Citation Nr: 9933497 Decision Date: 11/30/99 Archive Date: 12/06/99 DOCKET NO. 98-12 106 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES Entitlement to service connection for psoriasis. Entitlement to service connection for a navel disability. REPRESENTATION Appellant represented by: California Department of Veterans Affairs ATTORNEY FOR THE BOARD Marisa Kim, Associate Counsel INTRODUCTION The veteran had active military service from April 1943 to December 1946 and from April 1948 to November 1964. This matter is before the Board of Veterans' Appeals (Board) on appeal from a February 1998 rating decision from the Los Angeles, California, Department of Veterans Affairs (VA) Regional Office (RO) in which the veteran was denied service connection for psoriasis and for umbilicus for being not well grounded. FINDINGS OF FACT 1. The medical evidence includes a current diagnosis of psoriasis. 2. There is no medical evidence of a nexus between a current disability of psoriasis and military service. 3. The medical evidence does not include a current diagnosis of a navel disability. 4. There is no medical evidence of a nexus between a current navel disability and military service. CONCLUSIONS OF LAW 1. The claim for service connection for psoriasis is not well grounded. 38 U.S.C.A. §§ 1110, 1131, 5107(a) (West 1991). 2. The claim for service connection for a navel disability is not well grounded. 38 U.S.C.A. §§ 1110, 1131, 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Factual Background Service medical records do not include induction examination reports. In February 1953, when the veteran was admitted to the hospital for burning on urination, he reported that his umbilicus was open through to the abdomen because at birth it was cut too short. In April 1959, the veteran went to the clinic and complained of trouble with his navel because it was cut too short when he was a child. The examiner noted slight reddening of the base of the umbilicus but no exudate. The navel was cleaned with peroxide. The January 1960, March 1963 and August 1964 examination reports stated that the veteran's skin and lymphatics system were normal, and no skin defects or diagnoses were noted except for a scar on the left inner ankle in January 1960. In December 1979, the veteran was admitted for treatment at the VA Medical Center. One of the diagnoses was psoriasis. There were psoriatic lesions in the elbows, knees, and low back. From February-March 1981, the veteran was admitted for treatment at the VA Medical Center. One of the diagnoses was psoriasis. The veteran's skin disclosed psoriatic lesions on the upper and lower extremities, and the examiner noted that the veteran's history was remarkable for psoriasis. The August 1983 impression was psoriasis. The examiner noted a history of dry scaling rash on the veteran's arms and knees for the past 18 years. In September 1983, a dermatologist examined the veteran for complaints of a long history of scaly eruptions on his elbows and knees. The diagnosis was chronic psoriasis of the scalp and extremities. In October 1983, the veteran reported a history of chronic psoriasis of the scalp and extremities. In March 1984, the assessment was psoriasis in acute exacerbation. The September 1984 examiner noted that the veteran's psoriasis was not in remission. The May 1985 examiner noted that the veteran had been doing well but that his psoriasis flared because it was summer and he was out in the sun. In October 1985, the veteran reported a 12-15 years history of psoriasis. Physical examination revealed psoriatic plaques on the veteran's elbows and knees. In November 1985, the diagnosis was psoriasis. In March 1986, the examiner noted that the veteran had a large area of skin involvement with psoriasis. In April 1986, the impression was improving psoriasis. In February 1987, the veteran was seen at the emergency room, and the diagnosis was remarkably improving psoriasis. In April and May 1987, the emergency room examiners noted that the veteran had psoriatic lesions. In November 1991, the veteran was admitted to a military hospital with a chief complaint of psoriasis. One of the assessments was psoriasis. The veteran told the examiner that he had been given Duofilm for psoriasis by a Dr. Carter from Redlands, California. In June 1997, the veteran was examined at the Hi-Desert Medical Center for complaints that his stomach had a "hole in it." The examiner noted that the veteran reported a history of psoriasis and an umbilicus open since birth. The veteran reported occasional pain and periodic draining of pus from his navel. The examiner noted that there was no drainage. Prior to completion of the examination, the veteran voluntarily left against the medical advice of the attending physician. The veteran filed an informal claim for service connection for a navel condition in June 1997 and a formal