BVA9500052 DOCKET NO. 93-05 937 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to service connection for a skin disorder. 2. Entitlement to an increased rating for anxiety reaction with depression, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Georgia Department of Veterans Service WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD A. D. Jackson, Associate Counsel INTRODUCTION The veteran had active duty service from February 1970 to April 1975. This matter came before the Board of Veterans' Appeals (Board) on appeal from a rating decision dated in February 1991 from the Atlanta, Georgia, Regional Office (RO) which in pertinent part denied service connection for a skin rash and an increased rating for anxiety reaction with depression. CONTENTIONS OF APPELLANT ON APPEAL The veteran maintains that he should be granted service connection for a chronic skin disorder. He points out that he received treatment during service for skin rashes. He contends that he has continued to suffer from skin rashes subsequent to service discharge. He further asserts that he should be granted a higher rating than 10 percent for anxiety reaction with depression as this disorder is more severely disabling than the current evaluation reflect. Specifically, it is maintained that the disorder disables him to a degree that he is socially withdrawn, experiences decreased sleep, nervousness, and is easily angered which causes conflicts both at home and at work. 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 appellant has not met the initial burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that his claim for service connection for a skin disorder is well-grounded. Further, it is the decision of the Board that the preponderance of the evidence is against the veteran's claim for an increased evaluation for anxiety reaction with depression. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. Pityriasis, warts of the right hand and penis, and a sebaceous cyst of the right elbow were noted during service. 3. The evidence before the Board fails to demonstrate any pertinent findings demonstrating that the veteran currently suffers from pityriasis, warts of the right hand and penis or sebaceous cyst of the right elbow; nor does the evidence show that his tinea versicolor is related to service. 4. The veteran's anxiety reaction with depression is productive of not more than mild social and industrial impairment. CONCLUSIONS OF LAW 1. The appellant has not submitted evidence of a well-grounded claim for service connection for a chronic skin disorder. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303 (1993). 2. The schedular criteria for a rating in excess of 10 percent for anxiety reaction with depression have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321, 4.3, Part 4, Diagnostic Code 9400 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board observes that service connection may be granted if a chronic skin disorder was incurred or aggravated during the veteran's active military service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303(b) (1993). The threshold question to be answered in this case is whether the appellant has presented evidence of a well-grounded claim; that is, one which is plausible. If he has not presented a well- grounded claim, his appeal must fail and there is no duty to assist him further in the development of his claim because such additional development would be futile. 38 U.S.C.A. § 5107(a) (West 1991), Murphy v. Derwinski, 1 Vet.App. 78 (1990). As will be explained below, we find that his claim is not well-grounded. In this regard, no skin disorder was noted at the veteran's October 1969 enlistment examination. In July 1970, the veteran was referred to dermatology for wart(s) on the right hand. There was also noted a "pedunculated warty appearing" soft penile growth. The dermatology consultation report indicates a diagnosis of verruca of the penis and right hand. The warts were cauterized with liquid nitrogen in August 1970. In June 1972, he received treatment for a rash on both forearms. It was noted that he had been in a wooded area for 3 days. Physical examination revealed a pruritic vesicular rash on the anterior surfaces of both forearms. He was given Calamine lotion. No skin disorder was noted on his July 1972 reenlistment examination. In June 1974, the veteran was examined after complaining of a rash on his chest and abdomen. The physical examination revealed a red macular papular rash on the chest and abdomen. There was no edema on his arms, face and neck. The initial impression was possible allergic reaction. He was prescribed Mycostatin and Periactin. A week later, he was again examined. He reported that the Mycostatin did not help. He was referred to the dermatology clinic. A dermatology notation dated in July 1974 shows that the rash had spread to the inner arms and upper thighs. There was moderate itching. The physical examination revealed reddish brown maculopapular eruptions. There were oval lesions with fine central scaling in the chest, inner arms and upper thighs. The diagnosis was pityriasis rosea. The examiner commented that the lesions were partially involuting and treatment would probably not be very helpful at that stage. It was further noted that the rash would be self-limiting in 2 to 3 weeks. He was prescribed Periactin for itching. In September 1974, a sebaceous cyst was reported on the right elbow. He was advised to return to the clinic, if there was no improvement. There was no skin disorder noted on the veteran's separation examination dated in April 1975. The veteran submitted private medical records developed between 1983 and 1989. A December 1983 pathology report relates that a mass was removed from the elbow and a cyst was also removed from the left ear. The diagnoses were angiolipoma, benign (left elbow) and focal cystic foreign body granuloma consistent with infected sebaceous cyst (from left ear). In May 1985, examination disclosed a defuse erythematous rash over the trunk area. He related that the rash had been present for ten years. The diagnostic impression indicated tinea versicolor. He was given Lotrimin lotion. A May 1986, notation shows that the veteran was still having problems with his tinea versicolor. A different cream was recommended. A May 1987 clinical examination revealed patchy and confluent areas of erythema and scaling on the trunk. The diagnosis was tinea versicolor. A June 1989 notation shows that the veteran requested a prescription for the rash on his back. In November 1990, the veteran underwent a Department of Veterans Affairs (VA) compensation examination. He reported a history of intermittent eruptions of a rash on his neck and back for the previous 17 years. The rash would occur intermittently and continue for a month. The rash would disappear for a week to three weeks and recur. It caused redness over the upper back and neck areas. At other times it would appear over the upper arms. On examination the rash was described as 5 to 8 mm. in diameter, oval-shaped, erythematous and slightly violeaur. The nucleus was 2 to 4 mm. in diameter with silver scales. The rash was located on the upper and mid-back. There were noted oval shaped lesions. There was no rash reported on the neck, abdomen, or on the upper and lower extremities. The diagnostic impression was probably psoriasis versus possible lichen planus. The examiner suggested a skin biopsy for confirmation of a diagnosis. The veteran presented sworn testimony at a July 1991 personal hearing in which he related his medical history. He reported that he received inservice treatment for his skin disorder. He also related that he received private medical treatment subsequent to service discharge. He described his current symptoms and indicated that it was worse in the summertime. A VA dermatology examination report dated in August 1991 reveals that the veteran complained of an itchy, burning rash on the back. Physical examination evidenced a fan-shaped distribution of a papulosquamous dermatitis consistent with tinea versicolor. There was no papulosquamous dermatitis discerned on the buttocks or thighs. The papulosquamous dermatitis measured 5 inches in length on the mid-back and inferior aspect and 7 inches on the superior aspect. There was no keloid formation adherence. There was no pain or tenderness. There was mild erythema. The diagnosis was tinea versicolor, primary area of involvement, the back (history of involvement in the shoulders, upper arms and thighs). After a review of the claims folder the examiner amended his examination report. He articulated the veteran's medical history. He further commented that the present dermatitis, tinea versicolor was a different dermatosis than that suffered in service since pityriasis rosea is a self-limited condition. As referred to above, the threshold question to be answered in this case is whether the appellant has presented a well-grounded claim, that is, one which is plausible when the contentions and the evidentiary records are viewed in the light most favorable to that claim. If he has not, his appeal must fail. 38 U.S.C.A. § 5107(a) (West 1991). In reviewing the veteran's record, it is noted that there is no evidence that is clinically supportive of the appellant's theory. The appellant has not presented any probative evidence, medical or otherwise, that would indicate that he currently suffers from any residuals of pityriasis rosea, warts of the right hand and penis or sebaceous cyst of the right elbow or that his current skin disorders are related to service. A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service. See 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303 (1993); Rabideau v. Derwinski, 2 Vet.App. 141,143 (1992). There are various diagnoses of skin disorders noted following service; however, it is significant to note that he underwent clinical testing during service which reflected a diagnosis of pityriasis rosea and the examiner indicated that the dermatitis would be "self limiting" after a period of two or three weeks. Furthermore, the veteran has been examined on numerous occasions by private and VA physicians, subsequent to service, and there is no indication that the veteran experienced a recurrence of pityriasis rosea, warts of the right hand and penis or sebaceous cyst of the right elbow; nor has any physician related the veteran's current skin disorder to service. In fact, a VA dermatologist has specifically set forth the opinion that the current dermatitis is not the same that was diagnosed in service. Although the veteran has contended that his current skin manifestations are related to service, he has not presented any pertinent evidence to support his theory. For evidence to be credible as it pertains to questions involving medical expertise, such as whether a disability is etiologically related to a condition noted in service, it must generally be developed through individuals possessed of the appropriate qualifications, i.e. medical professionals. We carefully considered the veteran's testimony presented at his July 1991 personal hearing. Although the veteran has referred to receiving medical treatment for a rash similar to that which was documented in service, within a time period proximate to service discharge, the veteran has indicated that there are no obtainable clinical records verifying such treatment. Although this is unfortunate, the fact remains that this appeal must be resolved on the basis of the evidence which is on file. The veteran is always free to submit records in an effort to reopen his claim, in the event evidence supportive of his claim should be obtained and/or developed. II. Increased rating for a psychiatric disorder As noted, it is necessary to determine if the appellant has submitted a well-grounded claim and, if so, whether the VA has assisted the appellant in properly developing his claim. A "well-grounded" claim is one which is not implausible. The appellant's claim for an increased rating for anxiety reaction with depression appears to be reasonably based. A review of the evidence further indicates that all relevant facts have been properly developed and that there is sufficient evidence upon which to fairly resolve the issue of an increased rating for anxiety reaction with depression. Therefore, a remand in order to permit additional development of the record is unnecessary. An historical review of the veteran's medical record indicates that in June 1970, the veteran while receiving treatment for epigastric pain noted being nervous. Again in February 1972, while being treated for stomach pains he was noted to be nervous. In June 1974, there is a clinical notation indicating chronic anxiety. A July 1974 clinical note relates that he was very anxious and shaky after receiving a laceration to the forehead. His separation examination does not note any psychiatric difficulties. A rating decision dated in June 1975 granted service connection for anxiety reaction with depression, at a 10 percent disability rating. The veteran was interviewed by a VA social worker in April 1976. The social worker indicated that his psychiatric condition appeared aggravated by life's circumstances as opposed to general deterioration. His unemployment coupled with his foreseeable responsibilities contributed to his anxiousness. It was further noted that he had been faced with several adult decision making situations that apparently tested his imagination for appropriateness. The combination of job losses, temporary alienation from his sister, unemployment and his divorce offered threatening realities for him. The Board notes that ratings assigned for psychiatric disorders represent the impairment of social and industrial adaptability based on all of the evidence of record. 38 C.F.R. § 4.3 (1993). A 10 percent evaluation requires emotional tension or other evidence of anxiety productive of mild social and industrial impairment. Whereas, a 30 percent evaluation is warranted for anxiety reaction with depression when there is definite impairment in the ability to establish or maintain effective and wholesome relationships with people and when psychoneurotic symptoms result in such reduction in initiative, flexibility, efficiency and reliability levels as to produce definite industrial impairment. In Hood v. Brown, 4 Vet.App. 301 (1993), the United States Court of Veterans Appeals (hereinafter "the Court") stated that the term "definite" as utilized in 38 C.F.R. § 4.132 (1993) was "qualitative" in character, whereas the other descriptive terms were "quantitative" in character, and invited the Board to "construe" the term "definite" in a manner that would quantify the degree of impairment for purposes of satisfying the Board's statutory duty to articulate the "reasons and bases" for its decision under 38 U.S.C.A. § 7104(d)(1) (West 1991). The Board subsequently requested an opinion from the Office of the General Counsel of the VA. In a precedent opinion dated November 9, 1993, the General Counsel concluded that the term "definite" is to be construed as denoting "distinct, unambiguous, and moderately large in degree." It represents a degree of social and industrial impairment that is "more than moderate but less than rather large." O.G.C. Prec. 9-93 (Nov. 9, 1993). The Board is bound by this interpretation of the term "definite" when applying the provisions of 38 C.F.R. § 4.132, Diagnostic Code 9411 (1993). 38 U.S.C.A. § 7104(d)(1) (West 1991). In this regard, in September 1990, the veteran underwent a VA psychiatric examination. The veteran reported that he had been employed for the last 11 years. He reported that he had not been hospitalized or received psychiatric treatment in the past. He stated that he suffered from impaired sleep, being tense, and tremulous. He also stated that at night he would grind his teeth. Mental status examination revealed that he was casually dressed. He was coherent, goal directed, tremulous and uptight. There were no perceptual disorders. He was oriented times three. His memory was intact. His insight and judgment was fair. He was not suicidal or homicidal. The diagnosis was generalized anxiety disorder. Medication was being prescribed. At the veteran's July 1991 personal hearing he indicated that he was no longer employed. The veteran attributed this to the fact that his former place of employment had to downsize. He related that this resulted in increased anxiety. He reported that he did not like crowds. He sometime took out his frustration on his family. There was not much socializing and if upset he would not eat. He also reported impaired sleep. An April 1991 mental hygiene clinic report indicates that the veteran reported that his Valium helped him relax, but only 4 to 6 hours. He denied being depressed, suicidal or homicidal. He was calm and collected. He made good eye contact. His memory and concentration was good. He was oriented times four. He was prescribed Valium and told to return in four months. During a VA examination in August 1991, the veteran was noted to be employed as a production fabricator. The current 10 percent rating contemplates mild impairment in the ability to establish or maintain effective and wholesome relationships with people. In this regard, when evaluating psychiatric disabilities, it is necessary to consider, in addition to present symptomatology or its absence, the frequency, severity and duration of previous periods of impairment. As noted above, the veteran's most recent medical records do not indicate that there are symptoms of "definite" behavioral problems associated with anxiety reaction with depression such as would warrant assignment of a 30 percent evaluation. The psychiatric symptomatology has been historically mild in nature and recent examinations have not shown an increase in his clinical manifestations. The VA examination conducted during the appeal period reveals that the veteran's memory is intact, judgment is adequate, and there is no evidence of a thought or perceptual disorder. The evidence suggests he retains cognitive and other capacities consistent with a "mild" degree of social and industrial impairment. Although he was unemployed, it is not shown that this was a result of his psychiatric disability. Additionally, it appears that his medication controls those symptoms that are present. He admitted at his last examination that his current medication helps him relax. The Board has carefully considered the testimony furnished by the veteran at his July 1991 personal hearing in which he reported his medical history and current symptomatology. Nevertheless, while the veteran's symptomatology shows some impairment in interpersonal and social functioning, it is found that the predominant psychiatric manifestations are not shown to be more than mild in nature. Accordingly, because a higher evaluation requires definite impairment of social and industrial adaptability, 38 C.F.R. Diagnostic Code 9400 (1993), and in light of the veteran's psychiatric history and information developed pursuant to recent VA psychiatric examinations, it is found that a higher evaluation is not warranted. The Board has also considered the veteran's entitlement to an evaluation in excess of 10 percent pursuant to the provisions of 38 C.F.R. § 3.321 (1993); however, it is not found that this case presents such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards. Basically, a repeated pattern of hospitalizations or unusual interference with employment pursuits is not shown to be attributable to the veteran's psychiatric disorder. ORDER The appellant's claim for service connection for a chronic skin disorder is dismissed inasmuch as it is not well-grounded. An increased evaluation for anxiety reaction with depression, is denied. JEFFREY J. MARTIN 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.