Citation Nr: 1237998 Decision Date: 11/06/12 Archive Date: 11/16/12 DOCKET NO. 09-01 749 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUES 1. Entitlement to service connection a skin rash disorder, to include as manifested by jungle rot and scarlet fever. 2. Entitlement to service connection for a multi-nodular neck goiter. REPRESENTATION Appellant represented by: Illinois Department of Veterans Affairs ATTORNEY FOR THE BOARD J Fussell INTRODUCTION The Veteran had active service from January 1970 to January 1974, including combat service in the Republic of Vietnam. His Armed Forces Of The United States Report Of Transfer Or Discharge (DD Form 214) shows that his decorations include the Vietnam Service Medal, the Vietnam Campaign Medal, the Purple Heart Medal, and the Navy Achievement Medal with "V" device. Also, he served in Vietnam from July 1970 to April 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2007 decision by the Department of Veterans Affairs (VA), Regional Office (RO), in St. Louis, Missouri. Jurisdiction of this matter is currently with that of the RO in Chicago, Illinois. Based on the evidence of record and in the interest of clarity, the Board has recharacterized the Veteran's separate service connection claims for jungle rot and scarlet fever, as reflected on the title page. This matter was previously before the Board in January 2011 at which time it was remanded for additional development. It is now returned to the Board. The recent February 2011 VA examination found what was reported to be residuals of a shell fragment wound of the posterior aspect of the Veteran's right thigh. In this regard, "VA must determine all potential claims raised by the evidence, applying all relevant laws and regulations." Roberson v. Principi, 251 F.3d 1378, 1384 (Fed.Cir. 2001). VA's duty to assist attaches to the investigation of all possible cause of a current disability, including those unknown to the Veteran. See Schroeder v. West, 212 F.3d 1265, 1271 (Fed.Cir. 2000). Accordingly, matter of whether the Veteran desires to seek service connection for residuals of a shell fragment wound of the right thigh is referred to the RO for clarification. In addition to the paper claims file, there is a Virtual VA paperless claims file associated with the Veteran's claim. A review of the documents in such file reveals that they are either duplicative of the evidence in the paper claims file or are irrelevant to the issues on appeal. FINDINGS OF FACT 1. The Veteran served in the Republic of Vietnam from July 1970 to April 1971 and is presumed to have been exposed to herbicides. 2. Tinea cruris, jungle rot, heat rash, and tinea versicolor during service were acute and transitory resolving without residual disability; the Veteran has never had scarlet fever and his postservice episode of folliculitis keloidalis is unrelated to active service, including inservice herbicide exposure; and a chronic skin disorder of service origin, to include due to inservice herbicide exposure, is not otherwise shown. 3. A multi-nodular neck goiter, shown to be due to thyroid disease, was not present during service and was demonstrated medically many years after service; it is not shown to be any form of cancer; and is unrelated to the Veteran's active service and any incidence thereof, including herbicide exposure. CONCLUSIONS OF LAW 1. A skin rash disorder, to include as manifested by jungle rot and scarlet fever was not incurred in or aggravated by active service, nor is it presumptively due to inservice herbicide exposure and it is not proximately due to or aggravated by a service-connected disorder. 38 U.S.C.A. §§ 1110, 1116, 1154(b) (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310 (2012). 2. A multi-nodular neck goiter, including as a manifestation of thyroid disease, was not incurred in or aggravated by active service, nor did any thyroid pathology or other endocrinopathy manifest to a compensable degree within one year after service discharge; nor is it presumptively due to inservice herbicide exposure; and it is not proximately due to or aggravated by a service-connected disorder. 38 U.S.C.A. §§ 1110, 1112, 1116, 1137, 1154(b) (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist Review of the record reveals compliance with the Veterans Claims Assistance Act of 2000 (VCAA) which imposes certain duties to notify and provide assistance in substantiating claims. 38 U.S.C.A. § 5100, et seq (effective November 9, 2000); see also 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). This notice was intended to be provided prior to an initial adjudication of a claim. Pelegrini v. Principi, 18 Vet. App. 112, 120 (2004) (Pelegrini II). By letter dated in March 2007, prior to the initial adjudication of the claims, the RO advised the Veteran of the evidence needed for claim substantiation and explained what evidence VA would obtain or assist in obtaining and what information or evidence the claimant was responsible for providing. 38 U.S.C.A. § 5103(a). See also Quartuccio v. Principi, 16 Vet. App. 183 (2002). The letter apprised him of the downstream disability rating and effective date elements for claims. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), aff'd sub nom. Hartman v. Nicholson, 483 F.3d 1311 (2007). Thus, there has been full compliance with the duties to provide notice of what was need for claim substantiation. Pelegrini v. Principi, 18 Vet. App. 112, 120 (2004) (Pelegrini II); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). And as for the duty to assist, the RO obtained the Veteran's service treatment records and VA treatment records. The Veteran declined to testify in support of the claims. Pursuant to the January 2011 Board remand, the Veteran has been provided a VA compensation examination for a medical nexus opinion concerning the etiology of the claimed skin disorders and whether the claimed disabilities are related to military service. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); 38 U.S.C.A. § 5103A(d); and 38 C.F.R. § 3.159(c)(4). The adequacy of the examination and medical opinions obtained have not been challenged. The Board is entitled to assume the competence of a VA examiner and the adequacy of a VA medical examiner's opinion unless either is challenged. See Sickels v. Shinseki, 643 F.3d 1362, 1366 (Fed. Cir. 2011); Bastien v. Shinseki, 599 F.3d 1301, 1307 (Fed.Cir. 2010); Rizzo v. Shinseki, 580 F.3d 1288, 1290-91 (Fed. Cir. 2009); and Cox v. Nicholson, 20 Vet. App. 563, 569 (2007); and Hilkert v. West, 12 Vet. App. 145, 151 (1999). The case was remanded in 2011, in part, to attempt to obtain private clinical records. In response, as to Dr. E. A of the Riverside Medical Center, a response was received that all records requested were older than 10 years and understate state retention guidelines, records were only maintained for that length of time. However, records of 1992 and 1993 of Dr. D. L. of the Riverside Medical Center (whom the Veteran reported had treated him for thyroid problems) have been received. As to records of Dr. R. D. of Provena St. Mary's Hospital, whom the Veteran reported had treated him when he contracted scarlet fever, the response was that the Veteran had not been seen since 2003 and that earlier records had been provided in 2006. In fact, those records are on file. Prior to the Board remand, private clinical records of the Carle Clinic Association had been obtained. And all this was in substantial compliance with the Board remand. Substantial, rather than absolute or strict, remand compliance is the appropriate standard for determining remand compliance under Stegall v. West, 11 Vet. App. 268 (1998); see also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (citing Dyment v. West, 13 Vet. App. 141, 146-47 (1999)). Therefore, as there is no indication or allegation that other relevant evidence remains outstanding, the Board finds that the duty to assist has been met. 38 U.S.C.A. § 5103A. Service connection Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated during service. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. §§ 3.303, 3.304 (2012). In order to prevail on the issue of service connection for any particular disability, there must be evidence of a current disability; evidence of in-service occurrence or aggravation of a disease or injury; and medical evidence, or in certain circumstances, lay evidence, of a nexus between an in-service injury or disease and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999); see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). 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 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 (2012). Service connection for certain chronic diseases may also be established based upon a legal "presumption" by showing that it manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C.A. § 1112 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2012). In addition, service connection may be granted for any disease diagnosed after service when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2012). 38 U.S.C.A. § 1154(a) requires due consideration be given to all pertinent medical and lay evidence, even in cases not involving combat injury. 38 U.S.C.A. § 1154(b) and 38 C.F.R. § 3.304(d) provide that in the case of a combat Veteran lay or other evidence of service incurrence or aggravation is sufficient proof of the occurrence of an event but this deals with what happened during service and not the questions of either the existence of current disability or nexus to service. Davidson, 581 F.3d at 1315 (finding that 38 U.S.C.A. § 1154(b) does not require controlling weight be given to testimony as to the cause of a combat Veteran's death). 38 U.S.C.A. § 1154(a) requires that the VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim. However, "[c]ompetent medical evidence is [not always] required ... [when] the determinative issue involves either medical etiology or a medical diagnosis." Davidson, 581 F.3d at 1316 (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed.Cir. 2007). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional but not to complex medical questions. Jandreau, 492 F.3d at 1377; see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed.Cir. 2006) ("lay evidence [does not] lacks credibility merely because it is unaccompanied by contemporaneous medical evidence."); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. With respect to inservice exposure to an herbicide as being a cause of any asserted disability which the Veteran now has, a Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam era (beginning in January 1962 and ending in May 1975) shall be presumed to have been exposed during such service to herbicide agents, including an herbicide commonly referred to as Agent Orange. 38 U.S.C.A. § 1116(a)(3); 38 C.F.R. §§ 3.307, 3.309. Whenever VA's Secretary determines, on the basis of sound medical and scientific evidence, that a positive association exists between the exposure of humans to an herbicide agent and the occurrence of a disease in humans, the Secretary shall prescribe regulations providing that a presumption of service connection is warranted for that disease. 38 U.S.C.A. § 1116(b)(1). Scarlet fever, "jungle rot", tinea versicolor, tinea cruris, tinea pedis, tinea capitis, and thyroid disease, including goiters, are not listed as being presumptively due to inservice herbicide exposure. See generally 38 U.S.C.A. § 1116(a)(2); 38 C.F.R. §§ 3.307(a)(6), 3.309(e). VA's Secretary has determined that a presumption of service connection based on exposure to herbicides to include Agent Orange used in the Republic of Vietnam during the Vietnam era is not warranted for any condition for which the Secretary has not specifically determined a presumption of service connection is warranted. See Notice, 72 Fed. Reg. 32,395 (2007). Notwithstanding the aforementioned provisions relating to presumptive service connection, which arose out of the Veteran's Dioxin and Radiation Exposure Compensation Standards Act, Pub. L. No. 98-542, § 5, 98 Stat. 2 ,725, 2,727-29 (1984), and the Agent Orange Act of 1991, Pub. L. No. 102-4, § 2, 105 Stat. 11 (1991), the United States Court of Appeals for the Federal Circuit (Federal Circuit) has determined that a claimant is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994); 38 C.F.R. § 3.303(d). The Veteran's January 1970 examination for service entrance was negative. In September 1970 it was noted that he had had a rash on his back and both arms for one month. He had a history of a heat rash which resolved with cool weather, and on a current examination he had no rash. He was seen in June, November, and December 1971 for pseudofolliculitis barbae. In July 1972 the Veteran reported having a facial rash for the preceding two weeks. An examination revealed a rash on the right side of his face. The impression was pseudofollicullitis barbae. In November 1972 pseudofollicullitis barbae was noted, and he had yellow discoloration and irritation of the skin of the axilla. "KOH" was positive. The impression was tinea corporum, for which he was given Tinnactin solution. In December 1972 he was to be allowed not to shave for two weeks, and he was given Tinnactin for his shoulder rash. In January 1973 it was reported that he had had a facial skin rash for one year and the impression was pseudofollicullitis barbae, for which he was allowed not to shave for two weeks. In April 1973 he had a rash on his face and neck, for which he was allowed not to shave every day. In June 1973 it was noted that he had continuous pseudofollicullitis barbae for which he had been treated 11 times. He was seen again for this in August, September, and November 1973. A January 1974 examination for service separation was negative. Records of Dr. D. L. show that the Veteran was evaluated in 1992 for a thyroid nodule. In January 1993 he had swelling of the right side of his neck due to a persistent nodule of the right lobe of his thyroid gland. Records of Dr. R. W. K. reflect that in May 1996 the Veteran sought a second opinion as to a suggestion of surgery on his thyroid gland. He related that he had had a mass on his neck for five years. After a thyroid scan and biopsy he was told that the nodule was benign. Over the next five years the gland slowly enlarged. After an examination the impression was a probably multi-nodular goiter. In July 1996 he had a fine needle aspiration of a dominant hypo-functioning nodule of the right lobe of the thyroid, which appeared to be a multi-nodular goiter, which was the clinical impression. Records of Dr. T. D. show that in July 2000 the Veteran had folliculitis of the scalp. A private August 2000 clinical record noted that the Veteran had tinea capitis. Clinical records of St. Mary's show that an ultrasound in August 2003 revealed enlargement of the right lobe of the Veteran's thyroid gland. Another study that month noted that the ultrasound had revealed a solid lesion in the right thyroid lobe. In the Veteran's April 2006 claim for service connection for non-Hodgkin's lymphoma he reported that he had had outpatient treatment for this and that a certain times of the year his neck would swell for two to three days. On VA examination in November 2006 the Veteran denied having non-Hodgkin's lymphoma but reported a positive history of thyroid disease. Service connection for non-Hodgkin's lymphoma was denied in December 2006, and the Veteran did not appeal that decision. In the Veteran's January 2007 claim he reported that while in Vietnam he had had a rash which he had assumed was from the heat. He indicated that during the monsoon season he acquired "Jock Rot" and topical medication had not helped. He added that after service he had contracted scarlet fever but a dermatologist told him that adults rarely contracted such a fever. He noted that he now had a lump in his neck which had been found to be malignant VA outpatient treatment records show that in November 2007 it was reported that the Veteran had had radiation therapy for his thyroid 20 years ago, although in December 2007 it was noted that perhaps he had only had a nuclear up-take study done In the Veteran's Appeal To Board Of Veterans' Appeals (VA Form 9), he reported that he had contracted scarlet fever after he was discharged from active service; but while in Vietnam he had had heat rash and jock rot. While undocumented, when he was discharged from active service he had had a lump in his neck, now diagnosed as a multi-nodular goiter. On VA examination in February 2011, pursuant to the January 2011 Board remand, the Veteran's claim file was reviewed. The Veteran reported that he had had jungle rot while in Vietnam in 1970 but it had been treated and had not returned. Also while in Vietnam he had had heat rash but it had resolved and not returned. He reported having had scarlet fever after military service, in 1980, and that all of his skin peeled off and he had had residual papules on the back of his head from the scarlet fever that were still present and had never resolved. However, this seemed to get better if he let his hair grow out. After a physical examination the examiner reported that the "heat rash" was probably tinea versicolor which more likely than not was related to military service due to or related to exposure to tropical weather in Vietnam but this had resolved and never recurred. Further, no rash was found on the current examination on the Veteran's trunk or extremities. As to "jungle rot" the examiner stated that this had probably been tinea cruris which more likely than not was related to military service as a result of or related to exposure to tropical weather in Vietnam but which later resolved that same year and never recurred. There was no report in the claims file of this skin disorder but it would have been an endemic problem in a climate such as Vietnam's. As to the Veteran's reported history of scarlet fever with desquamation of all of his skin which occurred after service in 1980, the Veteran reported that he had residuals bumps on the back of his head ever since this episode. This appeared to be folliculitis keloidalis and was not caused by or a result of military service, and by the Veteran's history this occurred after military service. Also, both scarlet fever and folliculitis keloidalis were not recognized as being caused by Agent Orange. Initially, the Board notes that the Veteran is service-connected for: post-traumatic stress disorder (PTSD), rated 70 percent disabling; diabetes mellitus, type II, associated with inservice herbicide exposure, rated 20 percent disabling; peripheral neuropathy of the right lower extremity, rated 20 percent disabling; peripheral neuropathy of the left lower extremity, rated 20 percent disabling; peripheral neuropathy of the right upper extremity, rated 10 percent disabling; peripheral neuropathy of the left upper extremity, rated 10 percent disabling; and erectile dysfunction, due to diabetes mellitus, rated noncompensably disabling. He is also in receipt of special monthly compensation based on loss of use of a creative organ. The Veteran served in the Republic of Vietnam and, so, is presumed to have been exposed to herbicides. However, scarlet fever, jungle rot (or tinea pedis), folliculitis keloidalis, and goiters are not disabilities presumed to be due to inservice herbicide exposure. Nevertheless, service connection for these disorders may otherwise be established under the general principles governing claims for service connection. Skin Rash Disorder "'Scarlet fever' is defined as "infection with group A hemolytic streptococci of varying severity, ... characterized by pharyngitis and tonsillitis concurrent with' a redness of the skin produced by congestion of the capillaries "progressing from the trunk and neck to the extremities ... with flushed face'." Smith v. Shinseki, No. 07-3233, slip op. (U.S. Vet. App. July 28, 2009) (nonprecedential memorandum decision, citing Dorland's Illustrated Medical Dictionary 622-23 (27th ed.1988)); Slip Copy, 2009 WL 2240423 (Table) (Vet.App.). The evidence of record simply does not establish that the Veteran has ever had scarlet fever at any time. To the extent that the Veteran alleges that he did have scarlet fever, this is a disease with various symptoms and required medical training for a proper and valid diagnosis. The Veteran does not have such training or education and, so, his statements that he had scarlet fever are simply not competent. Moreover, as the 2011 VA examiner observed, even the Veteran's own statement was that he had scarlet fever a number of years after military service and, so, even if he had had scarlet fever, and again there is no competent evidence that he ever did, there is nothing which would relate it to the Veteran's military service, including any inservice herbicide exposure. Likewise, his residual bumps on the back of his head had existed only since a postservice episode of desquamation of the Veteran's skin in 1980, which the 2011 VA examiner diagnosed as folliculitis keloidalis. Thus, there is no competent evidence linking folliculitis keloidalis to the Veteran's military service, including any inservice herbicide exposure. As to jungle rot, this is not demonstrated by the service treatment records. However, even assuming that the Veteran did have what the recent VA examiner classified as tinea cruris, that same examiner noted that this fungal infection had resolved during service and had never recurred. The VA examiner concluded that the same was true as to the Veteran's heat rash during military service - that it resolved without ever recurring. See generally Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) ("Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability.) In the absence of proof of present disability there can be no valid claim. Degmetich v. Brown, 104 F.3d 1328 (1997) (interpreting 38 U.S.C. § 1131 as also requiring the existence of a present disability for VA compensation purposes). See, too, Wamhoff v. Brown, 8 Vet. App. 517, 521 (1996). The evidence does not otherwise establish that the Veteran now has a chronic skin disorder which is in any way related to his active service, including any inservice herbicide exposure, or which is related either causally or by aggravation to a service-connected disability, including his service-connected diabetes. Neck Goiter As to the Veteran's neck goiter, this is clearly due to the Veteran's thyroid disease. While the Veteran is competent to state that he had a lump on his neck at service discharge, whether such a lump was a manifestation of thyroid disease requires the type of medical training and education for diagnostic purposes which the Veteran simply does not have. Moreover, other evidence on file show that the first developed a lump on his neck, later found to be a manifestation of thyroid disease, in about 1992. In 1996, it was reported that he had had a mass on his neck for five years. This would antedate the lump, or goiter, to only 1991. Even if this history had been intended to mean that he had had the lump, or goiter, for five years prior to 1992, this would still antedate the symptom to about 1987, a time more than a decade after service discharge. Accordingly, the Veteran's statements as to continuity of symptomatology are not credible. See generally Jandreau, 492 F.3d at 1377 and Buchanan, 451 F.3d at 1336 (holding that the credibility of competent lay evidence must then be weighed against other evidence but is not refuted solely by the absence of corroborating medical evidence, but this is a factor, as are whether there is supporting or contradictory medical or lay evidence, and the length of time between alleged incurrence of disability and the first medical or lay evidence thereof). While the Veteran is not otherwise shown to have any form of cancer of the thyroid gland which is presumptively due to herbicides, there is no competent medical nexus evidence linking the Veteran's thyroid disease, with goiter, to his military service or inservice herbicide exposure. In sum, there is no competent evidence in the record which relates the Veteran's thyroid disease, a form of endocrinopathy to his military service, including any exposure to herbicides or which relates it either causally or by aggravation to a service-connected disability, including his service-connected diabetes. The Board recognizes the Veteran's contentions that he has had a skin rash and a neck goiter as a result of his active service. When a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. In such cases, the Board is within its province to weigh that testimony and to make a credibility determination as to whether that evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau, 492 F.3d at 1372. To the extent that the Veteran is able to observe continuity of symptoms, his opinion is outweighed by the competent medical evidence. Simply stated, the Veteran's service treatment records and post-service medical records outweigh the Veteran's contentions. Where a determinative issue involves medical causation or a medical diagnosis, competent medical evidence is required. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). While the Board is sympathetic to the Veteran's claims, and he is certainly competent to describe that which he experienced in service, any contentions by the Veteran that he has a current skin rash disorder or neck goiter that is related to active service are not competent. There is no indication that the possesses the requisite medical knowledge or education to render a probative opinion involving medical diagnosis or medical causation. See Cromley v. Brown, 7 Vet. App. 376, 379 (1995). This being the case, the claims must be denied because the preponderance of the evidence is unfavorable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. ORDER Service connection a skin rash disorder, to include as manifested by jungle rot and scarlet fever, is denied. Service connection for a multi-nodular neck goiter is denied. ____________________________________________ DEMETRIOS G. ORFANOUDIS Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs