Citation Nr: 18149756 Decision Date: 11/14/18 Archive Date: 11/13/18 DOCKET NO. 16-06 566 DATE: November 14, 2018 ORDER Entitlement to service connection for a rash on both hands is denied. Entitlement to service connection for diabetes mellitus, type II is denied. Entitlement to service connection for peripheral neuropathy, left upper extremity, secondary to diabetes mellitus, type II is denied. Entitlement to service connection for peripheral neuropathy, right upper extremity, secondary to diabetes mellitus, type II is denied. Entitlement to service connection for peripheral neuropathy, left lower extremity, secondary to diabetes mellitus, type II is denied. Entitlement to service connection for peripheral neuropathy, right lower extremity, secondary to diabetes mellitus, type II is denied. REMANDED Entitlement to service connection for a heart condition is remanded. FINDINGS OF FACT 1. The competent and credible evidence of record does not establish a current diagnosis of rash on both hands. 2. The preponderance of the evidence is against finding that the Veteran has diabetes mellitus, type II, due to an event, injury or disease in service. 3. The preponderance of the evidence is against finding that the Veteran has peripheral neuropathy, left upper extremity, secondary to service-connected disability. 4. The preponderance of the evidence is against finding that the Veteran has peripheral neuropathy, right upper extremity, secondary to service-connected disability. 5. The preponderance of the evidence is against finding that the Veteran has peripheral neuropathy, left lower extremity, secondary to service-connected disability. 6. The preponderance of the evidence is against finding that the Veteran has peripheral neuropathy, right lower extremity, secondary to service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for a rash on both hands have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for diabetes mellitus, type II, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for peripheral neuropathy, left upper extremity, secondary to diabetes mellitus, type II, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310. 4. The criteria for service connection for peripheral neuropathy, right upper extremity, secondary to diabetes mellitus, type II, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310. 5. The criteria for service connection for peripheral neuropathy, left lower extremity, secondary to diabetes mellitus, type II, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310. 6. The criteria for service connection for peripheral neuropathy, right lower extremity, secondary to diabetes mellitus, type II, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1971 to July 1975. The Veteran seeks service connection for three conditions (a heart condition, rash on both hands, and diabetes mellitus, type II) that he believes are due to exposure to chemicals on Pease Air Force Base while he was in service. The Veteran seeks service connection for four additional conditions that he believes are secondary to his diabetes (peripheral neuropathy of his left upper extremity, right upper extremity, left lower extremity, and right lower extremity). In a June 2014 rating decision, the Depart of Veteran Affairs (VA) regional office (RO) denied service connection for all seven issues. The Veteran timely appealed. Duty to notify and assist The Veteran has not raised any issues with the duty to notify. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board”). The Board also finds that the duty to assist requirements have been fulfilled. All relevant, identified, and available evidence has been obtained, and VA has notified the appellant of any evidence that could not be obtained. The Veteran has not been provided with a VA examination regarding his rash on both hands, diabetes mellitus, type II, or peripheral neuropathy of his upper and lower extremities, and no examination or nexus opinion is required regarding the claim as the weight of the evidence demonstrates no related injury, disease, or event during service, and no nexus between his current diagnosed disorders and service or service-connected disability. The Veteran has not presented sufficient evidence to establish that his claimed rash on both hands or diabetes mellitus, type II, onset during service or is otherwise related to service; therefore, no examination or nexus opinion is required, and any opinion would be speculative. For these reasons, a remand to provide the Veteran with a medical examination and/or obtain a medical opinion is not required with respect to these claims for service connection. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010). The Veteran has not referred to any additional, unobtained, relevant, available evidence. Thus, the Board finds that VA has satisfied the duty to assist. No further notice or assistance to the Veteran is required to fulfill VA’s duty to assist in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Service Connection To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). 1. Entitlement to service connection for a rash on both hands The Veteran contends he is entitled to service connection for a rash on his hands that is the result of exposure to chemicals while stationed at the Pease Air Force Base during his military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event or disease. The Board concludes that the Veteran does not have a current diagnosis of a rash on both hands. Service treatment records are silent for any complaint, diagnosis or treatment of a rash on both hands. The July 1975 exit Report of Medical Examination reflects the Veteran did have an abnormal skin examination, however, it was noted he had red, scaly erythematous area on his inner thighs and scrotum, not his hands. A diagnosis of tinea cruris was noted. No recommendation for further examination or treatment was indicated. Post service treatment records from the Fayetteville VAMC and the Durham VAMC are silent as to any complaint, diagnosis or treatment of a rash on both hands. Specific records reflect “no rash on extremities” in July 2017, December 2016, and December 2015. Upon review of the record, the Board finds that the competent and credible evidence of record does not establish a current diagnosis of a rash on both hands as available VA treatment records are silent with respect to a current diagnosis of rash on both hands. The Board notes that the existence of a current disability at any time during the current appeal period is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1131; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). Evidence must show that, at some time during the current appeal period, the Veteran has the disability for which benefits are being claimed. Here, however, as noted above, the competent and credible evidence of record does not establish that, at any time during the current appeal period, the Veteran had a diagnosis of a rash on both hands. In this regard, the Board notes that Congress has specifically limited service connection to instances where there is current disability (during the current appeal period) that has resulted from disease or injury. 38 U.S.C. § 1110. In the absence of a current disability at any time during the appeal period, the analysis ends, and the claim for service connection for a rash on both hands cannot be granted. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). The Board has considered the Veteran’s lay statements. However, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case, the diagnosis and etiology of a rash on both hands, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). While the Veteran is competent to report having experienced symptoms of a rash on both hands, he is not competent to provide a diagnosis in this case or determine the etiology of his symptoms. The issue is medically complex, as it requires knowledge and interpretation of complicated diagnostic medical testing. Id. In reaching this conclusion, the Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim of entitlement to service connection for a rash on both hands, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Entitlement to service connection for diabetes mellitus, type II The Veteran contends he is entitled to service connection for diabetes mellitus, type II, as a result of exposure to chemicals while stationed at the Pease Air Force Base during his military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event or disease. The Board has closely reviewed the medical and lay evidence in the Veteran’s claims file and finds no evidence that may serve as a medical nexus between the Veteran’s service and his diabetes mellitus, type II. Service treatment records are silent for any complaint, diagnosis or treatment of diabetes mellitus, type II. The July 1975 exit Report of Medical Examination reflects the Veteran had a normal examination of his heart, upper extremities, and lower extremities; his blood pressure reading was 138/86; and, there was no diagnosis of diabetes. No recommendation for further treatment by any specialist for any condition was indicated. Post service treatment records from the Fayetteville VAMC and the Durham VAMC reflect the Veteran was first diagnosed with diabetes mellitus, type II, in August 2006, and that diabetes has been an ongoing concern since then as it is listed in the Veteran’s “Active Problem List.” However, none of these records provide a nexus or link between the Veteran’s diabetes mellitus, type II, and his military service. The Board concedes that the Veteran has a current diagnosis of diabetes mellitus, type II, but none of his treatment providers have provided an opinion that any such disability is related to military service, including as a result of exposure to chemicals. There is simply no competent medical evidence of record to suggest that the Veteran’s diabetes mellitus, type II, is in any way related to his time on active duty. Thus, in this case, when weighing the evidence of record, the Board finds compelling the lack of evidence linking the Veteran’s diabetes mellitus, type II, to his military service. In this case, the only evidence in favor of the Veteran’s claim is his own statements concerning his belief that his diabetes mellitus, type II, diagnosed 30 years after service, is due to chemical exposure in service. With regard to the Veteran’s contentions, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, it falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Although the Veteran is competent to report symptoms of diabetes mellitus, type II, the claimed disability is not the type of condition that is amenable to lay determination regarding its etiology, as specific findings are needed to properly determine etiology. Id,; see Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Thus, the Veteran’s own