Citation Nr: 0943962 Decision Date: 11/18/09 Archive Date: 11/25/09 DOCKET NO. 09-12 499 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Oakland, California THE ISSUE Entitlement to service connection for skin rash of the buttocks. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD N. Snyder, Counsel INTRODUCTION The Veteran, who is the appellant, served on active duty from November 1954 to November 1956. This matter is before the Board of Veterans' Appeals (Board) on appeal from a rating decision, dated in January 2008, of the Department of Veterans Affairs (VA) Regional Office (RO) in Oakland, California. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2009). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDING OF FACT The Veteran's skin rash of the buttocks is causally related to his active duty service. CONCLUSION OF LAW Skin rash of the buttocks was incurred in active duty service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. § 3.303 (2009). REASONS AND BASES FOR FINDING AND CONCLUSION Service connection may be granted for a disability resulting from injury or disease incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. To establish service connection for the claimed disorder, there must be medical evidence of a current disability; medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the current disability. If a condition noted during service is not determined to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection. 38 C.F.R. § 3.303(b). Subsequent manifestations, however remote, of a chronic disease, shown as such in service, are service connected unless clearly attributable to intercurrent causes. Id. The August 1952 entrance examination record documents normal clinical findings for the skin and the anus and rectum and no history of a skin rash affecting the buttocks. July 1955 service treatment records reflect findings of a diffuse erethematous rash over the buttocks, which, after a dermatology consultation, was diagnosed as irritation from sweating. An August 1955 service treatment record documents that the Veteran continued to have a rash on his buttocks. Another dermatology consultation was conducted, after which the Veteran was assessed with tinea of the buttocks and provided ointment. Subsequent medical records do not document any additional complaints or findings pertaining to the rash, and a November 1956 examination record reflects normal clinical findings for the skin and the anus and rectum and no history of skin rash. VA examination records dating in February 1957, February 1970, and May 2004 reflect no histories or findings pertaining to a skin rash on the buttocks, and the February 1957 VA examination record reflects a negative finding as to any skin irritation in the anal/rectal region. In September and October 2006, the Veteran submitted statements in which he reported that he had had a rash on his buttocks since service. The Veteran later clarified that the rash had recurred annually, predominantly during the summer. A July 2006 VA treatment record reveals a finding that the Veteran had recurrent rash, for which he used ketoconazole. A January 2007 VA examination record reflects the examiner's notation that the Veteran had "recently" developed a rash to the right buttock region, which the Veteran believed might be related to onychomycosis of the right digits. After examination, Examination revealed a rash representative of a fungal condition to the right buttock. The examiner noted that it looked like the Veteran had developed a fungal rash on the right buttock, for which the Veteran was using ketoconazole cream and loperamide. The examiner reported that he did not believe the skin rash was related to the onychomycosis on the right hand. An October 2007 VA examination record reflects the Veteran's history of intermittent skin rash on his buttock since service. The Veteran reported that the rash was "red and erythematous with significant itching" and that it flared up in the summer and remained dormant in the winter. The Veteran also reported that he used hydrocortisone cream for the rash. The examiner, who also conducted the January 2007 examination, noted that the Veteran had mentioned a buttock rash during the previous examination. The examiner also noted that at the time of the previous examination, the Veteran had not provided a date of onset for the rash. Examination revealed that the buttock had a large annular erythematous rash to the left gluteal region with a small degree of similar rash on the left gluteal region. The examiner diagnosed the Veteran with buttock rash, bilateral, suggesting fungal appearance. The examiner noted that the Veteran had not used corticosteroid or immunosuppressive drugs or light or electron beam therapy for the rash, and although the Veteran used hydrocortisone, the examiner noted that no prescriptions had been provided within the previous 12 months. The examiner noted that the Veteran reported that the rash had been a constant (though "waxing and waning") problem since its onset in 1955 but he found that the "information in the [claims file did] not suggest that the rash was present with any certainty during the military service". After review of the evidence, the Board finds that service connection is warranted for a skin rash based on evidence that the condition onset during service. The evidence of record clearly indicates that the Veteran is currently diagnosed with a skin rash on the buttocks and that he was initially diagnosed with a skin rash on the buttock during active service. The Board acknowledges that the service treatment records do not explicitly document the existence of a chronic rash. The Board takes administrative notice, however, of the fact that the nature of many skin disorders is that they have periods of flare-ups followed by dormant periods. The Veteran is competent to report the recurrence of the same rash on the buttocks since service, and the Board had no reason to doubt his credibility as to a history of a skin rash of the buttocks, off and on, since service. The Veteran's statements in this regard show a continuity of pertinent symptomatology to link his skin rash of the buttocks to his active duty service. See 38 C.F.R. § 3.159(a)(2); Layno v. Brown, 6 Vet. App. 465, 471 (1994); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (the layperson may be competent to identify the condition where the condition is simple). Thus, resolving all reasonable doubt in the Veteran's favor, the Board finds that service connection is warranted for skin rash of the buttocks. In closing, there is no need to undertake any review of compliance with the Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations in this case since there is no detriment to the veteran as a result of any VCAA deficiency in view of the fact that the full benefit sought by the veteran is being granted by this decision of the Board. See generally 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107; 38 C.F.R §§ 3.102, 3.156(a), 3.159 and 3.326(a). By letter dated in September 2007, the Veteran was furnished notice of the manner of assigning a disability evaluation and an effective date. He will have the opportunity to initiate an appeal from these "downstream" issues if he disagrees with the determinations which will be made by the RO in giving effect to the Board's grant of service connection. ORDER Service connection for skin rash of the buttocks is warranted. The appeal is granted. ____________________________________________ ALAN S. PEEVY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs