INTERVERTEBRAL DISC SYNDROME

KRISTY L. ZADORA · 2026 · Case ID: A26039532

MIXED

Summary

The Veteran served from May 1993 to March 2009, including service in Southwest Asia. The Veteran sought readjudication of claims for a lumbar spine disorder, chronic fatigue syndrome, dermatitis, gastrointestinal problems, irritable bowel syndrome, a cervical spine disorder, neurologic signs or symptoms, and a right ankle disorder. The Board granted service connection for chronic fatigue syndrome, a gastrointestinal disorder, and irritable bowel syndrome, finding these conditions met the criteria for an undiagnosed illness or medically unexplained chronic multi-symptom illness, and were consistent with Southwest Asia service. The Board denied service connection for a neurologic disorder, finding insufficient evidence of service relation and no duty to provide a VA examination. The Board also denied service connection for a lumbar spine disorder, including as secondary to fibromyalgia, citing lack of service treatment records and insufficient indication of a nexus to service or fibromyalgia. The claims for dermatitis, a cervical spine disorder (as secondary to fibromyalgia), and a right ankle disorder were remanded for adequate VA examinations to determine etiology and service connection. The Board found new and relevant evidence, including private treatment records diagnosing lumbar intervertebral disc protrusion, chronic fatigue, cervical stenosis/spondylosis, and right ankle degenerative joint disease, supported readjudication for these conditions.

Rationale

New and relevant evidence received for readjudication.; Service treatment records negative for lumbar spine disorder.; Evidence does not indicate nexus to service or fibromyalgia.; Private treatment record diagnosed lumbar intervertebral disc protrusion.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

201112-121375

Full Decision Text

Citation Nr: A26039532
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 201112-121375
DATE: April 28, 2026

ORDER

New and relevant evidence having been received, the petition to readjudicate the claim of entitlement to service connection for a lumbar spine disorder is granted.

New and relevant evidence having been received, the petition to readjudicate the claim of entitlement to service connection for chronic fatigue syndrome is granted.

New and relevant evidence having been received, the petition to readjudicate the claim of entitlement to service connection for a cervical spine disorder is granted.

New and relevant evidence having been received, the petition to readjudicate the claim of entitlement to service connection for a right ankle disorder is granted.

Entitlement to service connection for chronic fatigue syndrome, a gastrointestinal disorder and irritable bowel syndrome, to include as due to an undiagnosed illness or medically unexplained chronic multi-symptom illness, is granted.

Entitlement to service connection for a neurologic disorder is denied.

Entitlement to service connection for a lumbar spine disorder, to include as secondary to service connected fibromyalgia, is denied.

REMANDED

Entitlement to service connection for dermatitis is remanded.

Entitlement to service connection for a cervical spine disorder as secondary to service connected fibromyalgia is remanded.

Entitlement to service connection for a right ankle disorder is remanded.

FINDINGS OF FACT

1. An April 2019 rating decision denied the claims of entitlement to service connection for a back condition, chronic fatigue syndrome, a neck condition and a right ankle condition based on finding that the disabilities were not etiologically related to service.

2. The evidence submitted since the issuance of the final April 2019 rating decision is new and relevant as it pertains to the Veteran's claims seeking service connection for a back condition, chronic fatigue syndrome, a neck condition and a right ankle condition.

3. The Veteran is diagnosed with chronic fatigue syndrome, a gastrointestinal disorder and irritable bowel syndrome, the etiology of which is unknown. His symptoms became manifest during active military service in the Southwest Asia theater of operations, and have been present for at least six months.

4. The Veteran's neurologic disorder is not etiologically related to his active service and did not have its onset in service.

5. The Veteran's lumbar spine disorder is not etiologically related to his active service and/or service connected fibromyalgia and did not have its onset in service.

CONCLUSIONS OF LAW

1. The April 2019 rating decision denying the claim for service connection for a back condition is final; new and relevant evidence has been received sufficient to readjudicate the claim. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.2501.

2. The April 2019 rating decision denying the claim for service connection for chronic fatigue syndrome is final; new and relevant evidence has been received sufficient to readjudicate the claim. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.2501.

3. The April 2019 rating decision denying the claim for service connection for a neck condition is final; new and relevant evidence has been received sufficient to readjudicate the claim. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.2501.

4. The April 2019 rating decision denying the claim for service connection for a right ankle condition is final; new and relevant evidence has been received sufficient to readjudicate the claim. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.2501.

5. The criteria for entitlement to service connection for chronic fatigue syndrome, a gastrointestinal disorder and irritable bowel syndrome, to include as due to an undiagnosed illness or a medically unexplained chronic multi-symptom illness have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317.

6. The criteria for service connection for a neurologic disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

7. The criteria for service connection for a lumbar spine disorder, to include as secondary to service connected fibromyalgia, have not been met. 38 U.S.C. §§
as due to an undiagnosed illness or a medically unexplained chronic multi-symptom illness have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317.

6. The criteria for service connection for a neurologic disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

7. The criteria for service connection for a lumbar spine disorder, to include as secondary to service connected fibromyalgia, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from May 1993 to March 2009, to include service in Southwest Asia.

These matters are before the Board of Veterans' Appeals (Board) on appeal from a rating decision dated in August 2020 issued by a Department of Veterans Affairs (VA) Regional Office (RO). The rating decision on appeal constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In June 2020, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of service connection claims for a lumbar spine disorder, chronic fatigue syndrome, dermatitis, gastrointestinal problems, irritable bowel syndrome, a cervical spine disorder, neurologic signs or symptoms and a right ankle disorder most recently addressed in an April 2019 rating decision. In August 2020, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received as to dermatitis, gastrointestinal problems, irritable bowel syndrome and neurologic signs or symptoms and denied the claims based on the evidence of record at the time of that decision. As to service connection for a lumbar spine disorder, chronic fatigue syndrome, a cervical spine disorder and a right ankle disorder, the AOJ found that new and relevant evidence had not been received. Therefore, the Board must determine whether new and relevant evidence has been received based only on the evidence of record at the time of the decision on appeal and any evidence submitted during an applicable evidentiary window.

In the November 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held in August 2024 before the undersigned Veterans Law Judge. A copy of the hearing transcript has been associated with the claims file. Therefore, the Board may only consider the evidence of record at the time of the August 2020 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.

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. However, because the Board is remanding the claims of service connection for dermatitis, a cervical spine disorder and a right ankle disorder, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Further, the Board notes that on the November 2020 Notice of Disagreement, the Veteran listed entitlement to a total rating based on individual unemployability (TDIU). However, the November 2020 Notice of Disagreement as to this issue is untimely as the last decision on this claim was issued in April 2019, more than 12 months prior to the Notice of Disagreement and the Veteran has not provided good cause for the delay in filing an appeal or requested an extension of time to file the Notice of Disagreement
Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Further, the Board notes that on the November 2020 Notice of Disagreement, the Veteran listed entitlement to a total rating based on individual unemployability (TDIU). However, the November 2020 Notice of Disagreement as to this issue is untimely as the last decision on this claim was issued in April 2019, more than 12 months prior to the Notice of Disagreement and the Veteran has not provided good cause for the delay in filing an appeal or requested an extension of time to file the Notice of Disagreement. Furthermore, entitlement to a TDIU is addressed in a separately docketed appeal at the Board.

1. New and relevant evidence having been received, the petition to readjudicate the claim of entitlement to service connection for a back condition is granted.

2. New and relevant evidence having been received, the petition to readjudicate the claim of entitlement to service connection for chronic fatigue syndrome is granted.

3. New and relevant evidence having been received, the petition to readjudicate the claim of entitlement to service connection for a neck condition is granted.

4. New and relevant evidence having been received, the petition to readjudicate the claim of entitlement to service connection for a right ankle condition is granted.

The Veteran seeks readjudication of the previously denied claims of entitlement to service connection for a back condition, chronic fatigue syndrome, a neck condition and a right ankle condition. See June 2020 VA Form 20-0995. The Veteran asserts that his lumbar spine disorder, chronic fatigue syndrome, cervical spine disorder and right ankle disorder are related to service. See December 2017 Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ).

VA will readjudicate a claim if new and relevant evidence is presented or secured. 38 C.F.R. § 3.156(d). New evidence is evidence not previously part of the actual record before agency adjudicators. 38 C.F.R. § 3.156. Relevant evidence is evidence that tends to prove or disprove a matter at issue in a claim, and it includes raising a theory of entitlement that was not previously addressed. 38 C.F.R. § 3.2501(a)(1).

By way of history, the Veteran filed his original claim for entitlement to service connection for chronic fatigue syndrome in February 2017. The AOJ denied the Veteran's claim for service connection for chronic fatigue syndrome in a July 2017 rating decision. In July 2017, the Veteran was advised of the decision. He appealed the decision in July 2017. In December 2017, the Veteran withdrew his appeal and requested reconsideration instead. In this regard, the Board has considered the applicability of 38 C.F.R. § 3.156(b). However, in the instant case, such regulation is inapplicable as no material evidence pertaining to the Veteran's claim for service connection was received or was in the constructive possession of VA prior to the expiration of the appeal period stemming from the July 2017 rating decision. See also Lang v. Wilkie, 971 F.3d 1348 (2020); Bond v. Shinseki, 659 F.3d 1362, 1367 (Fed. Cir. 2011); Roebuck v. Nicholson, 20 Vet. App. 307, 316 (2006); Muehl v. West, 13 Vet. App. 159, 161-62 (1999). Moreover, no additional relevant service records (warranting reconsideration of the claim) have been received at any time. See 38 C.F.R. § 3.156(c). Therefore, the July 2017 rating decision is final.

