BVA9504805 DOCKET NO. 92-03 886 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for basal cell carcinoma. 2. Entitlement to service connection for arthritis of the right thumb. 3. Entitlement to an increased rating for pes planus, currently evaluated as 10 percent disabling. 4. Entitlement to an increased rating for scabies, currently evaluated as 10 percent disabling. 5. Entitlement to an increased (compensable) rating for residuals of a laceration of the right thumb. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Mark D. Hindin, Counsel INTRODUCTION The veteran had active service from October 1942 to December 1945. This matter arises from a July 1989, rating decision in which the regional office (RO), in part, denied entitlement to increased ratings for pes planus and scabies, and confirmed a noncompensable evaluation for residuals of a laceration of the right thumb; from a May 1991, rating decision which denied entitlement to service connection for basal cell carcinoma secondary to scabies; and from an October 1994, rating decision which denied entitlement to service connection for degenerative joint disease of the right hand. In March 1994, the Board of Veterans' Appeals (the Board) remanded this case to the RO in order to afford the veteran Department of Veterans Affairs (VA) examinations to obtain medical opinions as to the relationships between scabies and skin cancer, and between the residuals of a laceration and degenerative joint disease of the right hand; and for the issuance of a statement of the case as to the issue of entitlement to service connection for skin cancer. The development was undertaken and the case has been returned to the Board for appellate consideration. The issues of entitlement to increased ratings for pes planus, scabies and a laceration of the right thumb, are being deferred pending completion of the remand portion of this decision. Although the RO has described one of the issues in this appeal as being entitlement to service connection for degenerative joint disease of the right hand, arthritis has only been identified in the right thumb and this appears to be the only disability of the right hand for which the veteran is claiming service connection. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he developed basal cell carcinoma secondary to service-connected scabies and that he developed arthritis of the right thumb secondary to a service-connected laceration of the thumb. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the the evidence is in favor of the grant of service connection for basal cell carcinoma and arthritis of the right thumb. FINDINGS OF FACT 1. All evidence necessary for an equitable resolution of this case has been secured. 2. Basal cell carcinoma is due to a service-connected skin disease. 3. Arthritis of the right thumb is due to a service-connected laceration. CONCLUSIONS OF LAW 1. Basal cell carcinoma is proximately due to a service- connected disease or disability. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.310 (1994). 2. Degenerative joint disease of the right hand is proximately due to a service connected disability. 38 U.S.C.A. §§ 1110, 5107; 38 C.F.R. § 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board finds that the veteran has presented well-grounded claims within the meaning of 38 U.S.C.A. § 5107. In this regard he has submitted evidence in support of his claims which renders them plausible. The Board also finds that VA has complied with its obligation to assist him with the development of those claims under the same code provision. I. Basal Cell Carcinoma Service connection for a skin disease, classified as scabies, has been in effect since the day after separation from service in December 1945. In October 1978, the veteran underwent excision of a tumor from the left external "nare" (sic). The diagnosis was basal cell carcinoma. In February 1989, the veteran reported that he had had several surgical procedures to remove skin cancers which he claimed were secondary to scabies. He reported that a private physician had told him that the skin cancer was related to scabies. These records were later found to be unavailable. On VA outpatient treatment in May 1991, it was reported that he had had basal cell carcinoma removed from his back three times. Pursuant to the Board's remand, the RO requested that a VA dermatologist express an opinion as to whether there was a relationship between the skin cancer and scabies or other skin conditions reported during service. Following an opportunity to review the claims folder, the examiner reported an inability to "determine an answer to this question." The VA physician's opinion suggests that it is as likely as not that the basal cell carcinoma was causally related to the service connected skin disease. The examiner was unable to say whether there was or was not a relationship between the service-connected skin disease and basal cell carcinoma. Such an inability would require, at least as far as the examiner was concerned, that the evidence was in equipoise. At this point there is no other medical evidence as to the relationship between the service-connected skin disease and basal cell carcinoma. Accordingly the Board must accept the VA examiner's opinion that the evidence is in equipoise. Where the evidence is in equipoise, the doctrine of reasonable doubt requires that the benefit be granted to the veteran. Gilbert v. Derwinski, 1 Vet.App. 49, 55 (1990). Accordingly, resolving reasonable doubt in the veteran's favor, service connection for basal cell carcinoma should be granted. II. Right Hand Arthritis Service medical records show that the veteran sustained a laceration of the right thumb in August 1944, when he dropped a water bottle. The laceration was in the extensor pollicis tendon and was two inches in length. Initially it was reported that the thumb could not be extended. The veteran returned to duty in January 1945. In October 1989, a VA X-ray examination, was interpreted as showing an accessory ossification in the center of the head of the first metacarpal. On VA outpatient treatment in July 1990, it was reported that a previous X-ray examination showed degenerative joint disease in the interphalangeal joint of the right thumb. An X-ray examination of the right thumb was performed during VA examination in April 1994. The X-ray examination was interpreted as showing degenerative arthritic changes in the first carpal- metacarpal articulation between the trapezium and carpal bones, and a bony exostosis projecting off the head of the first metacarpal. On examination the veteran was noted to have some limitation of flexion of the thumb. The examiner concluded that the limitation of flexion was due to degenerative joint disease "that may or may not be secondary to his right hand injury." The examiner's opinion constitutes the only medical evidence as to the relationship between the service connected laceration and the arthritic changes of the right thumb. This opinion also suggests that the evidence is in equipoise as to the question of their relationship. This being the case, the doctrine of reasonable doubt, would require that service connection for arthritis of the right thumb be granted. ORDER Service connection for basal cell carcinoma and for arthritis of the right thumb is granted. REMAND In view of the Board's decision granting service connection for arthritis of the right thumb, the impossibility of evaluating the laceration residuals without reference to the arthritis, and the fact that the RO has not had an opportunity to evaluate the arthritis of the right thumb, it is necessary to remand this case in part to the RO for the following development: 1. The RO should contact the veteran and request that he furnish information as to any treatment he has received since the last VA examinations in April 1994, for the conditions at issue in this appeal. The RO should then take all necessary steps to obtain those records and associate them with the claims folder. 2. The RO should schedule the veteran for comprehensive VA dermatologic and orthopedic examinations in order to evaluate his service connected skin disease, right thumb disabilities, and pes planus. All indicated tests must be conducted. The claims file must be made available to and reviewed by the examiners prior to the requested studies. A complete rationale for any opinion expressed must be provided. 3. Following completion of the foregoing, the RO must review the claims folder and ensure that all of the foregoing development actions have been conducted and completed in full. If any development is incomplete, including if the requested examination does not include all test reports, special studies or opinions requested, appropriate corrective action is to be implemented. 4. The RO should then rate the service connected skin disease, right thumb disabilities and pes planus. If after completion of the requested development the benefits sought have not been granted, the veteran and his representative should be furnished with a supplemental statement of the case, and be given a reasonable opportunity to respond. Thereafter, following compliance with all other procedures relative to the processing of appeals, the case should be returned to the Board for further appellate consideration of any issue for which a valid substantive appeal has been submitted. No action is required of the veteran until he receives further notice. LAWRENCE M. SULLIVAN Member, Board of Veterans' Appeals (CONTINUED ON NEXT PAGE) 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. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals. 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.