Citation Nr: 0003476 Decision Date: 02/10/00 Archive Date: 02/15/00 DOCKET NO. 98-07 755 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to service connection for generalized weakness and numbness in the legs and feet due to an undiagnosed illness. 2. Entitlement to service connection for joint pain due to an undiagnosed illness. 3. Entitlement to service connection for a sore throat due to an undiagnosed illness. 4. Entitlement to service connection for sores, infections, and skin rashes due to an undiagnosed illness. REPRESENTATION Appellant represented by: Alabama Department of Veterans Affairs WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD K. J. Loring, Counsel INTRODUCTION The veteran had active military service from October 1989 to March 1990 and from September 1990 to April 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 1998 rating decision by the Montgomery, Alabama, Regional Office (RO) of the Department of Veteran's Affairs (VA). The veteran's initial claim for compensation due to disability arising from service in the Persian Gulf was filed in March 1994, and was denied in June 1994 based upon her service medical records which showed no evidence of the claimed conditions, and her failure to appear for a VA examination. She did not appeal that determination. Due to a change in applicable law regarding undiagnosed illness claims, her claim was again reviewed. However, the March 1998 rating decision again denied her claims. The veteran filed a notice of disagreement, which was received in April 1998, a statement of the case was issued in April 1998, and a substantive appeal was received in May 1998. In June 1999, the veteran testified at a hearing before the undersigned member of the Board sitting at the RO. During the June 1999 Board hearing, the veteran raised a claim of entitlement to service connection for gastrointestinal disability. This matter is hereby referred to the RO for appropriate action. Also at the June 1999 hearing, the veteran submitted additional evidence, accompanied by a signed waiver of review by the agency of original jurisdiction. FINDINGS OF FACT 1. The veteran had military service in the Southwest Asia theater of operations from November 1990 to April 1991. 2. There is no medical diagnosis of disability manifested by generalized weakness and numbness in the veteran's feet and legs which is related to her period of active military service, nor is there any objective evidence perceptible to an examining physician, or other non-medical indicators that are capable of independent verification, which shows that the veteran currently suffers from disability manifested by generalized weakness and numbness in the veteran's feet and legs which cannot be attributed to a known clinical diagnosis. 3. There is no medical diagnosis of disability manifested by joint pain which is related to her period of active military service, nor is there any objective evidence perceptible to an examining physician, or other non-medical indicators that are capable of independent verification, which shows that the veteran currently suffers from disability manifested by joint pain which cannot be attributed to a known clinical diagnosis. 4. There is no medical diagnosis of disability manifested by a sore throat which is related to her period of active military service, nor is there any objective evidence perceptible to an examining physician, or other non-medical indicators that are capable of independent verification, which shows that the veteran currently suffers from disability manifested by a sore throat which cannot be attributed to a known clinical diagnosis. 5. There is no medical diagnosis of disability manifested by sores, infections, and skin rashes which is related to her period of active military service, nor is there any objective evidence perceptible to an examining physician, or other non- medical indicators that are capable of independent verification, which shows that the veteran currently suffers from disability manifested by sores, infections, and skin rashes which cannot be attributed to a known clinical diagnosis. 6. The veteran's complaints of joint pain in her left knee have been medically attributed to left knee bursitis which was not manifested during her period of active military service and is not otherwise shown to be related to such service. 7. The episodes of sinusitis treated during the veteran's service were acute and transitory in nature, and her current rhinitis/sinusitis is not related to the episodes of sinusitis treated during service.. 8. The veteran's skin rashes have been medically diagnosed as dyshidrosis of the feet and chronic dermatitis, neither of which was manifested during her period of active military service or otherwise shown to be related to such service. CONCLUSIONS OF LAW 1. A disability manifested by generalized weakness and numbness in the legs and feet was not incurred in or aggravated during the veteran's active military service. 38 U.S.C.A. §§ 1110, 1131, 1117, 5107 (West 1991); 38 C.F.R.§§ 3.303, 3.317 (1999). 2. A disability manifested by joint pain was not incurred in or aggravated during the veteran's active military service. 38 U.S.C.A. §§ 1110, 1131, 1117, 5107 (West 1991); 38 C.F.R.§§ 3.303, 3.317 (1999). 3. A disability manifested by a sore throat was not incurred in or aggravated during the veteran's active military service. 38 U.S.C.A. §§ 1110, 1131, 1117, 5107 (West 1991); 38 C.F.R.§§ 3.303, 3.317 (1999). 4. A disability manifested by sores, infections, and skin rashes was not incurred in or aggravated during the veteran's active military service. 38 U.S.C.A. §§ 1110, 1131, 1117, 5107 (West 1991); 38 C.F.R.§§ 3.303, 3.317 (1999). 5. The veteran's disabilities medically diagnosed as rhinitis, sinusitis, infrapatellar bursitis, dyshidrosis of the feet and chronic dermatitis were not incurred in or aggravated during the veteran's active military service. 38 U.S.C.A. §§ 1110, 1131, 1117, 5107 (West 1991); 38 C.F.R.§§ 3.303, 3.317 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS As a preliminary matter, the Board finds that the veteran's claims for service connection are well-grounded. 38 U.S.C.A. § 5107(a). A well-grounded claim for compensation under 38 U.S.C.A. § 1117(a) and 38 C.F.R. § 3.317 for disability due to an undiagnosed illness generally requires evidence of (1) active service in Southwest Asia during the Persian Gulf War, (2) manifestation of one or more signs or symptoms, (3) objective indications of chronic disability during the relevant period of service or to a degree of 10 percent or more within the specified presumptive period, and (4) a nexus between the chronic disability and the undiagnosed illness. See VAOGCPREC 4-99. In that regard, the veteran's qualifying military service, her reported complaints, and the unique nature of the statutory and regulatory provisions regarding disability due to undiagnosed illnesses render her claims plausible. The Board also finds that the evidence of record allows for equitable resolution of the claims on appeal, and that the duty to assist the veteran in establishing these claims has been satisfied. 38 U.S.C.A. § 5107(a). The record reflects that the veteran served in Southwest Asia from November 1990 to April 1991. Her military occupational specialty (MOS) was as an administrative specialist. She asserts that as a result of her service during the Gulf War, she has developed a chronic skin rash, joint pains, a sore throat, and a general weakness in her legs and feet. Generally, applicable law provides that service connection will be granted if it is shown that the veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Further, as noted previously, and as pertinent to this case, compensation for disability due to undiagnosed illness as a result of service in the Southwest Asia theater of operations during the Persian Gulf War requires the manifestation of one or more signs or symptoms of undiagnosed illness, objective indications of chronic disability during the relevant period of service or to a degree of disability of 10 percent or more within the specified presumptive period, and a nexus between the chronic disability and the undiagnosed illness. Evidence that the illness is "undiagnosed" may consist of evidence that the illness cannot be attributed to any know diagnosis or, at minimum, evidence that the illness has not been attributed to a known diagnosis by physicians providing treatment or examination. Signs or symptoms of undiagnosed illness or objective indications of chronic disability may be established by lay evidence if the claimed signs and symptoms, are of a type which would ordinarily be susceptible to identification by lay persons. See 38 C.F.R. § 3.317. The veteran's service medical records are completely negative for complaints or abnormalities involving her neurological or musculoskeletal system or skin. The records reveal that she was treated for a tick bite in May 1990 and sinusitis or bronchitis in October 1990. An April 1991 Southwest Asia demobilization medical report completed by the veteran indicated a sprained right ankle and sunburned lips. On separation examination in April 1991, the veteran's sinuses, musculoskeletal system, upper and lower extremities, , mouth and throat, and skin were clinically evaluated as normal. In March 1994, the veteran submitted a VA Persian Gulf Medical Administration Survey which reflected a report of symptoms the veteran believed she experienced related to Persian Gulf service. She included occasional sores or skin rash, muscle weakness and numbness or loss of feeling in her legs and feet. A November 1994 Persian Gulf protocol evaluation indicated a normal examination with the exception of diagnoses of post nasal drip, dyshidrosis of the feet, and a possible enlarged thyroid. VA outpatient treatment records covering the period from September 1993 to March 1999 show treatment for an upper respiratory infection and bronchitis in September 1993 and a rash on her lips in October 1993. In February 1995 the veteran's thyroid was evaluated by scan and the result was normal. A March 1995 annual evaluation for the reserves the veteran reported problems with pain in her knees and ankles as well as problems with sinuses. In April 1995 she complained of a rash on her face, and stated that she had the same rash while stationed in Saudi Arabia. She reported that she was treated with hydrocortisone during service. In November 1996 she was treated for rhinitis and bronchitis and contact dermatitis. In January 1997 she complained of a rash between her toes and post nasal drip. She was diagnosed as having chronic dermatitis and rhinitis. She was afforded a VA examination in June 1997 and reported a history of sinusitis since 1990, left knee pain since 1992, and a right foot rash since 