low testosterone, and thyroid issues. In M.D.'s opinion, there was no alternative medical explanation for the Veteran's condition. M.D. is competent to offer the opinion provided. The opinion is credible because it is based on a full review of the Veteran's medical records and symptoms. As a result, the Board assigns high probative value to the opinion. 

Accordingly, the probative evidence of record establishes a diagnosis of CFS.  Therefore, service connection for CFS is warranted as presumptively related to the Veteran's qualifying service during the Persian Gulf War. ?38 C.F.R. § 3.317(a)(2). 

 

 

M. M. Celli

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Gibbons, Douglas K.

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.