Service connection for a disorder manifested by generalized muscle pain is granted.

Citation Nr: 26001391 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 17-07 080 DATE: January 30, 2026 ORDER Service connection for a disorder manifested by generalized muscle pain is granted. Service connection for a disorder manifested by generalized joint pain is granted. FINDINGS OF FACT 1. The Veteran's muscle pain is a medically unexplained chronic multi-symptom illnesses (MUCMI) that manifested to a compensable degree during a six-month period since service. 2. The Veteran's joint pain is a MUCMI that manifested to a compensable degree during a six-month period since service. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for a disorder manifested by generalized muscle pain as due to the Veteran's Gulf War service have been met. 38 U.S.C. §§ 1110, 1117, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.317 2. The criteria for establishing entitlement to service connection for a disorder manifested by generalized joint pain as due to the Veteran's Gulf War service have been met. 38 U.S.C. §§ 1110, 1117, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.317 REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from October 1988 to October 1991, including service in the Persian Gulf from August 1990 to April 1991. This case comes before the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a July 2021 Board hearing. The transcript of the hearing is of record. When this case was initially before the Board in September 2021, the Board granted service connection for obstructive sleep apnea, reopened several of the Veteran's service connection claims and remanded several claims for further development. When the case was before the Board in April 2023, it was again remanded for further development. When this case was last before the Board in July 2024 it was remanded for additional development. However, as this decision constitutes a complete grant of the Veteran's claim on appeal, the Board finds that compliance with the prior remand directives is moot. As such, the Board finds that the RO either substantially complied with the directives in the July 2024 remand, or that such compliance is otherwise moot. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection-Legal Criteria Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be granted on a presumptive basis for a Persian Gulf veteran who exhibits objective indications of qualifying chronic disability, including resulting from undiagnosed illness, that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2026, and which by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1). In claims based on qualifying chronic disability, unlike those for direct service connection, there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004). Lay persons are competent to report objective signs of illness. The term "Persian Gulf veteran" means a veteran who served on active military, naval, or air service in the Southwest Asia Theater of operations during the Persian Gulf War. 38 C.F.R. § 3.317(e)(1). The DD Form 214 and service records reflect that the Veteran served in the Gulf War; therefore, this Veteran is a Persian Gulf veteran as defined by 38 C.F.R. § 3.317. A "qualifying chronic disability" for VA purposes is a chronic disability resulting from (A) an undiagnosed illness, (B) a medically unexplained chronic multi symptom illness (such as chronic fatigue syndrome (CFS), fibromyalgia, or IBS) that is defined by a cluster of signs or symptoms, or (C) any diagnosed illness that the Secretary determines in regulation prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection. 38 U.S.C. § 1117(a)(2); 38 C.F.R. § 3.317 (a)(2)(i)(B). An undiagnosed illness is defined as a condition that by history, physical examination, and laboratory tests cannot be attributed to a known clinical diagnosis. "Objective indications of chronic disability" include both "signs," in the medical sense of objective evidence perceptible to a physician, and other, non-medical indicators that are capable of independent verification. To fulfill the requirement of chronicity, the illness must have persisted for a period of six months. 38 C.F.R. § 3.317(a)(2), (3). Signs or symptoms that may be manifestations of undiagnosed illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; and (12) abnormal weight loss. 38 C.F.R. § 3.317(b). The Board additionally notes that ineligibility for presumptive service connection does not preclude the Veteran from achieving service connection on a direct basis due to his claims that his disabilities are the result of actual exposure to environmental toxins during his service in the Persian Gulf War. See e.g. Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the weight of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. To deny a claim on its merits, the weight of the evidence must persuasively stand against a finding that the evidence is in "approximate balance" or "nearly equal" to the evidence that supports the claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). Generalized Muscle Pain and Generalized Joint Pain At the outset, the Board notes that the essential facts of the Veteran's claims for entitlement to service connection for his above claimed issues are essentially identical. In addition, the resolution of these claims involves the application of identical law to similar facts. As such, in the interest of judicial economy these issues will be addressed together. The Veteran contends that service connection is warranted for his claimed generalized joint and muscle pain which he claims is etiologically related to his Southwest Asia service. The Board notes that the Veteran is considered a Persian Gulf veteran. 38 C.F.R. § 3.317(e). Additionally, the Board notes that the Veteran has reported shoulder, arm, hand, elbow, and knee pain which has persisted for longer than 6 months. See July 2021 Hearing Transcript. Therefore, the Veteran qualifies for consideration for presumptive service connection for disabilities resulting from an undiagnosed illness or medically unexplained chronic multi-symptom illness. The Veteran's available service treatment records (STRs) do not document any complaints, treatment, or diagnoses of any joint or muscle pain conditions. The Veteran provided a January 2012 lay statement wherein he reported that he experiences pain in his bilateral legs, arms, feet, and shoulders. Additionally, the Veteran's wife provided a January 2012 lay statement wherein she noted that she has witnessed the Veteran complaining about body pains in his legs, arms, and feet. Additionally, the Veteran's co-worker T.C. provided a January 2012 lay statement wherein they noted that they witnessed the Veteran complain of muscle and joint pains in the arms, legs, feet, and shoulders. In a September 2012 lay statement the Veteran reported that he had been experiencing joint and muscle pain since at least 1995 which has caused him weakened and painful movement. The Veteran noted that he sought medical treatment for these conditions and was told just to take over the counter medication. In May 2007 private medical records the Veteran was noted to have been involved in a workman's compensation injury where he had acute onset lower back pain while working at the Memphis Fire Department. December 2012 VA treatment records indicated that the Veteran was experiencing recurrent painful muscle spasms. Further, an October 2016 VA Mental Health Consult documented a history of multi-joint pain. During his July 2021 Board hearing, the Veteran testified that his muscle and joint pain began shortly after he left service. The Veteran noted that he has pains in his arms and hands where he cannot fully extend his arms. Further he noted that the pain occurs in his legs as well. The Veteran noted that the pain is periodic, but when it begins it can stay for any time between a week and a month. The Veteran testified that the pain would go away, but that it always comes back, and that it has been getting progressively worse. The Veteran noted that he suffers from these attacks around five to six times a year. The Veteran was provided with July 2022 VA examinations and medical opinions. With regard to his muscle and joint pain, the VA examiner opined that the Veteran's conditions were at least as likely as not etiologically related to his active-duty service. The rationale provided was that the Veteran's muscle and joint pain were MUCMIs of unexplained etiology and were at least as likely as not due to his Persian Gulf exposures. In a September 2022 Addendum Opinion, a VA examiner opined that the Veteran should be diagnosed with left shoulder, right elbow, and cervical spine degenerative joint disease. Further, the examiner noted that these conditions were less likely than not etiologically related to the Veteran's service, to include his Southwest Asia exposures. The rationale provided was that the Veteran's records show he complained of work-related injuries over the years while working as a firefighter, and his degenerative joint disease is more consistent with his injuries as a firefighter. The rationale continued that the underlying cause of these conditions is repetitive motion that causes wear and tear of the cartilage around the joints, and this causes pain, stiffness, tenderness, and inflammation. The Board notes that this opinion only addresses the Veteran's left shoulder, right elbow, and cervical spine, and does not address the pain complained of in the Veteran's other muscles and joints. The Veteran underwent December 2023 VA examinations; however, these examinations were found inadequate by the Board in the July 2024 remand. As such, the Board will not address these examinations further. In response to the Board's July 2024 Remand the Veteran was provided with August 2024 VA examinations and medical opinions regarding his claimed conditions. Here, the examiner opined that the Veteran's generalized joint and muscle pain conditions were less likely than not etiologically related to his active-duty service. The rationale provided was that the Veteran's STRs did not contain complaints or treatment of muscle and joint conditions. As such, there was no evidence of continuity from service. This rationale was continued in a February 2025 VA Addendum opinion. The Board notes that analysis of the Veteran's claim under the provisions of 38 C.F.R. § 3.317, pertaining to undiagnosed illnesses, is warranted. The regulatory provisions require only that the record establish objective indications of a chronic disability. 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. 38 C.F.R. § 3.317(a)(2)(ii)(3). In addition, symptoms like muscle pain and joint pain are specifically listed as manifestations of an undiagnosed illness capable of service connection. 38 C.F.R. § 3.317(b). As noted above, the July 2022 VA examiners noted that the Veteran's joint and muscle pain complaints were MUCMIs. Further, the Veteran has continually provided lay statements regarding the onset of his joint and muscle pain shortly after leaving service which he sought medical care for and treated with over-the-counter medications. Further, the Board finds that the Veteran is competent and credible to describe joint and muscle pain as objective indications of a chronic disability due to an undiagnosed illness. As noted above, while the September 2022 VA examination provided a negative nexus opinion, it only addressed the Veteran's left shoulder, right elbow, and cervical spine. The September 2022 VA examiner did not address the Veteran's complaints of generalized joint and muscle pain which occurred in his arms, legs, hands, and feet. Further, the Board notes that the August 2024 VA examiner provided a negative etiological opinion. However, the Board notes that the examiner's opinion focused solely on a direct nexus and did not provide an etiological opinion associated with the Veteran's Persian Gulf exposures, nor did it address the Veteran's conditions as a potential MUCMI. Accordingly, resolving all doubt in the Veteran's favor, the Board finds that the competent and credible evidence is at least approximately balanced as to whether the Veteran suffers from chronic joint and muscle pain that manifested to a compensable degree at some point during the presumptive period under 3.317(a). See 38 C.F.R. § 4.71a. As such, service connection for chronic generalized joint and muscle pain (as an undiagnosed illness associated with Persian Gulf War service) is warranted. In sum, as the weight of the evidence is in approximate balance, and this approximate balance must be weighed in favor of the Veteran, the Veteran's claims for service connection for generalized joint pain and generalized muscle pain conditions are granted. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Gresham, Trevor 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.