Citation Nr: 1319345 Decision Date: 06/14/13 Archive Date: 06/21/13 DOCKET NO. 09-19 662 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Indianapolis, Indiana THE ISSUE Entitlement to service connection for recurrent methicillin resistant staphylococcus infection (MRSA). REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD H.J. Baucom, Associate Counsel INTRODUCTION The Veteran had active service from June 1995 to August 1995, April 2003 to March 2004, August 2007 to May 2008, and October 2010 to December 2011. This matter comes to the Board of Veterans' Appeals (Board) from a January 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Indianapolis, Indiana. In April 2013, a Board hearing was held at the RO before the undersigned; the transcript is of record. The Veteran's virtual VA file has been reviewed. FINDING OF FACT The Veteran's recurrent MRSA is related to service. CONCLUSION OF LAW The criteria for service connection for recurrent MRSA have been met. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). To establish service connection, there must be a competent diagnosis of a current disability; medical or, in certain cases, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. Hickson v. West, 12 Vet. App. 247, 252 (1999); see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The nexus between service and the current disability can be satisfied by competent evidence of continuity of symptomatology and evidence of a nexus between the present disability and the symptomatology. See Voerth v. West, 13 Vet. App. 117 (1999); Savage v. Gober, 10 Vet. App. 488, 495 (1997). Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). 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). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. At the April 2013 Board hearing the Veteran testified that during his deployment to Iraq in 2007 he began to get boils throughout his body, with large noticeable ones on his face and neck. He testified that he went to the combat service hospital for treatment but his condition was so bad that he was quarantined to his room. The Veteran also testified that he asked to be tested to find out what he had but the hospital did not have the ability to test him. He testified that after service he sought private treatment to figure out what he had. During his deployment to Iraq in 2007 service treatment records show multiple treatments for skin infections identified as cysts, furuncles and cystic acne which were found on his face and abdomen. He was also treated for a rash and bug bites. In a February 2009 letter Captain AF, the Veteran's commander in Iraq, reported that he has known the Veteran for more than five years and never saw any sign or symptoms of MRSA or any other skin related infections prior to October 2007. Captain AF reported that the Veteran's infection was so severe in October 2007 he quarantined the Veteran for two weeks out of fear of the illness spreading throughout the company. He also reported that the Veteran said he was told by a doctor that the infection was probably MRSA. Captain AF stated that the small combat hospital did not do a skin culture of the Veteran due to being over tasked and under resourced (given the situation the Board finds highly understandable). In June 2008, within a few weeks of the end of this period of active duty, the Veteran sought private treatment to determine what his skin condition was. Dr. SV examined the Veteran and gave the impression of soft tissue abscess in a patient with history of previous abscess, suspect MRSA infection. The final report confirmed MRSA on the right thigh. In November 2008 Dr. SP reported that the Veteran had a recurrent MRSA infection. She noted that the first abscesses were in November 2007 on the face and abdominal wall. A January 2009 VA general examination evaluated the Veteran and his medical history and diagnosed recurrent MRSA. A November 2009 VA examination noted a medical history of 6-7 incisions and drainage for boils in the past two years. The VA examiner opined that there was no evidence of a MRSA infection in service as the MRSA was not cultured. He also noted that the Veteran was treated with antibiotics which usually are not effective against MRSA, and that he should have had treatment failures if it was MRSA. The medical examiner's statement is contradicted by the service treatment records. In December 2007 the Veteran sought treatment for a cyst to his face after he was given antibiotics for about a week and a half, as the cyst appeared to have grown during that time, indicating that the antibiotics at that time were not working. The competent evidence of record is in the Veteran's favor. There is no evidence of any cysts or boils or other symptoms of MRSA prior to the period of active service from August 2007 to March 2008. During that period of service the Veteran was treated for skin infections: cysts, boils, furuncles, acne of such severity that the Veteran was quarantined. No culture tests were done at that time as none were available however he was told at the time it was suspected MRSA. Within weeks of the end of active duty the Veteran was tested and diagnosed with MRSA for an abscess on his leg similar to the ones he had in service. In November 2008 and January 2009 he was diagnosed with recurrent MRSA. At the April 2013 Board hearing the Veteran testified that he continues to have MRSA breakouts approximately twice a year. The competent evidence of record demonstrates that the Veteran's recurrent MRSA began during active service and has continued. Service connection for MRSA is warranted. ORDER Service connection for MRSA is granted. ____________________________________________ JOHN J. CROWLEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs