Citation Nr: 1318410 Decision Date: 06/06/13 Archive Date: 06/11/13 DOCKET NO. 10-23 154 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in North Little Rock, Arkansas THE ISSUES 1. Entitlement to service connection for chronic obstructive pulmonary disease (COPD). 2. Entitlement to service connection for osteoarthritis. 3. Entitlement to service connection for a disability resulting from hepatitis-C infection. 4. Entitlement to service connection for scoliosis. 5. Entitlement to service connection for chronic dry skin with pruritis, to include as due to an undiagnosed illness or a medically unexplained multisymptom illness. 6. Entitlement to service connection for a chronic multisymptom disability manifested by joint/muscle pain, memory loss, anxiety, depression, night sweats, mood swings, emotional problems, sleep disturbance, nightmares and neurological symptoms, claimed as a pinched nerve in the back/neck with headaches, to include as due to an undiagnosed illness or a medically unexplained multisymptom illness. ATTORNEY FOR THE BOARD J. H. Nilon, Counsel INTRODUCTION The Veteran served on active duty from November 1989 to December 1992. He was discharged Under Honorable Conditions due to misconduct and abuse of illegal drugs. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a May 2009 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in North Little Rock, Arkansas that in relevant part denied service connection for COPD, osteoarthritis, hepatitis-C infection and scoliosis. Also on appeal is an April 2010 RO rating decision that in relevant part denied service connection for chronic dry skin with pruritis and also denied service connection for a chronic multisymptom disability manifested by joint/muscle pain, memory loss, anxiety, depression, night sweats, mood swings, emotional problems, sleep disturbance, nightmares and neurological symptoms. Both claims were based on an assertion that the claimed disabilities are due to an undiagnosed illness or a medically unexplained multisymptom illness. The Veteran requested a videoconference hearing before the Board, but he failed to appear at a videoconference hearing scheduled in November 2012. His request for a hearing before the Board is accordingly considered to be withdrawn. See 38 C.F.R. § 20.704 (2012). FINDINGS OF FACT 1. The Veteran served in Southwest Asia during the Persian Gulf War. 2. The Veteran does not have COPD or other chronic respiratory disorder that is etiologically related to service. 3. Arthritis was not manifested during service or to a compensable degree within the first year after service, and the currently-diagnosed osteoarthritis of the neck, back and hands is not etiologically related to service. 4. Hepatitis-C infection is not shown to have been contracted during service. 5. The Veteran does not have scoliosis that is etiologically related to service. 6. The Veteran does not have chronic dry skin with pruritis that is etiologically related to service or to an undiagnosed illness or a medically unexplained multisymptom illness that is associated with service. 7. The Veteran is service-connected for chronic fatigue syndrome; he does not have any other chronic disability manifested by joint/muscle pain, memory loss, anxiety, depression, night sweats, mood swings, emotional problems, sleep disturbance, nightmares and neurological symptoms claimed as pinched nerves in the neck and back and headaches that is etiologically related to service or to an undiagnosed illness or a medically unexplained multisymptom illness that is associated with service. CONCLUSIONS OF LAW 1. COPD is not due to or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 1154(a), 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). 2. Osteoarthritis is not due to or aggravated by service, and incurrence in service of osteoarthritis may not be presumed. 38 U.S.C.A. §§ 1110, 1131, 1154(a), 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2012). 3. A disability resulting from hepatitis-C infection is not due to or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 1154(a), 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). 4. Scoliosis is not due to or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131, 1154(a), 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). 5. Chronic dry skin with pruritis is not due to or aggravated by service and is not due to a chronic multisymptom illness or medically unexplained multisymptom illness. 38 U.S.C.A. §§ 1110, 1112, 1131, 1137, 5107(b) (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.303, 3.310, 3.317 (2012). 6. A chronic disability manifested by joint/muscle pain, memory loss, anxiety, depression, night sweats, mood swings, emotional problems, sleep disturbance, nightmares and neurological symptoms claimed as pinched nerves in the neck and back and headaches is not due to or aggravated by service and is not due to a chronic multisymptom illness or medically unexplained multisymptom illness. 38 U.S.C.A. §§ 1110, 1112, 1131, 1137, 5107(b) (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.303, 3.310, 3.317 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist Before addressing the merits of the Veteran's claim on appeal, the Board is required to ensure that the VA's "duty to notify" and "duty to assist" obligations have been satisfied. See 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2012). The VA is required to assist a claimant in obtaining evidence necessary to substantiate a claim but is not required to provide assistance to a claimant if there is no reasonable possibility that such assistance would aid in substantiating the claim. The VA is required to notify a claimant and the claimant's representative, if any, of any information, and any medical or lay evidence, not previously provided to the Secretary that is necessary to substantiate the claim. As part of the notice, the VA is to specifically inform the claimant and the claimant's representative, if any, of which portion, if any, of the evidence is to be provided by the claimant and which part, if any, the VA will attempt to obtain on behalf of the claimant. In addition, the United States Court of Appeals for Veterans Claims (Court) has held that the plain language of 38 U.S.C.A. § 5103(a) requires that notice to a claimant be provided "at the time" of, or "immediately after," the VA's receipt of a complete or substantially complete application for VA-administered benefits. Pelegrini v. Principi, 18 Vet. App. 112, 119 (2004). VA must also notify the claimant that, should service connection be awarded, a disability rating and an effective date for the award of benefits will be assigned. Dingess v. Nicholson, 19 Vet. App. 473 (2006). In this case, notice fully compliant with the law, including the disability-rating and effective-date elements, was provided to the Veteran by a letter in March 2009, and the Veteran had ample opportunity to respond prior to issuance of the May 2009 rating decision on appeal. In regard to the April 2010 rating decision on appeal, the Veteran was sent a letter in December 2009 that provided compliant notice pertaining to those issues. In any event, the Veteran has neither alleged nor demonstrated any prejudice with regard to the content or timing of the notice. See Shinseki v. Sanders, 129 S.Ct. 1696 (2009 (reversing prior cases law imposing a presumption of prejudice on any notice deficiency and clarifying that the burden of showing harmful or prejudicial error normally falls on the party attacking the agency's determination). See also Mayfield v. Nicholson, 444 F.3d 1328, 1333-34 (Fed. Cir. 2006). The record also reflects that service treatment records (STRs), service personnel records and all available post-service medical evidence identified by the Veteran have been obtained. The Veteran has been afforded appropriate medical examinations in regard to the claims on appeal; as noted in the Introduction he was scheduled to testify before the Board but he did not report for the hearing. The Veteran has not made the RO or the Board aware of any additional evidence that needs to be obtained in order to fairly decide this appeal, and has not argued that any error or deficiency in the accomplishment of the duty to notify and duty to assist has prejudiced him in the adjudication of this appeal. The Veteran reported during a VA psychiatric examination in March 2010 that he was receiving Social Security Administration (SSA) disability benefits based on neck, back and respiratory problems. Where there is actual notice to VA that the appellant is receiving disability benefits from the Social Security Administration (SSA), VA usually has the duty to acquire a copy of the decision granting SSA disability benefits and the supporting medical documentation relied upon. Baker v. West, 11 Vet. App. 163 (1998); Hayes v. Brown, 9 Vet. App. 67 (1996). However, VA's duty to assist applies only to relevant SSA records; in light of this, the Federal Circuit remarked that the legal standard for relevance requires VA to examine the information it has related to medical records, and, if there exists a reasonable possibility that the records could help the veteran substantiate the claim, to obtain those records. Golz v. Shinseki, No. 2009-7039 (Fed. Cir. Jan. 4, 2010) (finding VA was not obligated to obtain SSA records when the SSA grant was for orthopedic disability and the VA claim under review was for a psychiatric disorder). In the instant case, the Veteran had reported during earlier examination in September 2009 that he was still pursuing SSA benefits, so any grant by SSA would have been nearly 20 years after the Veteran was discharged from service. Because SSA adjudication is focused on current symptoms and employability, it is unlikely that any records in the Veteran's SSA file would provide evidence relevant to the question of service connection. The Board accordingly finds there is no duty to pursue SSA records in conjunction with the issues on appeal. Based on a review of the claims file, the Board finds that there is no indication in the record that any additional evidence relevant to the issue to be decided herein is available and not part of the claims file. See Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007). Therefore, the Board finds that duties to notify and assist have been satisfied and will proceed to the merits of the issue on appeal Applicable Laws and Regulations Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be granted on a presumptive basis for arthritis that became manifest to a compensable degree within the first year after discharge from service, even if not documented during service. 38 C.F.R. §§ 3.307, 3.309(a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed.Cir.1996) (table). The second and third elements may be established by showing continuity of symptomology. Continuity of symptomatology may be shown by demonstrating "(1) that a condition was 'noted' during service or any applicable presumption period; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology." Barr v. Nicholson, 21 Vet. App. 303, 307 (2007); see also Davidson, 581 F.3d at 1316; Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board"). Because the Veteran served in the Southwest Asia Theater of operations since August 2, 1990, service connection may also be established under 38 C.F.R. § 3.317. Under 38 C.F.R. § 3.317, 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. For a disability due to undiagnosed illness and medically unexplained chronic multisymptom illness, the disability must have been manifest either during active military service in the Southwest Asia Theater of operations or to a degree of 10 percent or more not later than December 31, 2016. See 76 Fed. Reg. 81834 (Dec. 29, 2011) (to be codified at 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.A 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. § 3.317, 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. A medically unexplained chronic multisymptom illnesses is one defined by a cluster of signs or symptoms and specifically includes chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders (excluding structural gastrointestinal diseases), 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 multisymptom illness. A "medically unexplained chronic multisymptom illness" contemplates 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 multisymptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii). For purposes of 38 C.F.R. § 3.317, disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a six-month period will be considered chronic. The six-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. 38 C.F.R. § 3.317(a)(4). "Objective indications of chronic disability" include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Signs or symptoms that may be manifestations of undiagnosed illness or medically unexplained chronic multisymptom illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders. 38 C.F.R. § 3.317(b). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the 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. Davidson, 581 F.3d 1313, 1316; Jandreau, 492 F.3d 1372, 1376-77. When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, 492 F.3d 1372, 1376-77. The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C.A. § 7104(a) (West 2002). Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, and consistency with other evidence submitted on behalf of the Veteran, and the Veteran's demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza, 7 Vet. App. 498, 511. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Evidence and Analysis Service connection for COPD Service treatment records (STRs) show no indication of respiratory complaints. Report of Medical Examination in September 1992 (separation examination) shows clinical evaluation of the lungs and chest as "normal." In the corresponding self-reported Report of Medical History the Veteran specifically denied symptoms of history of asthma, shortness of breath, tuberculosis or chronic cough. Chest X-ray at the time of separation was normal. The Veteran was discharged from service in 1992. In his claim for service connection the Veteran asserted that his COPD began in September 2008. VA primary care clinic (PCC) notes in October 2008 and February 2009 state the Veteran had a tobacco use disorder. The Veteran complained of dyspnea on exertion (DOE) and being winded after exertion; he also reported having a cough every morning. He was noted to have a family history positive for COPD. Physical examination showed the lungs to be grossly normal. The clinical impression in February 2009 was tobacco use and possible COPD. The treatment plan was to perform pulmonary function tests (PFTs). Of note, PFTs were subsequently performed but do not indicate a resultant diagnosis. The Veteran's wife and his mother submitted letters in March 2009 attesting that he was significantly impaired by shortness of breath, among other problems. Similarly, the Veteran's sister submitted a letter in October 2009 asserting the Veteran had health problems "for years" including COPD and shortness of breath. VA chest X-rays in June 2009 and October 2009 showed hyperinflated lungs with no focal abnormality and clear lungs without effusion or pneumothorax. The Veteran had a consult at the VA Diagnostic Unit in October 2009 in response to his multisymptom complaints. In regard to respiratory complaints, he was noted to have a history of smoking a pack of cigarettes per day for 20 years. Examination showed the lungs to be clear to auscultation and percussion. The examination report is silent in regard to any observed respiratory disorder. The Veteran had a VA chest X-ray in February 2011, which was compared to the previous study in June 2009. The impression was no significant interval changes. As of March 2011 the Veteran's VA active problems list included "tobacco use disorder" but no other respiratory disorder. Assuming the Veteran has COPD, a veteran seeking disability benefits must establish not only the existence of a disability, but also an etiological connection between his military service and the disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); D'Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000). In this case, there is no indication that the Veteran's current COPD or other chronic respiratory disorder is due to service. In that regard, the STRs do not show, and the Veteran has not asserted, that he has a chronic respiratory that began during service. The Veteran stated in his claim that symptoms began in 2008, which is 16 years after his discharge from service; the passage of many years between discharge from active service and the medical documentation of a claim disability is evidence against a claim of service connection. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); Shaw v. Principi, 3 Vet. App. 365 (1992). VA must consider all favorable lay evidence of record. 38 USCA § 5107(b); Caluza v. Brown, 7 Vet. App. 498 (1995). Accordingly, in addition to the medical evidence of record the Board has considered the lay evidence offered by the Veteran in the form of his correspondence to VA, the lay statements submitted by his family members and his statements to various medical providers and examiners. A layperson is competent to testify in regard to the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995). Accordingly, the Veteran is competent to report the onset of shortness of breath, and his family members are competent to report the Veteran's observable symptoms. However, nothing in the lay evidence suggests respiratory complaints during service or continuously since service. The statement by the Veteran's sister in October 2009 that the Veteran had problems "for years" including COPD and shortness of breath is inconsistent with the Veteran's assertion in his claim that symptoms began in 2008, and in any event does not suggest chronic complaints since discharge from service. The Veteran has asserted in his lay evidence that COPD or other respiratory complaints are due to exposure to Sarin gas in Saudi Arabia, but he has not demonstrated that he was in proximity to an area where Sarin gas usage has been documented. While there are recognized environmental hazards associated with service in Southwest Asia (dust, oil well fires, etc.) there is no presumption that COPD is residual to such exposure. The etiology of respiratory symptoms is a complex medical question that is not within the competence of a layperson; see Kahana, 24 Vet. App. 428. Rather, it is the province of trained health care professionals to enter conclusions that require medical expertise, such as opinions as to diagnosis and causation; see Jones v. Brown, 7 Vet. App. 134, 137 (1994). In this case, there is no competent medical opinion relating COPD or other respiratory diagnosis to service. Lastly, because the Veteran's respiratory complaints have been diagnosed as either COPD or tobacco use disorder, an analysis under 38 U.S.C.A. § 1117; 38 C.F.R. § 3.317 for an undiagnosed illness is not indicated. Likewise, disability resulting from use of tobacco products during service are not entitled to service connection benefits. 38 U.S.C.A. § 1103. In sum, the Board has found the Veteran does not have COPD or other chronic respiratory disorder that is etiologically related to service. Accordingly, the criteria for service connection are not met and the claim must be denied. Because the weight of the evidence is against the claim the benefit-of-the-doubt rule does not apply. Gilbert, 1 Vet. App. 49, 54. Service connection for osteoarthritis Service treatment records (STRs) show no indication of arthritis and no indication of musculoskeletal complaints other than a fractured right great toe (for which service connection has been granted). Report of Medical Examination in September 1992 (separation examination) shows clinical evaluation of the extremities, spine and other musculoskeletal as "normal." In the corresponding self-reported Report of Medical History the Veteran specifically denied history of arthritis, rheumatism or bursitis; swollen or painful joints; or, bone, joint or other deformity. The Veteran was discharged from service in 1992. In his claim for service connection the Veteran asserted that his osteoarthritis began in September 2008. The Board accordingly finds the evidence does not show arthritis to a compensable degree within the first year after discharge from service, so presumptive service connection under 38 C.F.R. § 3.309(a) is not for consideration. VA PCC notes in October 2008 and February 2009 state the Veteran had severe osteoarthritis manifested by neck pain and stiffness. Musculoskeletal examination was significant for crepitus (without pain) in the bilateral hips, knees and shoulder joints. The Veteran also had pain in the right elbow and the joints in his hands were enlarged. The clinical impression was osteoarthritis in multiple joints. The Veteran's wife submitted a letter in March 2009 attesting that he was significantly impaired by joint pain, among other problems. Similarly, the Veteran's sister submitted a letter in October 2009 asserting the Veteran had health problems "for years" including joint pain. VA MRI of the cervical spine in August 2009 showed an impression of degenerative changes at C5-6 and C6-7. The Veteran had a VA examination (Gulf War guidelines) in March 2010 in which the examiner noted the Veteran's diagnosed osteoarthritis was identified only in the neck and back, but that he probably had osteoarthritis in the metacarpophalangeal (MCP) joints of his hands as well. The examiner performed a clinical examination and noted observations in detail. The examiner diagnosed mild osteoarthritis of the hands and degenerative disc disease (DDD) of the lumbar and cervical spines. Review of the file shows the Veteran has been diagnosed with osteoarthritis of the neck, back and hands. However, evidence of a present condition is generally not relevant to a claim for service connection, absent some competent linkage to military service. Mingo v. Derwinski, 2 Vet. App. 51, 53 (1992). STRs do not show, and the Veteran has not asserted, that he had any trauma to the neck, back or hands during service to which traumatic osteoarthritis could arguably be attributed, and there is no medical evidence of record indicating that osteoarthritis that developed many years after discharge from service is somehow etiologically related to service. The Veteran evidently considers his osteoarthritis is somehow related to service. However, the etiology of osteoarthritis is a complex medical question that is not within the competence of a layperson; see Kahana, 24 Vet. App. 428. In this case, there is no competent medical opinion relating osteoarthritis to service. Jones, 7 Vet. App. 134, 137. In sum, the Board has found the Veteran's diagnosed osteoarthritis of the back, neck and hands is not etiologically related to service. Accordingly, the criteria for service connection are not met and the claim must be denied. Because the weight of the evidence is against the claim the benefit-of-the-doubt rule does not apply. Gilbert, 1 Vet. App. 49, 54. Service connection for a disability resulting from hepatitis-C infection STRs show no indication of symptoms suggestive of an active hepatitis infection during service. Report of Medical Examination in September 1992 (separation examination) shows no abnormal laboratory results." In the corresponding self-reported Report of Medical History the Veteran specifically denied history of jaundice or hepatitis. The Veteran was discharged from service in 1992. In his claim for service connection the Veteran asserted that his hepatitis-C (HCV) infection began in December 2005. A VA PCC history and physical (H&P) examination dated in September 2004 states the Veteran had been diagnosed with HCV in May 2004. There is no indication as to how the Veteran may have acquired the infection. A VA gastroenterology clinic note dated in November 2004 states the Veteran reported having been diagnosed with HCV in June 2004. Significantly, the Veteran admitted to using illegal drugs by intravenous (IV) injection during the period 1984-1985. The impression was chronic HCV, currently asymptomatic. The file contains a VA ophthalmology consult in July 2005 showing the Veteran was about to begin a treatment regimen of interferon/Ribavirin for his chronic HCV. A VA treatment note dated in December 2008 confirms a clinical impression of chronic HCV, genotype 1a, currently sustained virological response (SVR) 18 months post completion of a 48-week regimen of Pegasys/Ribavirin therapy. The Veteran's wife submitted letters in October 2008 and March 2009 attesting that the Veteran's hepatitis infection was causing significant impairment of his health and his employability. The Veteran's mother also submitted a letter in March 2009 stating that the medications the Veteran was taking for his hepatitis infection were depleting his body of calcium and thus causing joint pains and dental problems. Similarly, the Veteran's sister submitted a letter in October 2009 asserting the Veteran had health problems "for years" including hepatitis-C infection. The Veteran submitted a VA hepatitis risk factors questionnaire in March 2009 in which he denied exposure to any of the risk factors for hepatitis (intravenous drugs, intranasal cocaine, high-risk sexual activity, hemodialysis, tattoos or body piercings, sharing of toothbrushes or razor blades, acupuncture with non-sterile needles, blood transfusion, or work as a health care giver with exposure to contaminated blood or fluids). Review of the record shows the Veteran is diagnosed with HCV infection, which was identified in 2004. The Veteran's admission of IV drug use, made to the VA gastroenterology clinic in November 2004, is the only HCV risk factor that is of record. The Veteran has not articulated exposure during service to any recognized HCV risk factors, and in fact he specifically denied all risk factors in the March 2009 questionnaire. As there are no demonstrated risk factors during service, but a significant risk factor outside service, there is no basis on which the Board can find the Veteran contracted HCV infection during service. The Veteran evidently believes he somehow contracted the HCV infection during service. However, the etiology of HCV infection is a complex medical question that is not within the competence of a layperson; see Kahana, 24 Vet. App. 428. In this case, there is no competent medical opinion relating HCV infection to service. Jones, 7 Vet. App. 134, 137. In sum, the Board has found the Veteran's diagnosed HCV infection is not etiologically related to service. Accordingly, the criteria for service connection are not met and the claim must be denied. Because the weight of the evidence is against the claim the benefit-of-the-doubt rule does not apply. Gilbert, 1 Vet. App. 49, 54. Service connection for scoliosis Scoliosis is an abnormal lateral and rotational curvature of the vertebral column and may be "fixed" as the result of muscle and/or bone deformity or "mobile" as a result of unequal muscle contraction. Stedman's Medical Dictionary, 27th Ed. (2000), pg. 1606. STRs show no indication of scoliosis or any other complaint related to the spine during service. Report of Medical Examination in September 1992 (separation examination) shows clinical evaluation of the spine as "normal." In the corresponding self-reported Report of Medical History the Veteran specifically denied history of recurrent back pain. The Veteran was discharged from service in 1992. In his claim for service connection the Veteran asserted that his scoliosis began in September 2008. VA PCC notes in October 2008 and February 2009 show the Veteran complained of back pain. Examination showed the Veteran to have deformities of the left paraspinous muscles, which were atrophied and painful to palpation. The clinical impression was low back pain due to muscular strain related to scoliosis and job. The Veteran's wife and his mother submitted letters in March 2009 attesting that he was significantly impaired by back pain and scoliosis, among other problems. Similarly, the Veteran's sister submitted a letter in October 2009 asserting the Veteran had health problems "for years" including scoliosis, several bulging discs in the back and neck and pinched nerves in the back and neck. VA magnetic resonance imaging (MRI) of the lumbar spine in August 2009 was significant for mild bulging disc at L3-4. The MRI report is silent in regard to current scoliosis. The Veteran had a consult at the VA Diagnostic Unit in October 2009 in response to his multisymptom complaints. The Veteran complained of low back pain shooting into the right lower extremity (RLE). The examiner noted that MRI had shown L3-4 bulging with nerve root displacement. The examiner noted the Veteran had been referred to neurosurgical consult but this was denied because there was no surgical intervention to be offered; the recommended treatment was pain control. The consult report is silent in regard to scoliosis. The Veteran had a VA examination (Gulf War guidelines) in March 2010 in which the examiner diagnosed lumbar DDD at L3-4 left, with shooting pains and myalgia. The examiner noted the Veteran to have normal posture; the examination report is silent in regard to current scoliosis. On review, the evidence of record shows reference to scoliosis in October 2008 and February 2009, but there is nothing in the record to show a relationship between such disorder and service. STRs show the spine to have been clinically normal at the time of discharge from service, and the Veteran has not asserted that he had scoliosis during service. To the degree that scoliosis may arguably be a congenital deformity, congenital or developmental defects are not "diseases or injuries" within the meaning of applicable statutes and regulations. 38 C.F.R. § 3.303(c); Winn v.Brown, 8 Vet. App. 510, 516 (1996). To the degree that scoliosis may be an acquired deformity, there is no indication that scoliosis became manifest during service or that it became manifest after discharge in service due to a service-connected disability (the Veteran has DDD of the cervical and lumbosacral spines that may cause or contribute to acquired scoliosis, but DDD is not a service-connected disability). The Veteran evidently believes his scoliosis is somehow related to service. However, the etiology of scoliosis is a complex medical question that is not within the competence of a layperson; see Kahana, 24 Vet. App. 428. In this case, there is no competent medical opinion relating scoliosis to service. Jones, 7 Vet. App. 134, 137. In sum, the Board has found the Veteran's scoliosis is not etiologically related to service. Accordingly, the criteria for service connection are not met and the claim must be denied. Because the weight of the evidence is against the claim the benefit-of-the-doubt rule does not apply. Gilbert, 1 Vet. App. 49, 54. Service connection for chronic dry skin with pruritis STRs show no indication of skin disorder or complaints during service. Report of Medical Examination in September 1992 (separation examination) shows clinical evaluation of the skin as "normal." In the corresponding self-reported Report of Medical History the Veteran specifically denied history of skin disease. The Veteran had a VA dermatology consult in June 2009 in which he received a physical examination of the scalp, face, neck, chest, abdomen, back, arms and legs. The only abnormality noted was a pearly pink papule on the left ankle of uncertain diagnosis but probably a dermatofibroma. The Veteran's sister submitted a letter in October 2009 asserting the Veteran had health problems "for years" including skin disorders. The Veteran had a consult at the VA Diagnostic Unit in October 2009 in response to his multisymptom complaints. Physical examination showed papular rash on the torso and arms; the examiner did not provide a diagnosis or etiology. The Veteran had a VA examination (Gulf War guidelines) in March 2010 in which he reported a 5-10 year history of rather intense dryness and itching to the point of excoriation and bleeding, particularly in the hands and arms. The Veteran did not have current active lesions but had dark spots where lesions had healed. Examination showed the skin to be modestly dry with areas of hyperpigmentation where the Veteran had been scratching himself. The examiner diagnosed chronic dry skin with intense pruritis and excoriation with healing and hyperpigmentation. The examiner stated it is less likely than not that the Veteran's various illnesses, including skin condition, are related to a specific exposure in Southwest Asia as these symptoms and signs had their onset 5-10 years previously. Also, the Veteran had numerous current stresses (emotional, anxiety and financial) that were contributing to his current status. In his substantive appeal, received in October 2011, the Veteran asserted he had been exposed to Sarin nerve agent in Southwest Asia. He stated his personal belief that his claimed skin condition was part of a cluster of signs and symptoms attributable to "Gulf War syndrome." Review of the file shows the Veteran is identified as having chronic dry skin with intense pruritis and excoriation, but there is no indication that such disorder is related to service. STRs do not show, and the Veteran has not asserted, that he had a chronic skin disorder that became manifest during service. The Veteran evidently considers his skin disorder is somehow related to service, but the etiology of a skin disorder that became manifest years after a claimed exposure is a complex medical question that is not within the competence of a layperson; see Kahana, 24 Vet. App. 428. In this case, the competent and uncontroverted medical opinion of record shows the Veteran's skin disorder is not related to an exposure to toxins during service. The findings of a physician are medical conclusions that the Board cannot ignore or disregard. Willis v. Derwinski, 1 Vet. App. 66 (1991). The Board has determined that the March 2010 medical opinion cited above meets the criteria cited in Nieves-Rodriguez for determining probative value. The VA examiner was demonstrably fully informed of the pertinent factual premises in that he reviewed the medical record and cited to the record in his report. The examiner also provided a fully articulated opinion and a reasoned analysis. The Board accordingly deems the examination report to be of high probative value. In sum, the Board has found the Veteran's claimed chronic skin disorder is not etiologically related to service and is not due to a chronic multisymptom illness or to a medically unexplained multisymptom illness. Accordingly, the criteria for service connection are not met and the claim must be denied. Because the weight of the evidence is against the claim the benefit-of-the-doubt rule does not apply. Gilbert, 1 Vet. App. 49, 54. Service connection for a chronic multisymptom disability STRs show no indication of joint/muscle pain, memory loss, anxiety, depression, night sweats, mood swings, emotional problems, sleep disturbance, nightmares, neurological symptoms or headaches during service. Report of Medical Examination in September 1992 (separation examination) shows clinical evaluation of all physical systems, to include neurological and psychiatric, as "normal." In the corresponding self-reported Report of Medical History the Veteran specifically denied history of swollen or painful joints; frequent or severe headaches; dizziness or fainting spells; neuritis; frequent trouble sleeping; depression or excessive worry; or, nervous trouble of any sort. The Veteran's mother submitted a letter in March 2009 asserting that the Veteran's numerous disorders were caused by exposure to chemicals and other hazards during the Persian Gulf War. The Veteran had a VA MRI scan of the head and brain in June 2009 to follow up his complaint of headaches and memory loss. The impression was that the scan was essentially normal. VA MRI of the cervical spine in August 2009 showed an impression of degenerative changes at C5-6 and C6-7 with no evidence of focal nerve root or cord impingement. The Veteran presented to the VA PCC in September 2009 requesting documentation that he had "Gulf War syndrome." The Veteran complained of chronic fatigue, memory loss, muscle pain, pain in all joints, headaches and insomnia; he brandished a pamphlet that listed these symptoms as characteristic of "Gulf War syndrome" and asked for a corresponding diagnosis so that he could receive disability benefits from VA and from Social Security Administration for same. The Veteran described recent onset of memory loss "I can't remember anything") and his wife endorsed that he had once forgotten to pick up their children. The Veteran complained of pain, but he was observed to walk unassisted and to be without a limp or any sign of pain or distress. Clinical examination of all physical systems was essentially normal. The clinician stated he did not feel the Veteran had "Gulf War syndrome" and that the Veteran was possibly malingering for monetary gain. The Veteran was referred to the Diagnostic Unit for follow-up. The Veteran submitted a letter in September 2009 asserting he had been informed that he was exposed to Sarin nerve gas while performing duties in Southwest Asia during the Persian Gulf War. He intimated a belief that his spectrum of symptoms was related to such exposure. Similarly, the Veteran's sister submitted a letter in October 2009 asserting the Veteran had health problems "for years" including mood swings, emotional problems, muscle and joint pains, headaches and dizziness, sleep disturbances, nightmares, night sweats, depression, and memory loss. Like the Veteran, she intimated an opinion that these symptoms were related to exposure to Sarin nerve gas or other toxins in Southwest Asia. The Veteran had a consult at the VA Diagnostic Unit in October 2009 in response to his multisymptom complaints (neck and low back pain, headaches, memory loss, fatigue with shortness of breath, insomnia and difficulty urinating). The Veteran was noted to have a medical history significant for HCV, DJD, chronic low back pain and hyperlipidemia. The examiner stated the Veteran's memory problems did not seem to be progressive or significant. The Veteran's arthralgias were worst in the morning, with stiffness that took about 30 minutes to resolve, but joint pain increased with activity. Rheumatologic issues were a concern but on examination there was no joint swelling, warmth, redness or evidence of synovitis, and there were no trigger points to suggest fibromyalgia. The most likely diagnosis for the Veteran's constellation of symptoms was chronic fatigue syndrome (for which service connection was granted by a subsequent rating decision in May 2010). Otherwise, neck pain was associated with degenerative changes as documented by MRI and low back pain with radiculopathy was associated with disc bulging as documented by MRI; headaches, memory loss, fatigue and insomnia did not have listed etiology. The Veteran had a VA examination (Gulf War guidelines) in March 2010 for the purpose of determining whether the Veteran's complaints (joint pain, myalgia, headaches and pinched nerves in the head and neck) are related to an undiagnosed illness or to a diagnosable but medically unexplained multisymptom illness or unknown or partially-unexplained etiology, versus a disease with clear and specific diagnosis and etiology. The examiner noted the Veteran had recently been diagnosed with chronic fatigue syndrome based on symptoms of myalgia, fatigue, headaches, joint pain and sleep disturbance. The Veteran described joint pain and stiffness in the hands, elbows and knees, while his muscle aches were primarily in the neck, triceps, trapezius and calves. The Veteran described his headaches. The examiner noted the Veteran was indentified with HCV infection and with thyroid disorder, but stated that based on medical regimen the Veteran's complaints were not related to those disorders or to the medications for those disorders. The examiner performed a clinical examination and noted observations in detail. In relevant part the examiner diagnosed chronic fatigue syndrome; chronic epicondylitis of the bilateral lower extremities; mild osteoarthritis of the hands; chronic patellofemoral syndrome of the bilateral knees; lumbar DDD with shooting pains and radiculopathy; cervical DDD with radiculopathy and shooting pains into the arms, shoulders and neck, with myalgia; and, tension headaches secondary to poor sleep. The examiner stated an opinion that the Veteran had a combination of diagnosable chronic multisystem illness (i.e., chronic fatigue syndrome) and also diseases with clear and specific diagnosis and etiology (i.e., patellofemoral syndrome, tension headaches, cervical and lumbar DDD with radiculopathy, and myalgia). In sum, the examiner stated it is less likely than not that these illnesses are related to a specific exposure in Southwest Asia as these symptoms and signs had their onset 5-10 years previously. Also, the Veteran had numerous current stresses (emotional, anxiety and financial) that were contributing to his current status. The Veteran also had a VA psychiatric examination in March 2010 during which he stated that with medication he could sleep 5-7 hours but without medication he would awaken because of aches, pains and cramps. The examiner diagnosed adjustment disorder with depressed mood, and stated the depression was likely due to the Veteran's inability to work. Symptoms were mild-to-moderate and had persisted for 5-7 years. The Veteran presented to the VA PCC in July 2010 with multiple complaints (neck and back pain and overall feeling of tiredness). Physical examination was grossly normal for all systems. The clinical impression was chronic fatigue syndrome with multiple complaints. The Veteran was noted to having a poor diet and to be non-compliant with exercise or with medications. The Veteran presented again to the VA PCC in February 2011 with vague complaints of muscle and joint pains. Clinical examination was again grossly normal for all systems. The Veteran was provided a pain reliever for his achiness and counseled about the benefit of good diet and exercise. In his substantive appeal, received in October 2011, the Veteran asserted he had been exposed to Sarin nerve agent in Southwest Asia. He stated his personal belief that his claimed musculoskeletal problems, neurological symptoms, sleep disturbances, neuropsychological symptoms, headaches, gastrointestinal problems and fatigue are all part of a cluster of signs and symptoms attributable to "Gulf War syndrome." Review of the file shows the Veteran is service-connected for chronic fatigue syndrome, which is a chronic multisymptom illness. He does not have any other chronic multisymptom illness that is due to service or any medically unexplained multisymptom illness due to service. The VA examination in March 2010, which is not controverted by any other medical opinion of record, clearly establishes that the Veteran's claimed symptoms are attributable to known diagnoses that are not related to service. The Veteran considers his symptoms are related to service, as do his family members as asserted in their correspondence to VA. However, the presence or absence of a chronic multisymptom illness is a complex medical question that is not within the competence of a layperson; see Kahana, 24 Vet. App. 428. In this case, the competent and uncontroverted medical opinion of record shows the Veteran's does not have such an illness, other than chronic fatigue syndrome that is already service-connected. As noted above, the Board has determined that the March 2010 medical opinion cited above meets the criteria cited in Nieves-Rodriguez for determining probative value. In sum, the Board has found the Veteran does not have a chronic disability manifested by joint/muscle pain, memory loss, anxiety, depression, night sweats, mood swings, emotional problems, sleep disturbance, nightmares and neurological symptoms claimed as pinched nerves in the neck and back and headaches that is etiologically related to service or to an undiagnosed illness or a medically unexplained multisymptom illness that is associated with service. Accordingly, the criteria for service connection are not met and the claim must be denied. Because the weight of the evidence is against the claim the benefit-of-the-doubt rule does not apply. Gilbert, 1 Vet. App. 49, 54. ORDER Service connection for COPD is denied. Service connection for osteoarthritis is denied. Service connection for a disability resulting from hepatitis-C infection is denied. Service connection for scoliosis is denied. Service connection for chronic dry skin with pruritis is denied. Service connection for a chronic disability manifested by joint/muscle pain, memory loss, anxiety, depression, night sweats, mood swings, emotional problems, sleep disturbance, nightmares and neurological symptoms claimed as pinched nerves in the neck and back and headaches is denied. ____________________________________________ MICHAEL E. KILCOYNE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs