Veteranclaims’s Blog

September 24, 2021

Single Judge Application; a MUCMI is “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.” 38 C.F.R. § 3.317(a)(2)(ii). “Under the proper interpretation of the law, an illness is a MUCMI where either the etiology or pathophysiology of the illness is inconclusive.” Stewart v. Wilkie, 30 Vet.App. 383, 390 (2018); “Conversely, a multisymptom illness is not a MUCMI where both the etiology and the pathophysiology of the illness are partially understood.” Id.; “[W]hether an illness is ‘defined by a cluster of signs or symptoms’ . . . is a question of fact delegated to the VA . . . for consideration in the first instance.” Tadlock, 5 F.4th at 1338 (quoting 38 U.S.C. § 1117(a)(2)(B));

Filed under: Uncategorized — Tags: — veteranclaims @ 10:36 am

Designated for electronic publication only
UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS
No. 20-4497
PURDIE K. BURKES, APPELLANT,
V.
DENIS MCDONOUGH,
SECRETARY OF VETERANS AFFAIRS, APPELLEE.
Before FALVEY, Judge.
MEMORANDUM DECISION
Note: Pursuant to U.S. Vet. App. R. 30(a),
this action may not be cited as precedent.
FALVEY, Judge: Army veteran Purdie K. Burkes, through counsel, appeals a March 26,
2020, Board of Veterans’ Appeals decision that denied a disability rating greater than 50% for posttraumatic
stress disorder (PTSD) and denied service connection for left and right shoulder
disabilities, a headaches condition, a nasal disorder, a respiratory disability, irritable bowel
syndrome, restless leg syndrome, and a hand tremor condition. This appeal is timely, the Court has
jurisdiction to review the Board’s decision, and single-judge disposition is appropriate. See U.S.C.
§§ 7252(a), 7266(a); Frankel v. Derwinski, 1 Vet.App. 23, 25-26 (1990).
For PTSD, we are asked to decide whether the Board erred in denying a higher disability
rating and not obtaining clarification from a medical examiner. Because the Board’s findings are
well explained and not clearly erroneous and because the record did not require clarification, we
will affirm that part of the Board’s decision.
For the other disabilities, we are asked to address whether the Board should have awarded
benefits based on a medically unexplained chronic multisymptom illness (MUCMI) under
38 C.F.R. § 3.317. As we explain below, remand is warranted for the Board to apply the correct
law and address relevant facts in the first instance.
2
We thus affirm that part of the Board’s decision that addressed PTSD, and we will set aside
that part of the Board’s decision that addressed conditions other than PTSD and remand those
matters for further proceedings.
I. ANALYSIS
A. PTSD
Mr. Burkes argues that the Board improperly applied the law because it denied a higher
disability rating for PTSD based on the absence of certain symptoms rather than the presence of
symptoms similar to those listed in the rating criteria. He also contends that the Board did not
account for favorable evidence showing a poor relationship with his wife and possible suicidal
ideation. Apparently in the alternative, he also asserts that the evidence of suicidal ideation is
unclear and either showed that the evidence was in equipoise or required remand for the Board to
obtain clarification. We disagree.
In evaluating mental disorders such as PTSD, the Board must consider all the evidence,
determine the appellant’s overall disability picture, and then look to the list of symptoms outlined
in the diagnostic criteria as examples that can provide guidance in determining the severity of the
appellant’s condition. Mauerhan v. Principi, 16 Vet.App. 436, 442 (2002). PTSD is evaluated
under the general rating criteria for mental disorders at 38 C.F.R. § 4.130, Diagnostic Code (DC)

Designated for electronic publication only
UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS
No. 20-4497
PURDIE K. BURKES, APPELLANT,
V.
DENIS MCDONOUGH,
SECRETARY OF VETERANS AFFAIRS, APPELLEE.
Before FALVEY, Judge.
MEMORANDUM DECISION
Note: Pursuant to U.S. Vet. App. R. 30(a),
this action may not be cited as precedent.
FALVEY, Judge: Army veteran Purdie K. Burkes, through counsel, appeals a March 26,
2020, Board of Veterans’ Appeals decision that denied a disability rating greater than 50% for posttraumatic
stress disorder (PTSD) and denied service connection for left and right shoulder
disabilities, a headaches condition, a nasal disorder, a respiratory disability, irritable bowel
syndrome, restless leg syndrome, and a hand tremor condition. This appeal is timely, the Court has
jurisdiction to review the Board’s decision, and single-judge disposition is appropriate. See U.S.C.
