Citation Nr: 18146067 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 14-09 585 DATE: October 30, 2018 ORDER Entitlement to service connection for Stevens-Johnson syndrome, to include post Stevens-Johnson syndrome with residual of restrictive lung disease, is denied. FINDINGS OF FACT 1. The Veteran had active service from March 1974 to February 1982, the period when he is entitled to all VA benefits in accordance with law. 2. The preponderance of the evidence is against the finding that the Veteran has Stevens-Johnson syndrome due to a disease, injury or event in service between March 1974 and February 1982. CONCLUSION OF LAW The criteria for service connection for Stevens-Johnson syndrome have not been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. § 3.303 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active service from March 1974 to February 1982, at which time he was honorably discharged. The Veteran also had active duty from February 1982 to April 1989, at which time he was discharged other than honorably. By way of background, in a June 2009 rating decision, the Department of Veterans Affairs (VA) Regional Office (RO) denied the Veteran’s claim for service connection for Stevens-Johnson syndrome because the Veteran failed to show up for a VA examination. In May 2010, the Veteran notified the RO, explained why he failed to show up for the examination and requested that the RO reopen his claim and reschedule his examination. The RO then reopened the claim, rescheduled the examination for December 2011 and adjudicated the issue on the merits in January 2012. The Board finds that new and material evidence was received within a year of the June 2009 rating decision, and therefore, the current appeal stems from the original claim. 38 C.F.R. § 3.156(b). This matter comes before the Board of Veterans’ Appeals (Board) from a January 2012 decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) in July 2017. A transcript of the hearing is associated with the electronic claims file. To assist with the Veteran’s claim, an Independent Medical Examiner (IME) opinion was obtained in June 2018. The Veteran was afforded an opportunity to review the medical opinion and, thereafter, send any additional evidence or argument within 60 days of July 12, 2018, the date of the VA letter which was sent to the Veteran. 38 C.F.R. § 20.903. The Veteran did not submit additional evidence, argument or another medical opinion. Regarding the Veteran’s claim for service connection for Stevens-Johnson syndrome, service connection may be granted for a veteran if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). In general, service connection requires competent and credible evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See 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). To be considered a “veteran” for purposes of receiving VA benefits, including service-connection, a person must have had active service and been discharged or released therefrom under conditions “other than dishonorable.” 38 U.S.C. § 101 (2). A discharge or release because of one of the offenses found under 38 C.F.R. § 3.12 (d) is also considered to have been issued under dishonorable conditions and is a bar to VA compensation benefits. The provisions of 38 C.F.R. § 3.12 (d) state that a discharge or release because of one of the following offenses is considered to have been issued under dishonorable conditions: (1) acceptance of undesirable discharge in lieu of trial by general court-martial; (2) mutiny or spying; (3) offense involving moral turpitude (this includes, generally, conviction of a felony); (4) willful and persistent misconduct. The designation of a discharge as honorable by the service department is binding on VA as to character of discharge. 38 C.F.R. § 3.12 (a). In this case, the Veteran’s service from February 1982 to April 1989 was characterized as “under other than honorable.” In a document dated February 22, 1989, the Veteran signed a request to separate from military service in lieu of trial by court-martial and acknowledged that a discharge from military service under the conditions may deprive him of certain rights. Shortly thereafter, in April 1989, the Veteran’s request was approved and finalized. Accordingly, since the Veteran accepted a discharge of other than honorably in lieu of trial by court-martial, based on the laws enacted, and by VA regulations, the Veteran is barred from VA benefits from the period February 1982 to April 1989. 38 C.F.R. § 3.12 (d)(1); see 38 U.S.C. § 7104b. In his Notice of Disagreement dated January 2012, the Veteran requested that his ineligibility to receive VA benefits begin in January 1989, the time when his “lack of judgement and indiscretions came to be.” To assist the Veteran with this contention, in a VA letter dated November 19, 2013, the RO sent a letter to the Veteran explaining that to change the status of his character of discharge, he should complete and submit DD Form 293 and DD Form 149. The Veteran did not submit a form to request a change of his character of other than honorable discharge. Moreover, at the Board hearing on July 11, 2017, the Veteran did not argue that his discharge in April 1989 was mischaracterized. Therefore, in accordance with VA law and regulations, with the Veteran’s current discharge status, he is barred from VA benefits from the period February 1982 to April 1989. However, the Veteran is eligible for VA benefits for his service between March 1974 and February 1982. In his statement dated August 14, 2017, the Veteran stated that he is entitled to service connection for Stevens-Johnson syndrome because his in-service medical records from 1974 to 1982 reflect that he exhibited symptoms of Stevens-Johnson syndrome, and that his current diagnosis of post Stevens-Johnson syndrome with residual of restrictive lung disease is related to the symptoms that occurred during his eligible service period. In the August 2017 correspondence, the Veteran outlined multiple occasions during service where he stated he experienced symptoms similar to those that he experienced from when he was diagnosed with Stevens-Johnson syndrome in February 1985. In his correspondence and at the Board hearing, he noted and alluded that he was not diagnosed with Stevens-Johnson syndrome earlier than 1985 due to the rarity of the syndrome and the physicians’ lack of knowledge concerning the disorder. In this case, the Veteran currently exhibits post Stevens-Johnson syndrome with of residuals of restrictive lung disease, as evidenced by the December 2011 VA examination and the June 2018 IME. Turning to the evidence in the Veteran’s in-service records, his multiple in-service physical examinations show normal evaluations. However, his in-service treatment records between March 1974 and February 1982 show the following symptoms: in September 1974, treatment records indicate the Veteran was diagnosed with gastroenteritis following complaints of nausea and loose stools; in January 1977, the Veteran complained of fever and an aching feeling and was assessed with probable viral syndrome; in October 1978, the Veteran complained of myalgias, throbbing frontal headache, abdominal cramps, and diarrhea and was assessed with diarrhea with an unknown etiology; approximately a week later, the Veteran complained of dizziness, weakness, diarrhea, sore throat, headaches, and myalgias and was assessed with a viral gastrointestinal illness; in December 1978, he complained of flu-like symptoms, including fever and he was diagnosed with cold/flu syndrome; several days later, the Veteran again sought treatment, for fever and spitting up blood and was assessed with an upper respiratory infection; and in November 1981, he exhibited a moderately inflamed sore throat, fluid behind the right tympanic membrane and was diagnosed with otitis externa. Since the record reflects that the Veteran exhibits a current disability and he exhibited in-service symptoms that the Veteran claims is related to his current disability, the issue before the Board is whether there is a nexus between the claimed in-service symptoms and the current disability. The Veteran was afforded a VA examination in December 2011; however, a nexus opinion was not proffered at the time. Therefore, to assist the Veteran, the Board obtained an IME in June 2018. In the IME, it was the medical expert’s “opinion with the probability greater than 50% that the times in question which was March 1974-February 1982 the veteran did not have a pre-existing condition known as Stevens-Johnson syndrome.” The VA medical expert clarified that the onset of a Stevens-Johnson syndrome “is usually related to an infection or a reaction to a medication. Often the patient presents with myalgias and flulike symptoms followed rapidly by a painful skin eruption which develops into blisters.” He further explained that “the skin and mucous membrane involvement is a major hallmark of the syndrome.” He concluded that the clinical presentations and hospitalization that occurred in February 1985 were more consistent with the diagnosis of Stevens-Johnson syndrome, and that “the fact that this veteran during the periods in question between March 1974 through February 1982 was seen in various clinics for flulike symptoms and upper respiratory infections does not make a diagnosis for Stevens-Johnson syndrome.” The probative value of a medical opinion is based on the medical expert’s knowledge and skill in analyzing the data and the examiner’s medical conclusion. As is true with any piece of evidence, the credibility and weight to be attached to these opinions are within the province of the adjudicator. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Whether a physician provides a basis for his or her medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Other factors for assessing the probative value of a medical opinion are the physician’s access to the claims folder and the thoroughness and detail of the opinion. See Nieves-Rodriguez, 22 Vet. App. 295 (2008). Here, the Board accords great probative weight to the June 2018 IME as it is predicated with a detailed review of the Veteran’s records, including his in-service medical records, the Veteran’s lay statements and post-service VA examinations. The medical expert provided a clear explanation as to why the Veteran’s in-service symptoms were unlikely related to the Veteran’s current diagnosis, and an explanation as to why Stevens Johnson syndrome was diagnosed in February 1985 and not prior. Moreover, the medical expert had knowledge of the relevant facts and addressed the Veteran’s contentions. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion is determined by whether the examiner was informed of sufficient facts upon which to base an opinion and whether the report contains data, conclusions, and a complete rationale in support thereof). The record does not reflect any other medical opinion regarding the nexus between the Veteran’s current disability and his in-service symptomatology. The Board notes that in the Veteran’s August 14, 2017 correspondence and the Board hearing transcript, the Veteran asserted that the diagnosis of Stevens-Johnson syndrome is related to his military service between March 1974 and February 1982. Lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical expertise. See Layno v. Brown, 6 Vet. App. 465 (1994). Likewise, mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). “VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to.” Waters v. Shinseki, 601 F.3d at 1278. In the instant case, the Veteran provided a list of symptoms he experienced during service based on his in-service medical records and testified at the hearing that the symptoms he experienced during service were similar, but with less intensity, than the symptoms he experienced in 1985 when he was diagnosed with Stevens-Johnson syndrome. Therefore, he concludes that his current disability is related to his in-service symptoms. While the Veteran is competent to describe his symptoms, the Board finds that the question regarding the potential relationship between the Veteran’s Stevens-Johnson syndrome and any in-service symptoms is complex in nature, and therefore, as a layperson merely providing a generalized statement establishing a connection between his Stevens-Johnson syndrome and in-service symptoms is insufficient. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (Although a lay person is competent in certain situations to provide a diagnosis of a simple condition, a lay person is not competent to provide evidence as to more complex medical questions). Accordingly, a greater weight will be placed on the medical expert’s opinion. The Board is sympathetic to the Veteran’s claim. However, based on the relevant evidence of record, the Board finds that service connection is not warranted for Stevens-Johnson syndrome, to include post Stevens-Johnson syndrome with residual of restrictive lung disease. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. Given that no ultimate, material issues are in equipoise, that doctrine is not applicable in the instant appeal. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. For these reasons, the claim for service connection for Stevens-Johnson syndrome is denied. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Lee, Associate Counsel