FIBROMYALGIA

Summary

The Veteran, a Veteran who served on active duty from November 1990 to August 1991, including service in the Southwest Asia theater of operations, appeals the denial of service connection for fibromyalgia. The Veteran submitted a private physician's opinion diagnosing fibromyalgia and linking it to his service. The Board found the VA examinations inadequate, noting that the examiners failed to attribute all of the Veteran's symptoms and relied on inaccurate factual bases. Specifically, the April 2017 and January 2022 VA exams concluded most symptoms were related to other conditions but did not specify which symptoms or rule out fibromyalgia. The June 2023 VA exam incorrectly stated no diagnosis of fibromyalgia was in the records. The Board found the evidence to be in approximate balance and applied the benefit of the doubt in the Veteran's favor, granting service connection for fibromyalgia on a presumptive basis. The Board affirmed the RO's findings of service in the Southwest Asia theater of operations and that fibromyalgia is a presumptive condition associated with such service.

Rationale

Private physician diagnosed fibromyalgia and linked it to Veteran's symptoms.; VA examinations were inadequate as they failed to attribute all symptoms and relied on inaccurate factual bases.; Evidence was in approximate balance, warranting benefit of the doubt.; Veteran served in Southwest Asia theater of operations, and fibromyalgia is a presumptive condition for such service.

Full Decision Text

Citation Nr: A26037374
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 241016-483472
DATE: April 21, 2026

ORDER

Service connection for fibromyalgia is granted on a presumptive basis. 

FINDING OF FACT

The Veteran's fibromyalgia, as a medically unexplained chronic multisymptom illness, is presumptively related to his confirmed service in the Southwest Asia theater of operations.

CONCLUSION OF LAW

The criteria for service connection for fibromyalgia on a presumptive basis are met. 38 U.S.C. §§ 1110, 1117, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from November 1990 to August 1991. 

This matter is before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in October 2024 by a Department of Veterans Affairs (VA) Regional Office (RO). 

This appeal comes to the Board of Veterans' Appeals (Board) from an October 15, 2024 Higher-Level Review (HLR) rating decision. On October 16, 2024, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), electing the Direct Review option. Based upon the selection of the Direct Review option, the Board may only consider the evidence of record as of June 26, 2024-the date of the rating decision which prompted the Veteran's selection of the HLR review lane. See 38 C.F.R. §§ 20.301, 3.2601(f). If the Veteran submitted evidence that was added to the record after June 26, 2024, the Board did not consider it. If the Veteran wishes to have VA consider any evidence that was not considered, a supplemental claim should be submitted identifying such evidence. See 38 C.F.R. § 3.2501.

Regarding representation, it is noted that, in October 2025, VA received a VA Form 21-22 appointing the Florida Department of Veterans Affairs as the Veteran's representative. 10/24/2025 VA Form 21-22. The Veteran was previously represented in these matters by attorney, J.T. 3/24/2022 VA Form 21-22a. Relatedly, an October 31, 2024 letter from the Board to the Veteran informed him that his appeal had been docketed by the Board and it also informed that he had 90 days from the date the Board received his VA Form 10182 or until the Board issued a decision (whichever came first) to request a change in representation. 10/31/2024 BVA Docketing Letter. Here, the October 2025 VA Form 21-22 was received after the expiration of the 90 days referenced in the October 2024 letter. Pertinent VA regulations state that if a change in representation is requested more than 90 days after certification, good cause must be shown for the change. 38 C.F.R. § 20.1304(b) (eff. Feb. 19, 2019). The October 2025 request was made approximately one year after the notification letter from the Board in October 2024. The Veteran provided no cause for his change in representation. Accordingly, the Board concludes that James Trieschmann, Esq., is the Veteran's representative for the purpose of this decision. Id.; see also Perez v. Shinseki, 25 Vet. App. 190, 194-95 (2012) (concluding that when the Veteran submitted a request to change representation more than 90 days after his appeal was certified to the Board, he did not avail himself of the "good cause" provision contained in 38 C.F.R. § 20.1305(b) (now 38 C.F.R. § 20.1304(b)) (eff. Feb. 19, 2019). 

Additionally, the October 2024 docketing letter copying attorney J.T. provided notice that the Veteran's appeal was at the Board and that it was nearing time for adjudication, so the Board finds that the Veteran has been accorded full right to representation in all stages of this appeal. 38 C.F.R. § 20.5 (2024). For future matters and considerations after this decision is issued, the Florida Department of Veterans Affairs will be the Veteran's representative of record (barring another change of representation).

Service Connection

Service connection will be granted if the evidence demonstrates that a current
now 38 C.F.R. § 20.1304(b)) (eff. Feb. 19, 2019). 

Additionally, the October 2024 docketing letter copying attorney J.T. provided notice that the Veteran's appeal was at the Board and that it was nearing time for adjudication, so the Board finds that the Veteran has been accorded full right to representation in all stages of this appeal. 38 C.F.R. § 20.5 (2024). For future matters and considerations after this decision is issued, the Florida Department of Veterans Affairs will be the Veteran's representative of record (barring another change of representation).

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from a disease or injury incurred in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection requires evidence of a current disability, an in-service incurrence, disease or injury, and a causal relationship between the current disability and the in-service incurrence, disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018).

For a Veteran with service in the Southwest Asia theater of operations, including Kuwait and Saudi Arabia, during the Persian Gulf War, service connection for a qualifying chronic disability may be established under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317. See 38 C.F.R. § 3.317(e). A "qualifying chronic disability" may be one that results from an "undiagnosed illness" or a "medically unexplained chronic multisymptom illness" (MUCMI). 38 U.S.C. § 1117(a)(2)(A), (B); 38 C.F.R. § 3.317(a)(2)(ii). The term MUCMI refers to 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. 38 C.F.R. § 3.317(a)(2)(ii). Examples of MUCMIs include chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders (excluding structural gastrointestinal disabilities). 38 C.F.R. § 3.317(a)(2)(B).

An undiagnosed illness requires that the illness, by history, physical examination, and laboratory tests, not be attributed to any known clinical diagnosis. 38 C.F.R. § 3.317(a)(4). There is no burden on a veteran to demonstrate that a medical professional has eliminated all possible diagnoses before the veteran can be compensated for a disability stemming from an undiagnosed illness. Joyner v. McDonald, 766 F.3d 1393, 1395 (Fed. Cir. 2014).

On or after August 10, 2022, the manifestation period and the degree to which a qualifying chronic disability, such as fibromyalgia, must manifest were eliminated as part of the Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxins (PACT) Act of 2022. See Pub. L. 117-168, Section 405.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

Service connection for fibromyalgia.

The Veteran contends that he is entitled to service connection for fibromyalgia as a result of his in-service exposures during his deployment to Kuwait and Saudi Arabia. 12/20/2021 VA Form 21-4138. 

As to the first element of service connection, that of a current disability, the Board notes a private physician opinion submitted by the Veteran in support of his claim which includes a formal clinical diagnosis of fibromyalgia. 12/20/2021 Med. Treatment Rec. The private physician, Dr. C.C., considered medical literature detailing fibromyalgia characteristics in relation to the Veteran's reported symptomatology. Id.

The Board acknowledges the various VA examinations of record that rendered no diagnosis of fibromyalgia. 4/17/2017 C&P Exam; 1/2/2022 C&P Exam; 6/6/2023 C&P Exam. However, for the following reasons, the Board finds those examinations to be inadequate. The April 2017 examination concluded that "most of the [Veteran's] symptoms" were related to other well-defined conditions. 4/17/2017
 of fibromyalgia. 12/20/2021 Med. Treatment Rec. The private physician, Dr. C.C., considered medical literature detailing fibromyalgia characteristics in relation to the Veteran's reported symptomatology. Id.

The Board acknowledges the various VA examinations of record that rendered no diagnosis of fibromyalgia. 4/17/2017 C&P Exam; 1/2/2022 C&P Exam; 6/6/2023 C&P Exam. However, for the following reasons, the Board finds those examinations to be inadequate. The April 2017 examination concluded that "most of the [Veteran's] symptoms" were related to other well-defined conditions. 4/17/2017 C&P Exam. The April 2017 examiner failed, however, to specify exactly what symptoms were attributable to the Veteran's other conditions and the use of the word "most" implies that not all of the symptoms were separately attributable. Therefore, the Board finds this rationale to be incomplete and of no probative value. Similarly, a separate January 2022 VA examiner concluded that "most of the symptoms are related to other well-defined conditions." 1/2/2022 C&P Exam, p. 2. This conclusion is similarly inadequate because it failed to attribute all of the Veteran's symptoms while simultaneously ruling out a diagnosis of fibromyalgia, leaving multiple symptoms without an attributable etiology. Therefore, the Board finds that this opinion carries no probative weight.

Lastly, the Veteran was provided a June 2023 VA examination to address whether his claimed condition was the result of his separately confirmed in-service toxic exposure risk activities (TERA). See 6/6/2023 C&P Exam. After examination, the VA examiner concluded that there was no diagnosis of fibromyalgia in the records and that a diagnosis could not be made on an assessment exam alone. Id. at 4. The VA examiner's conclusion is factually inaccurate, as the December 2021 private physician opinion indicating a current diagnosis was of record as of the June 2023 examination. Resultingly, because the June 2023 VA examiner was  not fully informed of the Veteran's medical history and relied in part on an inaccurate factual basis, the June 2023 examination report is assigned little probative weight. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993).  

After review of the competing medical opinions of record, the Board finds that the evidence is at least in approximate balance and that the Veteran is entitled to the benefit of the doubt as to the first element of service connection. 38 C.F.R. §§ 3.102, 3.303(a); see Wise v. Shinseki, 26 Vet. App. 517, 531 (2014) (noting that the benefit of the doubt rule is a unique standard of proof, and "the nation, 'in recognition of our debt to our veterans,' has 'taken upon itself the risk of error' in awarding such benefits"). Therefore, the first element of service connection is satisfied. 

In its October 2024 rating decision, the Board made the favorable finding that the Veteran performed service in the Southwest Asia theater of operations and a January 2023 VA memorandum confirms the Veteran's status as a Persian Gulf Veteran. 10/15/2024 Rating Decision, p. 4; 1/27/2023 VA Memo. The RO also made the favorable finding that fibromyalgia is a presumptive condition associated with service in the Southwest Asia theater of operations. 10/14/2024 Rating decision, p. 4. The Board sees no clear and unmistakable error in any of these favorable findings and now finds that the remaining elements of presumptive service connection are satisfied by the record. 38 C.F.R. §§ 3.104(c), 3.317. 

Accordingly, the Veteran's claim for presumptive service connection for fibromyalgia is warranted by the record and is granted. 38 U.S.C. §§ 1117, 5107; 38 C.F.R. § 3.317. 

 

 

Paul Sorisio

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Donahue, Thomas P.

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.