BVA9503521 DOCKET NO. 92-11 047 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for malignant melanoma. 2. Entitlement to a rating in excess of 10 percent for psoriasis of the scalp, shoulders, upper back, and chest, with evidence of seborrheic dermatitis. 3. Entitlement to a compensable rating for a postoperative scar, the residual of an excision of basal cell carcinoma from the right hand. ATTORNEY FOR THE BOARD Harold A. Beach, Counsel INTRODUCTION The veteran, who is the appellant in this case, served on active duty from June 1950 to September 1981. In January 1992, the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri, denied entitlement to service connection for melanoma, postoperative. The veteran disagreed with that decision, and this appeal ensued. In February 1994, the Board of Veterans' Appeals (Board) found that the veteran also wished increased ratings for his service- connected psoriasis with seborrheic dermatitis and the service- connected post-operative scar on his right hand. Consequently, the case was remanded for further development. The Board requested that the RO schedule the veteran for an examination by a board-certified dermatologist to determine the extent of his service-connected skin disorders. The Board also requested that the examiner render an opinion as to the etiology of the veteran's melanoma. Thereafter, the RO was to adjudicate the issues concerning the increased ratings. It was to also review the claim for service connection for melanoma. In June 1994, following the requested development, the RO confirmed and continued the denial of service connection for melanoma. It also denied increased ratings for the veteran's service-connected skin disorders. The case was then returned to the Board for further appellate consideration. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he has melanoma, primarily as the result of sun exposure in service. Therefore, he maintains that service connection is warranted. It is also apparent that he wishes increased ratings for his service-connected psoriasis with seborrheic dermatitis and a post-operative scar on his right hand. 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(s). 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 preponderance of the evidence is against the veteran's claim for service connection for malignant melanoma. Further, it is the decision of the Board that the preponderance of the evidence is against the veteran's claims for increased ratings for his service connected psoriasis of the scalp, shoulders, upper back, and chest, with evidence of seborrheic dermatitis, as well as the postoperative scar, the residual of an excision of basal cell carcinoma from his right hand. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. Malignant melanoma was first clinically demonstrated many years after service, and there are no objective findings that it is in any way related thereto. 3. The veteran's service-connected psoriasis with evidence of seborrheic dermatitis is manifested primarily by localized areas of scaling on the dorsa of his hands and forearms and localized areas of erythema and dry desquamation on his back without constant exudation or itching, extensive lesions, ulceration or extensive exfoliation or crusting, systemic or nervous manifestations, or marked disfigurement. 4. The veteran's service-connected postoperative scar on his right hand is manifested primarily by a faint, hypo-pigmented lesion which is not ulcerated, poorly nourished, painful and tender on objective demonstration, or productive of limitation of function. CONCLUSIONS OF LAW 1. Malignant melanoma was not incurred in or aggravated by service, nor may it be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107(a) (West 1991); 38 C.F.R. §§ 3.303(a)-(b), 3.307, 3.309 (1993). 2. Malignant melanoma is not proximately due to or the result of a service-connected disease or injury. 38 U.S.C.A. § 5107 (a) (West 1991); 38 C.F.R. § 3.310(a) (1993). 3. The requirements for a rating in excess of 10 percent for psoriasis of the scalp, shoulders, upper back, and chest, with evidence of seborrheic dermatitis, have not been met. 38 U.S.C.A. §§ 1155, 5107(a) (West 1991); 38 C.F.R. Part 4, Diagnostic Codes 7806, 7816, 7817 (1993). 4. The requirements for a compensable rating for a postoperative scar, the residual of an excision of basal cell carcinoma from the right hand, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. Part 4, Diagnostic Codes 7803, 7804, 7805 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board notes that the veteran's claims for service connection for malignant melanoma and for increased ratings for his service-connected psoriasis with evidence of seborrheic dermatitis and a right hand scar are "well-grounded" within the meaning of 38 U.S.C.A. § 5107(a); that is, he has presented claims which are not implausible. The Board is also satisfied that all reasonable efforts have been expended to develop the evidence. Indeed, the veteran does not contend, and the claims file does not show, that there are any records currently outstanding. I. Melanoma Service connection connotes many factors, but basically it means that the facts, shown by the evidence, establish that a particular disease or injury, resulting in disability, was incurred coincident with service in the Armed Forces. 38 U.S.C.A. § 1110, 1131; 38 C.F.R. § 3.303(a). 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". When the disease identity is established, there is no requirement of an evidentiary showing of continuity. Continuity of symptomatology is required only 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). For certain disorders, such as malignant melanoma, service connection is presumed, when that disorder can be shown to a degree of ten percent during the first year after service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be granted, when it can be shown that a particular disease or injury is proximately due to or the result of a disorder for which service connection has already been established. 38 C.F.R. § 3.310(a). The veteran's service medical records are replete with references to various skin problems, including seborrheic dermatitis, actinic (solar) keratoses, psoriasis, and basal cell carcinoma of the right hand. They are negative, however, for any findings of melanoma. Such a disorder was not clinically identified until 1990, almost nine years after his retirement. There were no findings that it was in any way related to service or to his service-connected skin disorders. Indeed, following the VA examination in April 1994, the board-certified dermatologist stated specifically that there was no direct relationship between the service-connected basal cell carcinoma and melanoma. Essentially, the veteran maintains that his service-connected residuals of basal cell carcinoma and his non service-connected melanoma are the result of sun exposure in service; that they often occur years after the continued excessive exposure; and that both should, therefore, be service connected. The Board does not doubt the sincerity of the veteran's contentions; however, the difference is that regardless of cause, basal cell carcinoma was clinically identified in service while melanoma was not. By themselves, the veteran's contentions are not sufficient to establish a relationship between melanoma and his sun exposure in service. Tirpak v. Derwinski, 2 Vet. App. 609 (1992). Expert opinion is required to support such a conclusion. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Although the most recent VA examiner acknowledged that both basal cell carcinoma and melanoma were sun-induced lesions, neither he nor any of the physicians who have treated the veteran for melanoma have gone so far as to attribute that disease to any particular period of sun exposure, including that in service. Absent any findings of a relationship to service on a direct or presumptive basis or any findings of a relationship to a service-connected disability, the Board is of the opinion that service connection for melanoma is not warranted. II. Psoriasis with Seborrheic Dermatitis Disability evaluations are determined by comparing the manifestations of a particular disorder with the requirements contained in the Schedule for Rating Disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Psoriasis and dermatitis are rated in accordance with 38 C.F.R. Part 4, Diagnostic Codes 7816 and 7817, respectively. Those codes state that they will be rated as eczema. 38 C.F.R. Part 4, Diagnostic Code 7806. Under that code, a non compensable evaluation is warranted when there is slight, if any, exfoliation, exudation, or itching on a non- exposed surface or small area. A 10 percent evaluation requires exfoliation, exudation, or itching on an exposed surface or extensive area. A 30 percent evaluation requires constant exudation or itching, extensive lesions, or marked disfigurement. A 50 percent evaluation requires ulceration or extensive exfoliation or crusting and systemic or nervous manifestations or exceptionally repugnant disfigurement. As noted above, the veteran had psoriasis and dermatitis virtually throughout his long career. More recent records show that from 1988 through 1991, he was followed for various skin disorders at the medical facility at Ft. Leonard Wood, Missouri. The areas primarily affected were his chest, back, shoulders, and arms. During the VA examination in April 1994, it was noted that since the late 1970's, the veteran had used T-Gel shampoo on a daily basis with reasonably good control of his scalp chest and back lesions. It was also noted that he had had good results with Lac-Hydrin lotion which was used to treat his skin dryness. He demonstrated localized scaling on the dorsa of his hands and forearms and localized areas of erythema and dry desquamation on his back. There were no frankly keratotic lesions or actual keratotic change. The face had freckling consistent with chronic sun exposure, but without evidence of cutaneous malignancies. In general, the veteran had some dry, desquamative change to his skin without localized "rash". There was no evidence of psoriasis or seborrheic dermatitis of the chest, back, or base of the scalp. There were also no reports of constant exudation or itching, extensive lesions, ulceration or extensive exfoliation or crusting, systemic or nervous manifestations, or marked disfigurement. Indeed, photographs of the veteran's head, neck, shoulders, and upper chest revealed minimal, if any, disfigurement. On balance, such findings are productive of no more than slight impairment. The localized areas of scaling, erythema, and desquamation are contemplated by the ten percent rating currently in effect. III. The Right Hand Scar The surgical scars on the veteran's right hand are rated in accordance with 38 C.F.R. Part 4, Diagnostic Codes 7803, 7804, and 7805. Under those codes, a 10 percent evaluation is warranted for scars which are poorly nourished, with repeated ulceration or which are painful and tender on objective demonstration. A compensable evaluation may also be assigned on the basis of limitation of function of the affected body part. The service medical records show that in October 1967, the veteran underwent excision of a penny-sized lesion from the back of his right hand. A biopsy confirmed the presence of superficial basal cell carcinoma, multifocal. In December 1967, he underwent additional surgery on the scar to ascertain complete excision of the basal cell carcinoma. In May 1969, basal cell carcinoma was again excised from the back of his right hand. The surgical scars apparently healed well, as there were no findings that they were ulcerated or poorly nourished; that they were painful and tender on objective demonstration; or that they in any way affected the function of the right hand. Indeed, the recent VA examination revealed no more than a thin, hypo- pigmented scar across the dorsum of the right hand. It was barely visible in photographs and certainly not productive of any significant disfigurement. Such findings do not meet the requirements for a compensable evaluation. ORDER Service connection for melanoma is denied. An increased rating for psoriasis of the scalp, shoulders, upper back, and chest, with evidence of seborrheic dermatitis is denied. An increased rating for a postoperative scar, the residual of an excision of basal cell carcinoma from the right hand is denied. F. JUDGE FLOWERS Member, Board of Veterans' Appeals (CONTINUED ON NEXT PAGE) 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.