Citation Nr: 21028436 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 16-33 963 DATE: May 11, 2021 ORDER Entitlement to service connection for dermatomyositis is denied. Entitlement to service connection for an eye condition, to include as secondary to medication taken for dermatomyositis is denied. Entitlement to service connection for diabetes mellitus, type II, to include as secondary to medication taken for dermatomyositis is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran's dermatomyositis began during active service or is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence is against finding that the Veteran's eye condition began during active service or is otherwise related to an in-service injury or disease. 3. The preponderance of the evidence is against finding that the Veteran's diabetes began during active service or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for dermatomyositis have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 2. The criteria for service connection for an eye condition, to include as secondary to medication taken for dermatomyositis have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2019). 3. The criteria for service connection for diabetes mellitus, type II, to include as secondary to medication taken for dermatomyositis have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1978 to October 1982. This matter is before the Board of Veterans' Appeals (Board) on appeal from a January 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded these claims in July 2019. Service Connection Generally, to establish service connection a Veteran 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." Davidson v. Shinseki, 581 F.3d 1313, 131516 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be granted on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. The evidence must show: (1) that a current disability exists; and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated (worsened in severity beyond its natural progress) by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439, 44849 (1995). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a 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. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 133637 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran's lay statements. Id. Further, a negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). 1. Entitlement to service connection for dermatomyositis. 2. Entitlement to service connection for an eye condition, to include as secondary to medication taken for dermatomyositis. 3. Entitlement to service connection for diabetes mellitus, type II, to include as secondary to medication taken for dermatomyositis. In July 2011 the Veteran filed an application for service connection for dermatomyositis. Shortly thereafter, in September 2011 the Veteran wrote in a statement in support of claim that the treatment for his dermatomyositis caused diabetes and treatment of antimalarial drugs has affected his eyesight. In another March 2012 statement, the Veteran wrote that his treatment for dermatomyositis of prednisone had caused his diabetes according to his doctors. In a January 2013 rating decision, the RO denied service connection for dermatomyositis, diabetes, and eye conditions including hyperopia with presbyopia and astigmatism. In denying the claims, the RO found that there was no disease, event, or injury in service which caused any of the conditions. The Veteran appealed these issues up to the Board. The Board notes that a review of the Veteran's service treatment records shows a normal examination at separation with 20/20 vision and no defects or diagnoses noted other than a few scars. Moreover, on a civilian report of medical history completed by the Veteran in April 1987, well after his separation from active duty, he reported that he was in good health and taking no medication, had vision in both eyes, and had no skin diseases or any other problems. On his Form 9 appeal to the Board the Veteran contended that his dermatomyositis was a result of exposure to chemicals while he was in active service working in aircraft maintenance. Accordingly, in July 2019, the Board remanded the claim to obtain an opinion regarding the nature and etiology of the Veteran's dermatomyositis condition, including whether it may be related to in-service exposure to chemicals. Moreover, the Board instructed the RO to obtain an opinion regarding the nature and etiology of the Veteran's vision problems, including whether or not they may be related to the Veteran taking antimalarial drugs in service. Finally, the Board requested an opinion regarding the relationship between the Veteran's diabetes/eye conditions and his dermatomyositis "if, and only if" the examiner found the Veteran's dermatomyositis to be related to his active service. In December 2019 two VA opinions were uploaded into the Veteran's electronic claims files. First, with regard to the Veteran's dermatomyositis and whether it may be related to exposure to chemicals including toluene, naphtha, freon, CARC paint and paint thinner, hydraulic fluid, aviation gasoline, and/or JP-4 during the Veteran's active service, the examiner opined that it was less likely than not. In support of her opinion, the examiner provided background information regarding dermatomyositis from raredieases.org, explaining that the specific underlying cause of the condition is still unknown, but that evidence suggests that genetic, immune, and environmental factors play some role. With regard to environmental factors, these were only shown to play a role in cases of juvenile dermatomyositis that develop/exacerbate in the months of April and May. Thus, the examiner wrote "Based on literature no nexus to chemical exposure while on AD is plausible. The only environmental factor is seasonal in months of April/May for juvenile dermatomyositis not adult onset. No other environmental factors have been conclusively linked to development of dermatomyositis." In the second opinion another examiner opined that it was less likely than not that the Veteran's eye conditions were related to his active service, including taking antimalarial drugs. Specifically, the examiner wrote "The visual side effect of using Plaquenil which is an anti-malarial drug is that it can induce macular/retinal changes. According to medical records, the Veteran does not have any macular pathologies or complications." The examiner also provided a discussion regarding a potential relationship between the Veteran's eye conditions and his diabetes. However, this opinion was not requested and also provided a negative nexus. The Board finds both of these opinions to be well-reasoned and consistent with the record entitling them to significant weight. As noted above, at separation and following his separation from active service the Veteran reported no defects or diagnosis, and instead stated that he was in good health. While the Veteran has contended that his dermatomyositis is the result of chemical exposure during his active service, the preponderance of the evidence is against this claim. Moreover, the Board notes that the Veteran has not provided any medical literature or medical nexus opinions in support of this claim. The Board recognizes that there are instances in which a layperson may be competent to offer testimony on medical matters, such as describing symptoms observable to the naked eye or even diagnosing simple conditions. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board finds, however, that the questions posed by this claim are of such complexity as to require that individuals who provide competent medical evidence on these matters possess a level of expertise that a layperson simply does not possess. Accordingly, entitlement to service connection for dermatomyositis is denied. Turning to the Veteran's bilateral eye conditions, he has contended that these are the result of antimalarial drugs he took during his active service or secondary to medication taken for his dermatomyositis. Again, neither the Veteran nor his representative has provided any evidence in support of these claims. Moreover, the December 2019 VA examiner explained that the Veteran does not suffer from any of the eye conditions that may be caused by antimalarial drugs. The Board finds that the questions posed by this claim are of such complexity as to require that individuals who provide competent medical evidence on these matters possess a level of expertise that a layperson simply does not possess. Thus, the medical opinion is more probative than the Veteran's lay opinion. With regard to secondary service connection, as the Veteran is not service connected for dermatomyositis, he cannot be secondarily service connected for eye conditions. Accordingly, entitlement to service connection for an eye condition, to include as secondary to medication taken for dermatomyositis is denied. Finally, the Veteran's diabetes did not begin during his active service and he has not contended that it is the result of his active service. Instead, he has argued that it is secondary to the medication prednisone that he must take to control his dermatomyositis. As explained above, the Veteran has not been service connected for dermatomyositis, therefore he cannot be secondarily service connected for diabetes. Accordingly, entitlement to service connection for diabetes mellitus, type II, to include as secondary to medication taken for dermatomyositis is denied. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Ruiz, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.