Citation Nr: 0808555 Decision Date: 03/13/08 Archive Date: 03/20/08 DOCKET NO. 04-26 650 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in No. Little Rock, Arkansas THE ISSUE Entitlement to service connection for a skin condition, to include as the result of exposure to the herbicide Agent Orange. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD L.J. Bakke, Counsel INTRODUCTION The veteran served on active duty from March 1971 to May 1972. The veteran served in Vietnam from August 1971 to April 1972. This appeal arises before the Board of Veterans' Appeals (Board) from a rating decision rendered in September 2003 by the Department of Veterans Affairs (VA) Regional Office (RO) in North Little Rock, Arkansas in which service connection for a skin condition was denied. The veteran testified before the undersigned Veterans Law Judge in August 2006. A transcript of the hearing is associated with the claims file. This case was remanded for further development in October 2006. That development having been completed, the case is now again before the Board. FINDING OF FACT The veteran manifests a skin condition to include nonspecific dermatitis, lichen simplex chronicus, fungal dermatitis, atopic dermatitis, and eczema which had its onset during active service. CONCLUSION OF LAW The criteria for service connection for a skin condition to include nonspecific dermatitis, lichen simplex chronicus, fungal dermatitis, atopic dermatitis, and eczema have been met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1137, 5107(b) (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.303 (2007). REASONS AND BASES FOR FINDING AND CONCLUSION In light of the favorable action taken herein, discussion of whether VA has met its duties of notification and assistance is not required, and deciding the appeal at this time is not prejudicial to the veteran. The veteran argues that he has a skin disorder that is the result of his active service, including as a result of exposure to the herbicide Agent Orange. The record reflects that the veteran served in Vietnam. Therefore, exposure to herbicides may be presumed. 38 C.F.R. 3.307(a)(6)(iii). Service connection may be established for disability resulting from injury or disease incurred in service. 38 U.S.C.A. § 1110. Service connection connotes many factors, but basically, it means that the facts, as shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service. A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease in service. See Pond v. West, 12 Vet. App. 341 (1999); Hickson v. West, 12 Vet. App. 247, 253 (1999). In addition, certain presumptions are granted for veterans who were exposed to the herbicide Agent Orange during service in Vietnam. However, as will be explained below, the skin conditions with which the veteran has been diagnosed are not among the conditions for which presumptive service connection is available. See 38 C.F.R. § 3.307, 3.309 (2006). Notwithstanding, the veteran may still establish service connection with proof of actual direct causation. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Service medical records do not show complaints of or treatment for a skin condition. The veteran's reports of medical history and examination prior to and at discharge from active service show no diagnoses, defects, abnormalities or other findings of a skin condition. Notwithstanding, medical evidence documents current findings of a skin condition beginning in 1997, when the veteran reported for an Agent Orange examination and was diagnosed with nonspecific dermatitis. VA examination conducted in July 1998 revealed a diagnosis of lichen simplex chronicus, which the examiner opined is the chronic stage of neurodermatitis. However, the claims file was not reviewed in conjunction with the report and no opinion as to etiology was given. Subsequent VA treatment records show treatment and diagnosis of various skin conditions including fungal dermatitis, papular urticaria versus atopic dermatitis, atopic dermatitis, and violaceous papuls thought to represent sarcoid. In October 2006, the Board remanded the claim for clarification of the diagnosis and to obtain an opinion as to the etiology of the condition. VA examinations were conducted in December 2006 and April 2007, with a May 2007 addendum. These records reflect diagnoses of chronic dermatitis, most likely atopic dermatitis and eczema. The December 2006 examination was conducted with review of the claims file. The April 2007 examination was not, but the May 2007 addendum provided the physician an opportunity to review the claims file, which was done and described in detail. The physician noted that the first medical evidence of a skin condition presented by the record was in 1997. As to etiology, neither physician offered the opinion that the skin condition was the result of the veteran's military service. Moreover, neither physician diagnosed chloracne, and the VA examination conducted n April 2007 specifically ruled it out-both currently and in the past. Chloracne is a condition for which presumptive service connection is granted based on exposure to the herbicide Agent orange. But, the December 2006 VA examiner opined that exacerbation of the veteran's skin condition from an environmental contact allergen could not be excluded. More importantly, both physicians stated that the onset of the veteran's skin condition was during the time period of the veteran's active service. Confusingly, the April 2007 VA examiner stated it was unlikely the diagnosed eczema was etiologically related to the veteran's military service; however, she noted that the onset was in 1971, during his active service. The veteran testified before the undersigned Veterans Law Judge and stated that he began to experience the symptoms of his skin condition while service in jungle conditions in Vietnam, and that it has recurred since then. There is no evidence directly contradicting the veteran's reported version of events surrounding his averred skin condition. VA treatment records show that his reported history has remained consistent. While neither the 2006 or the 2007 VA examination is a model of clarity and, in fact, one is internally inconsistent and both are confusing, they both place the onset of veteran's current skin condition in the 1971 - 1972 timeframe, at which point the veteran was performing active service; and describe the condition as chronic since that time. As both examiners accepted the veteran's description of his symptomatology during and after service, the Board will as well. There are no other opinions or medical findings against a finding that the onset of the veteran's skin condition was during his active service. Resolving all doubt in the veteran's favor, service connection for a skin condition is warranted. See 38 C.F.R. § 3.102. ORDER Service connection for a skin condition, to include nonspecific dermatitis, lichen simplex chronicus, fungal dermatitis, atopic dermatitis, and eczema is granted. ____________________________________________ RONALD W. SCHOLZ Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs