CHRONIC FATIGUE SYNDROME

Summary

The Veteran, a Marine Corps Veteran who served from April 2009 to October 2013, appeals the denial of service connection for chronic fatigue syndrome. The Veteran claimed entitlement to service connection based on toxic exposure risk activity (TERA) in Afghanistan and alternatively, due to a high-stress military occupation. The Board acknowledged the favorable concession of TERA participation by the agency of original jurisdiction but ultimately denied the claim. The Board found that the Veteran did not have a current diagnosis of chronic fatigue syndrome, nor had he ever had one. The January 2025 VA examiner determined the Veteran experienced subjective fatigue but did not meet the diagnostic criteria for chronic fatigue syndrome, noting no relevant findings or significant impact on daily activities. The Veteran's VA treatment records for PTSD also did not mention or diagnose chronic fatigue syndrome. The Board afforded greater weight to the VA examiner's opinion, finding it more probative due to its in-person examination, consideration of history, and clear conclusion, which was consistent with the Veteran's lay statements and other medical evidence. The Board concluded the evidence weighed against a diagnosis of chronic fatigue syndrome, rendering the benefit-of-the-doubt rule inapplicable. Service connection for chronic fatigue syndrome was therefore denied.

Rationale

No current diagnosis of chronic fatigue syndrome; VA examiner found Veteran did not meet diagnostic criteria; No relevant findings or significant impact on daily activities; Treatment records for PTSD did not mention or diagnose CFS; Board afforded greater weight to VA examiner's opinion

Full Decision Text

Citation Nr: A26037450
Decision Date: 04/22/26	Archive Date: 04/22/26

DOCKET NO. 251230-632276
DATE: April 22, 2026

ORDER

Entitlement to service connection for chronic fatigue syndrome is denied.

FINDING OF FACT

At no time during the pendency of the claim, or prior thereto, does the Veteran have a current disability related to a diagnosis of chronic fatigue syndrome.

CONCLUSION OF LAW

The criteria for service connection for chronic fatigue syndrome have not 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 FINDING AND CONCLUSION

The Veteran served honorably on active duty in the United States Marine Corps from April 2009 to October 2013. 

This matter comes to the Board of Veterans' Appeals (Board) on appeal from a February 2025 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. 

In the December 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 February 2025 agency of original jurisdiction (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, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Entitlement to service connection for chronic fatigue syndrome, to include as due to exposure to toxins and environmental hazards.

Initially, the Veteran contends service connection for chronic fatigue syndrome is warranted based on participation in a toxic exposure risk activity (TERA) in accordance with 38 C.F.R. § 3.317. In the alternative, the Veteran contends that he has chronic fatigue syndrome due to a high stress environment and long hours performing the duties of his military occupation. 

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. Generally, service connection requires three elements: (1) a current disability diagnosis; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection also may be granted for a Persian Gulf Veteran with objective indications of a qualifying chronic disability, to include chronic fatigue syndrome. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. A Persian Gulf Veteran is defined as a Veteran who served on active military, naval or air service in the Southwest Asia theater of operations, to include Afghanistan, during the Persian Gulf War. 38 C.F.R. 

§ 3.317(e)(2). 

In adjudicating such claims, reasonable doubt that exists because of an approximate balance of positive and negative evidence concerning any point will be resolved in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derinski, 1 Vet. App. 49, 53 (1990).

In the February 2025 rating decision on appeal, the AOJ favorably conceded the Veteran's participation in a TERA based on his service in Afghanistan from November 2010 through May 2011. 38 C.F.R. § 3.104(c). 

Nevertheless, 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
 see also Gilbert v. Derinski, 1 Vet. App. 49, 53 (1990).

In the February 2025 rating decision on appeal, the AOJ favorably conceded the Veteran's participation in a TERA based on his service in Afghanistan from November 2010 through May 2011. 38 C.F.R. § 3.104(c). 

Nevertheless, 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 January 2025 VA examiner determined that, while the Veteran experienced subjective symptoms of feeling tired beginning in 2023, he did not have a diagnosis of chronic fatigue syndrome. In particular, the examiner found that the Veteran did not exhibit, nor had he ever had, six or more of the symptoms necessary to warrant a diagnosis of chronic fatigue syndrome or a 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. In addition, the Veteran did not have any findings, signs, or symptoms attributable to chronic fatigue syndrome. Moreover, his reported symptoms did not impact his ability to work.

Further, the Veteran's VA treatment records and VA examinations for his service-connected posttraumatic stress disorder reveal only intermittent reports of trouble sleeping and sleeplessness in 2015 and 2016 and do not contain any complaints, treatment, evaluation, or diagnosis of chronic fatigue syndrome. There is no mention of treatment or diagnosis of such a disability or a discussion or evaluation of any of the claimed symptoms. 

While the Veteran believes he has a current diagnosis of chronic fatigue syndrome, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Veteran has not contended that he has such specialized medical education, knowledge, or ability and there is no evidence of such qualifications associated with the Veteran's file. Therefore, the Veteran is not competent to render a diagnosis of chronic fatigue syndrome. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). 

Here, the Board affords greater weight to the medical evidence as it relates to rendering a medical diagnosis, to include the interpretation of medical testing and identified symptomatology. In particular, the January 2025 examiner performed an in-person examination of the Veteran, considered his relevant medical history, and offered a clear conclusion with supporting information. Nieves-Rodriguez v. Peake, 22?Vet. App.?295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the?probative?value?of a?medical?opinion); Stefl v. Nicholson, 21?Vet. App.?120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Moreover, the Board finds the examiner's opinion is consistent with the Veteran's lay statements regarding his symptoms and the remaining medical evidence of record.

For the foregoing reasons, the evidence of record persuasively weighs against a finding that the Veteran has a current diagnosis of chronic fatigue syndrome for the purpose of service connection. Thus, the evidence is not in at least relative equipoise, the benefit-of-the-doubt rule does not apply, and the appeal must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (2021).

 

M. M. Celli

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Webb, Katherine S.

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.