1992. She also reported previous hair loss. Her current complaints involved a generalized weakness without myalgia; right hip pain in the morning, and with exertion; left knee pain exertion; numbness in both legs, especially at night; and a history of sinus congestion with post nasal drip. A physical examination revealed normal nose, sinuses, and mouth with the exception of mild erythema of the mucosa of the nostril with no discharge and no ulcer. Her respiratory, digestive, and musculoskeletal systems were normal with full range of motion of the hips and knees. There was no effusion or erythema of the left knee, but there was moderate point tenderness over infrapatellar bursa. There was no evidence of injury of the meniscus or ligaments. Radiographs of the knees, lower legs, ankles, and feet were normal other than a bilateral hallux valgus of the feet. There was no evidence of neurological deficit. Examination of the veteran's scalp showed no active hair loss and her skin showed no evidence of rash, active skin lesions, or scars. The only significant finding was a .5 raised mole on her right flank with no evidence of abnormality. The examiner reported a diagnosis of chronic sinusitis; benign nevus of right flank; left infra-patellar bursitis with moderate impairment of function by history; and history of telogen effluvium (transient hair loss secondary to major stressful event). The veteran appeared for a Board hearing at the RO in June 1999 and testified that she was sick when she was stationed in the Persian Gulf and went to a field hospital where she was diagnosed as having sun poisoning. She stated that she had swelling in her face and her lips were chapped. She stated that she was in and out of the field hospitals regularly while there. She further testified that she served as an administrative specialist and mail clerk, and was back and forth on the highway transporting mail daily. She was separated from service in April 1991 and appeared at the VA in 1992 to obtain her "ID card." She testified that she had been receiving treatment for "all four undiagnosed illnesses" since 1992, and that she saw a private dermatologist for the skin rash and removal of an enlarged mole on her right side. She reported that she currently had several moles growing on her body that enlarged over time. She further noted that she was on the Persian Gulf Registry, but was not involved in any specialized clinic or treatment program. The veteran testified that the only symptoms she experienced during service was the skin rash and swelling in her face. She stated that the weakness of her legs and feet had not been diagnosed nor evaluated with clinical testing. With respect to her sore throat, she acknowledged that VA physicians had related it to her sinus drainage. She stated that all her medical treatment had been at the VA, with the exclusion of the private dermatologist, who told her it was related to a fungus. After reviewing the evidence of record, including the veteran's report of signs and symptoms of her claimed conditions, the Board concludes that the preponderance of the evidence is against each of the veteran's claims for service connection. Despite the veteran's testimony that she had regular field hospital visits during her service in Saudi Arabia, the service medical records are silent as to any medical problems during her stay in the Persian Gulf. Moreover, her separation examination report and demobilization medical survey reflect only a report of sunburned lips without sequelae. In addition, there is no medical evidence to support the veteran's assertions of generalized weakness and right hip joint pain. Her left knee pain has been attributed to a diagnosed infrapatellar bursitis, and her sore throat has been attributed to chronic sinusitis. The medical evidence of record does not link either condition to military service. The single episode of sinusitis during service was resolved prior to separation without evidence of continued symptomatology to indicate a chronic condition. The next diagnosis of rhinitis or sinusitis did not occur until November 1996. With regard to the veteran's claim for skin rash and infection, the medical evidence indicates a chronic dermatitis and dyshidrosis of the feet that did not occur until well after her April 1991 separation from service. Her VA examination of June 1997 showed no evidence of rash or lesion, and her testimony indicated that a rash and swelling reported during service was attributed to sun poisoning. The Board has considered the veteran's statements and sworn testimony, and the Board believes that the veteran is sincere in her belief that the claimed disorders are related to her service. However, the preponderance of the evidence is against a finding that the symptoms complained of are related to such service. With regard to the various issues, there is either no supporting evidence of the claimed symptoms or the symptoms have been attributed to known clinically diagnosed disorders which are not shown to be related to service. As the preponderance of the evidence is against the veteran's claims. It follows that there is not such a state of equipoise of the positive evidence with the negative evidence to otherwise permit favorable determinations. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990). ORDER The appeal is denied as to all issues. ALAN S. PEEVY Member, Board of Veterans' Appeals