BVA9508466 
DOCKET NO.  91-48 585     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in St. Petersburg,
Florida

THE ISSUES

1.  Entitlement to service connection for a disorder manifested
by shortness of breath, headaches and dizziness.

2.  Entitlement to service connection for a skin disorder.

REPRESENTATION

Appellant represented by: The American Legion

ATTORNEY FOR THE BOARD

Frank L. Christian, Counsel

INTRODUCTION

The veteran served on active duty from December 1982 to November
1988.

This matter comes before the Board of Veterans' Appeals (Board)
on appeal from a rating decision of June 1991 from the Department
of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg,
Florida.

CONTENTIONS OF APPELLANT ON APPEAL

The appellant contends that the RO committed error in failing to
grant service connection for a skin disorder and for a disorder
manifested by shortness of breath, headaches and dizziness
because it did not take into account or properly weigh the
medical and other evidence of record.  It is contended that the
veteran was treated on numerous occasions during his period of
active service for the disorders at issue, that such treatment is
clearly documented in his service medical records, and that he
has continued to receive treatment for these disabilities
following service separation.  It is contended that the veteran's
skin disorder was diagnosed during and after service as
cholinergic urticaria, hives and angioedema, and that continuity
of symptoms has been demonstrated.

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 evidence of record supports a grant of service
connection for urticaria productive of skin manifestations.

FINDINGS OF FACT

1.  All relevant evidence necessary for an equitable disposition
of the instant appeal with respect to the skin disorder has been
obtained by the RO.

2.  Urticaria productive of skin pathology was manifest during
active service and is present now.

CONCLUSION OF LAW

Urticaria productive of skin manifestations was incurred during
peacetime service.  38 U.S.C.A. §§ 1131, 5107 (West 1991).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Board finds that the veteran's claim for service connection
for a chronic skin disorder is plausible and is thus well
grounded within the meaning of 38 U.S.C.A. § 5107(a).  The Board
is also satisfied, with respect to this claim, that all relevant
facts have been properly developed, and that no further
assistance to the veteran is required to comply with 38 U.S.C.A.
§ 5107(a).

In order to establish service connection for claimed disability,
the facts, as shown by evidence, must demonstrate that a
particular disease or injury resulting in current disability was
incurred during active service or, if preexisting active service,
was aggravated therein.  38 U.S.C.A. §§ 1110, 1131.  A veteran
who served during a period of war or during peacetime service
after December 31, 1946, is presumed in sound condition except
for defects noted when examined and accepted for service.  Clear
and unmistakable evidence that the disability manifested in
service existed before service will rebut the presumption.
38 U.S.C.A. §§  1311, 1337.

For the showing of chronic disease in service there is required a
combination of manifestations sufficient to identify the disease
entity, and sufficient observation to establish chronicity at the
time, as distinguished from merely isolated findings or a
diagnosis including the word "chronic."  Continuity of
symptomatology is required where the condition noted during
service is not, in fact, shown to be chronic or where the
diagnosis of chronicity may be legitimately questioned.  When the
fact of chronicity in service is not adequately supported, then a
showing of continuity after discharge is required to support the
claim.  38 C.F.R. § 3.303(b) (1994).

Entitlement to Service Connection for a Chronic Skin Disorder

The veteran's service entrance examination disclosed that his
skin was normal.  His service medical records show that he was
seen on several occasions in April 1985, in October and November
1995, and in July and August 1986 for complaints of breaking out
in a rash after becoming overheated while running.  It was noted
that the skin rash usually resolved when he cooled off.
Examination in April 1985 disclosed a few lesions on the arms and
trunk and scattered areas of urticaria.  The diagnoses were
cholinergic urticaria and hives, and the veteran was treated with
Atarax.  An entry in November 1985 noted that the presence of an
intermittent skin rash on sweating or increased temperature had
been documented by other health care practitioners.  It was noted
that an extensive workup by internal medicine and the dermatology
clinic had all revealed normal findings and no pathology.  The
diagnosis was again shown as cholinergic urticaria and medication
with Atarax was continued.  The veteran did not undergo a service
separation examination.

VA outpatient clinic records dated in July 1991 show that the
veteran was seen for complaints which included episodes of
"sweating under the skin," and noted that a dermatologist who
examined him during active service was unable to establish the
etiology of his skin disorder.  The clinical impression was
possibly chronic skin disorder.

