Citation Nr: 22013409 Decision Date: 03/09/22 Archive Date: 03/09/22 DOCKET NO. 18-06 081A DATE: March 9, 2022 ORDER Service connection for a venereal disease, to include syphilis and residuals of syphilis, is denied. Service connection for a blood disorder is denied. FINDINGS OF FACT 1. The evidence of record persuasively weighs against finding that the Veteran has had syphilis and residuals of syphilis at any time since service, and the most probative evidence of record is against a link between any current venereal disease and any venereal disease in service. 2. The evidence of record persuasively weighs against finding that the Veteran has had a blood disorder at any time during or approximate to the pendency of the claim that is due to any disease or injury in service. CONCLUSIONS OF LAW 1. The criteria for service connection for a venereal disease, to include syphilis and residuals of syphilis, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a blood disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1973 to July 1976. This case is before the Board of Veterans' Appeals (Board) on appeal from a July 2014 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. In that decision, the RO denied entitlement to service connection for residuals of syphilis and a blood disorder. In September 2014, VA received the Veteran's Notice of Disagreement (NOD). In January 2018, the RO issued a Statement of the Case (SOC). In February 2018, VA received the Veteran's VA Form 9 to the Board. In May 2021, the Veteran testified at a video conference hearing at the RO before the undersigned Veterans Law Judge (VLJ). A transcript of that testimony is of record. In August 2021, the Board remanded the case for further development and adjudicative action. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). 1. Entitlement to service connection for a venereal disease, to include syphilis and residuals of syphilis. The Veteran contends that he has a venereal disease, to include syphilis and residuals of syphilis, with onset during service and continuing symptomatology to the present. During the May 2021 Board hearing, the Veteran testified that he has experienced intermittent scabbing and boils on his genitals since being treated for a venereal disease during service. He also claims that he was told he was unable to donate blood because of his history of syphilis. See May 2021 Board hearing transcript at 5-8. During the December 2021 VA examination (recorded in the December 2021 VA hematologic and lymphatic examination report), the Veteran reported experiencing "intermittent bumps on his penis, scrotum, and in the groin area" which were "[s]ometimes associated with a whitehead and are red and irritated. Other times the lesions are more of a knot. They will itch and are sore. The lesions occur every 2 to 4 months typically lasting 1 to 3 weeks." Finally, "the lesions are severe approximately 2 times per year." The Veteran denied any current treatment. When considering the credibility of lay evidence, the Board may consider internal consistency, facial plausibility, and consistency with other evidence of record. Caluza v. Brown, 7 Vet. App. 498, 511 (1995). Here, the Veteran's statements regarding in-service incurrence of a venereal disease are corroborated by the service treatment records (STRs). Specifically, STRs confirm that the Veteran was treated for venereal warts on his penis and open sores on his scrotum from approximately November 1973 to April 1974. See STRs dated November 28, 1973 and April 8, 1974. Furthermore, a January 1976 STR indicates that the Veteran again was observed to have penile warts and scrotal sores. The diagnosis at that time was uncertain; notably, the treating physician made a note to "R/O [rule out] syphilitic origin." STRs dated January 28, 1976. Although STRs contain no formal diagnosis of syphilis, lab findings from April 1974 indicate that the Veteran was positive "for organisms resembling Treponema Pallidrum." STRs dated April 8, 1974. Review of medical resources shows that Treponema Pallidrum is a bacterium that can cause syphilis. However, a May 1976 rapid plasma reagin (RPR) blood test for syphilis was non-reactive. See May 20, 1976. Nonetheless, based on the STR evidence noted above, a December 2021 VA examiner for the claimed syphilis concluded that the Veteran suffered a syphilis infection during service. Nonetheless, there is no evidence of active syphilis infection at any time following service. In this regard, a July 1995 RPR was nonreactive. See VA labs dated July 28, 1995. Furthermore, the December 2021 examiner indicated that the syphilis was inactive. Regarding residuals of syphilis, there is no medical evidence to support that the Veteran experienced syphilis-related intermittent scabbing and boils on his genitals following service. An August 2004 VA treatment record indicates that the Veteran believed that a foot ulcer was related to syphilis. See VA physician progress note dated August 16, 2004; VA nursing urgent care note dated August 16, 2004. However, the Veteran's opinion regarding the etiology of the foot ulcer is not competent because the etiology of the ulcer falls outside of the realm of common knowledge of a layperson. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In any case, VA treatment records indicate that care providers attributed the foot ulcer to a fungal infection. Finally, the December 2021 examiner indicated that the Veteran did not experience any active syphilis residuals. Regarding nexus, of record are a June 2014 VA opinion and December 2021 VA examination and opinion regarding the claimed syphilis and/or syphilis residuals. The June 2014 VA examiner opined that the Veteran's claimed syphilis and/or syphilis residuals was less likely than not related to service. The examiner noted STR evidence supporting a syphilis diagnosis. However, the examiner found that the syphilis was "cured/resolved as evidence by non-reactive RPR in 1976," Moreover, the examiner noted that there was "no evidence to support a finding of a chronic syphilis condition associated with AD service." As the June 2014 examiner did not personally examine the Veteran, the examiner stated that [i]f the Veteran currently has syphilis it is most likely associated with new syphilis infection with onset after 1995." The December 2021 VA examiner indicated an in-service diagnosis of syphilis; however, the examiner found that the Veteran did not have a current syphilis diagnosis or experience any residuals of syphilis. As such, regarding etiology, the examiner opined that the claimed syphilis and/or syphilis residuals were less likely than not related to service. The examiner reasoned that "[d]uring service, syphilis was acute only" and that the Veteran "completed an appropriate course of treatment with resolution of the condition." Additionally, the examiner stated that "[t]here is no evidence of chronicity of care and symptoms are subjective only. Repeat RPR on 5/20/1976 and 7/28/1995 were nonreactive. A nexus has not been established. No active venereal diseases diagnosed today." Although the Veteran did not present to the December 2021 VA examination with active symptoms of venereal disease, he did report intermittent symptoms of itchy and sore lesions appearing on his penis and scrotum. The Veteran is competent to report observable symptoms such as itchy and painful sores on his penis and scrotum, and there is no reason to doubt his credibility in this regard; however, he does not possess the requisite medical expertise to link his current symptoms to the in-service diagnosis because this is a medical matter requiring knowledge of internal medical processes and diagnostic testing. In this case, the question of the etiology of the Veteran's current symptoms falls outside the realm of common knowledge of a lay person, particularly where, as here, the STRs provide objective medical evidence indicating that the in-service venereal disease resolved prior to discharge and subsequent testing in 1976 and 1995 also show no evidence of syphilis disease or residuals therefrom. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The disease of syphilis involves a complex internal process and requires the ability to interpret diagnostic medical testing, as opposed to an external process or something capable of lay observation. The Veteran has not been shown to possess the requisite medical training, expertise, or credentials needed to render a competent nexus opinion in this case. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). Turning to the probative value of the medical opinions of record, the following factors are considered when evaluating the probative value of medical opinions: (1) whether the examiner is informed of the pertinent factual premises i.e. medical history of the case; (2) whether the examiner provides a fully articulable opinion, avoiding speculative language that does not provide the certainty needed for medical nexus evidence; and, (3) whether the opinion is supported by a reasoned analysis. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 303-4 (2008). Regarding the June 2014 VA opinion, there is no evidence that the examiner actually examined the Veteran in conjunction with the opinion. Therefore, the examiner was not informed of a pertinent factual premise the Veteran's current state of health and, as a result, the opinion is afforded little probative value as to nexus. Regarding the December 2021 opinion, the examiner reviewed the full claims file and acknowledged the Veteran's reported symptoms in the opinion. The examiner provided a fully articulated opinion supported by a reasoned analysis. Accordingly, the December 2021 opinion is afforded significant probative value as to nexus. In essence, as the in-service disability was acute and resolved, any current symptoms reported by the Veteran are necessarily not a continuation of the in-service disease, particularly given the negative objective testing in 1995. Based on the foregoing, the evidence persuasively suggests that the Veteran does not have a current venereal disease, to include syphilis and/or syphilis residuals, that is due to any in-service injury or disease, including the in-service treatment for syphilis. Therefore, the benefit of the doubt doctrine is inapplicable, and service connection for a venereal disease, to include syphilis and/or syphilis residuals, is not warranted. See 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 53 (1990). 2. Entitlement to service connection for a blood disorder. The Veteran contends that he has a blood disorder related to his in-service diagnosis of syphilis. During the May 2021 Board hearing, the Veteran stated that he was unable to donate blood due to his history of syphilis. See May 2021 Board hearing transcript at 6. However, there is no evidence of a blood disorder diagnosis. In December 2021, the Veteran received a VA hematologic and lymphatic examination. The examiner did not provide a diagnosis of any blood disorder. In addition, the examiner contacted a blood bank located in the Veteran's home state and town, and "they informed me that their policy was that unless the veteran tested positive or had been treated for syphilis within the last 3 months that there was no contraindication to donating blood." In other words, given the lack of a recent syphilis diagnosis, the Veteran would be able to donate blood. Given that there is no evidence of any diagnosis of a blood disorder or any functional impairment hematologically related to the Veteran's history of syphilis, the evidence persuasively suggests that the Veteran does not have a current blood disorder. Accordingly, the benefit of the doubt doctrine is inapplicable and service connection for a blood disorder is not warranted. L. B. CRYAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Small, Attorney Advisor 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.