§§ 7252(a), 7266(a); Frankel v. Derwinski, 1 Vet.App. 23, 25-26 (1990).
For PTSD, we are asked to decide whether the Board erred in denying a higher disability
rating and not obtaining clarification from a medical examiner. Because the Board’s findings are
well explained and not clearly erroneous and because the record did not require clarification, we
will affirm that part of the Board’s decision.
For the other disabilities, we are asked to address whether the Board should have awarded
benefits based on a medically unexplained chronic multisymptom illness (MUCMI) under
38 C.F.R. § 3.317. As we explain below, remand is warranted for the Board to apply the correct
law and address relevant facts in the first instance.
2
We thus affirm that part of the Board’s decision that addressed PTSD, and we will set aside
that part of the Board’s decision that addressed conditions other than PTSD and remand those
matters for further proceedings.
I. ANALYSIS
A. PTSD
Mr. Burkes argues that the Board improperly applied the law because it denied a higher
disability rating for PTSD based on the absence of certain symptoms rather than the presence of
symptoms similar to those listed in the rating criteria. He also contends that the Board did not
account for favorable evidence showing a poor relationship with his wife and possible suicidal
ideation. Apparently in the alternative, he also asserts that the evidence of suicidal ideation is
unclear and either showed that the evidence was in equipoise or required remand for the Board to
obtain clarification. We disagree.
In evaluating mental disorders such as PTSD, the Board must consider all the evidence,
determine the appellant’s overall disability picture, and then look to the list of symptoms outlined
in the diagnostic criteria as examples that can provide guidance in determining the severity of the
appellant’s condition. Mauerhan v. Principi, 16 Vet.App. 436, 442 (2002). PTSD is evaluated
under the general rating criteria for mental disorders at 38 C.F.R. § 4.130, Diagnostic Code (DC) 411. A 50% rating is warranted where evidence shows that the psychiatric condition causes
[o]ccupational and social impairment with reduced reliability and productivity due
to such symptoms as: flattened affect; circumstantial, circumlocutory, or
stereotyped speech; panic attacks more than once a week; difficulty in
understanding complex commands; impairment of short– and long-term memory
(e.g., retention of only highly learned material, forgetting to complete tasks);
impaired judgment; impaired abstract thinking; disturbances of motivation and
mood; difficulty in establishing and maintaining effective work and social
relationships.
38 C.F.R. § 4.130, DC 9411 (2021). A 70% rating for PTSD is warranted if the evidence shows
[o]ccupational and social impairment, with deficiencies in most areas, such as
work, school, family relations, judgment, thinking, or mood, due to such symptoms
as: suicidal ideation; obsessional rituals which interfere with routine activities;
speech intermittently illogical, obscure, or irrelevant; near-continuous panic or
depression affecting the ability to function independently, appropriately and
effectively; impaired impulse control (such as unprovoked irritability with periods
of violence); spatial disorientation; neglect of personal appearance and hygiene;
3
difficulty in adapting to stressful circumstances (including work or a worklike
setting); inability to establish and maintain effective relationships.
Id. A 100% rating is warranted if the evidence shows
[t]otal occupational and social impairment, due to such symptoms as: gross
impairment in thought processes or communication; persistent delusions or
hallucinations; grossly inappropriate behavior; persistent danger of hurting self or
others; intermittent inability to perform activities of daily living (including
maintenance of minimal personal hygiene); disorientation to time or place; memory
loss for names of close relatives, own occupation, or own name.
Id. The symptoms listed in the rating formula are examples, not an exhaustive list. Mauerhan,
16 Vet.App. at 442. Yet “a veteran may only qualify for a given disability rating under § 4.130
by demonstrating the particular symptoms associated with that percentage, or others of similar
severity, frequency, and duration.” Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir.
2013). “[W]here there is a question as to which of two evaluations shall be applied, the higher
evaluation will be assigned if the disability picture more nearly approximates the criteria for that
rating. Otherwise, the lower rating will be assigned.” 38 C.F.R. § 4.7 (2021).
We review the Board’s factual findings under the “clearly erroneous” standard. Butts v.
Brown, 5 Vet.App. 532, 534 (1993) (en banc). Under that standard, we may not reverse a Board
finding unless, on review of the entire record, we are left with the definite and firm conviction
that a mistake has been committed. Deloach v. Shinseki, 704 F.3d 1370, 1378-79 (Fed. Cir. 2013).
The appellant bears the burden of showing that the Board finding is clearly erroneous. Hilkert v.
West, 12 Vet.App. 145, 151 (1999) (en banc); aff’d per curiam, 232 F.3d 908 (Fed. Cir. 2000).
The Board also must support its decision with a written statement of its reasons or bases
that is understandable by the claimant and facilitates review by this Court. 38 U.S.C. § 7104(d)(1);
Allday v. Brown, 7 Vet.App. 517, 527 (1995). The statement of reasons or bases must explain the
Board’s reasons for discounting favorable evidence, Thompson v. Gober, 14 Vet.App. 187, 188
(2000); discuss all issues raised by the claimant or the record, Robinson v. Peake, 21 Vet.App.
545, 552 (2008), aff’d sub nom. Robinson v. Shinseki, 557 F.3d 1335 (Fed. Cir. 2009); and discuss
all provisions of law and regulation where they are made “potentially applicable through the
assertions and issues raised in the record,” Schafrath v. Derwinski, 1 Vet.App. 589, 592 (1991).
Here, the Board recited the relevant law and provided a detailed analysis of the facts. R. at
19-21. It noted that, in the 2018 VA examination, “the Veteran reported a history of family
4
difficulties due to his PTSD, [but] he described good relationships with his wife, chi ldren, and
grandchildren.” R. at 20-21. Notably, the Board also observed that “the VA examiner and the
Veteran’s private practitioner . . . agreed that, even when considering the Veteran’s difficulty in
adapting to stressful circumstances, his PTSD manifested in at worst reduced reliability and
productivity.” R. at 21. And, the Board found no evidence of “[m]ore significant symptoms . . .
such as[] suicidal ideation.” R. at 21. After carefully assessing the medical and lay evidence, the
Board found that the medical evidence outweighed any conflicting lay evidence and that “the
medical findings (as provided in the examination reports and the clinical records) directly address
the criteria under which the disability is evaluated.” R. at 22. The Board found that, “as a whole,
the Veteran’s PTSD more closely approximates the initial 50[%] rating currently assigned.” R. at

Thus, it concluded that “the evidence is against a finding that the Veteran has demonstrated
symptoms indicative of a higher 70[%]rating during the appeal.” Id.
Mr. Burkes fails to show error in the Board’s decision. Contrary to his argument, the Board
did not misapply the law or deny a higher PTSD disability rating based on a lack of symptoms
associated with the 70% disability rating. Instead, the Board carefully assessed the evidence and
found that “as a whole, the Veteran’s PTSD more closely approximates the initial 50[%] rating
currently assigned.” R. at 21. That finding follows the law, which requires the Board to analyze
the evidence holistically and award a higher disability rating when the evidence more nearly
approximates the kind of symptoms listed in the higher rating. See Vazquez-Claudio, 713 F.3d at
117; 38 C.F.R. § 4.7. Further, the Board’s factual finding that the evidence did not more nearly
approximate the higher disability rating is, in view of the entire record, not clearly erroneous. See
Deloach, 704 F.3d at 1378-79. And, the Board’s explanation for denying the higher rating is
understandable and facilitates judicial review. See Allday, 7 Vet.App. at 527.
Nor does the veteran show that the Board erred in its discussion of his marital relationship.
Mr. Burkes, who argues that his PTSD deleteriously affected his past relationship with his wife,
contends that the Board erred in failing to address a 2018 medical examination that noted the poor
relationship. But the Board did address that evidence. The Board specifically acknowledged that,
in the 2018 examination, “the Veteran reported a history of family difficulties due to his PTSD.”
R. at 20. Nonetheless, the Board also found that, during the same examination, the veteran
“described good relationships with his wife, children, and grandchildren.” R. at 20 -21. And the
Board noted the 2018 examiner’s finding that the veteran’s “PTSD manifested in at worst reduced
5
reliability and productivity,” which are criteria from the 50% disability rating. R. at 21; see also
38 C.F.R. § 4.130, DC 9411. Thus, the Board discussed and explained the reasons for rejecting the
favorable evidence, and that discussion is understandable and facilitates judicial review. See
Allday, 7 Vet.App. at 527. Further, the Board’s weighing of the evidence is not clearly erroneous.
See Deloach, 704 F.3d at 1378-79.
Mr. Burkes also fails to show that the Board erred about suicidal ideation. The veteran
contends that a 2019 examination “indicate[s] that some suicidal ideation is present,” because the
2019 examiner (1) found no acute indication of suicidal ideation or homicidal intent and (2) failed
to check a box to show the presence of suicidal ideation, yet (3) simultaneously found reckless and
self-destructive behavior. Appellant’s Brief at 10. He argues that the examination either was favorable evidence of suicidal ideation that should have been discussed by the Board, showed that the record was in equipoise, or demonstrated that the record was unclear about the presence of suicidal ideation.
The veteran’s arguments and characterization of the 2019 opinion do not convince us that
the Board erred about suicidal ideation. The Board specifically discussed the 2019 medical opinion
and weighed it along with the other evidence. R. at 20-21. The Board’s finding that the record
showed no evidence of suicidal ideation is supported by the 2019 examiner’s failure to check a box
signifying the presence of suicidal ideation and his statement that there was no acute indication of
suicidal ideation. R. at 329. Although the Board could have found, as the veteran argues, that his
reckless and self -destructive behavior rose to the level of suicidal ideation, an equally plausible
interpretation of the evidence is that the 2019 examiner recorded symptoms that were not severe or did not indicate suicidal thoughts. And, “[w]here there are two permissible views of the evidence, the factfinder’s choice between them cannot be clearly erroneous.” United States v. Yellow Cab Co., 338 U.S. 338, 342 (1949).
Given the Board’s findings, and in view of the entire record, we are not left with the definite
and firm conviction that the Board erred in finding no evidence of suicidal ideation. See Deloach,
704 F.3d 1378-79; see also Anderson v. City of Bessemer City, 470 U.S. 564, 573-74 (1985)
(stating that, when a lower tribunal’s “account of the evidence is plausible in light of the record
viewed in its entirety, the court of appeals may not reverse it”). Nor do we find that the examination
rendered the evidence in equipoise or showed that the record was unclear. The Board found no
evidence of suicidal ideation, and that finding is supported by the record and is not clearly
6
erroneous. R. at 21; see Deloach, 704 F.3d 1378-79. Further, the Board’s explanation for why it
accorded probative weight is understandable and facilitates judicial review. See Allday, 7 Vet.App.
at 527.
B. MUCMI
Mr. Burkes argues that the Board erred in finding that his current disabilities were not part of a MUCMI because they were diagnosed conditions. The Secretary concedes that “the Board denied service connection on the basis that these conditions have diagnoses, which is not required
for a MUCMI to be established.” Secretary’s Br. at 8. He maintains, however, that the Board’s error was not prejudicial because medical evidence not addressed by the Board shows that the veteran does not have a MUCMI. Secretary’s Br. at 8-9.
Veterans with certain chronic disabilities that became manifest during service in the Southwest Asia theater of operations during the Persian Gulf War or to a degree of 10% or more
not later than December 31, 2021, are entitled to a presumption of service connection. 38 U.S.C. § 1117(a); 38 C.F.R. § 3.317(a)(1)(i) (2021). A qualifying chronic disability may result from an undiagnosed illness or a MUCMI “that is defined by a cluster of signs or symptoms.” 38 U.S.C. § 1117(a)(2)(A), (B); 38 C.F.R. § 3.317(a)(2)(i); see Tadlock v. McDonough, 5 F.4th 1327, 1338
(Fed. Cir. 2021).
Of relevance here, a MUCMI is “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.” 38 C.F.R. § 3.317(a)(2)(ii). “Under the proper interpretation of the law, an illness is a MUCMI where either the etiology or pathophysiology of the illness is inconclusive.” Stewart v. Wilkie, 30 Vet.App. 383, 390 (2018) “Conversely, a multisymptom illness is not a
MUCMI where both the etiology and the pathophysiology of the illness are partially understood.”Id.
“[W]hether an illness is ‘defined by a cluster of signs or symptoms’ . . . is a question of fact delegated to the VA . . . for consideration in the first instance.” Tadlock, 5 F.4th at 1338 (quoting 38 U.S.C. § 1117(a)(2)(B)).
