CHRONIC FATIGUE SYNDROME

JENNA BRANT · 2026 · Case ID: A26038990

DENIED

Summary

The Veteran, who served from August 1984 to April 2004, including service in the Southwest Asia theater of operations, appeals the denial of service connection for chronic fatigue syndrome (CFS), fibromyalgia, and tremors of the hands. The Board reviewed the evidence, including service treatment records, post-deployment health assessments, VA examinations, and a private provider's opinion. For CFS, the Board found the evidence weighed against a diagnosis, noting the absence of relevant symptoms in service records, VA examinations, and the private opinion, which lacked specific symptom details. For fibromyalgia, the Board similarly found the evidence weighed against a diagnosis, citing negative findings in service records, VA examinations, and the private opinion's lack of specific symptoms. For hand tremors, the Board found the persuasive weight of evidence against a diagnosis, noting the absence of tremors in service records and VA examinations, and deeming the private opinion generic and lacking objective findings. The Board found the VA examinations adequate and more probative than the private opinions for all claims. The Board concluded that the evidence did not support a diagnosis of CFS, fibromyalgia, or hand tremors, and therefore, the claims were denied. The Veteran is not entitled to the benefit of the doubt as the evidence did not weigh in approximate balance.

Rationale

Service treatment records negative for fatigue/CFS symptoms.; VA examinations found no symptoms or diagnosis of CFS.; Private opinion lacked specific symptoms and probative value.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250925-593072

Full Decision Text

Citation Nr: A26038990
Decision Date: 04/27/26 Archive Date: 04/27/26

DOCKET NO. 250925-593072
DATE: April 27, 2026

ORDER

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

Entitlement to service connection for fibromyalgia is denied.

Entitlement to service connection for a disability causing tremors of the hands is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that the Veteran has had CFS at any time during or approximate to the pendency of the claim.

2. The evidence of record persuasively weighs against finding that the Veteran has had fibromyalgia at any time during or approximate to the pendency of the claim.

3. The evidence of record persuasively weighs against finding that the Veteran has had a disability causing tremors of the hands at any time during or approximate to the pendency of the claim.

CONCLUSIONS OF LAW

1. The criteria for service connection for CFS are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for fibromyalgia are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for a disability causing tremors of the hands are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 1984 to April 2004. He served in the Southwest Asia theater of operations. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2025 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).

In September 2024, the Veteran filed a new claim for service connection for CFS, fibromyalgia, and tremors of the hands. In April 2025, the RO denied all three claims. The Veteran appealed. In the September 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 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

For the current decision, the Board has recharacterized the claim for service connection for a disability resulting in tremors of the hands, in view of the Veteran's assertions and the medical evidence of record, as described below. See Clemons v. Shinseki, 23 Vet. App. 1 (2009).

General Service Connection Principles

Direct service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, or nexus, between the current disability and the in-service disease or injury.
and the medical evidence of record, as described below. See Clemons v. Shinseki, 23 Vet. App. 1 (2009).

General Service Connection Principles

Direct service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, or nexus, 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 may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

The current disability requirement is satisfied when a 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), or "when the record contains a recent diagnosis of disability prior to... filing a claim for benefits based on that disability." Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013).

The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997). In the absence of evidence of a current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board").

Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, supra (distinguishing between competency- "a legal concept determining whether testimony may be heard and considered"-and credibility, "a factual determination going to the probative value of the evidence to be made after the evidence has been admitted"). The Board is also charged with the duty to assess the probative weight given to all evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001).

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 Veteran the benefit of the doubt. 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 CFS is denied.

The Veteran contends he has chronic fatigue syndrome (CFS) due to his service in the Southwest Asia theater of operations. After careful review, the Board respectfully disagrees.

The record establishes that the Veteran is a Persian Gulf veteran as defined in 38 U.S.C. § 1117. 38 C.F.R. § 3.317(e). Service connection may be established for a Persian Gulf War 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, not later
2021).

Entitlement to service connection for CFS is denied.

The Veteran contends he has chronic fatigue syndrome (CFS) due to his service in the Southwest Asia theater of operations. After careful review, the Board respectfully disagrees.

To constitute as a "qualifying" chronic disability, the disability must not be attributed to any known clinical disease by history, physical examination, or laboratory tests. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1). The term "objective indications of chronic disability" includes both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(3). Signs or symptoms which may be manifestations of undiagnosed illness or MUCMI include, but are not limited to: fatigue, signs or symptoms involving skin, headache, muscle pain, joint pain, neurologic signs and symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper or lower), sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, menstrual disorders. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317(b).

A qualifying chronic disability means a chronic disability resulting from any of the following (or any combination of the following): an undiagnosed illness; the following MUCMIs that are defined by a cluster of signs or symptoms: chronic fatigue syndrome; fibromyalgia; irritable bowel syndrome; any diagnosed illness for which the Secretary determines that presumptive service-connection is warranted; or any other illness for which the Secretary determines that the following criteria for a MUCMI are met. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(2).

The term "medically unexplained chronic multi-symptom illness" 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 an inconsistent demonstration of laboratory abnormalities. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(2).

For VA purposes, the diagnosis of chronic fatigue syndrome 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; (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: (i) acute onset of the condition, (ii) low grade fever, (iii) nonexudative pharyngitis, (iv) palpable or tender cervical or axillary lymph nodes, (v) generalized muscle aches or weakness, (vi) fatigue lasting 24 hours or longer after exercise, (vii) headaches (of a type, severity, or pattern that is different from headaches in the pre-morbid state), (viii) migratory joint pains, (ix) neuropsychologic symptoms, or (x) sleep disturbance. 38 C.F.R. § 4.88a.

The evidence of record persuasively weighs against finding that the Veteran has CFS, or that he has had it any point.

The Veteran's service treatment records do not contain any reports of chronic fatigue. In June 2000, October 2001, and July 2003 post-deployment health assessments, the Veteran reported no complaints for issues including fatigue, malaise, multisystem complaints, weakness, muscle aches, skin issues, or headaches. The Veteran was examined regularly throughout his service, but none of
pre-morbid state), (viii) migratory joint pains, (ix) neuropsychologic symptoms, or (x) sleep disturbance. 38 C.F.R. § 4.88a.

The evidence of record persuasively weighs against finding that the Veteran has CFS, or that he has had it any point.

The Veteran's service treatment records do not contain any reports of chronic fatigue. In June 2000, October 2001, and July 2003 post-deployment health assessments, the Veteran reported no complaints for issues including fatigue, malaise, multisystem complaints, weakness, muscle aches, skin issues, or headaches. The Veteran was examined regularly throughout his service, but none of the examinations noted any relevant issues or diagnoses.

The Veteran's VA treatment records do not contain a diagnosis of CFS, nor any indication that his treating providers suspected CFS.

In September 2024, the Veteran provided an opinion from a private provider. The author wrote that the Veteran "reports symptoms of chronic fatigue syndrome. Diagnosis: Chronic fatigue syndrome." The author did not note any specific symptoms they attributed to CFS.

In February 2025, VA examined the Veteran for his CFS claim. The examiner completed a CFS disability benefits questionnaire (DBQ). The Veteran reported that

Around 2016, I began to get so tired that I started to drink a lot of caffeine around 1 or 2 o'clock, and I just wanted to go somewhere and nap. The Veteran reports he works approximately 5 days weekly as a fire inspector. The veteran denies Chronic Fatigue Syndrome but reports fatigue as a symptom in the afternoon after his daily caffeine level has decreased.

The examiner did not diagnose the Veteran with CFS. They noted no symptoms associated with CFS.

Also in February 2025, VA examined the Veteran for a central nervous system disability. The Veteran reported that around 2012 he began to experience tremors in both hands with intermittent numbness. He said the condition was worse on the left hand, and he did not seek medical treatment. The examiner found no objective evidence of a disability. The examiner did not diagnose the Veteran with any disability.

Also in February 2025, the VA examiner authored an opinion noting that October 2022 private chiropractic treatment records did not contain any diagnosis of fibromyalgia, CFS, or hand tremors.

The Board finds the VA examinations are adequate, and substantially more probative than the private opinion. Neither opinion contains any evidence that meets even one of the 38 C.F.R. § 4.88a criteria. Although the Veteran reported being tired in the afternoon, when he stopped drinking caffeine, this is not "debilitating fatigue severe enough to reduce daily activity to less than 50 percent of the usual level for at least six months," nor does it last 24 hours. There is no evidence of any other symptoms which might be relevant to the 38 C.F.R. § 4.88a criteria.

The private opinion did not note any specific symptoms, let alone any which might implicate the 38 C.F.R. § 4.88a criteria. The author simply stated that they found generic "symptoms," but 38 C.F.R. § 4.88a has very specific criteria. This lack of relevant symptoms is consistent with the VA examiner's conclusion that the Veteran does not have CFS. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (holding that a medical opinion obtains probative weight from "factually accurate, fully articulated, sound reasoning for the conclusion").

Accordingly, the evidence is not in approximate balance, and the Veteran is not entitled to the benefit of the doubt. This claim must be denied.

Entitlement to service connection for fibromyalgia is denied.

The Veteran contends he has fibromyalgia due to his service in the Southwest Asia theater of operations. After careful review, the Board respectfully disagrees.

The Veteran's service treatment records and post-service treatment records do not contain any notes concerning fibromyalgia. The Veteran's service treatment records do contain June 2000, October 2001, and July 2003 post-deployment health assessments, in which the Veteran reported no complaints for issues including fatigue, malaise, multisystem complaints, weakness, muscle aches, skin issues, or headaches. The Veteran was examined regularly throughout his service, but none of the examinations noted any relevant issues or diagnoses.

A May 2024 VA chiropractic visit noted the Veteran was negative for fibromyalgia.

In September 2024, the Veteran provided an opinion from a private provider. The author wrote that the Veteran "reports symptoms
Veteran's service treatment records and post-service treatment records do not contain any notes concerning fibromyalgia. The Veteran's service treatment records do contain June 2000, October 2001, and July 2003 post-deployment health assessments, in which the Veteran reported no complaints for issues including fatigue, malaise, multisystem complaints, weakness, muscle aches, skin issues, or headaches. The Veteran was examined regularly throughout his service, but none of the examinations noted any relevant issues or diagnoses.

A May 2024 VA chiropractic visit noted the Veteran was negative for fibromyalgia.

In September 2024, the Veteran provided an opinion from a private provider. The author wrote that the Veteran "reports symptoms of fibromyalgia. The symptoms are in the arms and legs. Diagnosis: Fibromyalgia."

In February 2025, VA examined the Veteran for his fibromyalgia claim. The VA examiner completed a fibromyalgia DBQ. The examiner noted no findings of signs or symptoms which might be attributable to fibromyalgia. The examiner did not diagnose the Veteran with fibromyalgia.

Also in February 2025, the VA examiner authored an opinion noting that October 2022 private chiropractic treatment records did not contain any diagnosis of fibromyalgia, CFS, or hand tremors.

This evidence persuasively weighs against finding a diagnosis of fibromyalgia. As with the claim for CFS, the private opinion does not list any specific symptoms, and there is no evidence of any symptoms which might be attributable to fibromyalgia. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (an opinion based upon an inaccurate factual premise has no probative value). The VA examiner also did not find any symptoms on examining the Veteran. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (holding that a medical opinion obtains probative weight from "factually accurate, fully articulated, sound reasoning for the conclusion").

Accordingly, the evidence is not in approximate balance, and the Veteran is not entitled to the benefit of the doubt. This claim must be denied.

Entitlement to service connection for a disability causing tremors of the hands is denied.

The Veteran contends he has tremors in his hands due to his active service. After careful review, the Board respectfully disagrees.

The Veteran's STRs and post-service medical records contain no complaints of tremors. May and December 2024 VA chiropractic treatment records were negative for tremors.

In September 2024, the Veteran provided an opinion from a private provider. The author wrote that the Veteran "reports tremors of the hands. Diagnosis: Tremors of the hands."

In November 2024, VA examined the Veteran for a peripheral nerve condition. The Veteran reported an onset of intermittent tremors in his hands around 2012. The examiner marked boxes for mild intermittent pain and mild paresthesias and numbness in all four extremities.

In February 2025, VA examined the Veteran again for a central nervous system disability. The Veteran reported that around 2012 he began to experience tremors in both hands with intermittent numbness. He said the condition was worse on the left hand, and he did not seek medical treatment. The examiner found no objective evidence of a disability. The examiner did not diagnose the Veteran with any disability.

Also in February 2025, the VA examiner authored an opinion noting that October 2022 private chiropractic treatment records did not contain any diagnosis of fibromyalgia, CFS, or hand tremors.

The persuasive weight of this evidence is against finding a diagnosis of a disability causing hand tremors. The Board finds the VA examinations to be adequate and more probative than the private opinion. The private opinion is completely generic and the author did not record their findings, if any. Further, the author only diagnosed the Veteran with "hand tremors," which is the symptom he complains of, and not a diagnosis. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (holding that a medical opinion obtains probative weight from "factually accurate, fully articulated, sound reasoning for the conclusion").
yalgia, CFS, or hand tremors.

The Board also finds that the tremors, numbness, or reports of mild intermittent pain or paresthesias in the Veteran's upper extremities do not qualify as a compensable disability. See Saunders v. Wilkie, 886 F.3d 1356 (2018) (holding that pain and other symptoms alone may qualify as a compensable disability if they result in measurable impairment). There is no evidence that pain, numbness, paresthesias, or tremors result in any functional impairment.

To the extent that the Veteran reported pain or paresthesias in his hands, the Board also finds that report is not credible, as it is inconsistent with his other descriptions of symptoms, and is only a checked box. The Veteran has never described pain in his hands, or described having any pain with his tremors. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Caluza v. Brown, 7 Vet. App. 498, 511 (1995); Curry v. Brown, 7 Vet. App. 59, 68 (1994); White v. Illinois, 502 U.S. 346, 356 (1992).

The evidence is also against finding that the Veteran has a MUCMI. To qualify as a MUCMI, the symptoms must be capable of independent verification. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(3). The February 2025 examiner found no objective evidence of a disability, including one producing tremors. The May and December 2024 VA chiropractic treatment notes also contain negative reports for tremors. Although the Veteran is competent to describe symptoms such as tremors and numbness, see Layno, supra, objective evidence is required to qualify as a MUCMI. 38 C.F.R. § 3.317.

Accordingly, the evidence is not in approximate balance, and the Veteran is not entitled to the benefit of the doubt. This claim must be denied.

Jenna Brant

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T.E. Yahner, 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.

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