BVA9501925 DOCKET NO. 93-06 348 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Togus, Maine THE ISSUE Entitlement to service connection for chronic fatigue syndrome. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD John J. Crowley, Associate Counsel REMAND The veteran served on active duty from February 1982 to April 1988. This matter is currently before the Board of Veterans' Appeals (Board) on appeal from a May 1992 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The veteran contends that his chronic fatigue syndrome (CFS) had its onset during his active service in Israel in November 1985. Service medical records reveal frequent treatment for irritable bowel syndrome from August 1986 until his discharge from active service (as the result of irritable bowel syndrome) in April 1988. No diagnosis of CFS was made during his active service. In an August 1988 rating decision, the RO granted service connection for irritable bowel syndrome. Significantly, the veteran did not claim entitlement to service connection for CFS at that time. VA outpatient treatment records in March 1991 noted the veteran's complaints of fatigue, headaches and trouble concentrating. In March 1992, the veteran was hospitalized at a VA facility and diagnosed with possible CFS of "uncertain etiology, ? related to stress and anxiety." However, in October 1992 Fredrick R. Ackley, Jr., Ph.D., stated his belief that the veteran's current stress reaction is a response to his medical symptoms, and not the converse. A March 1992 consultation performed by the chief of infectious diseases of the VA Medical Center in Togus, Maine, indicated her opinion that she "doubted" that the veteran had any unusual parasitic or other diseases stemming from his service abroad. Clinical testing for HHV-6 antibodies in April 1992 appears to show that the veteran has CFS. An October 1992 statement from A.L. Mesrobian, M.D., indicates that the veteran was under his care since July 1988, and that the veteran had repeatedly recounted his contention that he was well until his tour of military duty in Israel in November 1985. According to Dr. Mesrobian, the veteran complained of fatigue historically until April 1991, when he complained of more severe fatigue with the addition of neurologic symptoms. However, the undersigned notes that on VA examinations of June 1988 and January 1991, the veteran made no complaints of fatigue. At hearing in November 1991, the veteran testified that his symptoms of CFS began in November of 1985 during his service in Israel, and that he was diagnosed with CFS in the Spring of 1992. In view of the statements and medical evidence of record, the veteran's claim appears to be "capable of substantiation," and thus well-grounded within the meaning of 38 U.S.C.A. § 5107 (West 1991). Murphy v. Derwinski, 1 Vet.App. 78 (1991). As it now stands, the record is insufficient either to confirm or refute the veteran's contentions. With regard to the veteran's contentions, the United States Court of Veterans Appeals (Court) has held that a lay party is not competent to provide probative evidence as to matters requiring expertise derived from specialized medical education, such as the onset of his CFS. Espiritu v. Derwinski, 2 Vet.App. 492, 494, 495 (1992). However, VA has a duty to assist a veteran in the development of facts pertinent to well-grounded claims. 38 U.S.C.A. § 5107(a); 38 C.F.R. § 3.103(a) (1993). In view of the foregoing, the record before the Board at this time appears inadequate; thus, a remand is mandatory rather than permissive. See Littke v. Derwinski, 1 Vet.App. 90 (1990). In view of the current state of the record, the undersigned concludes that further development, as specified below, is required. Accordingly, the case is REMANDED to the RO for the following actions: 1. The RO should request the veteran to identify the names, addresses, and approximate dates of treatment for all health care providers who may possess additional records pertinent to his claim. With any necessary authorization from the veteran, the RO should attempt to obtain copies of those treatment records identified by the veteran which have not been previously secured. 2. Upon completion of the foregoing, the claim should be referred for review by a VA physician who has not examined the veteran in the past and who has experience in the diagnosis and treatment of CFS, if available, for an interpretation of the significance of the data obtained. After a thorough review of the file, the physician should be requested to express an opinion as to the etiology of the veteran's CFS. To the extent posssible, the date of onset of his CFS should be stated relative to the entries in his service medical records, viewed in the light of the entire clinical record. The basis for the conclusions reached should be stated in full. Additional testing and/or clinical studies of the veteran should be accomplished, if deemed necessary. Thereafter, the RO should readjudicate the veteran's claim of service connection for CFS. If the benefit sought on appeal is not granted to the veteran's satisfaction, the RO should issue a supplemental statement of the case to the veteran and his representative, and provide them an opportunity to respond. The case should then be returned to the Board for further appellate consideration, if otherwise in order. J.F. GOUGH Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1993).