assertions as to the etiology of his diabetes mellitus, type II, have little probative value. As such, the Board finds that, other than the Veteran’s unsupported contentions, there is simply no evidence in the record of any etiological relationship between the Veteran’s diabetes mellitus, type II, and his time in service, to include his reported exposure to chemicals at Pease Air Force Base. Further, there is simply no mention in VA treatment records of a relationship between the Veteran’s service and his current diabetes mellitus, type II, or any other competent evidence of record to suggest an etiological relationship between the Veteran’s service and his diabetes mellitus, type II. Thus, the criteria for service connection for diabetes mellitus, type II, have not been met. The evidence weighs against the Veteran’s claim. Service connection for diabetes mellitus, type II, must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 3. Entitlement to service connection for peripheral neuropathy, left upper extremity, secondary to diabetes mellitus, type II 4. Entitlement to service connection for peripheral neuropathy, right upper extremity, secondary to diabetes mellitus, type II 5. Entitlement to service connection for peripheral neuropathy, left lower extremity, secondary to diabetes mellitus, type II 6. Entitlement to service connection for peripheral neuropathy, right lower extremity, secondary to diabetes mellitus, type II The Veteran seeks service condition for peripheral neuropathy of the left upper extremity, right upper extremity, left lower extremity, and right lower extremity—all as secondary to diabetes mellitus, type II. As discussed in detail above, the evidence of record reflects the Veteran does not have diabetes mellitus, type II, that is attributed to his military service. Thus, the claims for service connection for peripheral neuropathy of the left upper extremity, right upper extremity, left lower extremity, and right lower extremity must be denied. The Board finds that there are no additional theories of entitlement to service connection to consider, based on review of the record and the Veteran’s contentions, which focused solely on his belief that his peripheral neuropathy of the left upper extremity, right upper extremity, left lower extremity, and right lower extremity developed not directly to service, but to his diabetes mellitus, type II. As the Veteran’s claim for entitlement to service connection for diabetes mellitus, type II, is herein denied, his secondary service connection claims for peripheral neuropathy of the left upper extremity, right upper extremity, left lower extremity, and right lower extremity must be denied as a matter of law. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310; see also Sabonis v. Brown, 6 Vet. App. 426 (1994). REASONS FOR REMAND 1. Entitlement to service connection for a heart condition is remanded. The Board finds that additional development is warranted in this case before a decision may be rendered. Specifically, the Veteran must be afforded a VA examination to determine whether his heart condition is related to his active service. The Veteran contends that his heart condition is a result of his exposure to chemicals while stationed at Pease Air Force Base. In support of his claim, the Veteran has attached three articles from the U.S. Environmental Protection Agency (EPA) that suggests drinking water on Pease Air Force Base was contaminated with chemicals during his time stationed there. The Board also notes the Veteran submitted a separate article that cites to studies suggesting that exposure to these chemicals can cause cardiovascular disease. Further, of record is a July 2014 letter from a physician who stated, regarding the Veteran’s heart disease, that “it is impossible to rule out some contribution from environmental exposure to chemical substances to which he has documented exposure.” However, the medical evidence of record is inadequate in opining whether it is at least as likely as not that there is a connection between the Veteran’s current heart condition and his claimed exposure to chemicals at Pease Air Force Base, or otherwise to his time on active duty. The matter is REMANDED for the following action: Schedule the Veteran for a VA examination to determine the nature and etiology of his claimed heart condition. The entire claims file, to include a complete copy of this remand, must be made available to, and reviewed by, the designated examiner. The examiner must offer an opinion as to whether it is at least as likely as not (i.e., there is at least a 50 percent or greater probability) that any diagnosed heart condition began in or is otherwise etiologically linked to service, to include as secondary to his claimed exposure to chemicals at Pease Air Force Base. In providing this opinion, the examiner must specifically comment on the Veteran’s lay statements, as the Veteran is competent to report history and symptoms. If the examiner rejects the Veteran’s reports, the examiner should provide a rationale for doing so. The examiner must also specifically comment on the three articles from the U.S. Environmental Protection Agency that suggests drinking water on Pease Air Force Base was contaminated with chemicals; and the article that suggests exposure to these chemicals can cause cardiovascular disease. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Jiggetts, Associate Counsel