Citation Nr: 1102065 Decision Date: 01/18/11 Archive Date: 01/26/11 DOCKET NO. 06-17 960 ) DATE ) ) On appeal from the Department of Veterans Affairs Medical and Regional Office Center in Wichita, Kansas THE ISSUES 1. Entitlement to service connection for hypertension, claimed as high blood pressure. 2. Entitlement to service connection for a skin disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Russell P. Veldenz, Associate Counsel INTRODUCTION The Veteran served on active duty from July 1970 to April 1972. The record also indicates that he served in the National Guard from approximately April 1972 to August 1996 (with a break in service between September 1978 and September 1980). This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from a March 2005 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Wichita, Kansas, which denied the benefits sought on appeal. The Veteran appealed that decision to BVA, and the case was referred to the Board for appellate review. A video conference hearing was held in May 2007, with the Veteran sitting at the Wichita RO, and Michelle L. Kane, a Veterans Law Judge (VLJ), sitting in Washington, DC. The VLJ was designated by the Chairman to conduct the hearing pursuant to 38 U.S.C.A. § 7107(c) (West 2002 & Supp. 2010) and is rendering the determination in this case. A transcript of the testimony is in the claims file. In July 2009, the Board remanded this matter requiring the RO to request the Veteran's personnel records from his National Guard service indicating when he served on active duty for training or inactive duty for training. The RO made the request and a response was received in July 2010. The response included the dates the Veteran was on active duty and provides the information that the Board needs to make a fully informed decision. As the requested development has been completed, no further action is necessary to comply with the Board's remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board observes that although the Veteran claimed entitlement to service connection for PTSD, and the Board, in a July 2009 decision, affirmed denial of service connection for PTSD, the Veteran has also been diagnosed with a chronic anxiety disorder and a panic disorder. The RO, however, did not consider any alternative diagnoses in processing the Veteran's PTSD claim. See Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009) (the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record). The issue of service connection for a mental health disability other than PTSD has been raised by the record, but has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action. FINDINGS OF FACT 1. Hypertension was not affirmatively shown to have had onset during service; hypertension, first diagnosed many years after discharge from active service, is unrelated to an injury, disease, or event of service origin. 2. A skin condition is unrelated to an injury, disease, or event of service origin. CONCLUSIONS OF LAW 1. Hypertension was not shown to have been incurred in or aggravated by service and may not be presumed to have been incurred or aggravated therein. 38 U.S.C.A. §§ 101(21), (22), (23) & (24), 1101, 1110, 1112, 1113, 1131, 5107(b) (West 2002 & Supp. 2010); 38 C.F.R. §§ 3.6, 3.303, 3.307, 3.309 (2010). 2. A skin disorder is not due to disease or injury that was incurred in or aggravated by service. 38 U.S.C.A. §§ 101(21), (22), (23) & (24), 1110, 1131, 5107(b) (West 2002 & Supp. 2010); 38 C.F.R. § 3.6, 3.303 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA, codified in part at 38 U.S.C.A. §§ 5103, 5103A, and implemented in part at 38 C.F.R § 3.159, amended VA's duties to notify and to assist a claimant in developing information and evidence necessary to substantiate the claims. Under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b), when VA receives a complete or substantially complete application for benefits, it will notify the claimant of the following: (1) any information and medical or lay evidence that is necessary to substantiate the claim, (2) what portion of the information and evidence VA will obtain, and (3) what portion of the information and evidence the claimant is to provide. See Shinseki v. Sanders, 556 U.S. __, 129 S. Ct. 1696, 1700-1701 (April 21, 2009). Also, the VCAA notice requirements apply to all five elements of a service connection claim. The five elements are: 1) veteran status; 2) existence of a disability; 3) a connection between the Veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess v. Nicholson, 19 Vet. App. 473, 484-86 (2006). The VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable adjudication by the RO. Pelegrini v. Principi, 18 Vet. App. 112, 119 (2004). The RO provided pre- and post- adjudication VCAA notice by letters, dated in August 2004, October 2004, and May 2006. The Board finds that the documents substantially complied with the specificity requirements of Quartuccio v. Principi, 16 Vet. App. 183, 186-87 (2002) (identifying evidence to substantiate a claim and the relative duties of VA and the claimant to obtain evidence); of Charles v. Principi, 16 Vet. App. 370, 374 (2002) (identifying the document that satisfies VCAA notice); and of Pelegrini v. Principi, 18 Vet. App. 112, 119-120 (2004) (38 C.F.R. § 3.159 notice). To the extent that the VCAA notice, concerning the effective date of a claim and the degree of disability assignable, came after the initial adjudication, the timing of the notice did not comply with the requirement that the notice must precede the adjudication. The timing error was cured by content-complying VCAA notice after which the claims were readjudicated as evidenced by the supplemental statements of the case, dated in January 2007 and August 2010. Mayfield v. Nicholson, 499 F.3d 1317, 1323 (Fed. Cir. 2007) (Timing error cured by adequate VCAA notice and subsequent readjudication without resorting to prejudicial error analysis.) Under 38 U.S.C.A. § 5103A, VA must make reasonable efforts to assist the claimant in obtaining evidence necessary to substantiate the claim. The RO has obtained service treatment records, VA records, records from private medical caregivers, and a videoconference hearing before the undersigned in May 2007. The Veteran has not been afforded a VA examination with respect to his claims seeking service connection for hypertension and a skin disorder. An examination is required when (1) there is evidence of a current disability, (2) evidence establishing an "in-service event, injury or disease," or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation, (3) an indication that the current disability may be related to the in- service event, and (4) insufficient evidence to decide the case. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). In the present appeal, the Board concludes an examination is not needed in this case. There is nothing mentioned in the service treatment records that indicates the Veteran was treated for or had developed hyper tension. The Veteran was not diagnosed and started treatment for hypertension until 1988, or approximately 15 years after separation from service. Although the Veteran was treated in March 1972 for itching between his toes during the heat, the Veteran also did not seek any further treatment for a skin disorder until many years after his separation from service. Stated another way, it appears the March 1972 treatment was related to an acute condition caused by heat and did not trouble the Veteran any further as a chronic disability. Moreover, the Veteran has also stated his skin disorder has manifested itself in other areas of his body and there is no competent lay or medical evidence indicating the later manifestation of symptoms are related to the March 1972 event. In addition, the Veteran has not stated that he experienced his current symptoms during service or as chronic symptoms since separation from active service. In short, the Veteran's service treatment records are absent for evidence of findings related to hypertension or a chronic skin disorder and his post-service medical records are absent for evidence of symptomatology related to either hypertension or a skin disorder until many years after the Veteran's separation from service. Absent some evidence, other than his own lay assertions, that the Veteran suffered an event, injury, or disease in service that may be associated with his current conditions, the Board finds that an examination is not necessary for either the Veteran's hypertension or skin disorder claim. See Duenas v. Principi, 18 Vet. App. 512, 519 (2004) (finding no prejudicial error in Board's statement of reasons or bases regarding why a medical opinion was not warranted because there was no reasonable possibility that such an opinion could substantiate the Veteran's claim because there was no evidence, other than his own lay assertion, that "'reflect[ed] that he suffered an event, injury[,] or disease in service' that may be associated with [his] symptoms"); see also Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010) (noting that a veteran's conclusory generalized statement that a service illness caused his present medical problems was not enough to entitle him to a VA medical examination since all veterans could make such a statement, and such a theory would eliminate the carefully drafted statutory standards governing the provision of medical examinations and require VA to provide such examinations as a matter of course in virtually every disability case). In addition, as is explained more fully below, there is no indication that hypertension or a skin condition is related to the Veteran's service. See Wells v. Principi, 326 F.3d 1381 (Fed.Cir. 2003) (noting that the Board has no obligation to obtain a medical opinion when there is no competent evidence that the appellant's disability or symptoms are associated with his service). In a November 2004 statement, the Veteran reported that his skin disorder began in the late 1980s, over 10 years after his separation from service, and the medical evidence establishes that hypertension was diagnosed in 1988. At best, the Veteran only has his own conclusion that his current disorders are related to his military service. While lay evidence may be competent to establish medical etiology or nexus, Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009), VA may give it whatever weight it concludes the evidence is entitled to and as will be explained, the only evidence suggesting a relationship or correlation between his claimed skin conditions and hypertension and his military service is his unsubstantiated lay allegation. A mere conclusory generalized lay statement that service event or illness caused the current condition is insufficient to require the Secretary to provide an examination. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). Accordingly, it is not necessary to obtain a medical examination or medical opinion in order to decide the claim in this case. 38 C.F.R. § 3.159(c)(4)(i), Duenas v. Principi, 18 Vet. App. 512, 517 (2004). As the Veteran has not identified any additional evidence pertinent to the claim and as there are no additional records to obtain, the Board concludes that no further assistance to the Veteran in developing the facts pertinent to the claims is required to comply with the duty to assist. Legal Principles The Board has thoroughly reviewed all the evidence in the Veteran's claims folder. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran). In this decision, the Board has considered all lay and medical evidence as it pertains to the issue. 38 U.S.C.A. § 7104(a) ("decisions of the Board shall be based on the entire record in the proceeding and upon consideration of all evidence and material of record"); 38 U.S.C.A. § 5107(b) (VA "shall consider all information and lay and medical evidence of record in a case"); 38 C.F.R. § 3.303(a) (service connection claims "must be considered on the basis of the places, types and circumstances of his service as shown by service records, the official history of each organization in which he served, his medical records and all pertinent medical and lay evidence"). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. See Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("Although interest may affect the credibility of testimony, it does not affect competency to testify."). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159. Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer a medical diagnosis, statement, or opinion. 38 C.F.R. § 3.159. The Board, as fact finder, must determine the probative value or weight of the admissible evidence. Washington v. Nicholson, 19 Vet. App. 362, 369 (2005) (citing Elkins v. Gober, 229 F.3d 1369, 1377 (Fed.Cir.2000) ("Fact-finding in veterans cases is to be done by the Board)). A veteran is competent to report symptoms that he experiences at any time because this requires only personal knowledge as it comes to him through his senses. Layno, 6 Vet. App. at 470; Barr v. Nicholson, 21 Vet. App. 303, 309 (2007) (when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation). The absence of contemporaneous medical evidence is a factor in determining credibility of lay evidence, but lay evidence does not lack credibility merely because it is unaccompanied by contemporaneous medical evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim); Barr v. Nicholson, 21 Vet. App. 303 (2007) ("Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms"). In determining whether statements submitted by a veteran are credible, the Board may consider internal consistency, facial plausibility, consistency with other evidence, and statements made during treatment. Caluza v. Brown, 7 Vet. App. 498 (1995). When there is an approximate balance of positive and negative admissible evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran. 38 U.S.C.A. § 5107(b). Principles of Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A.§ 1110, 38 C.F.R. § 3.303. The term "disability" in 38 U.S.C.A. § 1110 means impairment of earning capacity due to disease, injury, or defect, rather than to the disease, injury, or defect itself. Allen v. Brown, 7 Vet. App. 439, 448 (1995). Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service, or if preexisting such service, was aggravated by service. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303(a). For a Veteran who served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for certain diseases, including hypertension, if the disability is manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. § 1112; 38 C.F.R. §§ 3.307, 3.309. The presumption does not apply to skin disorders except purpura, idiopathic, hemorrhagic. 38 C.F.R. § 3.309. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection for the claimed disorder, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247, 253 (1999). The absence of any one element will result in the denial of service connection. Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006). Hypertension- Analysis In this case, the Veteran is claiming entitlement to service connection for hypertension (originally claimed as high blood pressure) and a skin disorder, other than due to herbicide exposure. The Board notes that the term hypertension refers to persistently high arterial blood pressure. Medical authorities have suggested various thresholds ranging from 140 mm. Hg systolic and from 90 mm. Hg diastolic. See Dorland's Illustrated Medical Dictionary 909 (31st ed. 2007). Similarly, for VA rating purposes, the term hypertension means that the diastolic blood pressure is predominantly 90 mm. or greater. The term isolated systolic hypertension means that the systolic blood pressure is predominantly 160 mm. or greater with a diastolic blood pressure of less than 90 mm. See 38 C.F.R. § 4.104, Code 7101, Note 1 (2008). The Veteran's active duty service treatment records from 1970 to 1972 do not show any complaints, treatment, or diagnoses for hypertension or any abnormal blood pressure readings. Neither the entrance examination in February 1970 nor the separation examination in 1972 indicates a history or medical finding of high blood pressure. His blood pressure reading at the separation examination was 130/84 and the Veteran stated he was in good health. When the Veteran re-entered the National Guard in 1980, his blood pressure was 126/70. Periodic examinations in the Guard occurred in April 1981 and March 1986. His blood pressure readings were 130/88 and 140/90 respectively. A private medical record recorded a blood pressure reading of 130/110 in December 1985. In reviewing the evidence of record, it appears that the Veteran was first diagnosed with hypertension in 1988. In this regard, a May 1988 private treatment record notes that the Veteran's blood pressure was consistently staying up, and that the Veteran required treatment. The private physician continued that the Veteran had consistent off and on elevations of systolic and diastolic pressure. After the Veteran started taking medication, by October 1988, his blood pressure was considered stable. Furthermore, on a January 1990 National Guard examination, the Veteran stated on his report of medical history that his private physician had placed him on medication for his high blood pressure, starting in the summer of 1988. In 1992, the Veteran was hospitalized for four days for both a hypertension episode and anxiety. In an Air Guard clinical note for December 1993, the Veteran stated he had been treated for high blood pressure for about eight years. Finally, the Veteran testified that he was never diagnosed with high blood pressure in the military nor has any doctor told him that his high blood pressure originated in service. On the basis of the active duty service treatment records alone, hypertension or high blood pressure was not affirmatively shown to have been present during service, nor does the Veteran contend that he ever had elevated blood pressure during his period of active duty. Therefore, service connection under 38 U.S.C.A. § 1131 and 38 C.F.R. § 3.303(a) is not established. Since high blood pressure was not noted in active service, nor is there any competent medical evidence either contemporaneous with or after service that high blood pressures was otherwise noted, that is, observed during service, and as the Veteran has not asserted in statements otherwise, the principles of service connection pertaining to chronicity and continuity of symptomatology under 38 C.F.R. § 3.303(b) do not apply. Savage v. Gober, 10 Vet. App. 488, 495-96 (1997). In the absence of continuity of symptomatology, service connection may be established under 38 C.F.R. § 3.303(d), that is, service connection based on the initial diagnosis. The question is whether there is an association between the high blood pressure, first diagnosed after service in 1988 or approximately 15 years after separation and service. A lay person is competent to identify a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Also, the Veteran as a lay person is competent to offer an opinion on a simple medical condition. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (citing Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007)). The Veteran argues his hypertension or high blood pressure was caused by the stress of service. The Veteran is competent to testify what occurred during service including how rigorous service is because the events of his service are matters within his personal knowledge, observed through his senses, and can be described by him. Thus, the Veteran can competently and credibly testify to basic training, regular training, what activities he performed on a daily basis, and the effect these various activities had upon him physically. Further, this testimony would be far more detailed and enlightening then any manuals or documentation describing training or service duties. Therefore, for purposes of this appeal only, the Board has assumed the Veteran's service was rigorous and stressful. The crucial question then becomes whether service caused or resulted in hypertension. There are, however, two problems with the Veteran's contention that service caused his hypertension. First, the Veteran, by asserting that the overall rigors of service triggered the high blood pressure that manifested itself fifteen years after separation and lead to a diagnosis of hypertension, has made a vague and extremely general connection and does not offer a single example or event of how service resulted in hypertension. It is too speculative and inconclusive to support a claim. The law provides that service connection may not be based on speculation or remote possibility. 38 C.F.R. § 3.102. He also does not state the he first experienced symptoms of high blood pressure and hypertension in service, but instead service laid the groundwork resulting in the symptoms manifesting themselves years after separation. Second, and more importantly, unlike a broken leg, high blood pressure is not a simple medical condition because it is not a condition a lay person can perceive through the senses as distinguished from an opinion or conclusion from one's own personal observation. Moreover, in this case, the cause of any current high blood pressure/hypertension disability cannot be determined by the Veteran's own personal observation without having specialized education, training, or experience. 38 C.F.R. § 3.159. And it is not argued or shown that the Veteran is otherwise qualified through specialization, education, training, or experience to offer an opinion on the cause of high blood pressure. Here the Veteran's lay opinion on causation is not competent evidence and his opinion on causation cannot be considered as evidence favorable to the claim. Although the Veteran is also competent to relate a contemporaneous medical diagnosis and symptoms that later support a diagnosis of by a medical professional, there is no such evidence offered by the Veteran, and as noted above, none of the treating physicians, private or VA, have concluded that the Veteran's high blood pressure was caused by the severity and hardship of service or is otherwise related to it. As the Veteran's lay statements and testimony are not competent evidence on causation and as there is no competent medical evidence on causation, the preponderance of the competent evidence of record is against the claim on the question of causation between hypertension and the Veteran's service from July 1970 to July 1972. Since the Veteran had service with the National Guard between 1972 and 1996, the Board must also address whether the Veteran is entitled to service connection because of this service. At the time the Veteran was diagnosed with hypertension, he was serving in the National Guard. In this regard, the Board notes that the term "active military, naval, or air service" is defined to include, inter alia, "any period of active duty for training during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty." 38 U.S.C.A. § 101(24); see also 38 C.F.R. § 3.6(a). The term "active duty for training" includes, inter alia, certain full time duty in the Army National Guard. 38 U.S.C.A. § 101(22); see also 38 C.F.R. § 3.6(c)(3). A determination of whether a period of service qualifies as active duty for training or inactive duty for training is of significance because for periods of inactive duty for training, service connection may be granted for disability resulting only from injuries incurred or aggravated during such periods, not disability resulting from diseases. 38 U.S.C.A. § 101(23), (24); see McManaway v. West, 13 Vet. App. 60, 67 (1999) (quoting Brooks v. Brown, 5 Vet. App. 484, 485 (1993) (discussing 38 U.S.C. §§ 101(24), 1131) (stating that the law "permits service connection for persons on inactive duty [training] only for injuries, not diseases, incurred or aggravated in line of duty"). Here, to warrant service connection for hypertension, the Veteran must show that he became disabled, i.e., that he was diagnosed with hypertension during a period of active duty for training. Because hypertension is classified as a disease rather than an injury, he cannot be service connected for hypertension if it was diagnosed during a period of inactive duty training, or otherwise. As noted above, the Veteran was diagnosed with hypertension of high blood pressure in approximately May 1988 and placed on medication in the summer of 1988. Records from the National Guard indicate the Veteran served a total of 17 days of active duty in 1988, all occurring in January 1988. Because the Veteran was not diagnosed with high blood pressure in January 1988 while he was on active duty or active duty for training, he is not entitled to service connection for his high blood pressure based upon service in the National Guard. As the preponderance of the evidence is against the claim that hypertension, claimed as high blood pressure, is due to an injury or event in service under 38 C.F.R. § 3.303(a), (b), and (d), the benefit-of-the-doubt standard or proof does not apply. 38 U.S.C.A. § 5107(b). Skin Disorder- Analysis The Veteran has filed a claim for a skin disorder. That claim originally included as due to exposure to Agent Orange. In a decision dated in July 2009, the Board determined that the Veteran was not entitled to service connection for a skin disorder due to exposure to Agent Orange or any other herbicide. This left open the question of whether the Veteran has a skin disorder caused by service other than Agent Orange exposure. Neither the entrance examination in February 1970 nor the separation examination in 1972 indicates a history or medical finding of a skin disorder or disease. The Veteran was treated in March 1972 for itching between his toes during the heat, and no diagnosis was recorded. He was prescribed ointment and a powder. The Veteran also did not seek any further treatment for the itching between his toes or a skin disorder in service and did not do so until many years after his separation from service. His re-entrance examination to the National Guard in August 1980 was silent regarding any skin problems and the Veteran stated his health was "good." A periodic examination in April 1981 did not reveal any skin disorders and the Veteran certified in March 1982 and March 1983 that he had not suffered any significant injuries or illnesses, including the skin. In March 1986, at a National Guard periodic examination he gave a negative history as to skin problems and none were noted upon physical examination. In March 1987, the Veteran sought treatment from a private physician because he had a rash "on and off" for four days. The assessment was hives. In July 1990, the Veteran again sought treatment from a private physician for a rash that had recently occurred and appeared on his arms, legs, shoulder, and back. In the history, the physician noted the Veteran reported previous episodes of hives. Treatment continued until September 1990 where the physician noted the Veteran had flare- ups of the rash but overall felt pretty good. The physician concluded that the Veteran did not have hives but rather recurrent urticaria of an unknown etiology (urticaria). National Guard periodic examinations in January 1990 and December 1993 did not record any history of a skin disorder and the physical examination was normal. In April 2004, VAMC outpatient treatment records reveal that a lesion removed from the Veteran was diagnosed as actinic keratosis, which his physicians explained to the Veteran results from sun damage. The diagnosis of actinic keratosis was made only after pathological examination. In a November 2004 statement, the Veteran asserted he noticed a lesion on his neck in late 1980, but his private doctor did not do anything after the Veteran brought it to his attention. He later noticed more lesions on his stomach and arms although he has not specified when he noticed the additional lesions. In May 2005, the Veteran stated that after returning home from his tour overseas and after suffering nightmares for two years, "bumps" formed under his skin. In July 2007, the Veteran described his disorder as a discoloration and that he has not had it in some time. He said it never appeared while he was in the military and no doctor had linked the condition to service. Initially, the Board notes the Veteran has been treated for several disorders of the skin, hives, urticaria, and actinic keratosis, but never more than once. The Veteran has testified to observing skin lesions or discolorations on his body at various times over the years. Therefore, for purposes of this appeal only, the Board will assume he has a current skin disorder. On the basis of the active duty service treatment records alone, a skin disorder was not affirmatively shown to have been present during service, and the Veteran does not contend otherwise. The active duty service treatment records document itching between the toes which was treated one time in March 1972. This appears to have been the result of an acute condition and did not result in any further treatment as a chronic or recurrent condition. The Veteran stated he first noticed a lesion in 1980, years after his separation from active duty. Therefore, service connection under 38 U.S.C.A. § 1131 and 38 C.F.R. § 3.303(a) is not established. Although there is no indication of the Veteran having any skin condition involving the toes since that time, symptoms of a skin condition were noted, suggesting that the presumption of service connection relating to chronic diseases might apply. 38 C.F.R. § 3.307. The presumption, however, does not apply to skin disorders except purpura, idiopathic, hemorrhagic. 38 C.F.R. § 3.309. In this instance, there is no medical evidence that the Veteran suffers from purpura, idiopathic, hemorrhagic. Therefore, the Board has determined that the principles of service connection, pertaining to chronicity and continuity of symptomatology under 38 C.F.R. § 3.303(b) do not apply to the Veteran's claim. As for whether service connection may be granted when the disability was first diagnosed after service, considering all the evidence of record under 38 C.F.R. § 3.303(d), the evidence shows that a skin disorder was not documented until the diagnosis of hives in 1987. The question is whether there is an association between any skin disorder, first diagnosed after service in 1987 or approximately 15 years after separation, and service. A veteran is competent to describe symptoms of an illness, Layno v. Brown, 6 Vet. App. 465, 469-71 (1994) (lay testimony is competent as to symptoms of an injury or illness, which are within the realm of personal knowledge), but unless a disorder is is a condition under case law that have been found to be capable of lay observation, the determination as to the presence or diagnosis of such a disorder therefore is medical in nature. Savage v. Gober, 10 Vet. App. 488, 498 (1997) (On the question of whether the veteran has a chronic condition since service, the evidence must be medical unless it relates to a condition as to which, under case law, lay observation is competent); Barr v. Nicholson, 21 Vet. App. 303 (2007) (Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation). Also, under certain circumstances, a layperson is competent to identify or to express an opinion of a simple medical condition. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (noting, in a footnote, that sometimes a layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer). The Veteran is certainly competent as a lay person to comment on any symptoms within his five senses such as the bumps or hives and skin discoloration. He is not competent to provide a probative opinion concerning the appropriate diagnosis of the underlying condition causing the bumps or hives and skin discoloration, i.e., whether it is urticaria, actinic keratosis, or some other skin disorder, nor is he competent to associate any current skin disorder to service. Skin disorders such as urticaria, or actinic keratosis, are not conditions under case law that have been found to be capable of lay observation, and the determination as to the presence or diagnosis of such a disorder therefore is medical in nature. Savage v. Gober, 10 Vet. App. 488, 498. Furthermore, unlike the varicose veins in Barr or a dislocated shoulder in Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007), the Board finds that urticaria, actinic keratosis, or any other skin disorder are not conditions capable of lay diagnosis, nor can they be causally related to military service without medical expertise. In this regard, the onset and diagnosis of a skin disorder, like a form of cancer, requires medical testing and the cause of the disease is a matter of medical complexity. As noted by the pathology testing in 2004, the diagnosis of actinic keratosis was made only by pathological examination that confirmed the presence of actinic keratosis. For the foregoing reasons, the Board determines that the Veteran's current skin disorder is not a simple medical condition that a lay person is competent to identify or is the Veteran competent to express an opinion that the skin disorder is related to symptoms in service. In this case, the cause of any current skin disease disability cannot be determined by the Veteran's own personal observation without having specialized education, training, or experience, 38 C.F.R. § 3.159, and it is not argued or shown that the Veteran is otherwise qualified through specialization, education, training, or experience to offer an opinion on the cause of a skin disorder. To this extent, the Veteran's statements and testimony are excluded or not admissible and the statements are not to be considered as evidence in support of the claim. Although the Veteran is also competent to relate a contemporaneous medical diagnosis and symptoms that later support a diagnosis of by a medical professional, there is no such evidence offered by the Veteran, and as noted above, none of the treating physicians have concluded that the Veteran's skin disorder was caused by service or is otherwise related to it. As the Veteran's lay statements and testimony are not competent evidence on causation and as there is no competent medical evidence on causation, the preponderance of the competent evidence of record is against the claim on the question of causation. Again, just as it had considered the issue with the claim for hypertension, since the Veteran had National Guard service between 1972 and 1996, the Board must consider whether service connection can be granted for a skin condition based on that service. The evidence reflects that the Veteran was treated for a skin disorder twice during the period in which he served in the National Guard, i.e., March 1987 and July 1990. In this regard, the Board notes that the term "active military, naval, or air service" is defined to include, inter alia, "any period of active duty for training during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty." 38 U.S.C.A. § 101(24); see also 38 C.F.R. § 3.6(a). The term "active duty for training" includes, inter alia, certain full time duty in the Army National Guard. 38 U.S.C.A. § 101(22); see also 38 C.F.R. § 3.6(c)(3). A determination of whether a period of service qualifies as active duty for training or inactive duty for training is of significance because for periods of inactive duty for training, service connection may be granted for disability resulting only from injuries incurred or aggravated during such periods, not disability resulting from diseases. 38 U.S.C.A. § 101(23), (24); see McManaway v. West, 13 Vet. App. 60, 67 (1999) (quoting Brooks v. Brown, 5 Vet. App. 484, 485 (1993) (discussing 38 U.S.C. §§ 101(24), 1131) (stating that the law "permits service connection for persons on inactive duty [training] only for injuries, not diseases, incurred or aggravated in line of duty"). Here, to warrant service connection for a skin disorder, the Veteran must show that he became disabled, i.e., that he was diagnosed with a skin disorder, during a period of active duty for training. Because skin disorders are classified as a disease rather than an injury, he cannot be service connected for a skin disorder if it was incurred during a period of inactive duty training. As noted above, the Veteran was diagnosed with hives in 1987 and urticaria in 1990. Records from the National Guard indicate the Veteran served a total of 15 days of active duty in 1987, all occurring in June 1987. Because the Veteran was not diagnosed with hives while he was on active duty or active duty for training, he is not entitled to service connection for a skin condition as a result of his service in June 1987. For 1990, the Veteran served from June 10 to June 23, 1990 and August 25 and 26, 1990. Because he was not diagnosed with urticaria while on active duty or active duty for training in June and August 1990, he is not entitled to service connection for a skin condition as a result of his service in 1990. As the preponderance of the evidence is against the claim that a skin condition is due to an injury or event in service under 38 C.F.R. § 3.303(a), (b), and (d), the benefit-of-the-doubt standard or proof does not apply. 38 U.S.C.A. § 5107(b). ORDER Service connection for hypertension/high blood pressure is denied. Service connection for a skin disorder is denied. ____________________________________________ MICHELLE L. KANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs