UNDIAGNOSED ILLNESSES

Summary

The Veteran served in the U.S. Navy from September 2004 to August 2011, with additional service in the Navy Reserve. The Veteran appealed the denial of service connection for chronic fatigue syndrome and sought remand for claims related to GERD, rhinitis, IBS, non-infectious gastroenteritis, and a UTI. The Board denied the chronic fatigue syndrome claim, finding no current diagnosis supported by competent medical evidence. The examiner concluded the Veteran did not meet the VA definition for chronic fatigue syndrome, noting that PTSD and obstructive sleep apnea could explain the reported fatigue. The Board also noted that the Veteran's claims for GERD, rhinitis, IBS, gastroenteritis, and UTI were remanded. The Board found that the Veteran had a current disability for these conditions, had a qualifying service event in Bahrain related to toxic exposure risk activity, and that the evidence indicated a possible association between these conditions and the exposure, with insufficient medical evidence to decide the claim. VA examinations and nexus opinions were ordered on remand for these gastrointestinal and urinary tract issues.

Rationale

No current diagnosis of chronic fatigue syndrome; Lay testimony not competent to diagnose complex medical condition; VA examiner found Veteran did not meet VA definition for CFS

Full Decision Text

Citation Nr: A26039039
Decision Date: 04/27/26	Archive Date: 04/27/26

DOCKET NO. 250703-561289
DATE: April 27, 2026

ORDER

Entitlement to service connection for chronic fatigue syndrome is denied.

REMANDED

Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded.

Entitlement to service connection for rhinitis is remanded.

Entitlement to service connection for irritable bowel syndrome (IBS) is remanded.

Entitlement to service connection for non-infectious gastroenteritis is remanded.

Entitlement to service connection for a urinary tract infection (UTI) is remanded.

FINDING OF FACT

The Veteran does not have a current diagnosis of chronic fatigue syndrome.

CONCLUSION OF LAW

The criteria for entitlement to service connection for chronic fatigue syndrome are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Navy from September 2004 to August 2011, with additional service in the Navy Reserve.

This matter comes before the Board of Veterans' Appeals (Board) from September 2024 and April 2025 rating decisions issued by an Agency of Original Jurisdiction (AOJ) of the Department of Veterans Affairs (VA).

In the July 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 rating decisions on appeal. 38 C.F.R. § 20.301.

The Board notes that the Veteran listed a number of other issues in her July 2025 VA Form 10182 that are not before the Board, including entitlement to service connection for a colon condition, infertility, left ear otitis media, sleep apnea, sinusitis, an upper and lower back condition, and varicose veins of the right lower extremity, as they are untimely, in that they were most recently addressed by the AOJ more than one year prior to receipt of the VA Form 10182. The Veteran is encouraged to work with her Veterans Services Organization (VSO) to file a supplemental claim of entitlement to service connection for these issues on a VA-promulgated form, and to include new and relevant evidence. 

1. Entitlement to service connection for chronic fatigue syndrome is denied.

The Veteran asserts that she has chronic fatigue syndrome related to her military service. See June 2024 VA Form 21-526EZ.

The presence of a current disability is fundamental to any successful claim of service connection, and in the absence of a current disability a claim must be denied. See Brammer v. Derwinski, 3 Vet. App. 223 (1992).  Here, 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 proximate 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 diagnosis of chronic fatigue syndrome is medically complex, and therefore, competent medical evidence is required. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007); Layno v. Brown, 6 Vet. App. 465, 470-71 (1994) (holding that lay testimony is not competent to prove that which would require specialized knowledge, training, or medical expertise). While the Veteran is competent to report symptoms of fatigue, she is not competent to attribute these symptoms to a diagnosed disability. Notably, the Veteran is already service connected for posttraumatic stress disorder, with chronic sleep impairment as a symptom, and obstructive sleep apnea. 

The Veteran was afforded a VA chronic fatigue syndrome examination and opinion in connection with her reported chronic fatigue syndrome in July 2024. See July 2024 C&P Exam. The examiner concluded that there was no diagnosis because the Veteran "does not meet VA definition of chronic fatigue syndrome as the condition 'the exclusion, by history, physical examination, and laboratory tests, of all other clinical conditions that may produce similar symptoms' is not met." The examiner noted that the Veteran's OSA and PTSD "both can and typically do cause persistent fatigue."

There is no diagnosis of chronic fatigue syndrome in the Veteran's post-service
 is already service connected for posttraumatic stress disorder, with chronic sleep impairment as a symptom, and obstructive sleep apnea. 

The Veteran was afforded a VA chronic fatigue syndrome examination and opinion in connection with her reported chronic fatigue syndrome in July 2024. See July 2024 C&P Exam. The examiner concluded that there was no diagnosis because the Veteran "does not meet VA definition of chronic fatigue syndrome as the condition 'the exclusion, by history, physical examination, and laboratory tests, of all other clinical conditions that may produce similar symptoms' is not met." The examiner noted that the Veteran's OSA and PTSD "both can and typically do cause persistent fatigue."

There is no diagnosis of chronic fatigue syndrome in the Veteran's post-service treatment records.  To the extent she reports a current diagnosis of chronic fatigue syndrome, she is not competent to do so, as the diagnosis of such a condition requires medical expertise.

Thus, as there is no competent evidence of a current diagnosis of chronic fatigue syndrome, the first element of service connection is not met, and the claims fails on this basis alone. Brammer, supra.

The Board notes that the Veteran and her representative have challenged the credentials of the July 2024 VA examiner and have requested their curriculum vitae (CV). See August 2025 Appellate Brief. In Francway v. Wilkie, the Federal Circuit held that "[o]nce the request is made for information as to the competency of the examiner, the veteran has the right, absent unusual circumstances, to the CV and other information about qualifications of a medical examiner," "mandated by VA's duty to assist." 940 F.3d 1304, 1308 (2019). However, the Board has no duty to assist under the AMA. See 38 C.F.R. § 3.159(c). Because the request for the examiner's CV was not received prior to the rating decisions on appeal, there is no duty to assist error. The Board acknowledges that the representative's request for the examiner's CV is still outstanding and the request is referred back to the Veterans Benefits Administration (VBA) for processing.

REASONS FOR REMAND

2. Entitlement to service connection for GERD is remanded.

3. Entitlement to service connection for rhinitis is remanded.

4. Entitlement to service connection for IBS is remanded.

5. Entitlement to service connection for non-infectious gastroenteritis is remanded.

6. Entitlement to service connection for a UTI is remanded.

The Veteran asserts that her GERD, rhinitis, IBS, gastroenteritis, and UTI are related to toxic exposures during her military service. See March 2025 VA Form 21-526EZ.

VA must afford a veteran a medical examination and/or obtain a medical opinion when it is necessary to make a decision on the claim.  38 C.F.R. § 3.159(c)(4). There are four elements necessary in determining the need for a medical examination: (1) a current disability; (2) an in-service event, injury, or disease; (3) an indication that the claimed disability may be associated with the established event; and (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81-85 (2006). The third prong, which requires the evidence of record "indicate" the claimed disability or symptoms "may be" associated with the established event, disease, or injury, is a low threshold. McLendon, 20 Vet. App. at 83.

Here, the Veteran has reported GERD, rhinitis, IBS, gastroenteritis, and a UTI. For some of these reported symptoms and conditions, the Veteran has documented treatment. See January 2009 Medical Treatment Record - Government Facility (gastroenteritis); See October 2010 Medical Treatment Record - Non-Government Facility (nasal passage blockage); November 2017 Medical Treatment Record - Non-Government Facility (UTI symptoms). Additionally, for each of these issues, the Board notes that the Veteran is competent to report symptoms and observable events within the realm of her own personal knowledge. Layno v. Brown, 6 Vet. App. 465, 470-471 (1994); Jandreau, 492 F.3d at 1377. The Board finds these reports competent and credible and finds that the first McLendon element is met for each issue.

As to the second McLendon element, the Board notes that the AOJ favorably found that the Veteran participated in a toxic exposure risk activity during service, with qualifying service in Bahrain. This finding is not clearly or unmistakably erroneous. See June 2024 TERA Memorandum; 38 C
, for each of these issues, the Board notes that the Veteran is competent to report symptoms and observable events within the realm of her own personal knowledge. Layno v. Brown, 6 Vet. App. 465, 470-471 (1994); Jandreau, 492 F.3d at 1377. The Board finds these reports competent and credible and finds that the first McLendon element is met for each issue.

As to the second McLendon element, the Board notes that the AOJ favorably found that the Veteran participated in a toxic exposure risk activity during service, with qualifying service in Bahrain. This finding is not clearly or unmistakably erroneous. See June 2024 TERA Memorandum; 38 C.F.R. § 3.104(c).

Finally, the Board finds that the Veteran has met the third and fourth McLendon elements of an indication that the claimed disability may be associated with the established event and insufficient competent medical evidence on file for the VA to decide the claim. Here, it is plausible that the Veteran's GERD, rhinitis, IBS, gastroenteritis, and UTI could be related to in-service toxic exposures, however the file does not contain any medical opinion linking these conditions to her in-service event.

Therefore, the Board finds that the low standard detailed in McLendon is met and VA examinations and medical nexus opinions regarding service connection for GERD, rhinitis, IBS, gastroenteritis, and UTI are warranted and should be obtained on remand. See McLendon, 20 Vet. App. at 81-85.

The matters are REMANDED for the following action:

Schedule the Veteran for a VA examination to address the nature and etiology of the Veteran's GERD, rhinitis, IBS, gastroenteritis, and UTI. All findings should be reported in detail.

Following examination and review of the claims file, the examiner should address the following:

(a.) Does the Veteran have a current diagnosis of rhinitis subject to presumptive service connection?

(b.) Is the Veteran's reported gastrointestinal symptoms attributable to a known clinical diagnosis, including but not limited to gastroenteritis, GERD, and IBS? See January 2009 Medical Treatment Record - Government Facility (diagnosing gastroenteritis).  If so, please state the diagnosis or diagnoses. If no diagnosis is warranted, but functional impairment due to gastrointestinal symptoms is identified, please note the same.

(c.) Is the Veteran's gastrointestinal disability pattern consistent with: (1) a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology, (2) a diagnosable chronic multisymptom illness with a partially explained etiology, (3) a disease with a clear and specific etiology and diagnosis, or (4) a disease with a known diagnosis and pathophysiology?

(d.) If, after examining the Veteran and reviewing the claims file, you determine that the Veteran's gastrointestinal disability pattern is a diagnosable chronic multi-symptom illness with a partially explained etiology ((c)(2) above), a disease with a clear and specific etiology or a diagnosis or a disease with a known diagnosis and pathophysiology ((c)(3) or (c)(4) above), or if the Veteran's gastrointestinal symptoms result in functional impairment, then please opine as to whether it is as least as likely as not (approximately 50 percent probability or nearly 50 percent probability) that such condition had its onset during service or is otherwise related to his service, to include as the result of the total potential exposure through all applicable deployments and the synergistic, combined effect of all her toxic exposure risk activities?

(e.) Is it as least as likely as not (approximately 50 percent probability or nearly 50 percent probability) that the Veteran's UTI residuals had their onset in or are otherwise etiologically related to the Veteran's active service, to include as the result of the total potential exposure through all applicable deployments and the synergistic, combined effect of all her toxic exposure risk activities?

A complete rationale for the examiner's opinion should be provided, citing to specific evidence of record, as necessary. If the examiner cannot provide an opinion without resort to 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).

If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts are required), the AOJ should develop the claim to the extent it is necessary to cure any such deficiency. If the inability to provide an opinion is due to the examiner's lack of requisite knowledge or training, then the AOJ should obtain an opinion from a medical professional who has the