Citation Nr: 1318760 Decision Date: 06/10/13 Archive Date: 06/21/13 DOCKET NO. 10-12 488 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Entitlement to service connection for a bilateral knee disorder. 2. Entitlement to service connection for a left shin skin disorder. ATTORNEY FOR THE BOARD J. Schulman, Associate Counsel INTRODUCTION The Veteran, who is the appellant in this case, had active service from September 1990 to September 1994. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2009 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California, which denied service connection for both of the claimed issues. The Veteran appealed the denials of service connection on this decision, and the matter is now before the Board. A review of the Virtual VA paperless claims processing system does not reveal any additional documents pertinent to the present appeal but not already associated with the claims file. FINDINGS OF FACT 1. The Veteran did not engage in combat with the enemy during service. 2. The Veteran did not sustain an injury or disease of the knees in service. 3. The Veteran does not have a current disability of either knee. 4. A bilateral knee disability is not etiologically related to service. 5. The Veteran did not sustain a disease or injury of the left shin skin in service. 6. The Veteran does not have a current left shin skin disability. 7. Symptoms of a left shin skin disability did not become manifest during service or to a compensable degree since service. 8. A left shin skin disability is not etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for a bilateral knee disorder have not been met. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107, 7104 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). 2. The criteria for service connection for a left shin skin disorder have not been met. 38 U.S.C.A. §§ 1110, 1117, 5103, 5103A, 5107, 7104 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.317, 4.118, Diagnostic Codes 7804, 7806 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim and of the relative duties of VA and the claimant for procuring that evidence. 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b) (2012). This notice must be provided prior to an initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ), as was done in this case. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). In this case, the RO provided VCAA notice letters to the Veteran in September and October 2010, prior to the initial adjudication of the service connection claims on appeal. The letters notified the Veteran of what information and evidence must be submitted to substantiate the claims, including a description of what information and evidence must be provided by the Veteran and what information and evidence would be obtained by VA. The Veteran was also advised to inform VA of any additional information or evidence that VA should have, and to submit evidence in support of the claims to the RO. The content of the letters complied with the requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b). In addition, the notice requirements of the VCAA apply to all elements of a service-connection claim, including: (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. See, Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Further, this notice must include information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. at 486. In this case the Veteran was provided with such notice, including the type of evidence necessary to establish a disability rating and effective dates in the letters of September and October 2010. Based on the foregoing, adequate notice was provided to the Veteran prior to the transfer and certification of this case to the Board and complied with the requirements of 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b). Next, VA has a duty to assist a veteran in the development of the claim. To that end, VA must make reasonable efforts to assist the claimant in obtaining evidence necessary to substantiate the claim for the benefit sought, unless no reasonable possibility exists that such assistance would aid in substantiating the claim. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159 (2012); see Golz v. Shinseki, 590 F.3d 1317, 1320-21 (2010) (stating that the "duty to assist is not boundless in its scope" and "not all medical records . . . must be sought - only those that are relevant to the veteran's claim"). Service records have been obtained, associated with the Veteran's claims file, and reviewed in consideration of the issues before the Board. Also associated with the record are private treatment records and lay evidence supplied by the Veteran. The Veteran has indicated that he has no additional information or evidence to submit in support of his claim. In disability compensation claims, VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). With respect to the factor of relationship of current disability to service (or, by analogy, to a service-connected disability), the U. S. Court of Appeals for Veterans Claims (Court) has indicated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and a veteran's service. The types of evidence that "indicate" that a current disability "may be associated" with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. McLendon, 20 Vet. App. at 83; see also Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010) (while there must be "medically competent" evidence of a current disability, "medically competent" evidence is not required to indicate that the current disability may be associated with service). The claims file contains the Veteran's service treatment records and reports of VA and private post-service treatment, as well as the Veteran's own statements in support of his claim. The Veteran has not been examined by VA in connection with his claims for service connection but, as will be explained below, the evidence demonstrates no in-service injury, disease, or event related to the left shin skin and no in-service injury, disease or event related to the knees. In September 2009 the Veteran sent VA a photograph which he stated depicts his left shin. The photograph shows a patch of skin with three light-colored areas. Even assuming the photograph does reflect a disability, such a disability does not trigger VA's duty to afford the Veteran an examination because there is no in-service injury, disease, or even event to which the current skin disorder could be related by competent medical opinion. See McLendon, at 83; see also Waters 601 F.3d 1274. Accordingly, the second McLendon factor, e.g., evidence establishing an in-service injury, disease, or event, have not been met and a remand to provide the Veteran with a medical examination or obtain a medical opinion is not required with respect to these claims for service connection. The Board finds that all necessary development has been accomplished; therefore, appellate review may proceed without prejudice to the Veteran. See, Bernard v. Brown, 4 Vet. App. 384 (1993). In addition to the evidence discussed above, the Veteran's statements in support of the claims are also of record. The Board has carefully considered such statements and concludes that no available outstanding evidence has been identified. Additionally, the Board has reviewed the records for references to additional treatment reports not of record, but has found nothing to suggest that there is any outstanding evidence with respect to the Veteran's claims. For these reasons, the Board finds that the duties to notify and assist the Veteran in the development of these claims have been met, so that no further notice or assistance to the Veteran is required to fulfill VA's duty to assist. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001). Legal Criteria for Service Connection Entitlement to service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The disorders for which the Veteran is seeking service connection, an unspecified left shin condition and an unspecified bilateral knee condition, are not "chronic diseases" as listed under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.303(b) does not apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Service connection may also be granted on a presumptive basis for a Persian Gulf Veteran who exhibits objective indications of qualifying chronic disability, including resulting from undiagnosed illness, that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 21, 2016, and which by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C.A. § 1117; 38 C.F.R. § 3.317(a)(1) (2012). In claims based on qualifying chronic disability, unlike those for "direct service connection," there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004). Notably, laypersons are competent to report objective signs of illness. A "qualifying chronic disability" for VA purposes is a chronic disability resulting from (A) an undiagnosed illness, (B) a medically unexplained chronic multisymptom illness (such as chronic fatigue syndrome (CFS), fibromyalgia, or irritable bowel syndrome) that is defined by a cluster of signs or symptoms, or (C) any diagnosed illness that the Secretary determines in regulation prescribed under 38 U.S.C.A. § 1117(d) warrants a presumption of service connection. 38 U.S.C.A. § 1117(a)(2); 38 C.F.R. § 3.317(a)(2)(i)(B). "Objective indications of chronic disability" include both "signs," in the medical sense of objective evidence perceptible to a physician, and other, non-medical indicators that are capable of independent verification. To fulfill the requirement of chronicity, the illness must have persisted for a period of six months. 38 C.F.R. § 3.317(a)(2), (3). Signs or symptoms that may be manifestations of undiagnosed illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; and (12) abnormal weight loss. 38 C.F.R. § 3.317(b). Compensation under 38 U.S.C.A. § 1117 shall not be paid if there is affirmative evidence that: (1) an undiagnosed illness was not incurred during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War; (2) an undiagnosed illness was caused by a supervening condition or event that occurred between the Veteran's most recent departure from active duty in the Southwest Asia theater of operations during the Persian Gulf War and the onset of the illness; or (3) the illness is the result of the Veteran's own willful misconduct or the abuse of alcohol or drugs. 38 C.F.R. § 3.317(c). The term "Persian Gulf Veteran" means a veteran who served on active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War. 38 C.F.R. § 3.317(e)(1). The "Southwest Asia theater of operations" refers to Iraq, Kuwait, Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. 38 C.F.R. § 3.317(e)(2). Here, the Veteran's DD Form 214 indicates that he was awarded the Southwest Asia Service Medal, among other decorations. While the Southwest Asia Service Medal indicates service in Southwest Asia, it does not necessarily confirm service in the Southwest Asia theater of operations. Nonetheless, even assuming that the Veteran had qualifying service within the theater of operations, for the reasons discussed below service connection cannot be awarded on a presumptive basis through operation of 38 C.F.R. § 3.317. Generally, lay evidence is competent with regard to a disease with "unique and readily identifiable features" that is "capable of lay observation." See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007) (concerning varicose veins); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (a dislocated shoulder); Charles v. Principi, 16 Vet. App. 370, 374 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398, 405 (1995) (flatfoot); Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge). Notwithstanding the above, however, a veteran is not competent to provide evidence as to more complex medical questions and, specifically, is not competent to provide an opinion as to etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever). See 38 C.F.R. § 3.159(a)(2). Lay evidence can be competent and sufficient evidence of a diagnosis if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau, 492 F.3d at 1376-77. Additionally, a lay person may speak to etiology in some limited circumstances in which nexus is obvious merely through observation, such as sustaining a fall leading to a broken leg. Jandreau at 1376-77. When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. The Court has held that an appellant need only demonstrate that there is an "approximate balance of positive and negative evidence" in order to prevail. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Court has also stated, "[i]t is clear that to deny a claim on its merits, the evidence must preponderate against the claim." Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert. The Veteran does not allege, and a review of his official military documentation contained in his claims file does not otherwise indicate, that he engaged in combat against enemy forces as contemplated by VA regulations. The Veteran's DD Form 214 does not reflect that he received any decorations or medals indicative of involvement in combat. The Veteran's military occupational specialty was a combat engineer, he earned the expert rifle badge, National Defense Service Medal with one star, Sea Service Deployment Ribbon with one star, Joint Meritorious Unit Commendation, and Good Conduct Medal. This evidence is not inconsistent with combat and could be of probative value in supporting a contention of combat; however, the Veteran has not contended that he engaged in combat service. For these reasons, the Board finds that the Veteran did not "engage in combat" with the enemy during service. Therefore, the provisions of 38 U.S.C.A. § 1154(b) are not for application. Service Connection for a Bilateral Knee Disability The Veteran contends that since leaving service his knees "pop/crack" and when he squats or kneels for more than a couple of minutes at a time his knees hurt. The Veteran has admitted that he never sought treatment during service, but states that symptomatology has been continuously present ever since service. The Veteran's service treatment records indicate that on enlistment examination in December 1989 the lower extremities were normal. The Veteran denied any history of arthritis, rheumatism, bursitis, bone or joint deformity, and "trick" or locked knees. Throughout service there are no service treatment records referential to the knees and, on separation examination in August 1994, the Veteran's lower extremities were normal. Additionally, on service separation examination the Veteran again denied any history of arthritis, rheumatism, bursitis, bone or joint deformity, and "trick" or locked knees. The only evidence relating to the claimed knee disorder to service is the Veteran's own lay statements endorsing in-service onset of symptomatology and recurrent symptoms since that time. The Board reiterates that the Veteran is competent to report on knee pain and knee sounds to the extent that these are observable symptoms. Jandreau at 1376-77. However, although competent, the Veteran's endorsements of bilateral knee symptoms are not credible. Specifically, the Board notes for the reasons below that the Veteran's statements averring to in-service onset and on-going symptoms since service are inconsistent with his own prior statements, including contemporaneous statements made during service and at the service separation examination. During service the Veteran was seen at the dermatology clinic at Camp Pendleton monthly from March through July 1994 for a papule on the left index finger. In February 1994 he reported symptoms of gastroenteritis and in December 1993 he sought an eye examination and complained of a tender left Achilles tendon. In July 1993 the Veteran reported an eight month history of left shoulder pain. In January 1992 he reported a rash on his inner shins and in December 1991 he reported a four and a half month history of a rash on upper trunk and arms. In September 1991 the Veteran reported a "scratchy" throat. In July 1991, the Veteran was treated for first and second degree burns of the right forearm. Finally, the Board notes that while he denied skin disease, arthritis, rheumatism, bursitis, bone