How the Board ruled on chronic fatigue claims, 2021–2025

Chronic fatigue (direct service connection)

Direct (began in or was caused by service), or theory not stated in the Board order

22.4% granted of 665 decided cases (margin of error 19.4–25.7%). 149 granted, 516 denied, 655 sent back to VA (remanded, not decided), 183 dismissed.

What convinced the Board in granted cases

• The Board granted when medical evidence, such as a reasoned private opinion, a VA examiner's diagnosis, or VA treatment records, showed chronic fatigue syndrome or tied the fatigue to service or a service-connected condition. (6 of 9 decisions read; e.g. 24003386, 21041380, A25038624)
• The Board gave little weight to VA opinions that ignored the veteran's statements and documented exposures, or did not explain why an existing diagnosis should be rejected. (3 of 9 decisions read; e.g. 24008588, A25038624, 22004081)
• The Board credited the veteran's consistent accounts of fatigue starting in service and continuing since, including when service records were lost. (3 of 9 decisions read; e.g. 24008588, 21076613, 21009749)

Common reasons in denied cases

• Most denials found no current diagnosis of chronic fatigue syndrome or a qualifying Gulf War chronic disability, often after a VA examiner found the diagnostic criteria were not met. (9 of 12 decisions read; e.g. A21016149, 22030131, 24018321)
• The Board denied when doctors explained the fatigue by another diagnosed condition, most often sleep apnea or an already service-connected condition such as PTSD. (3 of 12 decisions read; e.g. A24032794, 21041595, A25025058)
• The Board found the veteran's own belief that he or she had chronic fatigue syndrome was not competent medical evidence of a diagnosis. (4 of 12 decisions read; e.g. A21003036, A21016149, 21041595)

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Chronic fatigue (exposure claims)

Exposure (e.g. Agent Orange, Camp Lejeune, burn pits)

13.2% granted of 114 decided cases (margin of error 8.1–20.6%). 15 granted, 99 denied, 144 sent back to VA (remanded, not decided), 6 dismissed.

What convinced the Board in granted cases

• The Board gave weight to a detailed private or other favorable medical opinion, and little weight to VA opinions that were incomplete, skipped needed testing, or said an answer would be speculation without explaining why. (4 of 9 decisions read; e.g. 23003540, 22020366, 24003674)
• For Gulf War veterans, the Board granted when fatigue lasting at least six months had no known clinical cause, because an undiagnosed or unexplained multisymptom illness needs no medical link to service. (6 of 9 decisions read; e.g. 23057614, 21013659, 24009539)
• The Board accepted the veteran's, spouse's, or fellow servicemember's credible reports that tiredness began in service and continued afterward. (4 of 9 decisions read; e.g. 23055648, 21020413, 21013659)

Common reasons in denied cases

• The Board denied when VA examinations found no chronic fatigue syndrome or undiagnosed illness, and records showed no diagnosis, with no medical opinion to the contrary. (7 of 12 decisions read; e.g. 21004147, 21067915, A21003152)
• The veteran's own belief that he had chronic fatigue syndrome caused by service was not competent medical evidence, since diagnosis and cause were medically complex. (5 of 12 decisions read; e.g. 21001443, A21010140, 21060205)
• Some claims failed because the fatigue was found to be a symptom of a condition already service connected, such as PTSD or fibromyalgia, not a separate illness. (3 of 12 decisions read; e.g. 22021193, 23028770, A21000601)

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Chronic fatigue secondary to any service-connected condition

Secondary (caused or worsened by a service-connected condition)

27.6% granted of 58 decided cases (margin of error 17.8–40.2%). 16 granted, 42 denied, 122 sent back to VA (remanded, not decided), 3 dismissed.

What convinced the Board in granted cases

• The Board granted when a private or treating doctor reviewed the records, history and lay statements and gave a detailed explanation linking the fatigue to the service-connected condition. (4 of 12 decisions read; e.g. A23020381, 23055267, 21067053)
• Several grants rested on a VA examiner's own favorable opinion tying the fatigue to a service-connected condition such as asthma, PTSD or an immune disorder. (4 of 12 decisions read; e.g. A24046649, 24016130, 24009991)
• Negative VA opinions lost weight when they skipped the relevant question or wrongly said there was no diagnosis. (2 of 12 decisions read, few decisions; e.g. 23053173, 24009991)

Common reasons in denied cases

• Most denials found no current chronic fatigue syndrome diagnosis; fatigue alone was treated as a symptom, not a disability. (13 of 14 decisions read; e.g. A25035333, A24027719, 24031054)
• The veteran's belief that they had chronic fatigue syndrome, or about its cause, was not competent medical evidence, and no medical opinion supported it. (6 of 14 decisions read; e.g. 21048773, 21041655, 22010461)
• The fatigue was explained by another condition, such as sleep apnea, insomnia or depression; a private opinion that ignored sleep apnea got limited weight. (4 of 14 decisions read; e.g. 22002502, 21041655, A25035333)

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Chronic fatigue secondary to PTSD

Secondary (caused or worsened by a service-connected condition)

Small sample: 11 decided cases, too few for a reliable percentage. 3 granted, 8 denied, 17 sent back to VA (remanded, not decided), 1 dismissed.

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