We review the Board’s factual findings under the “clearly erroneous”
standard. Butts v. Brown, 5 Vet.App. 532, 534 (1993) (en banc). Under that standard, we may not
reverse a Board finding unless, on review of the entire record, we are left with the definite and
7
firm conviction that a mistake has been committed. Deloach v. Shinseki, 704 F.3d 1370, 1378-79(Fed. Cir. 2013).
The Secretary contends that, even though the Board erred, “the error is harmless because the medical evidence establishes [that Mr. Burkes’s] diagnoses do not qualify as a MUCMI.” Secretary’s Br. at 9. We acknowledge our duty to consider the rule of prejudicial error. See Shinseki v. Sanders, 556 U.S. 396, 409 (2009). But, “[t]he rule of harmless error cannot be invoked to allow the Court . . . to decide a matter that is assigned by statute to [VA] for the initial determination.”
Winters v. Gober, 219 F.3d 1375, 1380 (Fed. Cir. 2000). And, “when the Board misinterprets the law and fails to make the relevant initial factual findings, ‘the proper course for [us] is to remand the case to the Board for further development and application of the correct law.'” Deloach, 704 F.3d at 1381 (quoting Byron v. Shinseki, 670 F.3d 1202, 1205 (Fed. Cir. 2012)). Because the Board here misinterpreted the law and erroneously failed to address the disputed question whether the veteran’s diagnosed conditions qualify as a MUCMI, remand is warranted. See id.; see also Tadlock, 5 F.4th at 1337.
Because the claim is being remanded, the Court need not address Mr. Burke’s additional
arguments that would lead to no broader remedy than a remand. See Mahl v. Principi, 15 Vet.App.
37, 38 (2001) (per curiam order) (“[I]f the proper remedy is a remand, there is no need to analyze
and discuss all the other claimed errors that would result in a remedy no broader than a remand.”).
In pursuing his claim on remand, the veteran will be free to submit additional argument and
evidence as to the remanded matter, and he has 90 days to do so from the date of the postremand
notice VA provides. See Kutscherousky v. West, 12 Vet.App. 369, 372-73 (1999) (per curiam
order); see also Clark v. O’Rourke, 30 Vet.App. 92, 97 (2018). The Board must consider any such
evidence or argument submitted. See Kay v. Principi, 16 Vet.App. 529, 534 (2002); see also
Fletcher v. Derwinski, 1 Vet.App. 394, 397 (1991) (“A remand is meant to entail a critical
examination of the justification for the decision.”).
II. CONCLUSION
Based on the above, that part of the Board’s March 26, 2020, decision that denied a higher
disability rating for PTSD is AFFIRMED, and that part of the Board’s decision that denied benefits
for a MUCMI is SET ASIDE, and the matter is REMANDED for further proceedings.
8
DATED: September 23, 2021
Copies to:
Nicholas L. Phinney, Esq.
VA General Counsel (027)

  1. A 50% rating is warranted where evidence shows that the psychiatric condition causes
    [o]ccupational and social impairment with reduced reliability and productivity due
    to such symptoms as: flattened affect; circumstantial, circumlocutory, or
    stereotyped speech; panic attacks more than once a week; difficulty in
    understanding complex commands; impairment of short– and long-term memory
    (e.g., retention of only highly learned material, forgetting to complete tasks);
    impaired judgment; impaired abstract thinking; disturbances of motivation and
    mood; difficulty in establishing and maintaining effective work and social
    relationships.
    38 C.F.R. § 4.130, DC 9411 (2021). A 70% rating for PTSD is warranted if the evidence shows
    [o]ccupational and social impairment, with deficiencies in most areas, such as
    work, school, family relations, judgment, thinking, or mood, due to such symptoms
    as: suicidal ideation; obsessional rituals which interfere with routine activities;
    speech intermittently illogical, obscure, or irrelevant; near-continuous panic or
    depression affecting the ability to function independently, appropriately and
    effectively; impaired impulse control (such as unprovoked irritability with periods
    of violence); spatial disorientation; neglect of personal appearance and hygiene;
    3
    difficulty in adapting to stressful circumstances (including work or a worklike
    setting); inability to establish and maintain effective relationships.
    Id. A 100% rating is warranted if the evidence shows
    [t]otal occupational and social impairment, due to such symptoms as: gross
    impairment in thought processes or communication; persistent delusions or
    hallucinations; grossly inappropriate behavior; persistent danger of hurting self or
    others; intermittent inability to perform activities of daily living (including
    maintenance of minimal personal hygiene); disorientation to time or place; memory
    loss for names of close relatives, own occupation, or own name.
    Id. The symptoms listed in the rating formula are examples, not an exhaustive list. Mauerhan,
    16 Vet.App. at 442. Yet “a veteran may only qualify for a given disability rating under § 4.130
    by demonstrating the particular symptoms associated with that percentage, or others of similar
    severity, frequency, and duration.” Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir.
    2013). “[W]here there is a question as to which of two evaluations shall be applied, the higher
    evaluation will be assigned if the disability picture more nearly approximates the criteria for that
    rating. Otherwise, the lower rating will be assigned.” 38 C.F.R. § 4.7 (2021).
    We review the Board’s factual findings under the “clearly erroneous” standard. Butts v.
    Brown, 5 Vet.App. 532, 534 (1993) (en banc). Under that standard, we may not reverse a Board
    finding unless, on review of the entire record, we are left with the definite and firm conviction
    that a mistake has been committed. Deloach v. Shinseki, 704 F.3d 1370, 1378-79 (Fed. Cir. 2013).
    The appellant bears the burden of showing that the Board finding is clearly erroneous. Hilkert v.
    West, 12 Vet.App. 145, 151 (1999) (en banc); aff’d per curiam, 232 F.3d 908 (Fed. Cir. 2000).
    The Board also must support its decision with a written statement of its reasons or bases
    that is understandable by the claimant and facilitates review by this Court. 38 U.S.C. § 7104(d)(1);
    Allday v. Brown, 7 Vet.App. 517, 527 (1995). The statement of reasons or bases must explain the
    Board’s reasons for discounting favorable evidence, Thompson v. Gober, 14 Vet.App. 187, 188
    (2000); discuss all issues raised by the claimant or the record, Robinson v. Peake, 21 Vet.App.
    545, 552 (2008), aff’d sub nom. Robinson v. Shinseki, 557 F.3d 1335 (Fed. Cir. 2009); and discuss
    all provisions of law and regulation where they are made “potentially applicable through the
    assertions and issues raised in the record,” Schafrath v. Derwinski, 1 Vet.App. 589, 592 (1991).
    Here, the Board recited the relevant law and provided a detailed analysis of the facts. R. at
    19-21. It noted that, in the 2018 VA examination, “the Veteran reported a history of family
    4
    difficulties due to his PTSD, [but] he described good relationships with his wife, chi ldren, and
    grandchildren.” R. at 20-21. Notably, the Board also observed that “the VA examiner and the
    Veteran’s private practitioner . . . agreed that, even when considering the Veteran’s difficulty in
    adapting to stressful circumstances, his PTSD manifested in at worst reduced reliability and
    productivity.” R. at 21. And, the Board found no evidence of “[m]ore significant symptoms . . .
    such as[] suicidal ideation.” R. at 21. After carefully assessing the medical and lay evidence, the
    Board found that the medical evidence outweighed any conflicting lay evidence and that “the
    medical findings (as provided in the examination reports and the clinical records) directly address
    the criteria under which the disability is evaluated.” R. at 22. The Board found that, “as a whole,
    the Veteran’s PTSD more closely approximates the initial 50[%] rating currently assigned.” R. at
  2. Thus, it concluded that “the evidence is against a finding that the Veteran has demonstrated
    symptoms indicative of a higher 70[%]rating during the appeal.” Id.
    Mr. Burkes fails to show error in the Board’s decision. Contrary to his argument, the Board
    did not misapply the law or deny a higher PTSD disability rating based on a lack of symptoms
    associated with the 70% disability rating. Instead, the Board carefully assessed the evidence and
    found that “as a whole, the Veteran’s PTSD more closely approximates the initial 50[%] rating
    currently assigned.” R. at 21. That finding follows the law, which requires the Board to analyze
    the evidence holistically and award a higher disability rating when the evidence more nearly
    approximates the kind of symptoms listed in the higher rating. See Vazquez-Claudio, 713 F.3d at
    117; 38 C.F.R. § 4.7. Further, the Board’s factual finding that the evidence did not more nearly
    approximate the higher disability rating is, in view of the entire record, not clearly erroneous. See
    Deloach, 704 F.3d at 1378-79. And, the Board’s explanation for denying the higher rating is
    understandable and facilitates judicial review. See Allday, 7 Vet.App. at 527.
    Nor does the veteran show that the Board erred in its discussion of his marital relationship.
    Mr. Burkes, who argues that his PTSD deleteriously affected his past relationship with his wife,
    contends that the Board erred in failing to address a 2018 medical examination that noted the poor
    relationship. But the Board did address that evidence. The Board specifically acknowledged that,
    in the 2018 examination, “the Veteran reported a history of family difficulties due to his PTSD.”
    R. at 20. Nonetheless, the Board also found that, during the same examination, the veteran
    “described good relationships with his wife, children, and grandchildren.” R. at 20 -21. And the
    Board noted the 2018 examiner’s finding that the veteran’s “PTSD manifested in at worst reduced
    5
    reliability and productivity,” which are criteria from the 50% disability rating. R. at 21; see also
    38 C.F.R. § 4.130, DC 9411. Thus, the Board discussed and explained the reasons for rejecting the
    favorable evidence, and that discussion is understandable and facilitates judicial review. See
    Allday, 7 Vet.App. at 527. Further, the Board’s weighing of the evidence is not clearly erroneous.
    See Deloach, 704 F.3d at 1378-79.
    Mr. Burkes also fails to show that the Board erred about suicidal ideation. The veteran
    contends that a 2019 examination “indicate[s] that some suicidal ideation is present,” because the
    2019 examiner (1) found no acute indication of suicidal ideation or homicidal intent and (2) failed
    to check a box to show the presence of suicidal ideation, yet (3) simultaneously found reckless and
    self-destructive behavior. Appellant’s Brief at 10. He argues that the examination either was
    favorable evidence of suicidal ideation that should have been discussed by the Board, showed that
    the record was in equipoise, or demonstrated that the record was unclear about the presence of
    suicidal ideation.
    The veteran’s arguments and characterization of the 2019 opinion do not convince us that
    the Board erred about suicidal ideation. The Board specifically discussed the 2019 medical opinion
    and weighed it along with the other evidence. R. at 20-21. The Board’s finding that the record
    showed no evidence of suicidal ideation is supported by the 2019 examiner’s failure to check a box
    signifying the presence of suicidal ideation and his statement that there was no acute indication of
    suicidal ideation. R. at 329. Although the Board could have found, as the veteran argues, that his
    reckless and self -destructive behavior rose to the level of suicidal ideation, an equally plausible
    interpretation of the evidence is that the 2019 examiner recorded symptoms that were not severe
    or did not indicate suicidal thoughts. And, “[w]here there are two permissible views of the
    evidence, the factfinder’s choice between them cannot be clearly erroneous.” United States v.
    Yellow Cab Co., 338 U.S. 338, 342 (1949).
    Given the Board’s findings, and in view of the entire record, we are not left with the definite
    and firm conviction that the Board erred in finding no evidence of suicidal ideation. See Deloach,
    704 F.3d 1378-79; see also Anderson v. City of Bessemer City, 470 U.S. 564, 573-74 (1985)
    (stating that, when a lower tribunal’s “account of the evidence is plausible in light of the record
    viewed in its entirety, the court of appeals may not reverse it”). Nor do we find that the examination
    rendered the evidence in equipoise or showed that the record was unclear. The Board found no
    evidence of suicidal ideation, and that finding is supported by the record and is not clearly
    6
    erroneous. R. at 21; see Deloach, 704 F.3d 1378-79. Further, the Board’s explanation for why it
    accorded probative weight is understandable and facilitates judicial review. See Allday, 7 Vet.App.
    at 527.
    B. MUCMI
    Mr. Burkes argues that the Board erred in finding that his current disabilities were not part
    of a MUCMI because they were diagnosed conditions. The Secretary concedes that “the Board
    denied service connection on the basis that these conditions have diagnoses, which is not required
    for a MUCMI to be established.” Secretary’s Br. at 8. He maintains, however, that the Board’s error
    was not prejudicial because medical evidence not addressed by the Board shows that the veteran
    does not have a MUCMI. Secretary’s Br. at 8-9.
