Citation Nr: 1237444 Decision Date: 11/01/12 Archive Date: 11/09/12 DOCKET NO. 10-08 991 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUES 1. Entitlement to service connection for chronic fatigue syndrome. 2. Entitlement to service connection for urinary incontinence. ATTORNEY FOR THE BOARD M. Taylor, Counsel INTRODUCTION The Veteran had active service from June 1989 to March 2007. This case comes before the Board of Veterans' Appeals (Board) on appeal from January 2009 rating decision of the Roanoke, VA Regional Office (RO). The Board notes that a December 2011 rating decision reflects that service connection was granted for obstructive sleep apnea, posttraumatic stress disorder (PTSD), gastroesophageal reflex disease (GERD), fibromyalgia, migraine headaches, spondylolisthesis, plantar fasciitis, status post right ovarian cystectomy, allergic rhinitis and chronic urticaria. This represents a full grant of the benefits sought in regard to these issues. FINDINGS OF FACT 1. Chronic fatigue syndrome is documented during service and the Veteran has a current diagnosis of chronic fatigue syndrome. 2. The Veteran has credibly described the onset of urinary incontinence in service, and continuing since. CONCLUSIONS OF LAW 1. Chronic fatigue syndrome was incurred in active service. 38 U.S.C.A. §§ 1110, 1117, 1154(a), 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.317 (2011). 2. Urinary incontinence was incurred in active service. 38 U.S.C.A. §§ 1110, 1154(a), 5107 (West 2002); 38 C.F.R. § 3.303 (2011). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Laws and Regulations Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). The second and third elements may be established by showing continuity of symptomatology. Continuity of symptomatology may be shown by demonstrating "(1) that a condition was 'noted' during service or any applicable presumption period; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology." Barr v. Nicholson, 21 Vet. App. 303, 307 (2007); see also Davidson, 581 F.3d at 1316; Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board"). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Analysis In this decision, the Board grants service connection for chronic fatigue syndrome and stress urinary incontinence. As this represents a complete grant of the benefits sought on appeal, no discussion of VA's duty to notify and assist is necessary. A. Chronic Fatigue Syndrome The Veteran asserts entitlement to service connection for chronic fatigue syndrome due to her service in the Persian Gulf War. A diagnosis of chronic fatigue syndrome related to her deployment in support of Operation Desert Storm is well documented in the service treatment records. A December 2004 record notes that the diagnosis was based on extensive work-ups by rheumatology, podiatry, neurology and cardiology. In addition, a February 2005 Gulf War Health Center - Specialized Care Program (SCP) report notes that following the internal medicine evaluation and series of comprehensive specialty assessments, it was concluded that her symptoms and their associated functional impairment were incompletely explained through usual medical diagnostics. It was further noted that given the chronic nature of the symptoms, and even though it was expected that she would benefit from the SCP intervention, achieving a cure was not a realistic treatment objective, although a March 2005 record notes chronic fatigue was symptomatically improved on vitamin D replacement. Post service private treatment records also show the presence of chronic fatigue syndrome as reflected in the records received from Lorton Station Family medicine in 2010. Although a VA examiner concluded in a March 2010 report that the Veteran did not have a definitive diagnosis of chronic fatigue syndrome, the in-service diagnosis appears to have been based on a comprehensive work-up and post service records show an on-going diagnosis. On this record, it may not be concluded the evidence preponderates against the claim. Accordingly, a basis upon which to grant service connection has been presented and the appeal is granted. B. Incontinence The Veteran asserts entitlement to service connection for urinary incontinence. Having considered the evidence, a finding in favor of service connection is supportable. Essentially, the Veteran asserts she had an onset of recurrent urinary tract infections during service in 1991, and that by 1997 had developed urinary incontinence, with an increase in symptoms following the birth of her child. Her service records show several occasions where she was treated for urinary tract infections, together with irritative voiding symptoms, although incontinence was not explicitly noted. Nevertheless, the Veteran has not exhibited any reason to doubt the veracity of her history. Given that, together with the 2010 VA examination report that diagnosed urinary incontinence, which the examiner dated to 1997, a reasonable basis has been presented to establish service connection. ORDER Service connection for chronic fatigue syndrome is granted, subject to governing criteria applicable to the payment of monetary benefits. Service connection for stress urinary incontinence is granted, subject to governing criteria applicable to the payment of monetary benefits. ____________________________________________ MICHAEL E. KILCOYNE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs