BVA9500269 DOCKET NO. 93-11 945 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUE Entitlement to service-connection for psoriasis. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The appellant ATTORNEY FOR THE BOARD R. A. Caffery, Counsel INTRODUCTION The veteran served on active duty from May 1969 to December 1970. This is an appeal from a July 1991 rating action by the Department of Veterans Affairs (VA) Regional Office Louisville, Kentucky, which denied entitlement to service connection for psoriasis. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends, in substance, that service connection should be established for psoriasis since cysts in the scrotum area initially appeared during his active military service and he has suffered from these cysts and psoriasis ever since his active service. It is maintained that the cysts that formed during service were early manifestations of his current psoriasis. 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 veteran has not met the initial burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well-grounded. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the regional office. 2. Psoriasis was not demonstrated either during the veteran's active military service or for some two years following his release from active duty. 3. The veteran was treated during service for multiple inclusion cysts of the scrotum. No relationship between the cysts and his current psoriasis has been demonstrated. CONCLUSION OF LAW The veteran has not submitted evidence of a well-grounded claim. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board notes that it has found the veteran's claim not to be "well grounded" within the meaning of 38 U.S.C.A. § 5107(a); effective on and after September 1, 1989. That is, the Board finds, for the reasons discussed below, that he has not presented a claim which is plausible. The veteran's service medical records reflect that he was seen in March 1970 for multiple inclusion cysts of the scrotum. His service medical records, including the report of his physical examination for separation from service in December 1970, do not reflect any reference to psoriasis. The veteran's initial claim for VA disability benefits was submitted in early 1991. At that time he indicated that his skin disease had been first manifested in 1973. Medical records from a private physician reflect that the veteran was seen on several occasions beginning in February 1974 for a rash on his chest and back. When the veteran was examined by the VA in April 1991, he stated that in 1970 while he was in Vietnam, he noted numerous lesions that appeared on his body, especially on the knees, hands, scrotum and feet. He stated that those were diagnosed as psoriasis and he was given Lidex cream. The nails on his hands also became atrophic and depressed. On examination psoriatic lesions were noted on the veteran's back, over his knees and in the scrotal, buttock and crural areas. The fingernails and toenails were atrophic and flattened and somewhat deformed. The diagnosis was generalized psoriasis. In connection with his substantive appeal in February 1992, the veteran submitted statements from several family members who indicated that they had never had psoriasis and that there was no history of psoriasis in the veteran's family. He also submitted a February 1992 statement by Orson L. Arvin, M.D., who indicated that he had treated the veteran with Lidex for psoriasis on several occasions beginning in March 1975. The veteran was again examined by the VA in April 1992 and a diagnosis of psoriasis of the skin and nails was made. The veteran testified at a hearing at the regional office in July 1992. He indicated that he had been treated during service in 1970 for multiple cysts in the scrotum area. Following service, he had received treatment for skin problems at the VA Medical Center Lexington. The regional office thereafter received a number of outpatient and inpatient treatment records reflecting treatment of the veteran at the VA Medical Center Lexington beginning in 1973 for psoriasis and multiple sebaceous cysts of the scrotum. The veteran was also examined by the VA in August and November 1992 when diagnoses were made of psoriasis and psoriatic arthritis. In January 1993, the medical member of the rating board indicated that sebaceous or inclusion cysts were due to stopped up sebaceous glands resulting in a cyst formation. He stated that psoriasis was an inflammatory lesion of the skin characterized by a scaly plaque formation that could be widespread over the body. He stated that the cause of psoriasis was unknown. He indicated that there was no relationship between the two skin conditions which were totally different in appearance and etiology. He referred to a medical publication in support of his opinion. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by wartime service. 38 U.S.C.A. § 1110. In this particular case, as indicated previously, the veteran's service medical records do not contain any reference to psoriasis. The initial medical records of treatment for that condition date from early 1973 or more than two years following the veteran's separation from military service. The veteran's service medical records do reflect that he was observed for multiple sebaceous or inclusion cysts of the scrotum in March 1970 and the veteran has maintained that those cysts represented an early manifestation of the psoriasis that was demonstrated after service. However, the veteran has not provided any medical authority in support of his assertion. With regard to these contentions, the United States Court of Veterans Appeals (Court) has recently stated that: Where the issue is factual in nature, e.g., whether an incident or injury occurred in service, competent lay testimony, including a veteran's solitary testimony, may constitute sufficient evidence to establish a well-grounded claim under section 5107(a). See Cartright v. Derwinski, 2 Vet.App. 24 (1992). However, where the determinative issue involves medical causation or a medical diagnosis, competent medical evidence to the effect that the claim is "plausible" or "possible" is required. See Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). A claimant would not meet this burden imposed by section 5107(a) merely by presenting lay testimony because lay persons are not competent to offer medical opinions. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). Consequently, lay assertions of medical causation cannot constitute evidence to render a claim well grounded under section 5107(a); if no cognizable evidence is submitted to support a claim, the claim cannot be well grounded. Tirpak v. Derwinski, 2 Vet.App. 609, 611 (1992). Grottveit v. Brown, 5 Vet.App. 91, 93 (1993). Thus, since there is no evidence that the veteran has any level of medical expertise, his contentions are beyond his level of medical competence and do not need to be accepted as true for the purposes of determining whether his claim is well grounded. Accordingly, since the veteran has submitted no medical evidence that would support his contentions, the Board finds that the veteran has not met the initial burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. Thus, since the Board does not have jurisdiction to adjudicate his claim, the appeal is dismissed. See Boeck v. Brown, 6 Vet.App. 14 (1993). The Board notes that this decision is to the appellant's benefit since, if he should decide to file another claim in the future, he will not be burdened with having to submit new and material evidence; he need only present a well-grounded claim. McGinnis v. Brown, 4 Vet.App. 239, 244 (1993). There is of record a January 1993 opinion by a VA physician to the effect that there is no relationship between the two skin conditions which are totally different in appearance and etiology. The Board concurs in that opinion. Since psoriasis was not medically demonstrated either during the veteran's service or for some two years following his separation from service, the Board finds that the claim is not well-grounded and therefore should be dismissed. 38 U.S.C.A. §§ 1110, 5107; 38 C.F.R. § 3.303. ORDER Entitlement to service connection for psoriasis is not established. The appeal is dismissed. WAYNE M. BRAEUER 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.