The Veteran filed a claim to reopen service connection for chronic fatigue syndrome in December 2017. The Veteran filed his original claims for entitlement to service connection for a lumbar spine disorder, a cervical spine disorder and a right ankle disorder in April 2019. In April 2019, the Veteran was advised of the decision and his appellate rights and did not appeal. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. Moreover, no additional relevant service records (warranting reconsideration of the claims) have been received at any time. See 38 C.F.R. § 3.156(c). Therefore, the April 2019 rating decision is final.

Evidence considered by the AOJ in April 2019 included the Veteran's service department records and post-service treatment records.

spine disorder, a cervical spine disorder and a right ankle disorder in April 2019. In April 2019, the Veteran was advised of the decision and his appellate rights and did not appeal. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. Moreover, no additional relevant service records (warranting reconsideration of the claims) have been received at any time. See 38 C.F.R. § 3.156(c). Therefore, the April 2019 rating decision is final.

Evidence considered by the AOJ in April 2019 included the Veteran's service department records and post-service treatment records.

In June 2020, the Veteran filed a VA Form 20-0995 seeking to readjudicate the claims. In the August 2020 rating decision on appeal, the AOJ denied the Veteran's petition to readjudicate the previously denied claims for entitlement to service connection for a back condition, chronic fatigue syndrome, a neck condition and a right ankle condition. Evidence received since the April 2019 rating decision includes post-service treatment records.

As it relates to the Veteran's petition to readjudicate the claims for entitlement to service connection for a back condition, chronic fatigue syndrome, a neck condition and a right ankle condition, the evidence received since the April 2019 rating decision includes evidence that is both new and relevant to the claims. For example, a December 2020 private treatment record submitted by the Veteran in November 2024 during the 90 day evidence submission window following the August 2024 Board hearing reveals a diagnosis of lumbar intervertebral disc protrusion. A September 2020 private treatment record submitted by the Veteran in November 2024 during the 90 day evidence submission window following the August 2024 Board hearing reveals a diagnosis of chronic fatigue. A December 2021 private treatment record submitted by the Veteran in November 2024 during the 90 day evidence submission window following the August 2024 Board hearing reveals a diagnosis of cervical stenosis/spondylosis and right ankle degenerative joint disease. This new evidence tends to prove or disprove a matter at issue in the claims, specifically, whether the Veteran was clinically diagnosed with a lumbar spine disorder, chronic fatigue syndrome, a cervical spine disorder and a right ankle disorder. Therefore, the claims will be readjudicated on the merits.

Accordingly, the Board finds that new and relevant evidence has been presented with respect to the Veteran's claim seeking service connection for a back condition, new and relevant evidence has been presented with respect to the Veteran's claim seeking service connection for chronic fatigue syndrome, new and relevant evidence has been presented with respect to the Veteran's claim seeking service connection for a neck condition and new and relevant evidence has been presented with respect to the Veteran's claim seeking service connection for a right ankle condition. To that extent, the appeals are granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

Service Connection Criteria

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may be granted based on evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. 38 C.F.R. § 3.304. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439 (1995). VA has amended 38 C.F.R. § 3.310 to explicitly incorporate the holding in Allen, except that it will not concede aggravation unless a baseline for the claimed disability can be established with evidence created prior to any aggravation. 38 C
of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439 (1995). VA has amended 38 C.F.R. § 3.310 to explicitly incorporate the holding in Allen, except that it will not concede aggravation unless a baseline for the claimed disability can be established with evidence created prior to any aggravation. 38 C.F.R. § 3.310(b).

Furthermore, compensation may be granted for disability due to undiagnosed illness of a veteran who served in the Southwest Asia Theater of operations during the Persian Gulf War. 38 U.S.C. § 1117.

Under this statute, the term "chronic disability" was changed to "qualifying chronic disability," and the definition of "qualifying chronic disability" was expanded to include (a) undiagnosed illness, (b) a medically unexplained chronic multi-symptom illness, to include chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome, that is defined by a cluster of signs or symptoms, or (c) any diagnosed illness that the Secretary determines, in regulations, warrants a presumption of service connection. Effective June 10, 2003, VA promulgated revised regulations to, in part, implement these statutory changes. See 38 C.F.R. § 3.317(a)(2).

Under 38 U.S.C. § 1117(a)(1), as amended, compensation is warranted for a Persian Gulf 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 during the presumptive period prescribed by the Secretary. The period within which such disabilities must become manifest to a compensable degree in order for entitlement to compensation to be established is currently December 31, 2026. See 38 C.F.R. § 3.317(a)(1)(i). In order to qualify, the chronic disability must not be attributed to any known clinical disease by history, physical examination, or laboratory tests. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a), (b).

The term "objective indications of a qualifying chronic disability" includes both "signs," in a medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Signs or symptoms that may be manifestations of undiagnosed illness or a chronic multi-symptom illness include the following: fatigue, unexplained rashes or other dermatological signs or symptoms, headache, muscle pain, joint pain, neurological signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the upper or lower respiratory system, sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, or menstrual disorders. 38 U.S.C. § 1117(g).

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 inconsistent demonstration of laboratory abnormalities. Chronic multi symptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii). Disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a six-month period will be considered chronic. The six-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. 38 C.F.R. § 3.317(a)(4).

The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991).

The veteran can provide competent reports of factual matters of which he has first-hand knowledge, such as experiencing pain in service, reporting to sick call, being placed
of the disability first became manifest. 38 C.F.R. § 3.317(a)(4).

The veteran can provide competent reports of factual matters of which he has first-hand knowledge, such as experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a lay person is competent to identify the medical condition (noting that sometimes the lay person will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Similarly, laypersons are competent to diagnose and provide nexus opinions to some extent, notably where the diagnosis or opinion is not of a complex nature. Id.; see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104(a); Baldwin v. West, 13 Vet. App. 1 (1999).

When there is an approximate balance of positive and negative evidence as to any issue material to the determination of a matter, VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

5. Entitlement to service connection for chronic fatigue syndrome, a gastrointestinal disorder and irritable bowel syndrome, to include as due to an undiagnosed illness or medically unexplained chronic multi-symptom illness, is granted.

The Veteran seeks entitlement to service connection for chronic fatigue syndrome, a gastrointestinal disorder and irritable bowel syndrome, to include as due to a medically unexplained chronic multi-symptom illness. See August 2024 Hearing Transcript. April 2019 and August 2020 rating decisions made favorable findings that new and relevant evidence was received, that the Veteran was diagnosed with gastritis, performed service in Southwest Asia and that service treatment records showed treatment/complaint for gastroenteritis; the Board is bound by these favorable findings.

The record reflects that the Veteran served in the Southwest Asia theater of operations during the Persian Gulf War. See January 2023 VA memorandum. Therefore, service connection may potentially be established under 38 C.F.R. § 3.317.

The Veteran's service treatment records reveal a February 2003 complaint of abdominal pain and a diagnosis of viral gastroenteritis. A March 2003 service treatment record reveals a complaint of abdominal pain. The Veteran's service treatment records are negative for complaints of, treatment for, or diagnoses related to chronic fatigue syndrome and/or irritable bowel syndrome. Post-service treatment records show that the Veteran was diagnosed with Helicobacter pylori associated gastritis, irritable bowel syndrome and chronic fatigue syndrome. See April 2018 VA examination; May 2019 VA treatment record; September 2020 private treatment record submitted by the Veteran in November 2024 during the 90 day evidence submission window following the August 2024 Board hearing.

Turning to the evidence of record, the Veteran was afforded a Gulf War General Medical Examination in April 2017. The examiner determined that there were no diagnosed illnesses for which no etiology was established and there was no undiagnosed illness. The examiner noted the Veteran's report that he was "always tired," woke up tired and slept a few hours at night. The Veteran stated that his symptoms started around 2007 or 2008. The examiner stated that the Veteran had not been diagnosed with chronic fatigue syndrome. The examiner opined that the Veteran's daytime fatigue had alternate etiologies such as obstructive sleep apnea and depression. The Board finds the April 2017 VA medical opinion inadequate to decide the claim. In this regard, the examiner did not provide an adequate
Veteran was afforded a Gulf War General Medical Examination in April 2017. The examiner determined that there were no diagnosed illnesses for which no etiology was established and there was no undiagnosed illness. The examiner noted the Veteran's report that he was "always tired," woke up tired and slept a few hours at night. The Veteran stated that his symptoms started around 2007 or 2008. The examiner stated that the Veteran had not been diagnosed with chronic fatigue syndrome. The examiner opined that the Veteran's daytime fatigue had alternate etiologies such as obstructive sleep apnea and depression. The Board finds the April 2017 VA medical opinion inadequate to decide the claim. In this regard, the examiner did not provide an adequate rationale as to why the Veteran's fatigue had alternate etiologies unrelated to service. 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.").

The Veteran was afforded a VA examination in April 2018 for stomach and duodenal conditions. The examiner diagnosed the Veteran with Helicobacter pylori associated gastritis. The Veteran reported chronic epigastric burning radiating to his chest since 2009, heartburn and vomiting with certain foods. The examiner opined that the Veteran's chronic gastritis was less likely than not due to service. The rationale provided was that there was no evidence of chronic gastritis that began in service. The examiner noted that the episode of gastritis during service appears to have been acute. The Board finds the April 2018 VA medical opinion inadequate to decide the claim. In this regard, the VA examiner seems to rely solely on the lack of treatment during active service when rendering the opinion. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). This opinion is therefore afforded little, if any probative weight.

In May 2019, the Veteran underwent testing at the VA War Related Illness and Injury Center. The provider noted that he reviewed the Veteran's medical records and discussed with the Veteran his exposures during service including in Southwest Asia. The provider noted the Veteran's reports of chronic fatigue, gastrointestinal upset and chronic diarrhea. The provider opined that the Veteran's medically unexplained fatigue, gastrointestinal upset and diarrhea were consistent with a medically unexplained chronic multi-symptom illness. The provider cited to applicable medical literature. The rationale provided was that the Veteran's symptoms started around the time of his deployment and lasted more than six months.

The May 2019 VA provider conducted a thorough review of the medical records and medical literature, interviewed the Veteran, and relied on his expertise when rendering the opinion. This provider noted the Veteran's statements and contentions regarding the onset and continuity of his symptoms and the current diagnoses and symptoms as it related to this particular Veteran. The Board finds this opinion to be adequate as it provides a thorough rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Stefl v. Nicholson, supra. In addition, this provider related the particular circumstances of this Veteran when rendering the opinion. Thus, this opinion is afforded high probative value.

A medically unexplained chronic multi-symptom illness must further be characterized by a cluster of signs or symptoms, including overlapping symptoms and signs with features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. As described above, the Veteran experiences a cluster of symptoms, including fatigue, gastrointestinal distress and irritable bowel syndrome.

There are also objective indications of the Veteran's medically unexplained chronic multi-symptom illness. Objective indications of a chronic disability include 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. Here, the May 2019 VA medical opinion determined that there were objective indications of the Veteran's medically unexplained chronic multi-symptom illness.

The Veteran's medically unexplained chronic multi-symptom illness also met the six-month "chronicity requirement" of the regulation. The Veteran reported an onset of chronic fatigue syndrome, a gastrointestinal disorder and irritable bowel syndrome during service.

Accordingly, the Board finds that entitlement to service connection for chronic fatigue syndrome, a gastrointestinal disorder and irritable bowel syndrome, to include as due to an undiagnosed illness or medically unexplained chronic multi-symptom illness is warranted. The appeal is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

6. Entitlement to service connection for a neurologic disorder is denied.

The Veteran seeks service connection for a neurologic disorder as etiologically related to service. See November 202
requirement" of the regulation. The Veteran reported an onset of chronic fatigue syndrome, a gastrointestinal disorder and irritable bowel syndrome during service.

6. Entitlement to service connection for a neurologic disorder is denied.

The Veteran seeks service connection for a neurologic disorder as etiologically related to service. See November 2020 Notice of Disagreement. Specifically, the Veteran, through his representative, asserts that his neurologic disorder is a medically unexplained chronic multi-symptom illness related to his Southwest Asia service. See August 2024 Hearing Transcript. An August 2020 rating decision made favorable findings that new and relevant evidence was received and the Veteran performed service in Southwest Asia; the Board is bound by these favorable findings.

Turning to the evidence, service treatment records are negative for complaints of, treatment for, or diagnoses of any condition related to a neurologic disorder. Post-service treatment records document that the Veteran was diagnosed with idiopathic peripheral neuropathy and small fiber neuropathy. See December 2016 VA treatment note and May 2019 VA treatment note.

The Board concludes that, while the Veteran has subjectively reported a neurologic disorder during the appellate period, the evidence of record is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease.

The Board notes that the Veteran has not been afforded a VA examination addressing his claimed neurologic disorder. However, the Board finds that such an examination is not required. In this regard, in determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court has stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and the veteran's service. McLendon v. Nicholson, 20 Vet. App. 79 (2006).

The service treatment records are negative for complaints, treatments or diagnoses related to a neurologic disorder and the evidence does not indicate that his claimed neurologic disorder may be related to his military service. See McLendon v. Nicholson, supra. In this regard, while the Veteran himself has advanced such a theory, a mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). The Court has held that VA is not required to provide a medical examination when there is not credible evidence of an event, injury, or disease in service. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010). Therefore, the Board finds that a VA examination and/or opinion is not necessary to decide the claim.

The Board has also considered whether a remand is warranted to consider the Veteran's contention that his neurologic disorder is due to a medically unexplained chronic multi-symptom illness related to his Southwest Asia service. However, under the AMA, VA's duty to assist ends when the AOJ issues the decision on appeal and does not restart unless a supplemental claim is submitted, or a claim is returned to the AOJ for correction of an error. 38 U.S.C. § 5103(A); 38 C.F.R. § 3.159(c). In this case, the record indicates that no contentions of a neurologic disorder due to a medically unexplained chronic multi-symptom illness were made until August 2024, well after the August 2020 AOJ decision on appeal. Argument made at the August 2024 Board hearing cannot form the basis for a pre-decision
ptom illness related to his Southwest Asia service. However, under the AMA, VA's duty to assist ends when the AOJ issues the decision on appeal and does not restart unless a supplemental claim is submitted, or a claim is returned to the AOJ for correction of an error. 38 U.S.C. § 5103(A); 38 C.F.R. § 3.159(c). In this case, the record indicates that no contentions of a neurologic disorder due to a medically unexplained chronic multi-symptom illness were made until August 2024, well after the August 2020 AOJ decision on appeal. Argument made at the August 2024 Board hearing cannot form the basis for a pre-decisional duty to assist error in August 2020 for which the Board may remand this matter. To the extent that the Veteran believes his neurologic disorder to be related to his military service, he is invited to submit a supplemental claim of entitlement for VA consideration.

In reaching this determination, the Board has also considered the lay assertions of record, including the contentions of the Veteran in support of a diagnosis and/or medical nexus. The Veteran generally contends that he has a neurologic disorder that is due to his service. As a lay person, the Veteran is competent to report observable symptoms. See Washington v. Nicholson, supra; see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (Lay testimony is competent to establish the presence of observable symptomatology); Layno v. Brown, 6 Vet. App. 465 (1994). Lay evidence may be competent on a variety of matters concerning the nature and cause of disability. Jandreau, 492 F.3d at 1377 n.4. However, while the Veteran is competent to report having experienced symptoms of pain and discomfort, he is not competent to opine on the etiology of the condition. See Jandreau v. Nicholson, supra.

Accordingly, the Board finds that service connection for a neurologic disorder is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

7. Entitlement to service connection for a lumbar spine disorder, to include as secondary to service connected fibromyalgia, is denied.

The Veteran seeks entitlement to service connection for a lumbar spine disorder as etiologically related to his active service. See November 2020 Notice of Disagreement. In the alternative, the Veteran, through his representative, contends that his lumbar spine disorder is secondary to his service connected fibromyalgia. See August 2024 Board Hearing Transcript. An April 2019 rating decision made a favorable finding that the Veteran had been diagnosed with low back pain; the Board is bound by this favorable finding.

The Veteran's service treatment records are negative for complaints of, treatment for, or diagnoses related to a lumbar spine disorder. Post-service treatment records show a medical history of lower back pain, lumbar intervertebral disc protrusion and lumbar spondylosis with disc protrusion. See July 2016 VA treatment record; December 2020 private treatment record and December 2021 Social Security Disability decision submitted by the Veteran in November 2024 during the 90 day evidence submission window following the August 2024 Board hearing.

The Board concludes that, while the Veteran has subjectively reported a lumbar spine disorder during the appellate period, the evidence of record is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease.

The Board notes that the Veteran has not been afforded a VA etiology opinion addressing his claimed lumbar spine disorder. However, the Board finds that such an opinion is not required. In this regard, in determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court has stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "
or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court has stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and the veteran's service. McLendon v. Nicholson, supra.

The service treatment records are negative for complaints, treatments or diagnoses related to a lumbar spine disorder and the evidence does not indicate that his claimed lumbar spine disorder may be related to his military service. See McLendon v. Nicholson, supra. In this regard, while the Veteran himself has advanced such a theory, a mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, supra. The Court has held that VA is not required to provide a medical examination when there is not credible evidence of an event, injury, or disease in service. See Bardwell v. Shinseki, supra. Therefore, the Board finds that a VA examination and/or opinion is not necessary to decide the claim.

The Board has also considered whether a remand is warranted to consider the Veteran's contention that his lumbar spine disorder is due to his service connected fibromyalgia. However, under the AMA, VA's duty to assist ends when the AOJ issues the decision on appeal and does not restart unless a supplemental claim is submitted, or a claim is returned to the AOJ for correction of an error. 38 U.S.C. § 5103(A); 38 C.F.R. § 3.159(c). In this case, the record indicates that no contentions of a secondary relationship were made until August 2024, well after the February 2025 AOJ decision on appeal. The May 2019 VA examination for fibromyalgia did not reference related lumbar spine pain. Argument submitted by the Veteran during the August 2024 Board hearing cannot form the basis for a pre-decisional duty to assist error in August 2020 for which the Board may remand this matter. To the extent that the Veteran believes that his lumbar spine disorder to be related to his military service, he is invited to submit a supplemental claim of entitlement for VA consideration.

In reaching this determination, the Board has also considered the lay assertions of record, including the contentions of the Veteran in support of a diagnosis and/or medical nexus. The Veteran generally contends that he has a lumbar spine disorder that is due to his service and/or service connected fibromyalgia. As a lay person, the Veteran is competent to report observable symptoms. See Washington v. Nicholson, supra; see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (Lay testimony is competent to establish the presence of observable symptomatology); Layno v. Brown, 6 Vet. App. 465 (1994). Lay evidence may be competent on a variety of matters concerning the nature and cause of disability. Jandreau, 492 F.3d at 1377 n.4. However, while the Veteran is competent to report having experienced symptoms of pain and discomfort, he is not competent to opine on the etiology of the condition. See Jandreau v. Nicholson, supra.

Accordingly, the Board finds that service connection for a lumbar spine disorder, to include as secondary to service connected fibromyalgia, is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, supra.

REASONS FOR REMAND

1. Entitlement to service connection for dermatitis is remanded.

The Veteran seeks entitlement to service connection for dermatitis as etiologically related to service. See February 2017 VA Form 21-526EZ. Specifically, the Veteran, through his representative, asserts that his dermatitis is due to Southwest Asia service. Id. April 2019 and August 2020 rating decisions made favorable findings that new and relevant evidence was received, that the Veteran performed service in Southwest Asia and the Veteran had been diagnosed with dermatitis in a June 2018 VA examination; the Board is bound by these favorable findings.

A June 1993 service
.102; Lynch v. McDonough, supra.

REASONS FOR REMAND

1. Entitlement to service connection for dermatitis is remanded.

A June 1993 service treatment record reveals that the Veteran complained of a rash on his groin area. A December 2005 service treatment record reveals a rash of the arms and trunk areas.

In an April 2017 VA medical opinion associated with the claims file in May 2017, the examiner opined that the Veteran's skin disorder was less likely than not due to service. The rationale provided was that the only specific skin condition noted in the record was per an October 2013 dermatology consultation, which was 10 years after the Veteran served in Southwest Asia. The Board finds the April 2017 VA medical opinion inadequate to decide the claim. Specifically, the examiner stated that a skin disorder was first noted in 2013. However, the examiner did not address the June 1993 and December 2005 service treatment records revealing complaints of rashes. Accordingly, the April 2017 VA examination is inadequate as it does not sufficiently consider the Veteran's prior medical history. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (a medical opinion based on an inaccurate factual premise is not probative).

The Veteran was afforded a VA examination in June 2018. The examiner diagnosed dermatitis and tinea pedis. The examiner noted the Veteran's report of jock itch and Athlete's foot during service. In a July 2018 VA addendum opinion, the examiner opined that the Veteran's dermatitis and tinea pedis were less likely than not related to service. The rationale provided was that there was no nexus of chronicity or disability. The examiner stated that there was no evident tinea pedis or dermatitis at the June 2018 VA examination. The Board finds the July 2018 VA medical opinion inadequate to decide the claim. In this regard, the VA examiner seems to rely solely on the lack of treatment during active service when rendering the opinion. See Dalton v. Nicholson, 21 Vet. App. 23 (2007).

As such, the Board finds that a remand is necessary in order to obtain an addendum opinion regarding the etiology of the Veteran's claimed dermatitis. Where VA provides a veteran with an examination in a service connection claim, the examination and etiology opinion must be adequate. Barr v. Nicholson, supra. The failure to obtain an adequate etiology opinion is a pre-decisional duty to assist error. On remand, such an opinion should be obtained.

2. Entitlement to service connection for a cervical spine disorder as secondary to service connected fibromyalgia is remanded.

The Veteran seeks service connection for a cervical spine disorder as secondary to his service connected fibromyalgia. See August 2024 Board Hearing Transcript. An August 2020 rating decision made a favorable finding that the Veteran had been diagnosed with cervical spondylosis; the Board is bound by this favorable finding.

The Veteran was afforded a VA examination in June 2018. The examiner diagnosed cervical spinal stenosis and mild C4-C5 disc bulge. The VA examiner did not provide an etiology opinion. The Board finds the June 2018 VA examination to be incomplete to decide the claim as there is no conclusion for the Board to weigh.

During a May 2019 VA examination for fibromyalgia, the examiner noted that the Veteran endorsed widespread pain in the neck joints. Therefore, the Board finds that service connection as secondary to service connected fibromyalgia is raised by the record.

As such, the Board finds that a remand is necessary in order to obtain an addendum opinion regarding the etiology of the Veteran's claimed cervical spine disorder. Where VA provides a veteran with an examination in a service connection claim, the examination and etiology opinion must be adequate. Barr v. Nicholson, supra. The failure to obtain an adequate etiology opinion is a pre-decisional duty to assist error. On remand, such an opinion should be obtained.

Entitlement to service connection for a right ankle disorder is remanded.

The Veteran
the examiner noted that the Veteran endorsed widespread pain in the neck joints. Therefore, the Board finds that service connection as secondary to service connected fibromyalgia is raised by the record.

Entitlement to service connection for a right ankle disorder is remanded.

The Veteran seeks entitlement to service connection for a right ankle disorder as etiologically related to service. See August 2024 Board Hearing Transcript. Specifically, the Veteran contends that he sprained his ankle during service and had an ankle tear during service. Id. An August 2020 rating decision made favorable findings that the Veteran had been diagnosed with right ankle pain and that the evidence showed that a qualifying event, injury or disease had its onset during his service based on treatment for the right ankle; the Board is bound by these favorable findings.

An April 2003 service treatment record reveals that the Veteran was treated for a right ankle sprain.

A December 2021 Social Security Disability decision submitted by the Veteran in November 2024 during the 90 day evidence submission window following the August 2024 Board hearing revealed a diagnosis of right ankle degenerative joint disease.

In light of the above, the Board concludes that the Veteran should be afforded a VA examination to determine the nature and etiology of any currently present right ankle disorder. McLendon v. Nicholson, supra. Where VA provides a veteran with an examination in a service connection claim, the examination and etiology opinion must be adequate. Barr v. Nicholson, supra. The AOJ's failure to obtain an adequate etiology opinion is a pre-decisional duty to assist error. On remand, such an opinion should be obtained.

The matters are REMANDED for the following actions:

1. Schedule the Veteran for a VA examination with an appropriately qualified clinician to determine the etiology of the Veteran's claimed dermatitis. The record, to include a copy of this Remand, should be made available to the examiner, and all indicated tests should be conducted. The need for further in-person physical examination is left to the discretion of the examiner.

The examiner is asked to furnish an opinion with respect to the following question:

Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's dermatitis is related to his toxic exposures? The examiner must consider (i) total potential exposure through all applicable military deployments; and (ii) synergistic, combined effect of all toxic exposure risk activities.

A rationale should be provided for all opinions offered.

The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resorting to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge.

2. Schedule the Veteran for a VA examination with an appropriately qualified clinician to determine the etiology of the Veteran's claimed cervical spine disorder. The record, to include a copy of this Remand, should be made available to the examiner, and all indicated tests should be conducted. Further physical examination is left to the discretion of the examiner.

The examiner is asked to furnish an opinion with respect to the following question:

Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the cervical spine disorder was caused and/or aggravated by his service connected fibromyalgia?

The examiner should address a May 2019 VA examination for fibromyalgia in which the examiner noted that the Veteran endorsed widespread pain in the neck joints.

A rationale should be provided for all opinions offered.

3
May 2019 VA examination for fibromyalgia in which the examiner noted that the Veteran endorsed widespread pain in the neck joints.

A rationale should be provided for all opinions offered.

3. Schedule the Veteran for a VA examination with an appropriate medical professional to offer an opinion regarding the etiology of the Veteran's claimed right ankle disorder. The record, to include a copy of this Remand, should be made available to the examiner.

The examiner should offer an opinion with respect to the following questions:

(A) Identify all of the Veteran's right ankle disorders that met the diagnostic criteria identified during the pendency of this claim.

The December 2021 Social Security Disability decision submitted by the Veteran in November 2024 during the 90 day evidence submission window following the August 2024 Board hearing revealing a diagnosis of right ankle degenerative joint disease should be discussed. If the examiner finds that a diagnosis is not appropriate, the opinion should address any inconsistency with the December 2021 Social Security Disability decision.

(B) For each diagnosis referable to a right ankle disorder, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any right ankle disorder had its onset in service or is etiologically related to service?

The examiner should address an April 2003 service treatment record revealing that the Veteran was treated for a right ankle sprain.

A rationale should be provided for all opinions offered.

(Continued on the next page)

KRISTY L. ZADORA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board A. Kuhn, 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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