A July 1991 letter from R. A. Hoff, M.D., stated that the veteran
had a history consistent with recurrent angioedema brought on by
being very warm, as in exercising for a few minutes.  He
indicated that the condition first began while in the service in
1986.  Treatment notes from Dr. Hoff cited a history of inservice
treatment for a skin disorder, noting that the veteran's skin was
normal on current examination.  The diagnosis was angioedema, by
history.

In August 1991 and in September 1992, the veteran submitted
written statement describing the onset and the current state of
his skin disorder and provided color photographs showing areas of
his back, trunk, arms and legs with a clearly discernible rash.

A report of VA examination, conducted in September 1992, noted a
history offered by the veteran of recurrent welts, rashes and
occasional itching since 1986, precipitated by exposure to
sunlight or getting too much heat.  It was noted that one
physician had diagnosed the veteran's skin disorder as
angioedema.  On current evaluation, the veteran's skin was
normal.  The diagnosis was history of angioedema.

A report of dermatology consultation from the Florida Department
of Corrections, dated in March 1992, shows that the veteran had a
rash on his buttocks with some scarring, suggestive of a
folliculitis.  The clinical impression was folliculitis.

An October 1992 letter from Dermatologists Associates Clinic
noted the veteran's complaints of intermittent problems with
pruritic lesions that appeared when he got hot, exercised, or
took hot showers.  The lesions reportedly involved his legs,
chest, arms, and face, and resolved when he cooled off.  No skin
disorder was present on examination.  It was noted that the
veteran had had an extensive laboratory evaluation, and was
currently medicated with Atarax.  The clinical impression was
cholinergic urticaria (heat induced), by history.

An October 1993 letter from R. F. Humphreys, M.D., noted that the
veteran developed small hives when he became emotionally upset,
took a hot shower, exercised, or undertook any activity that made
him sweat.  It was noted that he had received an extensive
systemic workup.  The veteran expressed the opinion that his
current skin condition was related to exposure to gas fumes while
in military service.  Apart from his complaints of a skin
disorder, the veteran was completely healthy.  The clinical
impression was cholinergic urticaria, and medication with Atarax
was continued.

The Board notes that the veteran's skin was normal at service
entry, that he was seen repeatedly during active service for skin
eruptions attributable to cholinergic urticaria or hives, and
that he was given medication to relieve that condition.
Following service separation, he continued to manifest similar
eruptions attributable to angioedema and cholinergic urticaria,
and medication for the control of symptoms of that disorder was
continued.  The Board has considered the veteran's written
statements regarding the onset and severity of symptoms of his
skin eruptions, and we have carefully examined the photographs
submitted by the veteran showing skin rash on various areas of
his body.

Based upon the foregoing, the Board finds that the veteran's
currently manifested urticaria manifested by skin eruptions was
incurred during his period of peacetime service and that service
connection is warranted for that disorder.

ORDER

Entitlement to service connection for urticaria productive of
skin eruptions is granted.

REMAND

The veteran was seen for various symptoms, including headaches,
on a number of occasions during his active service.  Moreover, on
a VA examination in September 1992, headaches of unknown etiology
were diagnosed.  Based upon the current record, the Board is
uncertain as to the current nature of the veteran's headaches and
whether they are related to symptoms present in service.  It is
the opinion of the Board that a neurologic examination would be
helpful in determining the nature and etiology of any current
headaches.  Consequently, this issue is REMANDED for the
following action:

The veteran should be examined by a
neurologist in order to determine the
nature of his claimed headaches.  The
examiner should have access to the claims
folder for review of the record.  The
examiner should express an opinion as to
the etiology of the veteran's headaches and
whether they are related to symptomatology
shown in service.

Upon completion of the noted development, the RO should again
consider the issue of service connection for a disability
manifested by shortness of breath, headaches and dizziness.  If
the decision remains adverse to the veteran, he and his
representative should be furnished a Supplemental Statement of
the Case and given the appropriate time to respond.  Thereafter,
the case should be returned to the Board for final appellate
consideration.  The purpose of this REMAND is further
development, and the Board intimates no opinion as to the final
action on this matter by dint of our present action.

          EDWARD W. SEERY
          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.

Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals.  This remand is in the nature of a
preliminary order and does not constitute a decision of the Board
on the merits of your appeal.  38 C.F.R. § 20.1100(b) (1994).