    Veterans with certain chronic disabilities that became manifest during service in the
    Southwest Asia theater of operations during the Persian Gulf War or to a degree of 10% or more
    not later than December 31, 2021, are entitled to a presumption of service connection. 38 U.S.C.
    § 1117(a); 38 C.F.R. § 3.317(a)(1)(i) (2021). A qualifying chronic disability may result from an
    undiagnosed illness or a MUCMI “that is defined by a cluster of signs or symptoms.” 38 U.S.C. §
    1117(a)(2)(A), (B); 38 C.F.R. § 3.317(a)(2)(i); see Tadlock v. McDonough, 5 F.4th 1327, 1338
    (Fed. Cir. 2021).
    Of relevance here, a MUCMI is “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.” 38 C.F.R. § 3.317(a)(2)(ii). “Under the proper interpretation of the law,
    an illness is a MUCMI where either the etiology or pathophysiology of the illness is inconclusive.”
    Stewart v. Wilkie, 30 Vet.App. 383, 390 (2018) “Conversely, a multisymptom illness is not a
    MUCMI where both the etiology and the pathophysiology of the illness are partially understood.”
    Id.
    “[W]hether an illness is ‘defined by a cluster of signs or symptoms’ . . . is a question of fact
    delegated to the VA . . . for consideration in the first instance.” Tadlock, 5 F.4th at 1338 (quoting
    38 U.S.C. § 1117(a)(2)(B)). We review the Board’s factual findings under the “clearly erroneous”
    standard. Butts v. Brown, 5 Vet.App. 532, 534 (1993) (en banc). Under that standard, we may not
    reverse a Board finding unless, on review of the entire record, we are left with the definite and
    7
    firm conviction that a mistake has been committed. Deloach v. Shinseki, 704 F.3d 1370, 1378-79
    (Fed. Cir. 2013).
    The Secretary contends that, even though the Board erred, “the error is harmless because
    the medical evidence establishes [that Mr. Burkes’s] diagnoses do not qualify as a MUCMI.”
    Secretary’s Br. at 9. We acknowledge our duty to consider the rule of prejudicial error. See Shinseki
    v. Sanders, 556 U.S. 396, 409 (2009). But, “[t]he rule of harmless error cannot be invoked to allow
    the Court . . . to decide a matter that is assigned by statute to [VA] for the initial determination.”
    Winters v. Gober, 219 F.3d 1375, 1380 (Fed. Cir. 2000). And, “when the Board misinterprets the
    law and fails to make the relevant initial factual findings, ‘the proper course for [us] is to remand
    the case to the Board for further development and application of the correct law.'” Deloach, 704
    F.3d at 1381 (quoting Byron v. Shinseki, 670 F.3d 1202, 1205 (Fed. Cir. 2012)). Because the Board
    here misinterpreted the law and erroneously failed to address the disputed question whether the
    veteran’s diagnosed conditions qualify as a MUCMI, remand is warranted. See id.; see also
    Tadlock, 5 F.4th at 1337.
    Because the claim is being remanded, the Court need not address Mr. Burke’s additional
    arguments that would lead to no broader remedy than a remand. See Mahl v. Principi, 15 Vet.App.
    37, 38 (2001) (per curiam order) (“[I]f the proper remedy is a remand, there is no need to analyze
    and discuss all the other claimed errors that would result in a remedy no broader than a remand.”).
    In pursuing his claim on remand, the veteran will be free to submit additional argument and
    evidence as to the remanded matter, and he has 90 days to do so from the date of the postremand
    notice VA provides. See Kutscherousky v. West, 12 Vet.App. 369, 372-73 (1999) (per curiam
    order); see also Clark v. O’Rourke, 30 Vet.App. 92, 97 (2018). The Board must consider any such
    evidence or argument submitted. See Kay v. Principi, 16 Vet.App. 529, 534 (2002); see also
    Fletcher v. Derwinski, 1 Vet.App. 394, 397 (1991) (“A remand is meant to entail a critical
    examination of the justification for the decision.”).
    II. CONCLUSION
    Based on the above, that part of the Board’s March 26, 2020, decision that denied a higher
    disability rating for PTSD is AFFIRMED, and that part of the Board’s decision that denied benefits
    for a MUCMI is SET ASIDE, and the matter is REMANDED for further proceedings.
    8
    DATED: September 23, 2021
    Copies to:
    Nicholas L. Phinney, Esq.
    VA General Counsel (027)

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