NOTE: This disposition is nonprecedential.

United States Court of Appeals 

for the Federal Circuit ______________________ 

TIMOTHY H. JOECKEL,

Claimant-Appellant,

v.

ERIC K. SHINSEKI, Secretary of Veterans Affairs,

Respondent-Appellee.

______________________ 

2013-7122

______________________ 

Appeal from the United States Court of Appeals for 

Veterans Claims in No. 12-623, Judge William Greenberg.

______________________ 

Decided: November 8, 2013 

______________________ 

TIMOTHY H. JOECKEL, of Taylor, Texas, pro se. 

A. BONDURANT ELEY, Trial Attorney, Commercial Litigation Branch, Civil Division, United States Department 

of Justice, of Washington, DC, for respondent–appellee. 

With her on the brief were STUART F. DELERY, Assistant 

Attorney General, JEANNE E. DAVIDSON, Director, MARTIN 

F. HOCKEY, JR., Assistant Director. Of counsel on the 

brief were DAVID J. BARRANS, Deputy Assistant General 

Counsel, and JOSHUA P. MAYER, Attorney, United States 

Department of Veterans Affairs, of Washington, DC.
2 JOECKEL v. SHINSEKI

______________________ 

Before LOURIE, BRYSON, and O’MALLEY, Circuit Judges.

PER CURIAM. 

DECISION

Appellant Timothy H. Joeckel seeks to appeal from a 

decision of the Court of Appeals for Veterans Claims (“the 

Veterans Court”), which upheld a ruling of the Board of 

Veterans’ Appeals denying Mr. Joeckel’s claim of service 

connection for chronic fatigue syndrome (“CFS”). Because 

we lack jurisdiction to address the issues raised by Mr. 

Joeckel, we dismiss the appeal.

BACKGROUND

Mr. Joeckel served on active duty with the United 

States Army from 1969 to 1971. His active duty included 

combat service in Vietnam from January to December 

1970. In June 1990 Mr. Joeckel claimed service connection for CFS resulting from exposure to Agent Orange. 

He modified that claim in 1993, asserting direct service 

connection for CFS, rather than as a result of Agent 

Orange exposure. A regional office of the Department of 

Veterans Affairs (“DVA”) denied service connection for 

CFS. After appeals to the Board and the Veterans Court, 

the claim was remanded to the regional office in 2000 

with instructions to “afford the veteran an examination 

by, or refer the case to, a specialist in infectious disease/immune disorders . . . for an opinion as to . . . whether the diagnosis of CFS is correct.”

In September 2002, a DVA rheumatologist examined 

Mr. Joeckel and concluded that Mr. Joeckel’s symptoms 

were likely the result of a hepatitis C infection that he 

contracted from blood transfusions in 1975. Mr. Joeckel 

was first diagnosed with a chronic hepatitis C infection in 

1993. In September 2008 the regional office granted 

service connection for hepatitis C with chronic fatigue. 
JOECKEL v. SHINSEKI 3

As a result of the rheumatologist’s examination, the 

regional office denied Mr. Joeckel’s claim for service 

connection for CFS. In 2007 the Veterans Court again 

remanded the claim because the examination by the

rheumatologist did not comply with the 2000 remand 

order requiring a medical examination or opinion by a 

“specialist in infectious disease/immune disorders.” 

In May 2008, an infectious disease specialist examined Mr. Joeckel. The specialist stated his opinion that 

Mr. Joeckel “does have chronic fatigue symptoms, but

these do not appear to fit the classic definition” of CFS. 

The CFS claim was thereafter denied. The Board, however, remanded the claim to allow the infectious disease 

specialist to supplement and clarify his opinion with 

respect to the definition of CFS contained in federal 

regulations. 

Because the infectious disease specialist who conducted the May 2008 examination was unavailable on remand, a different doctor, who was not an infectious 

disease specialist, conducted a review of the records and 

issued an opinion in November 2009. The 2009 opinion 

found that Mr. Joeckel did not have a CFS diagnosis. 

Because the 2009 opinion was not obtained from an 

infectious disease specialist, the Board in February 2011 

sought an “advisory medical opinion” from Dr. Suganthini 

Krishnan Natesan, an infectious disease specialist. After 

a review of the medical records Dr. Natesan expressed his 

opinion in April 2011 that despite having symptoms of 

chronic fatigue, Mr. Joeckel did not meet the criteria for a 

CFS diagnosis set forth in 38 C.F.R. § 4.88a. Instead, Dr. 

Natesan believed that Mr. Joeckel “has chronic fatigue 

that could very well be related to hepatitis C and/or posttraumatic stress disorder and other psychiatric problems.”

On appeal, the Board found that “[t]he negative evidence in this case outweighs the positive” and denied 

service connection for CFS. The Veterans Court affirmed, 
4 JOECKEL v. SHINSEKI

holding that “the Board ensured substantial compliance 

with the August 2000 remand order.” The Veterans Court 

ruled that even though “multiple specialists were required to ensure substantial compliance with the remand 

order . . . the two examinations, together, entailed a 

thorough review by infectious disease specialists that 

specifically considered both [Mr. Joeckel’s] symptoms and

the regulatory definition of CFS.”

DISCUSSION

Our jurisdiction to review a decision of the Veterans 

Court is limited by statute to deciding the validity of a 

decision of the Veterans Court on a rule of law, the validity of any statute or regulation, or any interpretation of a 

statute or regulation relied upon by that court in making 

its decision. 38 U.S.C. 7292(a), (c). This court lacks 

jurisdiction to review “a challenge to a factual determination” or “a challenge to a law or regulation as applied to 

the facts of a particular case” unless the appeal presents a 

constitutional question. Id. § 7292(d)(2).

Mr. Joeckel contends on appeal that the Veterans 

Court decided both statutory and constitutional issues in

his case. Mr. Joeckel’s arguments, however, are really 

challenges to the conclusions reached by the medical 

examiners. A review of the medical examiners’ determinations would require us to review factual determinations. Because we lack jurisdiction to review factual 

determinations under 38 U.S.C. § 7292(d)(2), we cannot 

provide Mr. Joeckel with the relief he seeks.

No costs.

DISMISSED