Citation Nr: 0000646 Decision Date: 01/10/00 Archive Date: 01/19/00 DOCKET NO. 96-36 670 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Paul, Minnesota THE ISSUES 1. Entitlement to service connection for diabetes. 2. Entitlement to service connection for major depressive episode with psychotic features. 3. Entitlement to service connection for post-traumatic stress disorder (PTSD). 4. Entitlement to service connection for arthritis. 5. Entitlement to service connection for dermatofibromas. 6. Entitlement to service connection for seborrheic dermatitis. 7. Entitlement to service connection for rhinitis with chronic rhinorrhea. 8. Entitlement to service connection for male pattern baldness. 9. Entitlement to service connection for blurry vision due to an undiagnosed illness. 10. Entitlement to service connection for fatigue, sleep disturbance, insomnia, nervousness, irritability, memory loss, and depression due to an undiagnosed illness. 11. Entitlement to service connection for headaches with sinus congestion due to an undiagnosed illness. 12. Entitlement to service connection for muscle pain and cramps in calves due to an undiagnosed illness. 13. Entitlement to service connection for joint pain in the elbows, knees, hands, knuckles, and left fourth toe due to an undiagnosed illness. 14. Entitlement to service connection for weight loss due to an undiagnosed illness. 15. Entitlement to service connection for skin rashes and lumps due to an undiagnosed illness. 16. Entitlement to service connection for increased sweating due to an undiagnosed illness. 17. Entitlement to service connection for runny nose and chronic cough due to an undiagnosed illness. 18. Entitlement to service connection for hair loss due to an undiagnosed illness or to toxic exposure. 19. Entitlement to an increased (compensable) rating for tinea corporis. 20. Entitlement to an increased (compensable) rating for blepharitis with watering and swelling of the eyes. REPRESENTATION Appellant represented by: AMVETS ATTORNEY FOR THE BOARD Andrew E. Betourney, Associate Counsel INTRODUCTION The veteran served on active duty from March 1987 to May 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 1996 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky, and from a November 1997 rating decision by the VA RO in St. Paul, Minnesota, which denied the claims listed above. The veteran filed timely appeals to these adverse determinations. The Board notes that one of the issues denied by the RO in the January 1996 rating decision consisted of an unspecified "disability" which was comprised of eleven different "manifestations," and this claim was properly and timely appealed. In later statements of the case (SOC) and supplemental statements of the case (SSOC), the RO divided this claim into its several component parts, listing each manifestation as a different claim. The veteran then filed timely appeals to some, but not all, of these newly-created separate issues. However, the Board finds that the veteran's appeal to the initial denial of his multi-symptom disability, which specified the manifestations claimed, constitutes a timely appeal to all of these issues. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the appeal has been obtained by the RO. 2. The veteran has not presented competent evidence that his current diabetes is related to an injury or disease incurred in service. 3. The veteran has not presented competent evidence that his current major depressive episode with psychotic features is related to an injury or disease incurred in service. 4. The veteran has not presented competent evidence that he currently suffers from post-traumatic stress disorder (PTSD). 5. The veteran has not presented competent evidence that he currently suffers from arthritis. 6. The veteran has not presented competent evidence that his current dermatofibromas are related to an injury or disease incurred in service. 7. The veteran has not presented competent evidence that his current seborrheic dermatitis of the scalp is related to an injury or disease incurred in service. 8. The veteran has not presented competent evidence that his current rhinitis with chronic rhinorrhea is related to an injury or disease incurred in service. 9. Male pattern baldness is a congenital and developmental defect, and, as such, is not a disease or injury within the meaning of applicable legislation. 10. The veteran has not presented competent evidence that his current blurry vision is due to an undiagnosed illness. 11. The veteran has not presented competent evidence that his current fatigue, sleep disturbance, insomnia, nervousness, irritability, memory loss, and depression are due to an undiagnosed illness. 12. The veteran has not presented competent evidence that his current headaches with sinus congestion are due to an undiagnosed illness. 13. The veteran has not presented competent evidence that his current muscle pain and cramps in calves are due to an undiagnosed illness. 14. The veteran has not presented competent evidence that his current joint pain in the elbows, knees, hands, knuckles, and left fourth toe is due to an undiagnosed illness. 15. The veteran has not presented competent evidence that his current weight loss is due to an undiagnosed illness. 16. The veteran has not presented competent evidence that his current skin rashes and lumps are due to an undiagnosed illness. 17. The veteran has not presented competent evidence that his current increased sweating is due to an undiagnosed illness. 18. The veteran has not presented competent evidence that his current runny nose and chronic cough are due to an undiagnosed illness. 19. The veteran has not presented competent evidence that his current hair loss is due to an undiagnosed illness or to toxic exposure. 20. The veteran's tinea corporis was most recently found to be inactive, and is reportedly nonpruritic and easily controlled by medicated cream when it is active. 21. The veteran's blepharitis is currently active, and is manifested by itching which requires a hygiene regimen for control. CONCLUSIONS OF LAW 1. The veteran's claim for service connection for diabetes is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The veteran's claim for service connection for major depressive episode with psychotic features is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 3. The veteran's claim for service connection for post- traumatic stress disorder (PTSD) is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 4. The veteran's claim for service connection for arthritis is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 5. The veteran's claim for service connection for dermatofibromas is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 6. The veteran's claim for service connection for seborrheic dermatitis of the scalp is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 7. The veteran's claim for service connection for rhinitis with chronic rhinorrhea is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 8. The veteran's claim for service connection for male pattern baldness must fail as a matter of law. 38 C.F.R. § 3.303(c) (1999); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). 9. The veteran's claim for service connection for blurry vision due to an undiagnosed illness is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 10. The veteran's claim for service connection for fatigue, sleep disturbance, insomnia, nervousness, irritability, memory loss, and depression due to an undiagnosed illness is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 11. The veteran's claim for service connection for headaches with sinus congestion due to an undiagnosed illness is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 12. The veteran's claim for service connection for muscle pain and cramps in calves due to an undiagnosed illness is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 13. The veteran's claim for service connection for joint pain in the elbows, knees, hands, knuckles, and left fourth toe due to an undiagnosed illness is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 14. The veteran's claim for service connection for weight loss due to an undiagnosed illness is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 15. The veteran's claim for service connection for skin rashes and lumps due to an undiagnosed illness is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 16. The veteran's claim for service connection for increased sweating due to an undiagnosed illness is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 17. The veteran's claim for service connection for a runny nose and chronic cough due to an undiagnosed illness is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 18. The veteran's claim for service connection for hair loss due to an undiagnosed illness or to toxic exposure is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 19. The schedular criteria for a compensable rating for tinea corporis have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321, 4.1-4.3, 4.7, 4.118, Diagnostic Code 7899-7806 (1999). 20. The schedular criteria for a 10 percent rating for blepharitis with watering and swelling of the eyes have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321, 4.1-4.3, 4.7, 4.118, Diagnostic Code 7899-7806 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service connection claims A. Non-Persian Gulf War undiagnosed illness claims In order to establish service connection for a claimed disability, the facts, as shown by the evidence, must demonstrate that a particular injury or disease resulting in a current disability was incurred in or aggravated coincident with service in the Armed Forces. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303(a) (1999). However, the first step in this analysis is to determine whether the veteran has presented a well-grounded claim for service connection. In this regard, the veteran bears the burden of submitting sufficient evidence to justify a belief by a fair and impartial individual that the claim is well grounded. 38 U.S.C.A. § 5107(a); Robinette v. Brown, 8 Vet. App. 69, 73 (1995). Simply stated, a well-grounded claim must be plausible or capable of substantiation. Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). Where the determinative issue involves medical etiology or a medical diagnosis, competent medical evidence that a claim is "plausible" or "possible" is required for the claim to be well grounded. See Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997); Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Grottveit, 5 Vet. App. 91 (1993). This burden may not be met merely by presenting lay testimony, because lay persons are not competent to offer medical opinions. See Epps, supra; Grottveit, supra; Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). Service connection generally requires: (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of inservice incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed inservice disease or injury and the present disease or injury. See Epps, supra; Caluza v. Brown, 7 Vet. App. 498 (1995); see also Heuer, supra and Grottveit, both supra; Savage v. Gober, 10 Vet. App. 488, 497 (1997). In addition, a well-grounded claim may be established under the provisions of 38 C.F.R. § 3.303(b) when the evidence, regardless of its date, shows that a veteran had a chronic condition in service or during an applicable presumption period and still has such a condition. Such evidence must be medical unless it relates to a condition as to which, under the case law of the United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) (Court), lay observation is competent. If the chronicity provision is not applicable, a claim may still be well grounded on the basis of § 3.303(b) if the condition observed during service or any applicable presumption period still exists, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present condition to that symptomatology. Savage, 10 Vet. App. at 498. In the absence of evidence of a well-grounded claim, there is no duty to assist the claimant in developing the facts pertinent to the claim, and the claim must fail. Gregory v. Brown, 8 Vet. App. 563, 568 (1996) (en banc); Slater v. Brown, 9 Vet. App. 240, 243 (1996); Grivois v. Brown, 6 Vet. App. 136, 140 (1994); Grottveit, supra. 1. Diabetes A review of the veteran's service medical records reveals that they are negative for evidence of any reported complaint or diagnosis of, or treatment for, diabetes. The first evidence relating to the existence of diabetes is contained in a statement from the veteran, received by VA in May 1995. At that time, the veteran stated that he had been diagnosed with diabetes. He enclosed a statement from his treating physician, dated May 15, 1995, which noted that "[the veteran] was seen in the urgent care clinic this morning." No reason for this visit was given. In July 1995, the veteran underwent a VA examination. At that time, the veteran reported that he had experienced polydipsia, polyuria, and polyphagia for the previous year, and had been diagnosed with Type II diabetes. The examiner rendered a relevant diagnosis of Type II diabetes. At the time of a subsequent VA psychiatric examination in September 1995, no findings related to diabetes were noted. However, the examiner rendered an Axis III diagnosis of "Type II diabetes mellitus, diagnosed 5/15/95." Subsequent VA records, including various VA outpatient treatment notes and the reports of VA examinations, indicated several diagnoses of Type II diabetes. However, none of these records related the veteran's diabetes to service. On the contrary, those records which did refer to the veteran's history of diabetes consistently stated that the disorder was not diagnosed until May 1995. Of particular note is the May 15, 1995 VA treatment record itself, which noted that the veteran had been experiencing related symptoms for several months, and which diagnosed probable adult onset diabetes mellitus "since symptoms [have been] present 5-6 months." A review of this medical evidence indicates that the veteran clearly suffers from a current diabetes disorder. However, the Board has found no competent medical evidence to link the veteran's current diabetes to his period of active duty service, more than three years prior to the first post- service diagnosis. Indeed, the only evidence purporting to link the veteran's diabetes to service consists of statements made by the veteran himself in various correspondence sent to the VA. As the veteran is not a medical expert, he is not competent to express an authoritative opinion regarding the medical etiology of a current disorder, and, thus, the veteran's lay opinions cannot be accepted as competent evidence to the extent that they purport to establish such medical causation. See Espiritu v. Derwinski, 2 Vet. App. 492, 494-5 (1992). See also Heuer v. Brown, 7 Vet. App. 379, 384 (1995), citing Grottveit, in which the Court held that an appellant does not meet his or her burden of presenting evidence of a well-grounded claim where the determinative issue involves medical causation and the appellant presents only lay testimony by persons not competent to offer medical opinions. Thus, the Board finds that the veteran's lay opinions do not provide competent evidence of the required nexus. 2. Major depressive episode with psychotic features A review of the veteran's service medical records reveals that they are negative for evidence of any reported complaint or diagnosis of, or treatment for, a major depressive episode. Relevant post-service evidence includes the report of a VA psychiatric examination conducted in July 1995. Following an examination, the examiner found that the veteran did not meet the criterion for an Axis I psychiatric diagnosis other than alcohol abuse, in remission, and thus rendered a diagnosis of same. In August 1995, the veteran underwent a Persian Gulf War Registry examination. At that time, he reported a 3-year history of depression. He noted that he had been recently diagnosed with diabetes, and was "having a hard time accepting this." He stated that he was unsure what effect the Persian Gulf War had had on him, but he stated that he was "different." The examiner rendered Axis I diagnoses of major depression, and rule out PTSD. In September 1995, the veteran again underwent a VA psychiatric examination. At that time, the examiner noted that the veteran had symptoms of dysthymia, but did not meet the criteria for a diagnosis of this disorder because of his coexisting organic factor of diabetes. The examiner rendered an Axis I diagnosis of alcohol abuse, in remission. In July 1997, the veteran underwent another psychiatric examination. At that time, the examiner noted the findings and results of the previous examinations, discussed above, and noted that the veteran was being followed in the Mental Health Clinic for major depressive disorder. Following an examination, the examiner stated that the sole Axis I disorder "remains that of major depressive disorder with psychotic features." However, no statement regarding the etiology or onset of this disorder was provided. A review of this medical evidence indicates that the veteran clearly suffers from a current major depressive disorder with psychotic features. However, the Board has found no competent medical evidence to link the veteran's current major depressive disorder to his period of active duty service, several years prior to the first post-service diagnosis. Indeed, the only evidence purporting to link the veteran's major depressive disorder to service consists of statements made by the veteran himself. Once again, the Board does not doubt the sincerity of the veteran's belief in this claimed causal connection, but as the veteran is not a medical expert, he is not competent to express an authoritative opinion regarding the medical etiology of a current disorder. See Espiritu, supra. Thus, the Board finds that the veteran's lay opinions do not provide competent evidence of the required nexus. 3. Post-traumatic stress disorder (PTSD) A thorough review of the medical evidence in this case, including the veteran's service and post-service medical records, reveals no evidence that the veteran has ever been diagnosed with PTSD. The Board acknowledges that at the time of the veteran's August 1995 Persian Gulf War Registry examination, discussed above, the veteran was diagnosed with major depression and "rule out" PTSD. As a result the veteran was referred later that same day to Dr. Russell at the post-traumatic stress recovery (PTSR) Clinic at the VA Medical Center. Following this examination, also conducted in August 1995, the examiner stated that the veteran did not appear depressed, and noted that he did not see any evidence of PTSD, since the veteran did not report either the symptoms or the stressors associated with that disorder. The veteran was again seen at the psychiatry service in October 1995. At that time, the examiner noted that the veteran had been referred "apparently for maintenance of medication, on the thought that he has PTSD. He was referred to me notwithstanding [the fact] that Dr. Russell had seen him on the 31st of August and found that he does not have PTSD, and that there is not a history of exposure to traumatic stressors." This examiner then detailed the veteran's chart entries, and diagnosed dysthymia and hypochondriasis. He specifically found that "[t]here is no evidence of PTSD." Finally, the veteran underwent a VA psychiatric examination in July 1997, at which time it was noted that the veteran had previously been investigated for PTSD, but that this disorder was not found. Following an examination, the examiner determined that the veteran's diagnosis "remains that of major depressive disorder with psychotic features." A review of all the medical evidence of record in this claim, including the veteran's service and post-service medical records, thus fails to indicate that the veteran has ever been diagnosed with PTSD. As a well-grounded claim requires medical evidence of a current disability, the veteran's claim for service connection for PTSD must be denied as not well grounded. See Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). 4. Arthritis A thorough review of the medical evidence in this case, including the veteran's service and post-service medical records, reveals no evidence that the veteran has ever been diagnosed with arthritis. As a well-grounded claim requires medical evidence of a current disability, as discussed above, the veteran's claim for service connection for arthritis must be denied as not well grounded. See Rabideau, 2 Vet. App. at 144. 5. Dermatofibromas A review of the veteran's service medical records reveals that they are negative for evidence of any reported complaint or diagnosis of, or treatment for, dermatofibromas. The first, and indeed the only, evidence of the existence of dermatofibromas is contained in the report of a VA dermatology examination conducted in August 1997. At that time, the veteran reported having persistent bumps involving his right dorsal forearm, left dorsal forearm and left lateral lower leg. He stated that these lesions had been present for approximately four or five years, and were asymptomatic. On examination, a dermatofibroma was found on each of the veteran's left lateral lower leg, right dorsal forearm, and left dorsal forearm. The examiner diagnosed dermatofibromas of the right and left dorsal forearms, and of the left lateral lower leg. No statement regarding the etiology of these dermatofibromas was made. A review of this medical evidence indicates that the veteran clearly suffers from dermatofibromas. However, the Board has found no competent medical evidence to link the veteran's current dermatofibromas to his period of active duty service, more than five years prior to the first post-service diagnosis. Indeed, the only evidence purporting to link the veteran's dermatofibromas to service consists of statements made by the veteran himself. Once again, the Board does not doubt the sincerity of the veteran's belief in this claimed causal connection, but as the veteran is not a medical expert, he is not competent to express an authoritative opinion regarding the medical etiology of a current disorder. See Espiritu, supra. Thus, the Board finds that the veteran's lay opinions do not provide competent evidence of the required nexus. 6. Seborrheic dermatitis of the scalp A review of the veteran's service medical records reveals that they are negative for evidence of any reported complaint or diagnosis of, or treatment for, seborrheic dermatitis of the scalp. As was the case with dermatofibromas, above, the first and only evidence of the existence of seborrheic dermatitis of the scalp is contained in the report of the VA dermatology examination conducted in August 1997. At that time, examination of the scalp was remarkable for diffuse scale scattered throughout the veteran's hair, consistent with seborrheic dermatitis. The examiner diagnosed seborrheic dermatitis involving the scalp, but, again, no statement regarding the etiology of this disorder was made. A review of this medical evidence indicates that the veteran currently suffers from seborrheic dermatitis of the scalp. However, as the Board has found no competent medical evidence to link the veteran's current seborrheic dermatitis to his period of active duty service, more than five years prior to the first post-service diagnosis, the Board again determines that, in the absence of competent evidence of the required nexus, the veteran's claim is not well grounded. See Espiritu, supra. 7. Rhinitis with chronic rhinorrhea A review of the veteran's service medical records reveals that the veteran was seen on several occasions in service with complaints or a runny or congested nose, among other symptoms. However, none of the examinations conducted at those times resulted in a definite diagnosis of rhinitis. Instead, the veteran was diagnosed with an upper respiratory infection (URI) in April 1987, post-nasal drip in September 1987, a URI versus allergic rhinitis in January 1991, and a URI/common cold in October 1991. The only post-service diagnosis of rhinitis is found in the report of a VA examination conducted in August 1997. At that time, the veteran complained of recurrent rhinorrhea and postnasal drainage, which he stated had been a problem for "several" years. Examination revealed a moderate deviation of the nasal septum with significant inferior turbinate hypertrophy bilaterally. The mucosa was edematous and erythematous, which was consistent with rhinitis. The examiner diagnosed rhinitis and chronic rhinorrhea. A review of this medical evidence indicates that the veteran clearly suffers from a current rhinitis disorder. However, the Board has found no competent medical evidence to link the veteran's current rhinitis and chronic rhinorrhea to his period of active duty service, more than five years prior to the first post-service diagnosis. Indeed, the only evidence purporting to link the veteran's rhinitis to service consists of statements made by the veteran himself. Once again, the Board does not doubt the sincerity of the veteran's belief in this claimed causal connection, but as the veteran is not a medical expert, he is not competent to express an authoritative opinion regarding the medical etiology of a current disorder. See Espiritu, supra. Thus, the Board finds that the veteran's lay opinions do not provide competent evidence of the required nexus. 8. Male pattern baldness A review of the veteran's service medical records reveals that in April 1990, the veteran presented with multiple complaints, including the fact that the hair on his head was getting thinner. The examiner advised the veteran that "it was hereditary." No diagnosis was rendered at that time. Relevant post-service evidence includes a treatment report dated in October 1995 from a VA PTSR Clinic. At that time, the veteran stated his belief that his "hair loss...are due to toxic exposure in the Persian Gulf." However, the examiner noted that the veteran's condition was male pattern baldness, and stated that the veteran's belief that his symptoms were due to toxic exposure were "not shakeable by discussion," despite the fact that the veteran's father and two uncles had male pattern baldness. In August 1997, the veteran underwent a VA dermatological examination. At that time, the veteran stated that he had noticed gradual thinning and loss of hair over the crown of his scalp. He reported a family history significant for father and paternal uncles who had the same pattern of hair loss and had essentially the same amount of hair as he did, but was concerned because these family members lost their hair at a much later age. On examination, the examiner noted diffuse thinning of hair over the entire crown with almost complete alopecia involving the posterior crown and anterior portion of the scalp. The examiner diagnosed androgenetic alopecia involving the scalp. The Board acknowledges that the veteran was found to suffer from "hereditary" hair thinning in service, and was twice diagnosed with male pattern baldness after service. However, to the extent that the veteran is attempting to establish service connection for male pattern baldness, the law concerning awards of service connection for congenital and developmental defects is dispositive in this case. In this regard, 38 C.F.R. § 3.303(c) (1999) provides that congenital or developmental defects are not diseases or injuries within the meaning of applicable legislation governing the award of compensation benefits. As such, regardless of the character or the quality of any evidence which the veteran could submit, a strictly congenital or developmental defect, such as hereditary male pattern baldness (androgenic alopecia), cannot be recognized as a disability under the terms of the VA's Schedule for Rating Disabilities and must be denied as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). B. Persian Gulf War undiagnosed illness claims The veteran has claimed entitlement to service connection for numerous disabilities which he asserts are due to an undiagnosed illness caused by toxic exposure during the Persian Gulf War. These claimed disabilities include the following: blurry vision, fatigue, sleep disturbance, insomnia, nervousness, irritability, memory loss, depression, headaches with sinus congestion, muscle pain and cramps in calves, joint pain in the elbows, knees, hands, knuckles, and left fourth toe, weight loss, skin rashes and lumps, increased sweating, a runny nose and chronic cough, and hair loss. As noted above, in order to establish service connection for a claimed disability, the facts, as shown by the evidence, must demonstrate that a particular injury or disease resulting in a current disability was incurred in or aggravated by service in the United States Armed Forces. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. §§ 3.303(a), 3.304 (1999). In addition, 38 U.S.C.A. § 1117, "The Persian Gulf War Benefits Act," authorized the Secretary of VA to compensate any Persian Gulf veteran suffering from a chronic disability resulting from an undiagnosed illness, or combination of undiagnosed illnesses, that became manifest either during active duty in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more within a prescribed presumptive period following such service. As a result, VA regulations now authorize compensation for disabilities resulting from the undiagnosed illness of Persian Gulf veterans. 38 C.F.R. § 3.317, as amended by 62 Fed. Reg. 23, 139 (1999). VA shall pay compensation in accordance with chapter 11 of title 38, United States Code, to a Persian Gulf veteran who exhibits objective indications of chronic disability resulting from an illness or combination of illnesses manifested by one or more signs or symptoms, provided that such disability became manifest either during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2001, and by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. "Objective indications of chronic disability" include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. Signs or symptoms which may be manifestations of undiagnosed illness include, but are not limited to: fatigue, signs or symptoms involving skin, headache, muscle pain, joint pain, neurologic signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper or lower), sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. However, compensation shall not be paid under this section if any of the following is the case: there is affirmative evidence that an undiagnosed illness was not incurred during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War; or there is affirmative evidence that an undiagnosed illness was caused by a supervening condition or event that occurred between the veteran's most recent departure from active duty in the Southwest Asia theater of operations during the Persian Gulf War and the onset of the illness; or there is affirmative evidence that the illness is the result of the veteran's own willful misconduct or the abuse of alcohol or drugs. Furthermore, as with all service connection claims, the first step in this analysis is to determine whether the veteran has presented a well-grounded claim for service connection. Relevant evidence includes a VA outpatient treatment note dated in May 1995. At that time, the veteran presented with complaints of weight loss, insomnia, fatigue, polyuria, polydipsia, and depression, and noted that he had not felt well since his tour of duty in the Persian Gulf. The examiner diagnosed probable adult onset diabetes mellitus, since his symptoms had been present for the previous 5 to 6 months. In July 1995, the veteran underwent a VA general medical examination. At that time, he presented with multiple complaints, including difficulty sleeping and staying asleep, and having lost 20 pounds in the past year. The examiner diagnosed Type II diabetes mellitus, and "complaints of chronic fatigue which may be well related [sic] to his diabetes, as is the weight loss." In October 1995, the veteran underwent a psychiatric examination at a VA PTSR Clinic. At that time, the examiner recorded the veteran's complaints as follows: As best I can tell, pt. thinks that his diabetes, hair loss, elbow and knee pains, occasional big red welts on the face which come out as he is looking in the mirror (and thus are not mosquito bites), insomnia, depression, irritability, anxiety, a weight loss of 14 lbs. (since gained back), [and] decreased recreational activities are all due to toxic exposure in the Persian Gulf. Pt. was stationed in Quatar at an airbase. He was a structural maintenance person, and says he worked on many F-16s which were hosed down in case of chemical [sic], prior to his working on them; he also thinks he might have been contaminated by cutting up a piece of SCUD missile [] for souvenirs; he says further that he may have been exposed to the oil fire smoke, and during the course of his repair work on the bodies of aircraft, came into contact with epoxys, sealants, glues, resins, fiber glass, and p[a]ints. In summary, this is a patient with no history of exposure to traumatic stressors...who thinks he had multiple phy[s]ical sy[]mptoms caused by chemical exposure. The diagnosis is Dysthymia and Hypochodrias [sic]. Pt.'s beliefs that his symptoms are due to toxic exposure... are not shakeable by discussion. I was frank to tell him that I think most of his problems, other than the diabetes, are due to depression. The final diagnoses rendered were dysthymia and hypochondrias [sic]. Also relevant are multiple VA outpatient psychiatry notes dated throughout 1996. Symptoms reported included difficulty sleeping, fatigue, weight loss, night sweats, facial tics, depressed mood, a lack of interest, as well as paranoid ideation and ideas of reference, and some auditory hallucinations. These records indicate repeated diagnoses of major depressive disorder and major depressive episode, sometimes with a diagnosis of psychotic features as well. Also of note is a VA outpatient progress noted dated in March 1996 from a VA ophthalmology clinic. At that time, the patient reported a little blurring of his visual acuity, but no other eye problems. It was noted that the veteran had been diagnosed with diabetes mellitus one year earlier, and that the veteran "didn't understand why diabetes affect[s] him in his eyes." The final assessment was Type I diabetes mellitus. In July 1997, the veteran underwent a VA neurological examination. At that time, the veteran reported having experienced headaches over the past four or five years. He stated that the onset of these headaches coincided roughly with his experience of depression. He also stated that he only had these headaches when he had "stuffed up" sinuses. Following an examination, the examiner diagnosed headaches related to sinus congestion, with no deficits on neurologic examination. In addition, the veteran underwent a VA ophthalmology examination in July 1997. Following this examination, the examiner diagnosed "[i]nsulin dependent diabetes since 1992 without retinopathy. The patient has poor blood sugar control and this is probably causing his intermittent blurred vision." Finally, the Board notes that the veteran himself has attributed some of his "Gulf War" symptoms to other causes, including his diabetes. For instance, in his VA Form 9 Appeal dated in October 1998, the veteran argued that he should be granted service connection for diabetes because he "had symptoms of full blown diabetes which included drinking four gallons of liquid a day, still thirsty, weight loss lost over twenty pounds, urination twenty or more times a day, blurry vision." The Board thus finds that all of the veteran's various symptomatic complaints have been attributed by examiners to known, clinical diagnoses. Several symptoms, such as weight loss, increased urination, increased sweating, and blurred vision, have repeatedly been attributed to his diabetes. Others, such as fatigue, insomnia, nervousness, irritability, memory loss, anxiety, skin problems, joint pains, and a general loss of interest in activities, have been attributed to depression, which, in turn, has been linked on many occasions to his difficulty dealing with his diabetes. Still others, such as hair loss, have been found to be due to inherited male pattern baldness, while his runny nose and cough have been attributed to upper respiratory infections, post-nasal drip, and, most recently, to rhinitis. In addition, his complaint of headaches has been specifically found to be due to sinus congestion. Similarly, his complaints of skin rashes and boils have been diagnosed as dermatofibromas and seborrheic dermatitis. The Board notes that the examiner who performed the August 1997 VA dermatology examination was unable to make specific diagnoses for several other reported skin disorders due to the fact that the complained-of problems were not present on examination, not because they were "undiagnosable." Furthermore, the examiner who performed the October 1995 VA psychiatric examination stated that he tried, unsuccessfully, to convince the veteran that his belief that his symptoms, including joint pains, skin disorders, insomnia, depression, irritability, anxiety, weight loss, male pattern baldness, and diabetes, were related to toxic exposure in the Persian Gulf was wrong. Clearly, this implies that this physician believed that the veteran's belief in a causal connection between his Gulf War service and his current complaints was unfounded. In any case, he diagnosed, among other things, hypochondriasis, which raises the question of whether some of these complaints even have a physical, clinical basis. In short, there is no evidence that the veteran's various somatic complaints, listed above, are in any way attributable to an "undiagnosed illness." The evidence does show that the veteran has suffered from several of these problems since service, which he believes are related to toxic exposure in the Persian Gulf. However, as noted above, service connection under section 3.317 is available only for undiagnosed illnesses attributable to Southwest Asia service during the Persian Gulf War, i.e., those illnesses which "by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis." In this case, the veteran's complaints have been specifically attributed to identifiable causes, and, as such, are not illnesses which "cannot be attributed to any known clinical diagnosis," and service connection under section 3.317 is precluded. C. Conclusion for service connection claims Therefore, given the lack of competent evidence that his claims are plausible, the Board determines that the veteran has not met his initial burden of submitting evidence sufficient to establish that his claims for service connection are well grounded, and the claims must be denied on that basis. As the duty to assist is not triggered here by the submission of well-grounded claims, the Board finds that VA has no obligation to further develop the veteran's claims. See Epps, supra; Grivois v. Brown, 5 Vet. App. 136, 140 (1994). In reaching this determination, the Board recognizes that some of these issues are being disposed of in a manner that differs from that employed by the RO. The RO denied some of the veteran's claims on the merits, while the Board has concluded that these claims are not well grounded. The Board has therefore considered whether the veteran has been given adequate notice to respond, and if not, whether he has been prejudiced thereby. Bernard v. Brown, 4 Vet. App. 384, 394 (1993). Since the Court has held that "when an RO does not specifically address the question whether a claim is well grounded but rather, as here, proceeds to adjudication on the merits, there is no prejudice to the veteran solely from the omission of the well-grounded-claim analysis," the Board finds no prejudice to the veteran in this case. Meyer v. Brown, 9 Vet. App. 425, 432 (1996). In addition, in reaching these determinations the Board notes that it has not been made aware of any outstanding evidence which could serve to well ground his service connection claims. Accordingly, there is no further duty on the part of VA to inform the veteran of the evidence necessary to complete his application for these benefits. 38 U.S.C.A. § 5103 (West 1991); McKnight v. Gober, 131 F.3d 1483, 1484-85 (Fed. Cir. 1997). II. Initial disability rating issues The veteran originally claimed entitlement to increased (compensable) ratings for his service-connected tinea corporis and blepharitis. This are original claims placed in appellate status by a notice of disagreement (NOD) taking exception to the initial rating award dated in November 1997. Accordingly, his claims must be deemed well grounded within the meaning of 38 U.S.C.A. § 5107(a), and VA has a duty to assist the veteran in the development of the facts pertinent to his claims. See Fenderson v. West, 12 Vet. App.119, 127 (1999) (applying duty to assist under 38 U.S.C.A. § 5107(a) to initial rating claims); cf. Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (increased rating claims). Under these circumstances, VA must attempt to obtain all such medical evidence as is necessary to evaluate the severity of the veteran's disabilities from the effective date of service connection to the present. Fenderson, supra., citing Goss v. Brown, 9 Vet. App. 109, 114 (1996); Floyd v. Brown, 9 Vet. App. 88, 98 (1996); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). See also 38 C.F.R. § 4.2 (ratings to be assigned "in the light of the whole recorded history"). This obligation was satisfied by the various examinations and treatment reports described below, and the Board is satisfied that all relevant facts have been properly and sufficiently developed. Disability evaluations are determined by the application of the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (1999). Any reasonable doubt regarding the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3 (1999). Where the particular disability for which the veteran has been service connected is not listed, it may be rated by analogy to a closely related disease in which not only the functions affected, but also the anatomical location and symptomatology are closely analogous. 38 C.F.R. §§ 4.20, 4.27; see also Lendenmann v. Principi, 3 Vet. App. 345 (1992); Pernorio v. Derwinski, 2 Vet. App. 625 (1992). A. Initial disability rating for tinea corporis. A review of the evidence related to this claim reveals that the veteran was first diagnosed with tinea corporis in April 1990, while still in service. At that time, the veteran complained of a rash, consisting of dry skin patches on the arms. Examination revealed ring-like scaly eruptions with erythema. The only post-service evidence relating to the veteran's tinea corporis is found in the August 1997 VA dermatological examination. At that time, the veteran reported a history of nonpruritic dry patches involving the dorsal arms, chest, lower legs and back, first noted in approximately 1989 or 1990. He stated that he believed that a diagnosis of a fungal infection was made at that time, and that he was treated with anti-fungal agents. He stated that he experienced flare-ups of this disorder approximately once per month, noting that if he did not use Micatin cream, the condition would either fail to improve or worsen. However, he said that the use of Micatin cream rapidly treated it. He reported that the condition was not currently active. Following an examination, the examiner diagnosed reported episodes of nonpruritic dry patches involving upper extremities, chest, back, and lower legs, currently not active, unable to make specific diagnosis based on veteran's history alone. The veteran's tinea corporis has been evaluated as noncompensably (zero percent) disabling by analogy to the provisions of 38 C.F.R. § 4.118, Diagnostic Code (DC) 7806. Pursuant to DC 7806, a noncompensable (zero percent) rating is warranted for eczema with slight, if any, exfoliation, exudation or itching, if on a nonexposed surface or small area. A 10 percent rating is warranted for eczema with exfoliation, exudation, or itching, if involving an exposed surface or extensive area. A 30 percent rating is warranted for eczema with exudation or itching which is constant, extensive lesions, or marked disfigurement. Finally, a 50 percent rating is warranted for eczema with ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or when it is exceptionally repugnant. A review of the evidence detailed above reveals no evidence that the veteran's tinea corporis disorder is currently active. Furthermore, the veteran has stated that this skin disorder is nonpruritic even when it is active, and that it is "rapidly treated" by the use of Micatin cream. Finally, the Board also notes that the areas affected include the upper extremities, chest, back, and lower legs, areas which are normally covered by clothing. Therefore, the Board finds that the veteran's symptomatology more closely corresponds to the criteria for a noncompensable rating under DC 7906, which contemplates eczema with slight, if any, exfoliation, exudation, or itching. However, since the evidence does not show that this skin disorder is manifested by eczema with exfoliation, exudation, or itching, involving an exposed surface or extensive area, a 10 percent rating under DC is not warranted. B. Initial disability rating for blepharitis with watering and swelling of the eyes. A review of the record reveals that the veteran was first diagnosed with blepharitis in March 1990, while in service. At that time, he complained of itching in both eyes since the previous night. Examination revealed a conjunctival infection, and exudate along the lashes of the eyelids. The examiner diagnosed blepharitis. The only post-service evidence which relates to blepharitis is the report of a VA examination conducted in August 1997. At that time, the veteran did not complain of blepharitis, per se, but anterior slit lamp examination was significant for +1 blepharitis. The examiner diagnosed blepharitis, both eyes, and recommended that the veteran use lid hygiene with lid scrubs and warm cloths for the blepharitis. The veteran's blepharitis has also been evaluated as noncompensably (zero percent) disabling by analogy to the provisions of 38 C.F.R. § 4.118, Diagnostic Code (DC) 7806. Pursuant to DC 7806, a noncompensable (zero percent) rating is warranted for eczema with slight, if any, exfoliation, exudation or itching, if on a nonexposed surface or small area. A 10 percent rating is warranted for eczema with exfoliation, exudation, or itching, if involving an exposed surface or extensive area. A 30 percent rating is warranted for eczema with exudation or itching which is constant, extensive lesions, or marked disfigurement. Finally, a 50 percent rating is warranted for eczema with ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or when it is exceptionally repugnant. A review of the evidence detailed above reveals that the veteran's blepharitis was recently found to be active, requiring the following of a lid hygiene regimen to control the disorder. The veteran has also complained of itching of the eyelids. The Board thus finds that the veteran's symptomatology more closely corresponds to criteria for a 10 percent evaluation under DC 7806, which contemplates eczema with itching on an exposed surface. However, there is no evidence which indicates that this itching is constant, or causes extensive lesions. Furthermore, although the veteran undoubtedly suffers from some swelling of the lids due to his blepharitis, the evidence does not show that this caused "marked disfigurement." Therefore, the criteria for a rating in excess of 10 percent have not been met. ORDER 1. Evidence of a well-grounded claim having not been submitted, service connection for diabetes is denied. 2. Evidence of a well-grounded claim having not been submitted, service connection for major depressive episode with psychotic features is denied. 3. Evidence of a well-grounded claim having not been submitted, service connection for post-traumatic stress disorder is denied. 4. Evidence of a well-grounded claim having not been submitted, service connection for arthritis is denied. 5. Evidence of a well-grounded claim having not been submitted, service connection for dermatofibromas is denied. 6. Evidence of a well-grounded claim having not been submitted, service connection for seborrheic dermatitis of the scalp is denied. 7. Evidence of a well-grounded claim having not been submitted, service connection for rhinitis with chronic rhinorrhea is denied. 8. Evidence of a legally meritorious claim having not been submitted, service connection for male pattern baldness is denied. 9. Evidence of a well-grounded claim having not been submitted, service connection for blurry vision due to an undiagnosed illness is denied. 10. Evidence of a well-grounded claim having not been submitted, service connection for fatigue, sleep disturbance, insomnia, nervousness, irritability, memory loss, and depression due to an undiagnosed illness, is denied. 11. Evidence of a well-grounded claim having not been submitted, service connection for headaches with sinus congestion due to an undiagnosed illness is denied. 12. Evidence of a well-grounded claim having not been submitted, service connection for muscle pain and cramps in calves due to an undiagnosed illness is denied. 13. Evidence of a well-grounded claim having not been submitted, service connection for joint pain in the elbows, knees, hands, knuckles, and left fourth toe due to an undiagnosed illness is denied. 14. Evidence of a well-grounded claim having not been submitted, service connection for weight loss due to an undiagnosed illness is denied. 15. Evidence of a well-grounded claim having not been submitted, service connection for skin rashes and lumps due to an undiagnosed illness is denied. 16. Evidence of a well-grounded claim having not been submitted, service connection for increased sweating due to an undiagnosed illness is denied. 17. Evidence of a well-grounded claim having not been submitted, service connection for a runny nose and chronic cough due to an undiagnosed illness is denied. 18. Evidence of a well-grounded claim having not been submitted, service connection for hair loss due to an undiagnosed illness or to toxic exposure is denied. 19. A compensable rating for tinea corporis is denied. 20. An increased disability rating to 10 percent for the veteran's blepharitis with watering and swelling of the eyes is granted, subject to the controlling regulations governing the payment of monetary awards. WARREN W. RICE, JR. Member, Board of Veterans' Appeals