On Veterans Administration examination in February 1969 the veteran complained of “burns of throat”, Examination disclosed a 3-inch by 3-inch area of scarred skin involving the neck. The skin over the lower part of the nose, upper lip and chin was described as dry, thin and smooth and there was superficial atrophic scarring. There was no sign of sycosis vulgaris. The diagnosis was radiodermatitis, mild, on the nose, upper lip and chin (not disfiguring); radiodermatitis, moderately severe, anterior portion of the neck ma. (disfiguring). Type of Injury: Sycosis Vulgaris Including Residual Radiation Burns. Medical Evidence. A report from the outpatient department of the agency of original jurisdiction contained an expression of medical opinion that skin changes disclosed on Veterans Administration examination in February 1969 were compatible with late effects of radiation therapy and could have been the result of X-ray treatment dosage rendered the veteran during service. It was further stated that therapy rendered was acceptable treatment at the time and there was no negligence or lack of skill apparent. BVA’s Decision: Denial Reversed. Date of Decision: 1970. Appellant's Allegation: That sycosis vulgaris was aggravated by service including extensive treatment therefor. Facts: The veteran had active service from July 1943 to December 1944 when he was discharged on report of medical survey by reason of sycosis vulgaris. No pertinent defects were noted on examination for service at which time the skin wasreferred to as normal or negative. Service medical records show that the veteran was hospitalized in August 1943 complaining of pustular injection of the beard present for approximately two years. There had been prior treatment, but no X-ray therapy. Physical examination disclosed discrete follicular pustulous eruption of the beard area of the cheeks and chin, The neck was very slightly affected. Medication was prescribed and improvement was noted. He was discharged to duty in September 1943 described as apparently well. The diagnosis was sycosis vulgaris, He reported to sick bay in May 1944 for the same complaint and was ullimately transferred through channels to a fleet hospital in June 1944. At that time it was reported that there had been eruption of the beard area of the face for the preceding five years, usually fairly well under control. It was further reported that when the ship entered the tropics, pustules began to erupt. Physical examination disclosed severe follicular pustular eruption of the beard area of the face and neck. Medication was prescribed with no definite improvement. Moderate anemia was noted. Subsequently he received 10 X-ray treatments which markedly improved the disorder, but never entirely clearedit up. The notation was made that in the tropics the disorder became markedly worse. Ultraviolet ray therapy was prescribed, He wasassigned to limited duty within the continental United States pursuant to the action of a survey board which determined that sycosis vulgaris preexisted active service and had been aggravated thereby. Subsequently, another survey board determined that aggravation had not occurred as the condition was much improved. It was further determined that he was not fit for further duty because of the chronic dermatitis which would be aggravated by tropical service. It was stated that the veteran was desirous of remaining in service and his record was good. However, he was discharged from the hospital in October 1944 to limited duty and from the service in December 1944. 54 Findings of the BVA and Basis for Decision: In resolving reasonable doubt in ee eee ER on le ts ans a NESSTTere ‘ 7 le 7 CASE NO. 15 favor of the veteran, the Board concluded that sycosis vulgaris which was present before service was aggravated by service, andit said: The evidence, including statements recorded for clinical purposes, shows that sycosis vulgaris preexisted active service and it is not otherwise contended. The only question for consideration by the Board is whether the preservice skin disorder was aggravated by service. Aggravation arises where, during service, a preexisting disease or disability undergoes increase in severity not accounted for by natural progress. Usually, an increase not due to natural progress, would be conceded where additional disease or injury was superimposed upon the preexisting condition while the veteran was in service, constituting a greater disability than that which existed at the time he entered service. The question of aggravation is determined by a preponderance of the evidence. Where a preexisting disease or injury was manifested during service only by its usual or expected characteristics, aggravation is not demonstrated. [t may be stated that the usual effects of medical treatment during service, having the effect of ameliorating disease or other conditions incurred before service, will not be considered service connected, unless the disease or injury was aggravated by service other than by the usual effects of treatment. In this case the skin was described as negative or normal at the time the veteran entered active service. Symptoms of the preservice skin disorder were manifested approximately one month later. After approximately a month of treatment there was apparent subsidence of the disorder and: he was returned to duty. However, he reentered the hospital in May 1944 and remained hospitalized or under medical supervision practically continuously until the time of his discharge from service in December 1944. During this interval it was reported that after the ship on which he was stationed entered tropical waters there was a recurrence of the skin disorder and the condition was markedly worse. 55