Citation Nr: 0803433 Decision Date: 01/30/08 Archive Date: 02/08/08 DOCKET NO. 06-22 870 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in No. Little Rock, Arkansas THE ISSUE Entitlement to service connection for seborrheic dermatitis with folliculitis, claimed as scalp rash and fever blisters as due to an undiagnosed illness. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD Sarah E. Abraham, Associate Counsel INTRODUCTION The veteran had active military service from May to August 1990, and from November 1990 to September 1991. He served in the Southwest Asia theater of operations from December 1990 to August 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a May 2005 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in No. Little Rock, Arkansas, that denied service connection for seborrheic dermatitis with folliculitis, claimed as scalp rash and fever blisters as due to an undiagnosed illness. The veteran testified at a Board hearing in August 2007. FINDINGS OF FACT The veteran's seborrheic dermatitis with folliculitis had its onset during service. CONCLUSION OF LAW The criteria for establishing service connection for seborrheic dermatitis with folliculitis have been met. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.02, 3.303, 3.317 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In this decision, the Board grants service connection for seborrheic dermatitis with folliculitis, which represents a complete grant of the benefit sought on appeal. As such, no discussion of VA's duties to notify and assist is necessary. Service connection may be granted for a disability resulting from disease or injury incurred or aggravated during active service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. The law also provides that service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, to establish "direct" service connection, there must be (1) medical evidence of a current disability, (2) medical evidence, or in certain circumstances lay testimony, of in-service incurrence or aggravation of an injury or disease, and (3) medical evidence of a nexus between the current disability and the in-service disease or injury. See Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004); Hickson v. West, 12 Vet. App. 247, 253 (1999). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Because the veteran served in the Southwest Asia theater of operations during the Persian Gulf War, service connection may be established under 38 C.F.R. § 3.317. Under that section, service connection may be warranted for a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability that became manifest 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 not later than December 31, 2011. 38 C.F.R. § 3.317(a)(1). For purposes of 38 C.F.R. § 3.317, there are three types of qualifying chronic disabilities: (1) an undiagnosed illness; (2) a medically unexplained chronic multi symptom illness; and (3) a diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. 1117(d) warrants a presumption of service-connection. An undiagnosed illness is defined as a condition that by history, physical examination and laboratory tests cannot be attributed to a known clinical diagnosis. In the case of claims based on undiagnosed illness under 38 U.S.C.A. § 1117; 38 C.F.R. § 3.117, unlike those for "direct service connection," there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. at 8-9. Further, lay persons are competent to report objective signs of illness. Id. A medically unexplained chronic multi symptom illnesses is one defined by a cluster of signs or symptoms, and specifically includes chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome, as well as any other illness that the Secretary determines meets the criteria in paragraph (a)(2)(ii) of this section for a medically unexplained chronic multi symptom illness. A "medically unexplained chronic multi symptom illness" means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi- symptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii). There are currently no diagnosed illnesses that have been determined by the Secretary to warrant a presumption of service connection under 38 C.F.R. § 3.317(a)(2)(C). The medical evidence shows the veteran has a current diagnosis of seborrheic dermatitis with folliculitis, a diagnosed disability, and an onset date during active duty service. Thus, service connection for this condition under 38 U.S.C.A. § 1117 and 38 C.F.R. § 3.317 is not permitted as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426 (1994). As such, the Board must consider whether service connection may be granted on another basis. At his August 2007 Board hearing, the veteran testified that he experienced scalp rash and fever blisters since his August 1991 return from service in Southwest Asia. His enlistment examination, dated in December 1988, is negative for any complaint, treatment, or diagnosis of a skin abnormality. Service medical records show that he was treated for tinea cruris in July 1989, and for heat rash in August 1989. VA medical records show that the veteran was diagnosed as having folliculitis in May 2001. Follow-up appointment records, dated from November 2001 to December 2002, reflect a diagnosis of folliculitis/dermatitis, with recurring flare- ups. A VA skin examination was conducted in May 2005. At that time, the veteran reported that he had had a rash on his scalp area since 1991. The examiner found follicular erythematous papules and pustules present from the veteran's frontal to the occipital scalp. He also noted a scale diffusely on the scalp, but did not find any spread of the rash to the rest of the head or neck. The examiner diagnosed the veteran as having seborrheic dermatitis with folliculitis. He stated that the onset of these skin conditions was in 1991, and opined that the veteran's rash was associated with the aforementioned diagnoses. Given the presence of skin complaints and treatment since the veteran's active duty service, as well as the May 2005 VA examiner's diagnoses and concurring opinion regarding this date of onset, and resolving any reasonable doubt in the veteran's favor, the Board finds that the criteria for service connection have been met, and the veteran's claim is granted. ORDER Service connection for seborrheic dermatitis with folliculitis is granted. ____________________________________________ STEVEN D. REISS Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs