08-21 574, 08-21 574

Veteran served in Southwest Asia (Saudi Arabia) during Operation Desert Storm from Dec 1990 to May 1991; active duty multiple periods including 1976–1994.
Veteran filed for service connection for tension headaches, COPD, and a sleep disorder (including OSA); RO denied in April 2007.
Board denied claims in Aug 2014 on both direct grounds and under 38 C.F.R. § 3.317 (undiagnosed illness); Veteran appealed to CAVC.
CAVC granted a Joint Motion for Remand (Apr 2015), directing the Board to consider whether the conditions qualify as "medically unexplained chronic multisymptom illnesses" under § 3.317(a)(2)(ii).
Veteran died June 2015; appellant (surviving spouse) was substituted in Mar 2016, and the Board remanded for further development and a VA medical opinion addressing etiology and whether the conditions qualify as medically unexplained chronic multisymptom illnesses.
Remand instructs obtaining an M.D. opinion on nexus to service/Gulf War exposures and whether each condition meets the regulatory definition; adequate rationale required and readjudication thereafter.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Service connection for tension headaches	Headaches caused by Gulf War toxin/environmental exposures; qualify under § 3.317	Denied by RO/Board as not service connected and not an "undiagnosed illness"	Remand for medical opinion on etiology and whether headaches are a medically unexplained chronic multisymptom illness
Service connection for COPD	COPD caused by Gulf War exposures; alternative § 3.317 basis	Denied as not service connected and not an "undiagnosed illness"	Remand for medical nexus opinion and determination whether COPD fits § 3.317 definition
Service connection for sleep disorder/OSA	Sleep disorder/OSA caused by service exposures; alternative § 3.317 basis	Denied as not service connected and not an "undiagnosed illness"	Remand for medical opinion on causation and whether sleep disorder is a medically unexplained chronic multisymptom illness
Proper consideration of "medically unexplained chronic multisymptom illnesses" under § 3.317	Board must evaluate whether conditions meet definition (diagnosed illness without conclusive pathophysiology/etiology)	Prior Board decision did not address this theory adequately	Remand ordered to obtain a medical determination because eligibility under § 3.317 is a medical question

Kutscherousky v. West, 12 Vet. App. 369 (1999) (claimant may submit additional evidence/argument after Board remand; procedural rights on remand)