BVA9502399 DOCKET NO. 89-26 513 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to service connection for arthritis. 2. Entitlement to service connection for disability of the cervical spine, to include cervicobrachial neuritis. 3. Entitlement to service connection for a back disorder, to include thoracic and lumbosacral radiculitis. 4. Entitlement to service connection for residuals of a shell fragment wound (SFW) of the left foot. 5. Entitlement to service connection for a skin disorder, to include folliculitis of the scalp. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and his wife ATTORNEY FOR THE BOARD J. W. Loeb, Counsel INTRODUCTION The veteran was separated from service in May 1969 after more than 23 years of active duty. This case was last remanded by the Board of Veterans' Appeals (Board) in June 1993 to the Department of Veterans Affairs(VA) Regional Office (RO) in Montgomery, Alabama for additional development. The Board notes that the June 1993 remand referred the issues of entitlement to service connection for residuals of a pilonidal cystectomy, sebaceous cysts, boils, prostatitis, and residuals of frostbite of the feet, as well as the issue of entitlement to a compensable evaluation for the veteran's service-connected disabilities under the provisions of 38 C.F.R. § 3.324 (1993), to the RO for appropriate action. However, no subsequent action by the RO appears to have been undertaken. Therefore, the Board again refers these issues to the RO for appropriate action. The Board also notes that the veteran's notice of disagreement in this case was received by the VA in May 1988. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that service connection for the disabilities at issue is warranted because his service medical records show that his skin and low back were treated in service, because he received a Purple Heart award for the SFW to his left foot, and because arthritis, cervical spine disability, and thoracic and lumbosacral radiculitis are related to service. 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 files. 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 veteran has not met the initial burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that his claims for service connection for arthritis, cervical spine disability, and thoracic and lumbosacral radiculitis are well-grounded. The preponderance of the evidence supports the grant of service connection for low back syndrome, folliculitis, acne, tinea pedis, and a SFW of the left foot. FINDINGS OF FACT 1. Satisfactory effort has been made to obtain all relevant evidence necessary to an equitable determination of the veteran's appeal. 2. The claims for service connection for arthritis, cervical spine disability, and thoracic and lumbosacral radiculitis are not plausible. 3. Chronic low back and skin disabilities were first demonstrated in service. 4. The evidence as a whole shows that a SFW of the left foot is related to service. CONCLUSIONS OF LAW 1. The claims for service connection for arthritis, cervical spine disability, and thoracic and lumbosacral radiculitis are not well-grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. Low back syndrome, folliculitis, acne, tinea pedis and residuals of a SFW of the left foot were incurred in service. 38 U.S.C.A. §§ 1110, 1131, 5107(a) (West 1991); 38 C.F.R. § 3.303(d) (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS To establish service connection for a claimed disability, the facts, as shown by the evidence, must demonstrate that a disease or injury resulting in current disability was incurred during active service or, if preexisting active service, was aggravated therein. 38 U.S.C.A. §§ 1110, 1131 (West 1991). Service connection may also be granted on a presumptive basis for certain chronic disabilities, including arthritis, when manifested to a compensable degree within a year after service discharge. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R. 3.307, 3.309 (1993). A person who submits a claim for benefits under a law administered by VA shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well-grounded; if a claim is not well-grounded, VA does not have a duty to assist the claimant in developing facts pertinent to the claim. 38 U.S.C.A. § 5107(a). A well-grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). Moreover, where the determinative issue involves a medical diagnosis or medical causation, competent medical evidence to the effect that the claim is plausible is required to establish that the claim is well-grounded. Grottveit v. Brown, 5 Vet.App. 91, 93 (1993). The veteran's service medical records, including his December 1968 retirement medical history and examination reports, do not contain any findings indicative of arthritis, cervical spine disability, or thoracic or lumbosacral radiculitis. The first post-service diagnosis of any of these disabilities was not until October 1981, which is a number of years after discharge, when Army outpatient records contain an assessment of an acute arthritis exacerbation involving the right hand and wrist. There is also a 1980 reference to possible slight lipping of the hips. Although subsequent medical records prior to October 1987 diagnose arthritis of the hands, shoulders, wrist, and lumbar spine, no supporting X-ray studies were associated with these records. Rheumatoid arthritis was suspected on occasion, but never confirmed. While January 1985 X-ray studies of the cervical spine were said to show arthritis, October 1987 VA X-ray studies of the cervical and lumbar spine, right hand and wrist, left foot, and right hip did not show any arthritis. October 1993 X-ray studies of the lumbar spine revealed mild degenerative arthritis. Although