Citation Nr: 0003367 Decision Date: 02/09/00 Archive Date: 02/15/00 DOCKET NO. 96-23 086 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for a skin rash for VA health care benefits under Chapter 17, Title 38, United States Code. 2. Entitlement to service connection for a stomach condition for VA health care benefits under Chapter 17, Title 38, United States Code. 3. Entitlement to service connection for a bowel disability for VA health care benefits under Chapter 17, Title 38, United States Code. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD L. J. Wells-Green, Counsel INTRODUCTION The veteran served on active duty from August 1989 to November 1991 and was discharged under conditions other than honorable. This matter came to the Board of Veterans' Appeals (Board) on appeal from an August 1995 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. In February 1999 the Board remanded the case for further development. The requested development has been completed and the case has been returned to the Board for further appellate action. In his September 1995 notice of disagreement, the veteran raised the issues of entitlement to service connection for headaches and chest pain for the first time. The RO has not addressed these issues in the first instance. Therefore these issues are referred to the RO for appropriate action and initial adjudication. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the appellant's appeal has been obtained. 2. The claims of entitlement to service connection for a skin rash, stomach condition and bowel disability are not plausible. CONCLUSION OF LAW The claims for service connection for a skin rash, stomach condition and bowel disability are not well grounded. 38 U.S.C.A. § 5107(a)(West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION Applicable regulations provide that health care and related benefits authorized by Chapter 17 of Title 38, United States Code, shall be provided to certain former service persons, such as the appellant, with administrative discharges under other than honorable conditions for any disability incurred or aggravated during active service in line of duty; such benefits may not be furnished for any disability incurred or aggravated during a period of service terminated by a bad conduct discharge or when other bars provided at 38 C.F.R. § 3.12 (1999) apply. In making determinations of health care eligibility the same criteria will be used as are applicable to determinations of service incurrence and line of duty when there is no character of discharge bar. 38 C.F.R. § 3.360 (1999). Before the Board may address the merits of the appellant's claims, it must first be established that the claims are well-grounded. In this regard, a person who submits a claim for VA benefits shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well-grounded. 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. Such a claim need not be conclusive but only possible to satisfy the initial burden of [38 U.S.C.A. § 5107]." Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). If the claim is not well-grounded there is no duty to assist. Struck v. Brown, 9 Vet. App. 145 (1996). In order for a claim to be well-grounded, there must be competent evidence of a current disability; of incurrence or aggravation of a disease or injury in service (lay or medical evidence); and of a nexus between the in-service injury or disease and the current disability (medical evidence). Caluza v. Brown, 7 Vet. App. 498 (1995). For reasons indicated below, the veteran's claims of entitlement to service connection for a skin rash, stomach condition and bowel disability are not well-grounded. Factual Background The veteran's service medical records show no complaints, findings, treatment or diagnoses for stomach or bowel disabilities. His July 1989 enlistment medical examination report shows that he had dermatitis on his left thigh associated with a milk allergy. An August 1989 dermatology follow-up report indicates that the veteran had a 6 to 7 year history of the left lateral thigh rash that had been treated by civilian physicians. The examiner's impression was chronic eczema secondary to lichen simplex chronicus. Later service medical records show that the veteran was also treated for chronic pseudofolliculitis barbae (PFB). In August 1990, the veteran was again treated for lichen simplex chronicus on his left thigh. He was treated for dry skin on his right arm in March 1991. At the time of his September 1991 separation medical history, the veteran denied any skin diseases, stomach or intestinal trouble or rectal disease. The accompanying medical examination report shows that evaluations of his skin, abdomen, anus and rectum were normal. An April 1995 Gulf War examination report, conducted by Raymond Jeffers, M.D., shows that the veteran pertinently complained of a rash on his arms and legs since his service in the Persian Gulf. There were no stomach or bowel complaints at that time. The examiner noted that the veteran had a hyperpigmented scaly-type rash that was non-ulcerated and nontender involving a large area of the left thigh. He also had some mild hyperpigmented areas over the right thigh, and some slight fine papules over the upper extremity areas predominately involving the forearms. The examiner diagnosed dermatitis of unclear etiology. Later that month, a VA treatment record again shows that the veteran was diagnosed with dermatitis over the distal lateral left thigh and dry skin appearing on areas of both shoulders and the right thigh. A February 1996 VA administrative decision determined that the veteran's November 1991 discharge was not issued under conditions other than dishonorable and is a bar to VA benefits, but that he is entitled to health care under Chapter 17, Title 38, U.S.C. for any disabilities determined to be service connected. During his September 1996 personal hearing, the veteran testified that he had scars on both legs prior to his enlistment as a result of football injuries. He was in aircraft maintenance and a flight deck attendant while in service and was responsible for cleaning and maintaining aircraft. As a result his skin came in contact with aircraft fuels, oils and hydraulic fluids, as well as aircraft soap. He noticed afterwards that his skin would peel and he would begin to scratch his legs and develop a rash 6 to 8 hours after his exposure. He was not provided any protective clothing to guard him from contact with these chemicals. After service, he was first treated for his skin condition, as well as his stomach and bowel conditions in 1992 with a Dr. Jeffers and also at the Kansas City, Kansas, VA Medical Center. The veteran further testified that he first experienced stomach and bowel problems (described as stomach cramping and bloody diarrhea) beginning in 1991 while still in service. He sought treatment at that time and continued to suffer the same symptoms since his discharge. An October 1996 VA dermatology examination report shows that the veteran was diagnosed with tinea corpora. The examiner opined that the rash was not caused by airplane soap but rather a cutaneous infection with a fungus. VA gastrointestinal and rectal examinations conducted that same month show that the veteran complained of sharp abdominal pain twice a month, lasting 2 to 3 minutes that began in 1990 and also gave a history of bright red blood in his stool since 1990. He denied any weight loss. The examiner noted that the veteran had normal active bowel sounds. His abdomen was soft and nontender with no hepatosplenomegaly or masses and no herniae. The veteran was mildly anemic but not malnourished. He denied nausea, diarrhea, constipation or any bowel disturbances. The examiner opined that it was likely that his abdominal cramping was from irritable bowel syndrome versus a benign disorder that started in 1991. The examiner further opined that the veteran's bright red bowel bleeding was likely secondary to hemorrhoids. However, the examiner felt the veteran should be referred to the gastroenterology clinic for both complaints. Subsequent VA treatment records show that the veteran was treated for ischthymic dermatitis in April 1997. He failed to report to his scheduled appointments in May and July 1997. Analysis The veteran contends that he currently suffers a skin rash, stomach condition and bowel disability. He concedes that his skin rash preexisted service but contends that it was aggravated by his service. He further contends that he currently has a stomach condition and bowel disability as a result of his service. The veteran has also claimed these disabilities under the provisions of 38 C.F.R. § 3.317, for undiagnosed illnesses. While the veteran is competent to provide evidence of visible symptoms, he is not competent to provide evidence that requires medical knowledge. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Moreover, where a determinative issue involves medical causation or a medical diagnosis, competent medical evidence to the effect that the claim is plausible is required. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). A preexisting injury or disease is considered aggravated by military service where there is an increase in disability during service, absent a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306(a). Temporary or intermittent flare-ups of symptoms during service are not sufficient to be considered aggravation absent worsening of the underlying disorder. Jensen v. Brown, 19 F.3d 1413, 1416 (Fed. Cir. 1994); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). The veteran was noted to have a left thigh rash at his entrance into military service. It was later identified as chronic eczema secondary to lichen simplex chronicus. Thus, the disorder preexisted service. Accordingly, service connection is warranted only if his left thigh rash was aggravated in service. The evidence does not support a conclusion that the inservice lichen simplex chronicus increased in severity in service. Moreover, subsequent to service the veteran has been diagnosed with dermatitis and a cutaneous infection with a fungus. The veteran has not provided competent medical opinions linking these diagnosed skin disabilities with his inservice lichen simplex chronicus or any incident therein. To the contrary, the October 1996 examiner actually opined that his rash was not caused by airplane soap. The veteran, an individual not trained in medicine, is not competent to offer an opinion as to whether his skin rash increased in severity in service or was caused by his service. Grottveit, 5 Vet. App. at 93; Espiritu, 2 Vet. App. at 494. The evidence of record does indicate that the veteran has been diagnosed with irritable bowel syndrome and hemorrhoids; this satisfies the first requirement of a well-grounded claim. However, these disabilities were not shown in service, nor is there competent medical evidence of a nexus between these disabilities and his service or any incident therein; the remaining two elements necessary to well- grounded claim his claims. In this regard, as noted although the October 1996 VA compensation examiner recorded the veteran's history of abdominal pain and blood in his stool since service, evidence which is simply information recorded by a medical examiner unenhanced by any additional medical comment by that examiner does not constitute "competent medical evidence." LeShore v. Brown, 8 Vet. App. 406, 409 (1995). In light of these circumstances, the Board must conclude that the veteran has failed to meet his initial burden of producing evidence of well-grounded claims for service connection for a skin rash, stomach condition and bowel disability. The Board notes that it was recommended that the veteran be referred to the gastroenterology clinic for a complete evaluation. There is no evidence that the veteran underwent such an evaluation. However, there is no duty to assist the veteran in this matter with his claims for a stomach condition and bowel disability, as he must first submit a well-grounded claim. The Board has considered the provisions of 38 C.F.R. § 3.317 (1999), relating to service connection for certain disabilities due to undiagnosed illnesses, but has found that they are not applicable to the specific issues decided herein. In this regard, the Board notes that the provisions do not relate to diagnosed disorders. Although the Board has considered and denied the veteran's claim for a skin rash on a ground different from that of the RO, that is, whether the claim is well grounded rather than whether he is entitled to prevail on the merits, the appellant has not been prejudiced by the Board's decision. In assuming that the claim was well grounded, the RO accorded the appellant greater consideration than his claim warranted under the circumstances. Bernard v. Brown, 4 Vet. App. 384, 392-94 (1993). To remand this case to the RO for consideration of the issue of whether the appellant's claim is well grounded would be pointless, and in light of the law cited above, would not result in a determination favorable to the appellant. VAOPGCPREC 16-92 (O.G.C. Prec. 16-92). ORDER Service connection for a skin rash, stomach condition and bowel disability for VA health care benefits under Chapter 17, Title 38, United States Code, is denied. RENÉE M. PELLETIER Member, Board of Veterans' Appeals