claim for service connection for psoriasis, based upon a navel with an open hole that had not healed, in January 1998. The June 1998 notice of disagreement alleged that the veteran was treated in service for his navel, and it became worse. He alleged that he was seen many times for the skin problem. The July 1998 appeal alleged that the veteran was treated in service for psoriasis and for umbilicus open to his abdomen. He alleged that he was given various ointments for the psoriasis while in the military, and the navel condition was treated and cleaned many times. The veteran filed two August 1998 statements that alleged treatment for psoriasis by P. Salhorta, M.D.; at the Sepulveda Hospital in 1971-1972 and 1982; and in France in 1944. He alleged that the records at Sepulveda Hospital were destroyed. He further alleged that he was inflicted with psoriasis in service because he did not have it prior to entering the military. Dr. Salhorta also filed a handwritten statement in August 1998 that he alleged was based on a personal interview and examination of the veteran in August 1998. He stated that the veteran had an extensive history of psoriasis. Criteria The Court has held that a well-grounded claim is "a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of § [5107(a)]." Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). The Court has held that a well-grounded claim requires competent evidence of current disability (a medical diagnosis), of incurrence or aggravation of a disease or injury in service (lay or medical evidence), and of a nexus between the in-service injury or disease and the current disability (medical evidence). See Epps v. Brown, 126 F.3d. 1464, 1468 (Fed. Cir. 1997); Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Service connection may be established where the evidence demonstrates that an injury or disease resulting in disability was contracted in the line of duty coincident with military service, or if pre-existing such service, was aggravated therein. 38 U.S.C.A. § 1131 (West 1991); 38 C.F.R. § 3.303 (1999). A veteran is presumed to be in sound condition when accepted for service, with the exception of disorders noted at the time of entrance into service unless clear and unmistakable (obvious and manifest) evidence demonstrates that the injury existed prior to service. 38 U.S.C.A. §§ 1111, 1132; 38 C.F.R. § 3.304(b) (1999). Analysis The claim of entitlement to service connection for psoriasis The medical evidence includes a current diagnosis of psoriasis. In addition to multiple diagnoses of psoriasis from December 1979 to August 1998, the September 1983 examiner stated that the diagnosis was chronic psoriasis. However, the claim for service connection for psoriasis is not well grounded because there is no medical evidence of a nexus between the current disability of psoriasis and service. The service medical records do not include a diagnosis of psoriasis, and the August 1964 discharge examination report stated that the veteran's skin was normal. Although the veteran was examined and treated for psoriasis many times since service, none of the examiners provided a medical opinion linking the veteran's psoriasis to service. The veteran was first diagnosed with psoriasis in December 1979, over 15 years after separation from service. The claim of entitlement to service connection for a navel disability The claim for service connection for umbilicus is not well grounded because the medical evidence does not include a current diagnosis of a navel disability. Although the April 1959 examiner noted slight reddening of the base of the umbilicus and treated the veteran by cleaning the navel, the medical evidence does not include an in- service diagnosis of a navel disability. At separation from service, the August 1964 discharge examination report stated that the veteran's skin was normal. The veteran waited until June 1997, over 32 years after separation from service, to see an examiner for complaints that his stomach had a "hold in it," and even then, the examiner noted that there was no drainage from the veteran's navel. The foregoing discussion is sufficient to inform the veteran of the elements necessary to complete an application to reopen the claim. See Graves v. Brown, 8 Vet. App. 522 (1996); Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995); McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997); Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). The VA cannot assist in any further development of the claim because the claim is not well grounded. 38 U.S.C.A. § 5107(a); Morton v. West, No. 96-1517 (U.S. Vet. App. July 14, 1999). ORDER The claim of entitlement to service connection for psoriasis is denied as not well grounded. The claim of entitlement to service connection for a navel disability is denied as not well grounded. V. L. Jordan Member, Board of Veterans' Appeals