Citation Nr: 18139999 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 15-02 595 DATE: October 2, 2018 ORDER Entitlement to service connection for lupus is granted. FINDING OF FACT Resolving reasonable doubt in favor of the Veteran, the Veteran’s lupus is related to her active service. CONCLUSION OF LAW The criteria for entitlement to service connection for lupus have been met. 38 U.S.C. §§ 1110, 5017 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1998 to April 1999. This matter is on appeal from a March 2014 rating decision. In June 2018, the Veteran testified at a videoconference Board hearing before the undersigned. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Entitlement to service connection for lupus The Veteran contends that her lupus is related to her active service. There is no dispute that the Veteran was diagnosed with a current disability. Specifically, post-service private treatment records confirm the Veteran was diagnosed with lupus in March 2004. The dispositive issue is whether the Veteran’s lupus began during service or is otherwise related thereto. The Veteran was afforded a VA examination in March 2014. The Veteran reported that she was healthy when she entered the military. She recalled ingesting “dirty water” during training exercises that required her to crawl through mud. She indicated that around 2003, she became sick with fatigue, a skin rash, and arthralgia, and that at present, her symptoms related to lupus include hair loss, swollen joints, weakness, fainting spells, and gastrointestinal pain. The VA examiner found no current diagnosis and offered no opinion as to service connection, stating review of the Veteran’s service treatment records (STRs) did not show a diagnosis of lupus and that no further medical treatment records were available for the examiner to review. The Veteran testified at her June 2018 videoconference Board hearing that during basic training in the military in 1998, she went through a confidence course that contained dirty and murky water, which entered her eyes, mouth, and hair. She stated that over time, she became sick, weak, and tired, and was diagnosed with low blood anemia while in service, for which she was given iron pills. She asserted that her private dermatologist indicated that there was a probable chance that her skin rash associated with her diagnosis of lupus was related to the dirty water she came into direct contact with during service. In support of her claim, the Veteran submitted a July 2018 medical opinion from her private physician, Dr. G. L., who opined that, upon review of the Veteran’s post-service private treatment record, in conjunction with examination of the Veteran, it is at least as likely as not that the Veteran’s lupus is caused by or a result of her military service. Dr. G. L. rationalized that while lupus has an unknown cause, environmental factors, infections, antibiotics, traumatic injuries, stress, and exhaustion are known triggers for this disease. Dr. G. L. indicated that the Veteran’s exposure to contaminated water in service, as well as the physical stress endured in the military both contributed to her flare-up of lupus after service. After consideration of the entire record and relevant law, the Board finds that service connection for lupus is warranted. While the March 2014 VA examiner found no diagnosis of lupus to provide a medical opinion as to service connection, the examiner indicated she did not have access to any of the Veteran’s private treatment records. The Veteran’s private physician, Dr. G. L., provided a positive nexus opinion, linking the Veteran’s current diagnosis of lupus to her active service. The Board finds the June 2018 private medical opinion by Dr. G. L. to be more probative in weight, as it considered the Veteran’s private treatment records and discussed how lupus, with an unknown origin, may be triggered by several factors, two of which the Veteran experienced during service. The Board finds that the medical opinions of record for and against the claim of entitlement to service connection for lupus are at least in equipoise. Therefore, reasonable doubt must be resolved in favor of the Veteran, and entitlement to service connection for lupus is warranted. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). (Continued on the next page)   (Continued on the next page) KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Houle, Associate Counsel