Citation Nr: 1037553 Decision Date: 10/04/10 Archive Date: 10/12/10 DOCKET NO. 06-03 275 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Pittsburgh, Pennsylvania THE ISSUE Entitlement to service connection for a skin disorder. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD B. Diliberto, Associate Counsel INTRODUCTION The Veteran had active service from March 1980 to September 1983. This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from an October 2004 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Pittsburgh, Pennsylvania, that denied the benefit sought on appeal. The Veteran appealed that decision and the case was referred to the Board for appellate review. The Board remanded the claim to the RO/AMC in January 2009 for additional development. The requested development has been completed to the extent possible and no further action is necessary to comply with the Board's remand directives. Stegall v. West, 11 Vet. App. 268 (1998). FINDING OF FACT The Veteran's claimed skin disorder has not been shown to be causally or etiologically related to active service. CONCLUSION OF LAW The Veteran's claimed skin disorder was not incurred in or aggravated by active service, nor may it be presumed to have been so incurred. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. (2009). REASONS AND BASES FOR FINDING AND CONCLUSION Before addressing the Veteran's claim on appeal, the Board is required to ensure that the VA's "duty to notify" and "duty to assist" obligations have been satisfied. See 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2009). The notification obligation in this case was met by way of letters from the RO to the Veteran dated July 2004, May 2006 and April 2009. See Quartuccio v. Principi, 16 Vet. App. 183 (2002); Pelegrini v. Principi, 18 Vet. App. 112 (2004); Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006); Dingess v. Nicholson, 19 Vet. App. 473 (2006). The RO also provided assistance to the Veteran as required under 38 U.S.C.A. § 5103A and 38 C.F.R. § 3.159(c), as indicated under the facts and circumstances of this case. In addition, the Veteran and her representative have not made the RO or the Board aware of any additional evidence that needs to be obtained in order to fairly decide this appeal and have not argued that any errors or deficiencies in the accomplishment of the duty to notify or the duty to assist have prejudiced the Veteran in the adjudication of her appeal. Nor are any deficiencies otherwise apparent. As for a VA examination, the Board remanded the Veteran's claim in January 2009 for an examination to determine whether the Veteran's skin condition had its onset during service or is otherwise related to active service. The Veteran was scheduled for an examination in March 2010, but failed to report. In April 2010, through her representative, the Veteran requested that an examination be scheduled at the VA Medical Center in Cleveland, Ohio. That examination was scheduled for April 2010 and the Veteran was so notified. She again failed to report for the scheduled VA examination. As she has failed to comply with VA's efforts to examiner her, the Board finds that no further efforts to schedule her for an examination are necessary. The Board accordingly finds that the RO has satisfied the duty to notify and the duty to assist and will proceed to the merits of the Veteran's appeal. The Veteran had claimed entitlement to service connection for a skin disorder. Service connection will be granted for a disability resulting from an injury or disease incurred in or aggravated by active service. See 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303. If there is no showing of a resulting chronic disorder during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, to prove service connection, the record must contain: (1) evidence of a current disability, (2) medical evidence, or in certain circumstances, lay testimony, of an in-service incurrence or aggravation of injury or disease, and (3) evidence of a nexus or relationship between the current disability and the in-service disease or injury. Coburn v. Nicholson, 10 Vet. App. 427 (2006); Disabled American Veterans v. Secretary of Veterans Affairs, 419 F. 3d 1317 (Fed. Cir. 2005). If the Veteran fails to demonstrate any one element, denial of service connection will result. As a preliminary matter, the Board notes that the Veteran has already been granted entitlement to service connection for hyperkeratosis of both feet and that she has been granted entitlement to a 10 percent rating for each foot. The evidence in the claims file consists of service treatment records, VA treatment records, VA examination reports and written statements from the Veteran. The Veteran's service treatment records indicate that she was seen once in October 1981 for a rash on her legs, once in December 1982 for contact dermatitis on the neck and that she requested removal of moles from her face in July 1983. VA treatment records from May 1989 indicate that a thorough dermatological examination was performed. Examination of the skin revealed hyperkeratosis of the right great toe, right fifth toe and the plantar surface of the left foot on the metatarsal region. Examination of the hands revealed verrucous over the right index finger and left palm. The rest of the Veteran's skin was within normal limits. In August 2004 the Veteran was afforded an additional VA examination. A report from that examination indicates that the Veteran reported a history of rashes on her legs. The examiner diagnosed hyperkeratosis manifested by corns, calluses and warts to the bilateral hands, and keratotis dermatitis of the bilateral lower extremities which was determined to be in remission and was not indicated on physical examination. VA treatment records from April 2006 indicate that the Veteran was seen for a dermatology consult. At that time the Veteran reported an itchy skin condition that was not relieved by urea or eucerin. On examination the Veteran's skin was found to be dry and scaly. The Veteran's shins evidenced ichthyotic scaly changes and some ill-defined pigmented macules over her legs. The examiner diagnosed the Veteran with xerosis with possible atopic diathesis. As indicated above, the Board remanded the Veteran's claim in January 2009 for an examination to determine whether the Veteran's skin condition had its onset during service or is otherwise related to active service. The Veteran was scheduled for an examination by the VA Medical Center in Pittsburgh, Pennsylvania, in March 2010, but failed to report for that examination. In April 2010, through her representative, the Veteran requested that an examination be scheduled at the VA Medical Center in Cleveland, Ohio. That examination was scheduled for April 2010 and the Veteran was so notified. She again failed to report for the scheduled VA examination. A claimant is responsible for supporting a claim for benefits under laws administered by the VA, and the Veteran was clearly advised of the need to submit medical evidence demonstrating both the presence of a skin disorder and a nexus or relationship between that condition and service. The Veteran has presented no evidence of any link between her claimed skin disorder and her time in service beyond her own statements. While service records do show that the Veteran was treated for a rash on her legs the May 1989 and August 2004 VA examiners did not indicate any active skin disorder with regard to the Veteran's lower extremities. Other VA treatment records from April 2006 show that the Veteran was treated for ichthyotic scaly changes on her legs and was diagnosed with xerosis with possible atopic diathesis, but these findings have not been related to service by competent medical evidence. In the absence of any evidence showing possible etiology during the Veteran's period of service or evidence showing that the Veteran continues to have chronic skin disorder dating back to her period of service the claim for service connection must be denied. The Veteran has expressed a belief that her claimed skin disorder is causally related to active service. Although competent to report her observations of skin problems, she is not competent to opine as to whether the skin conditions in service are the same as what she has now. Such an opinion clearly requires medical expertise in assessing something as varied as skin disorders. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, this is not a case in which the Veteran's lay beliefs alone can serve to establish any association between the Veteran's claimed condition and her military service. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992); Moray v. Brown, 5 Vet. App. 211 (1993). In sum, her lay report is outweighed by the other evidence of record, specifically the August 2004 VA examination which revealed no active skin disorder associated with the Veteran's bilateral lower extremities. In conclusion, the most persuasive and probative evidence of record fails to demonstrate that the Veteran's claimed skin disorder began during active service or is causally related to service. As there is a preponderance of evidence against the claim, the benefit-of-the-doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54- 56 (1990). Accordingly, the Board finds that service connection for a skin disorder is not warranted. (CONTINUED ON THE NEXT PAGE) ORDER Entitlement to service connection for a skin disorder is denied. ____________________________________________ Thomas H. O'Shay Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs