Citation Nr: 0005425 Decision Date: 02/29/00 Archive Date: 03/07/00 DOCKET NO. 94-46 854 A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Paul, Minnesota THE ISSUES 1. Entitlement to service connection for a skin condition, including as due to an undiagnosed illness. 2. Entitlement to service connection for hair loss, including as due to an undiagnosed illness. 3. Entitlement to service connection for infertility, including as due to an undiagnosed illness. 4. Entitlement to service connection for numbness of the fingers, including as due to an undiagnosed illness. 5. Entitlement to service connection for memory loss, including as due to an undiagnosed illness. 6. Entitlement to service connection for a chronic respiratory condition, including as due to an undiagnosed illness. 7. Entitlement to service connection for diarrhea, including as due to an undiagnosed illness. 8. Entitlement to service connection for gum disease, including as due to an undiagnosed illness. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Ralph G. Stiehm, Associate Counsel INTRODUCTION The veteran had active service from May 1986 to August 1986 and from November 1990 to May 1991. This case comes before the Board of Veterans' Appeals (Board) on appeal from a September 1995 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Saint Paul, Minnesota. Service connection for numbness of the fingers, including as due to an undiagnosed illness, is addressed in the REMAND portion of this decision. FINDINGS OF FACT 1. The veteran's skin disease has been attributed to a known diagnosis and there is no medical evidence linking her skin disorder to service. 2. The veteran's hair loss has been attributed to a known diagnosis and there is no competent medical evidence linking any hair loss to service. 3. The veteran's endometriosis clearly and unmistakably existed prior to service, and endometriosis was not chronically worsened during active service. 4. The veteran's infertility has been attributed to a known diagnosis and there is no competent medical evidence linking infertility to service. 5. There is no medical evidence of a current diagnosis of memory loss. 6. The veteran's sinusitis clearly and unmistakably existed prior to service, and sinusitis was not chronically worsened during active service. 7. The veteran's respiratory conditions have been attributed to known diagnoses, and there is no competent medical evidence linking a respiratory condition to service. 8. The veteran's diarrhea ahs been linked to or associated with his service-connected chronic fatigue syndrome. 9. The veteran's gum disease has been attributed to periodontal disease, a known diagnosis, and there is no competent medical evidence linking gum disease to service. CONCLUSIONSOF LAW 1. A skin condition, including as due to an undiagnosed illness, was not incurred in or aggravated in service. 38 U.S.C.A. §§ 1110, 1117, 1131 (West 1991); 38 C.F.R. §§ 3.303, 3.317 (1999). 2. Hair loss, including as due to an undiagnosed illness, was not incurred in or aggravated in service. 38 U.S.C.A. §§ 1110, 1117, 1131 (West 1991); 38 C.F.R. §§ 3.303, 3.317 (1999). 3. Infertility, which preexisted active service, was not aggravated therein and is not due to an undiagnosed illness. 38 U.S.C.A. §§ 1110, 1111, 1117, 1131, 1153 (West 1991); 38 C.F.R. §§ 3.303, 3.306, 3.317 (1999). 4. The claim for service connection for memory loss, including as due to an undiagnosed illness, is not well grounded. 38 U.S.C.A. §§ 1110, 1117, 1131 (West 1991); 38 C.F.R. §§ 3.303, 3.317 (1999). 5. Sinusitis, which preexisted active service, was not aggravated therein; a chronic respiratory condition was not incurred in or aggravated by service, nor is it due to an undiagnosed illness. 38 U.S.C.A. §§ 1110, 1111, 1117, 1131, 1153 (West 1991); 38 C.F.R. §§ 3.303, 3.306, 3.317 (1999). 6. Diarrhea is secondary to a service-connected disability. 38 C.F.R. § 3.310(a) (1999). 7. Gum disease, including as due to an undiagnosed illness, was not incurred in or aggravated in service. 38 U.S.C.A. §§ 1110, 1117, 1131 (West 1991); 38 C.F.R. §§ 3.303, 3.317 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service connection may be granted for a disorder that was incurred in or aggravated during the veteran's active duty service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a) (1999). In addition, service connection may also be granted for disability which has been aggravated by a service-connection disease or injury. Allen v. Brown, 7 Vet. App. 439 (1995). A veteran is afforded a presumption of sound condition upon entry into service, except for any defects noted at the time of examination for entry into service; that presumption can be overcome only by clear and unmistakable evidence that a disability existed prior to service. 38 U.S.C.A. § 1111; see Doran v. Brown, 6 Vet. App. 283 (1994); Laposky v. Brown, 4 Vet. App. 331 (1993). Further, a preexisting injury or disease is considered to have been aggravated by service if there is an increase in disability during service, unless there is 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). However, intermittent or temporary flare-ups during service of a preexisting injury or disease do not constitute aggravation. Rather, the underlying condition must have worsened. Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). The initial inquiry in reviewing any claim before the Board is whether the appellant has presented evidence of a well- grounded claim; that is, one that is plausible or capable of substantiation. The appellant carries 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); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). If the appellant has not presented a well-grounded claim, that appeal must fail. While the claim need not be conclusive, it must be accompanied by supporting evidence; a mere allegation is not sufficient. Tirpak v. Derwinski, 2 Vet. App. 609 (1992). In cases which the determinative issue is one involving medical causation, competent medical evidence is required to establish a well- grounded claim. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). A well-grounded claim for service connection, moreover, requires that three elements be satisfied. First, there must be competent evidence of a current disability, as established by a medical diagnosis; second, there must be evidence of an incurrence or aggravation of a disease or injury in service, as established by lay or medical evidence, as appropriate; third, there must be competent evidence of a nexus or relationship between the in-service injury or disease and the current disorder, as established by medical evidence or a medical opinion. See generally Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997); Caluza v. Brown, 7 Vet. App. 498, 506 (1995). Alternatively, a claim may be well grounded based upon application of the rule for chronicity and continuity of symptomatology, set forth in 38 C.F.R. § 3.303(b). See Savage v. Gober, 10 Vet. App. 488 (1997). The chronicity provision applies where there is evidence, regardless of its date, which shows that a veteran had a chronic condition either in service or during an applicable presumption period and that the veteran still has such a condition. That evidence must be medical, unless is relates to a condition that may be attested to by lay observation. If the chronicity provision does not apply, a claim may still be well grounded "if the condition is observed during service or any applicable presumption period, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present condition to that symptomatology." Savage, 10 Vet. App. at 498. Compensation is available to Persian Gulf veterans for any chronic disability resulting from an undiagnosed illness manifested by one or more of a number of signs or symptoms. These signs or symptoms must become manifest to a degree of 10 percent no later than December 31, 2001, and must have existed for at least six months or have manifested episodes or improvement or worsening over a six-month period in order to be considered chronic. 38 U.S.C.A. § 1117; 38 C.F.R. § 3.317. See also VAOGCPREC 8-98. 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 and 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. See VAOGCPREC 4-99. As a preliminary matter, the Board finds that the veteran's claim service connection for various disorders are "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). That is, the Board finds that the veteran has presented claims which are not implausible when her contentions and the evidence of record are viewed in the light most favorable to her claims. The Board is also satisfied that all the facts relevant to these claims have been properly and sufficiently developed. I. Skin The veteran served on active duty from May to August 1986, and from November 1990 to May 1991. Service medical records contain no findings documenting the presence of a skin disorder, although an April 1991 entry documents facial burns sustained when the veteran lit a heater. A history obtained earlier that month during a separation examination reflects complaints of a recurring rash on the throat. However, examination of the skin at that time revealed the skin to be normal. During a VA examination in January 1994, the veteran complained of hives and of wart like lesions of the trunk and lower extremities, adding that a physician had indicated that the latter were seborrheic keratoses. Examination revealed seborrheic keratoses on the back and extremities, but no other lesions. The assessments included angioneurotic edema or hives of undetermined etiology. Treatment records from 1994 document complaints involving the veteran's skin. A November 1994 entry documents complaints of various skin lesions, at least some of which the veteran indicated had their onset during a period of service in the Persian Gulf. Examination of the skin revealed findings including chronic solar elastosis over the area of the face and neck, scars of the right cheek, anterior chest and left arm, papular structures, seborrheic keratoses, telangiectasis and erythema. The diagnoses included acne rosacea, right cheek excoriation, benign seborrheic keratoses, as well as a possible cyst over the right arm and a history of complaints since returning from Saudi Arabia. Another entry from November 1994 reflects diagnoses including Pityrosporum folliculitis, as does a December 1994 entry. During a VA examination in August 1995, the same examiner who examined the veteran in January 1994 noted the presence of scattered seborrheic keratoses and of hive formation. Assessments included probable angioneurotic edema or hives of an allergic basis, seborrheic keratoses, and a history of second degree burns to the face without clinical residuals. Additionally, in his summary, the examiner indicated that he would add to the veteran's dermatological diagnosis miliaria and seborrheic keratosis with a history of rosacea, seborrhea and tenia. In January 1998, the veteran underwent a VA examination by another examiner who reviewed the claims file. Examination of the skin revealed telangiectasis over the back and chest, benign lentigines and freckles, and flattened seborrheic keratoses. Assessments included seborrheic keratoses and acne rosacea. There is no medical evidence linking a diagnosed disorder to service. The reference to hives of unknown etiology raises some question as to the etiology of some of the veteran's skin complaints, and, therefore renders well grounded the veteran's claim under the presumption pertaining to undiagnosed illnesses manifested in veterans with service in the Persian Gulf. However, the subsequent characterization by the same examiner in August 1995 of the etiology the veteran's hives as allergic confirms the existence of a diagnosed disorder with respect to the veteran's claims in this respect. Treatment records do not otherwise suggest skin complaints that defy diagnosis. Under these circumstances, service connection for a skin disorder due to a claimed undiagnosed illness is not warranted under 38 C.F.R. § 3.317. II. Hair Loss Service medical records contain no reference to hair loss. During a VA examination in January 1994, the veteran complained of hair loss. However, examination revealed no obvious evidence of hair loss. The assessment included the possibility of excessive hair loss of undetermined etiology. During a VA examination in August 1995, the same examiner who examined the veteran in January 1994 noted a history of hair loss, as well as infertility, and pointed to a diagnosis of prolactinemia in 1992. According to the examiner, the veteran's hair loss and some other gynecological problems cleared up since prolactinemia treatment was started, although the veteran continued to suffer from infertility. The assessment was history of hyperprolactinemia in the past with hair loss and infertility associated with endometriosis of a mild nature. The examiner observed that hyperprolactinemia had since resolved. During a VA examination in January 1998, another examiner concluded that the veteran did not have hair loss. The January 1994 remarks raise some question as to the etiology of the veteran's hair loss and render the veteran's claim for service connection for an undiagnosed illness well grounded. However, August 1995 remarks made by that same examiner clarify that any hair loss was related to diagnosed prolactinemia. Because the evidence reflects that the veteran's hair loss is due to a diagnosed disorder, service connection for hair loss claimed as due to an undiagnosed illness is not warranted under the cited legal authority. Service medical records contain no reference to prolactinemia, and, although medical evidence in the claims file reflects a history of endometriosis prior to active service, there is no medical evidence suggesting that prolactinemia was present either during or prior to service. There is also no medical evidence otherwise linking prolactinemia or hair loss to service. Therefore, service connection is not warranted for hair loss on a direct incurrence or presumptive basis under 38 C.F.R. § 3.317. III. Infertility Service medical records contain no reference to infertility or any gynecological abnormalities. A January 1990 entry in treatment records contains a reference to problems with endometriosis in 1977 and 1981, and a September 1991 entry, which documents complaints of infertility of three years, notes a history of laparoscopies in 1977, 1981, and 1989, with treatment with medication from August 1989 to November 1990. The impression in September 1991 was infertility with a history of endometriosis. Subsequent records document an endometrial biopsy. A November 1991 entry reflects that in 1977 the veteran had a diagnostic laparoscopy with endometriosis and that a repeat laparoscopy in 1982 was negative. A pelvic examination was negative except for a small cervix, and the impression was infertility with a probable cervical factor. A December 1991 entry notes a three year history of infertility; it was also reported at that time that the veteran had no pregnancy during her first marriage beginning in 1971. That entry also reflects that the veteran was treated for nine months with medication with no relief. The impression in December 1991 was infertility with a history of luteal phase deficiency; an elevated Prolactin of 23, a Huhner test, which is inadequate with no sperm; and a history of two previous lasers of the veteran's cervix. A subsequent entry from that month reflects surgery, including a diagnostic laparoscopy, and reflects a preoperative diagnosis of infertility and a post operative diagnosis of "endometriosis, pelvic adhesions." Subsequent entries from 1992 document continued treatment for infertility and contain references to endometriosis and elevated Prolactin. In November 1992, the veteran apparently discontinued treatment, after expressing frustration with the results of the treatment for infertility. In January 1994, the veteran underwent a VA examination, during which she indicated that she experienced decreased menses or absence of menses while in the Persian Gulf. The examiner noted in the report that the veteran had had diagnoses of mild endometriosis and increased prolactin levels in the past. Assessments included infertility, possibly related to increased Prolactin levels in the past. During an August 1995 VA examination, that examiner, who noted that the veteran continued to suffer from infertility, had a history of endometriosis, and had undergone several laparoscopies. The assessments included history of hyperprolactinemia with hair loss and infertility associated with endometriosis of a mild nature. The examiner indicated that hyperprolactinemia was resolved. During a January 1998 VA examination, an examiner assessed endometriosis with secondary infertility. That examiner observed that veteran's infertility was more likely than not secondary to endometriosis and/or treatment used to treat endometriosis. Infertility has been attributed to prolactinemia and endometriosis. Because the veteran's complaints of infertility have not eluded diagnosis, service connection for an undiagnosed illness is not warranted. As noted above, there is no medical evidence linking prolactinemia to service. The veteran's medical history, however, provides clear and unmistakable evidence that endometriosis existed prior to service. However, neither endometriosis nor infertility are mentioned in service medical records or in any other medical records documenting treatment during periods of active service. Evidence in the claims file also contains no medical opinion that endometriosis or infertility was chronically worsened or aggravated during the veteran's period of service. Temporary flare-ups will not be considered to be an increase in severity. Hunt v. Derwinski, 1 Vet. App. 292, 295 (1991). Aggravation may not be conceded, however, where the disability underwent no increase in severity during service. 38 C.F.R. § 3.306(b). The determination whether a preexisting disability was aggravated by service is a question of fact. Doran v. Brown, 6 Vet. App. 283, 286 (1994). Here, there is no medical evidence to support a finding that the veteran's endometriosis or infertility was chronically worsened or aggravated during service. Service connection for infertility, therefore, is not warranted. IV. Memory Loss During a January 1994 VA examination, the veteran complained of short term memory loss described as absent-mindedness. The examiner's report reflects that the etiology was "not clear." The assessment was short-term absent-mindedness, probably benign absent-mindedness. The examiner added that there was no other evidence of cognitive deficit at that time. During a VA examination in August 1995, the examiner indicated that the veteran's complaints of memory loss apparently had abated and that memory testing, therefore, probably was not needed. The examiner's assessment was history of perception of short term memory loss on a fairly short term basis after the Gulf, adding that this had now more or less resolved itself. During a January 1998 examination, an examiner concluded that memory loss was not present. Although the January 1994 examination report suggests that the etiology of the veteran's complaints of memory loss are clear, the results of the August 1995 examination suggests that any symptoms may be attributed to benign absent mindedness. In any event, the results of the January 1998 examination reflect that memory loss is not present. The conclusions provided during that examination were based upon a review of the claims file. Further, the earlier reference to memory loss appears largely equivocal. The Board, therefore, finds that there is no medical evidence of a current diagnosis of memory loss. Because a disability characterized by memory loss is not present, either as an undiagnosed or as a diagnosed disorder, the claim for service connection for memory loss is not well grounded and must be denied. V. Respiratory Condition Service medical records document treatment in December 1990 for complaints of a sinus or ear infection, as well as complaints of a sore throat with a cough and stuffiness. The assessment at the time that the veteran presented sinus complaints was sinusitis/viral infection. During a separation examination in April 1991, the veteran's lungs and chest, ears, mouth, throat, nose and sinuses were reportedly all normal, although the examination report reflects a history of occasional sinus and ear infections. An August 1991 entry reflects complaints that included a persistent intermittent cough that the veteran indicated had its onset in service, as well as intermittent pleuritic chest pains. The lungs at that time were clear and the treating physician, by way of assessment, indicated that the veteran was probably having some sequelae of a viral infection. That physician added that there was no evidence of "serious disease" on physical examination. During a VA examination in January 1994, the veteran complained of a cough and of chest pain, and she indicated that this was especially prominent when she came home from the Persian Gulf. Examination revealed the lungs to be clear with no crackles or wheezing, and the examiner diagnosed a history of pleuritic chest pain associated with a cough. The examiner characterized the etiology as undetermined but suggested the possibility of a pleurisy in the past. During a VA examination in June 1996, the veteran gave a positive history of cigarette smoking of one pack per day for 20 years. She complained of an intermittent cough. The examiner noted a history of treatment in service for complaints of a sore throat, stuffiness, and a cough during December 1990, as well as complaints of a sinus and of an ear infection with an assessment of sinusitis during that same time frame. The examiner also noted a history of an injury by a brief flash fire. Assessments included status post flash explosion with findings supporting an impression that no upper or lower respiratory tract damage occurred; chronic bronchitis secondary to a nicotine addiction and a 20 pack- per-year cigarette smoking history; and intermittent acute episodes of pharyngitis, sinusitis, and occasional otitis medial infections over several years described before and after military service. The examiner added that the one infection was exacerbated somewhat by flights to the Persian Gulf and that no subsequent problems with sinusitis infections or acute otitis media infections were reported since discharge from service. During a January 1998 examination administered by the same examiner, the veteran complained of a productive cough. The examiner assessed hyperactive airway disease and chronic bronchitis secondary to a nicotine addiction. There is no medical evidence that bronchitis was manifested in service or that it is otherwise related to service. The evidence before the Board, instead, suggests that bronchitis is secondary to nicotine addiction, and it is evident from the record that the veteran had been smoking for many years prior to service. Furthermore, the results of the June 1996 opinion constitute clear and unmistakable evidence that sinusitis existed prior to service. Although the veteran was treated for a respiratory infection while on active duty, the body of evidence indicates that there was no chronic worsening or aggravation of preexisting sinusitis or incurrence of any other chronic respiratory disorder during the veteran's brief period of active service. In this respect, the June 1996 opinion reflects that the veteran's sinus infection in service was exacerbated by flights to the Persian Gulf and suggests that that episode was a temporary flare-up rather than a chronic worsening or aggravation of a preexisting disorder. Hunt, supra. Furthermore, that the affected systems, including the veteran's nose, ears, throat, sinuses, and lungs, were described as normal at the time of separation and that the veteran reportedly experienced no recurrence of sinusitis after separation from service, tend to suggest that any increase in service was simply a temporary flare-up of an underlying condition, but did not constitute a worsening of the underlying at condition. Id. Although the veteran also seeks service connection for her complaints under the presumptions applicable to Persian Gulf War veterans, the claims file does not reflect the presence of a disability or of signs or symptoms in this respect that elude diagnosis. An initial examination in January 1994 suggested the presence of a cough and chest pain of undetermined etiology. Although that examiner's characterization of the etiology of the veteran's symptoms as undetermined might otherwise raise some question as to whether an undiagnosed disability existed, the subsequent examination revealed clear diagnoses associated with the veteran's complaints. The latter examination reveals a review of the evidence associated with the claims file. The Board, therefore, finds this evidence probative, and further finds that the veteran's respiratory complaints have been attributed to a known diagnosis. Under these circumstances, service connection for a respiratory disorder, to include as due to an undiagnosed illness, is not warranted. VI. Diarrhea Service medical records contain no reference to diarrhea or to generalized gastrointestinal complaints. During an August 1991 consultation for evaluation of upper respiratory symptoms, during which an examiner diagnosed sequelae of a viral infection with no evidence of a serious disease, the veteran also gave a history of alternating diarrhea and constipation. During a VA examination in January 1994, the veteran's complaints included diarrhea. She complained of symptoms that began shortly before her return from the Persian Gulf that included abdominal cramping and nausea, with associated loose stools and diarrhea, although according to the veteran the loose stools had "more or less" abated. The examiner's assessments included fatigue, night sweats, low grade fever, and mild abdominal nausea and cramping. The examiner indicated that from the clinical history, the veteran would meet the criteria for chronic fatigue syndrome, especially with the lymphadenopathy the veteran stated that she had. The examiner added that the veteran did not have these symptoms at the time of the examination, but instead had only fatigue. A report of an August 1995 examination reflects that in January 1994, the veteran continued to experience fatigue, but that other symptoms including low grade fever, night sweats, diarrhea, nausea, vomiting, etc., had "more or less abated." The examiner assessed a history of a number of symptoms associated with the Gulf War, including fatigue, night sweats, low grade fever, and abdominal with nausea and vomiting. The examiner indicated in that assessment that these symptoms had "more or less" resolved, except the fatigue as a mild residual. In a discussion contained in the report of the examination, the examiner added that gastrointestinal exams were not warranted, that gastrointestinal symptoms were associated with a viral syndrome most likely or were perhaps of unknown etiology and has "more or less resolved." In September 1995, the RO granted service connection for fatigue, night sweats, fever, nausea, vomiting, generalized joint aches as due to an undiagnosed illness. Although the veteran's complaints of diarrhea appear to be part and parcel of this body of symptomatology, the RO inexplicably denied service connection for diarrhea in that same rating decision. Although the VA examiner's opinions suggest that the veteran's gastrointestinal complaints had largely abated by the time of the examination, the repeated qualification of that conclusion by the phrase "more or less" may be read to suggest that some symptoms beyond fatigue remained. Further, the evidence the evidence does not warrant isolating diarrhea, as symptom, from other gastrointestinal complaints, which the RO clearly has associated in its grant of service connection with the veteran's fatigue. In February 1998, the RO granted service connection for Epstein-Barr reactivation syndrome and rated that disability together with symptoms previously associated with fatigue due to an undiagnosed illness. To the extent that diarrhea, however slight, is secondary to the veteran's service connected disability, the veteran is entitled to secondary service connection. VII. Gum Disease A January 1994 VA examination report notes a history of gum disease after the veteran returned home from the Persian Gulf War and reflects an assessment of a history of periodontal disease of a mild nature, under control at that time of the examination. An August 1995 report reflects that the veteran apparently had some gum disease "around the Gulf time or during the Gulf." The assessment at that time was mild periodontal disease, which was characterized as fairly stable. During a January 1998 examination, the veteran indicated that her teeth were fine, and that in the past she was treated for periodontal disease and mild gum recession after she returned from the Gulf. She denied having any active gingivitis, halitosis, or significant bleeding from her gums. A report of a February 1998 dental examination reveals that a soft tissue examination was negative. Examination revealed mild gingival recession and mild gingivitis. At the time of that examination there were no subjective complaints other than occasional sensitivity to cold and examination revealed no loss of teeth as a result of loss of substance of the maxilla or mandible. There is no medical evidence suggesting that the veteran's complaints of gum disease have eluded diagnosis. Although periodontal disease has been diagnosed, service connection for periodontal disease will be considered solely for the purpose of establishing eligibility for outpatient dental treatment. 38 C.F.R. § 3.381. Although service connection may be granted for the limited purpose of obtaining one-time outpatient dental treatment for periodontal disease, the veteran has not claimed eligibility for such treatment. See 38 C.F.R. §§ 4.149, 17.161. In any event, the most recent dental examination suggests that periodontal disease is no longer present. The veteran's gum disease has been attributed to periodontal disease, a known diagnosis, and there is no competent medical evidence linking claimed current gum disease to service. ORDER A claim for service connection for a skin condition, to include as due to an undiagnosed illness, is denied. A claim for service connection for hair loss, to include as due to an undiagnosed illness, is denied. A claim for service connection for infertility, to include as due to an undiagnosed illness, is denied. A claim for service connection for memory loss, to include as due to an undiagnosed illness, is denied A claim for service connection for a chronic respiratory condition, to include as due to an undiagnosed illness, is denied. Secondary service connection for diarrhea is granted. A claim for service connection for gum disease, to include as due to an undiagnosed illness, is denied. REMAND The veteran has complained of numbness and tingling in her extremities, which she asserts are attributable to service. In reviewing the record, the Board finds that, in January 1998, the veteran complained of numbness of the fingers, and an examiner diagnosed possibility of early carpal tunnel syndrome greater in the right than the left., she complained of numbness and tingling in the fingers, and the same examiner diagnosed symptoms suggestive of carpal tunnel. During another January 1998 examination, an examiner concluded that, at the time, there was insufficient evidence to make a diagnosis of carpal tunnel syndrome. The latter examiner's opinion leaves unclear whether that determination reflects a conclusion that there was no objective of evidence of the symptoms of which the veteran complained or whether the veteran's complaints eluded a known diagnosis. Further examination is, therefore, needed to clarify this point. Therefore, this case is REMANDED for the following development: The veteran should be afforded a neurological examination to ascertain the nature and etiology of any disorder associated with the veteran's complaints of tingling and numbness of the fingers. After reviewing the claims file, including the reports of VA examinations in January 1994, August 1995, and January 1998, the examiner should indicate whether there are is objective evidence of clinically significant findings associated with the veteran's complaints of finger numbness and tingling. If there is such evidence, the examiner should indicate whether it is possible to attribute the findings in question to a known diagnosis. If so, that diagnosis should be identified. If there is no objective evidence of clinically significant findings, or if such findings elude diagnosis, the examiner should so indicate. All necessary tests, studies, or examinations should be performed. The claims file must be made available to the examiner for review. When the development requested has been completed, the case should again be reviewed by the RO on the basis of all the evidence. If the benefit sought is not granted, the appellant should be furnished a supplemental statement of the case, and be afforded the appropriate time period to respond before the record is returned to the Board for further review. The purpose of this REMAND is to obtain additional development. The Board does not intimate any opinion as to the merits of the case, either favorable or unfavorable, at this time. No action is required of the appellant until she is notified. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). R. F. WILLIAMS Member, Board of Veterans' Appeals