a February 1986 letter from Ervin Chafian, D.C., reveals that he had treated the veteran since April 1985 for cervicobrachial neuritis and thoracic and lumbosacral radiculitis, VA examination in October 1987 did not find any evidence of radiculitis and VA neurological examination in October 1993 concluded that there were no symptoms referable to the cervical spine. Moreover, there is no medical evidence on file of a causal connection between arthritis, cervical spine disability, or spinal radiculitis and the veteran's military service. In light of the normal findings on the service discharge examination and the absence of any postservice medical evidence supportive of the claims for service connection for arthritis, cervical spine disability, or spinal radiculitis, the Board must conclude that these claims are not well-grounded. Id. The veteran's claims for service connection for other low back disability, a skin disability, and residuals of a SFW of the left foot are well-grounded within the meaning of 38 U.S.C.A. § 5107(a) because they are not inherently implausible. Additionally, the facts relevant to these issues have been properly developed and the statutory obligation of the VA to assist the veteran in the development of these issues has been satisfied. 38 U.S.C.A. § 5107(a). The veteran's service medical records reveal that he had purulent folliculitis and acne vulgaris in February 1957. Recurrent purulent acne, folliculitis of the face, was noted in April 1957. Mild acne vulgaris was diagnosed in July 1960. The veteran had bilateral tinea pedis in January 1968. In February 1968, he fell on his lower back and injured his coccyx. Examination revealed extensive surgical scars in the lower back and slight tenderness of the coccyx. Coccygeal trauma was diagnosed. It was noted in March 1968 that he complained of continuous back pain, which prevented him from performing all of his assigned duties as a Combat Infantry platoon sergeant. It was recommended that he be reassigned to a noncombat unit. In June 1968, the veteran was given a limited duty profile for chronic back pain. On his retirement medical history report in December 1968, the veteran noted athlete's foot from time to time and back strain off and on since 1954, which made it difficult to assume certain positions. He also noted that he had had a pilonidal cystectomy in 1948 and rectal absess surgery in 1954. The only pertinent abnormality reported on discharge examination in December 1968 was chronic recurrent back pain. Evidence on file reveals that the veteran was awarded the Purple Heart Medal, although there is no notation of where he was wounded. Army treatment records from March 1980 to August 1986 reveal that in August 1980 the veteran had rashes on his upper extremities and the upper parts of his body. Tinea pedis and tinea cruris were diagnosed in June 1981. In July 1981, it was noted that the veteran had "chronic papulovesicular" with occasional pustules of the scalp off and on for a year; chronic folliculitis was diagnosed. Tinea pedis and pseudofolliculitis were found in October 1982. A scalp infection was noted in January and February 1983, with facial acne also mentioned in January 1983. He had a scaly rash on his scalp in July 1983. Army hospital records from December 1984 to January 1985 reveal that the veteran complained of right costovertebral angle and right upper quadrant pain. Examination showed evidence of tenderness to point pressure at the level of L1 on the right, with induration suggestive of muscle spasm. The January 1985 diagnoses included right osteoarthritis of the spine with paravertebral muscle spasm and possible radiculopathy. According to a July 1987 statement from a private dermatologist, the veteran was first seen in October 1986 with a two year history of folliculitis of the scalp, for which he was given medication. On VA examination in October 1987, the veteran's complaints included back pain with radiation, residuals of a GSW of the left foot, and small lumps and pustules in his scalp and other hairy areas. Examination of his skin in October 1987 revealed scattered acneiform lesions on the back, chest, legs, and, especially, scalp; there were also scattered hair follicle infections of the scalp. Lumbosacral spine motility was normal except for limited backwards flexion of approximately 10 degrees. X-ray studies of the lumbar spine and left foot did not show any abnormality. The diagnoses in October 1987 included no significant scarring of the left foot with no metallic foreign body shown on X-ray, acneiform lesions on the back and chest, and chronic folliculitis of the scalp. VA outpatient records for May 1989 reveal complaints of skin problems. Physical examination showed numerous 1-2 cm atrophic scarred areas of alopecia and several erythematous areas of follicular prominence on the shins. The examiner's impressions included scalp lesions that appeared to be discoid lupus and probable tinea pedis vs. dyshidrosis. VA outpatient records for December 1990 reveal that the veteran complained of pustular eruptions on his face. On examination in December 1990, there were a few pustules on both lower cheeks; acne was diagnosed. The veteran testified at his personal hearing before the Board in Washington, D.C., in March 1991 that during service he incurred a shrapnel injury of the foot, for which he said he was awarded the Purple Heart, a cyst-type skin condition, and a low back disability, for which he sought treatment soon after discharge. On VA orthopedic examination in October 1993, the veteran noted a history of mild low back pain in the late 1940s, which worsened significantly after he underwent a pilonidal cystectomy in 1948, and pain in the left foot since a shrapnel injury in service. Physical examination revealed a significant scar in the midline of the lower lumbar region and back tenderness to palpation somewhat generalized over the area of the scar. Range of motion of the lumbar spine was 80 degrees of flexion and 20 degrees of extension. There was a very faint scar, approximately 1 cm in length, on the medial aspect of the left foot adjacent to the navicular; the scar area was described as tender. X-ray studies of the lumbar spine revealed mild degenerative osteoarthritis; X- rays of the left foot did not show any abnormality. The examiner's impressions were recurrent low back syndrome, with a history of multiple excisions of a pilonidal cyst in the lower back region, and old SFW of the left foot. On VA skin examination in October 1993, the veteran described a history of periodic outbreaks of lesions on his face, scalp, buttocks, armpits, and groin. Physical examination revealed the following: several foci of follicular crusts on the scalp; erythema and scaling of the feet, particularly in the interdigital spaces, which were macerated, and of the toenails, which were thickened and hyperkeratotic; a single red inflammatory papule, with multiple acne scars, on his face and two filiform papules on his cheek; multiple scars and brown macules and papules on his buttocks; and multiple scarred lesions of the axilla, groin, and scrotum. The diagnoses were tinea pedis, macerated type with onychomycosis; adult acne, moderately severe with scarring; scalp folliculitis; and hidradenitis suppurativa. On VA neurological examination in October 1993, the veteran noted a long history of episodic back pain. He said that the pain was in the base of his sacral region and that occasionally, on prolonged standing, he would have shooting numbness into his right leg and sciatic distribution. The examiner's impression after examination was mild, service-related chronic low back pain. Satisfactory lay or other evidence that an injury or disease was incurred or aggravated in combat will be accepted as sufficient proof of service connection if the evidence is consistent with the circumstances, conditions, or hardships of such service even though there is no official record of such incurrence or aggravation. 38 C.F.R. § 3.304(d)(1993). The veteran was awarded the Purple Heart Medal for a wound incurred in service, although there is no evidence on file of what area of the veteran's body was wounded. The veteran testified at his Board hearing in March 1991 that the award was for a wound of the left foot. There was no evidence in service that he was wounded in the left foot. VA examination in October 1987 did not find any "significant scarring" of the left foot. However, VA orthopedic examination in October 1993 found an approximately 1 cm very faint scar on the medial aspect of the left foot, which was tender. The examiner in October 1993 diagnosed an old SFW of the left foot and concluded that pain in the veteran's left foot was likely due to the SFW. Consequently, the Board concludes that service-connection is warranted for residuals of a SFW of the left foot. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.304(d). The veteran's service medical records reveal that he first complained of low back pain after he fell on his lower back and injured his coccyx in February 1968. It was noted in March 1968 that he had chronic low back pain that prevented him from performing all of his duties as a Combat Infantry platoon sergeant. He was given a limited duty profile in June 1968 due to his chronic low back pain. Chronic recurrent back pain was noted on his discharge examination report in December 1968. The veteran testified at his Board hearing in March 1991 that he had a low back problem that began in service and that he had sought treatment for his back soon after discharge, although no records of such treatment are on file. The diagnosis on VA orthopedic examination in October 1993 was low back syndrome, with service excision of a pilonidal cyst considered to be the most significant contributing factor to the veteran's lower back pain. The examiner on VA neurological examination concluded that the veteran had mild chronic low back pain that was related to his military service. Based on the above, the Board finds that service connection for low back syndrome is warranted. 38 U.S.C.A. §§ 1110, 1131. Purulent folliculitis and acne vulgaris was noted in service beginning in February 1957. Bilateral tinea pedis was first noted in January 1968. The veteran continued to have skin problems after service discharge. Outpatient records and a July 1987 private dermatologist's statement reveal that the veteran had a rash on the upper parts of his body in August 1980, tinea pedis and cruris in June 1981, chronic folliculitis of the scalp in July 1981, tinea pedis and pseudofolliculitis in October 1982, scalp problems in January and July 1983, July 1987, and May 1989, and acne in December 1990. VA skin examination in October 1993 found multiple problems, including tinea pedis, adult acne, and scalp folliculitis. Because there is evidence of continued problems with folliculitis, acne, and tinea pedis since service, service connection is warranted for these disorders. Id. ORDER Evidence of well-grounded claims for service connection for arthritis, a cervical spine disability, including cervicobrachial neuritis, and thoracic or lumbosacral radiculitis not having been submitted, the claims are dismissed. Service connection for residuals of a SFW of the left foot, low back syndrome, folliculitis, acne, and tinea pedis is granted. J. J. SCHULE 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. 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.