or joint deformity, and "trick" or locked knees on separation examination in December 1994, the Veteran endorsed left elbow pain, asthma, leg cramps, left shoulder pain and right ankle pain. The foregoing evidence reflects numerous complaints throughout service of various conditions, but none relating to the knees. In an April 2010 statement, the Veteran indicated that he did not report the claimed disorder during service out of concern for being ridiculed by others and due to a lack of time. Yet the Board is presented with numerous instances of the Veteran reporting symptomatology relating to various other conditions during service. The service treatment records appear complete. The Veteran was treated in service for various complaints during service ( leg cramps, cold sores, asthma, eye examination, upper body heat rash, upper respiratory infection, index finger papule, forearm burn, gastroenteritis), including of an orthopedic nature (right ankle, left shoulder, left foot pain, Achilles tendonits), but did not report a knee injury or knee pain or complaints. See Kahana v. Shinseki, 24 Vet. App. 428, 440 (2011) (Lance, J., concurring) (holding that silence in a medical record can be weighed against lay testimony if the alleged injury, disease, or related symptoms would ordinarily have been recorded in the medical record being evaluated by the fact finder (citing Fed. R. Evid. 803(7)). Not until the Veteran submitted a claim for compensation for knee disorder did he endorse knee problems. The Board may properly consider the personal interest a claimant has in his or her own case, but the Board is not free to ignore assertions as to any matter upon which a veteran is competent to offer an opinion. See Pond v. West, 12 Vet. App. 341, 345 (1999); and see Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (interest may affect the credibility of testimony). Here, the Board recognizes the Veteran's competent recent assertions of in-service onset of the claimed knee disorder, but finds them not credible. In light of the lack of credible evidence of an in-service disease or injury, or even complaints or symptoms, combined with the Veteran's affirmative denial of knee symptoms at service separation, the Board finds that the Veteran did not sustain a disease or injury of the knees in service, and did not experience knee disorder symptoms during service. Furthermore, although the Veteran has presented competent evidence of knee symptoms, the Veteran's statements are competent only for the purposes of establishing current symptoms, not a diagnosis associated with such symptomatology. Jandreau, at 1372. See Kahana, 24 Vet. App. at 435. A review of the claims file does not reflect competent evidence of a current diagnosis associated with the knees. In order for service connection to be established, the evidence must show an "in-service incurrence or aggravation of a disease or injury." Shedden, 381 F.3d at 1167. Here in addition to the lack of competent evidence of a current disability, the evidence of in-service incurrence of disease or injury is not credible, and the Veterans claim for service connection cannot be granted. The preponderance of the evidence of record is against the claim of service connection for a bilateral knee disability and the claim is denied. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. Service Connection for a Left Shin Skin Disability The Veteran contends that three white spots on the skin of his left shin first manifest following deployment to the Persian Gulf in 1991, and have been present since that time. The Veteran submitted photograph showing a patch of skin over the left shin with three light-colored areas. On the question of current disability, the Veteran has three light colored areas to the skin over the left shin that are not productive of disability. In September 2009 the Veteran sent VA a photograph which he stated depicts his left shin. The photograph shows a patch of skin with three light-colored areas. After a review of all the evidence, the Board finds that the weight of the evidence demonstrates no in-service injury or disease of the skin in the shin area, that symptoms of a left shin skin disability did not become manifest during service or to a compensable degree at any time since service, and that a left shin skin disability is not otherwise etiologically related to service. Service treatment records indicate that on enlistment examination in December 1989, the Veteran denied a history of skin disease and the skin was normal. Service treatment records are negative for injury or disease of skin disorder of the shin, or for any complaints, findings, diagnosis, or treatment for a skin disorder of the shin. During service, treatment regarding the skin includes a July 1991 treatment for right forearm burns. In December 1991 the Veteran reported a four and a half month history of a rash since returning from the Persian Gulf. The Veteran reported having been told the rash was a "heat rash," and he denied any prior history of rashes or heat sensitivity. The rash was limited to the upper trunk and upper arm. The assessment was heat rash. In January 1992, the Veteran reported a rash in the genital area since September 1991. The assessment was heat rash. Finally, in 1994 the Veteran reported to the dermatology clinic at Camp Pendleton monthly from March through July 1994 for a papule on the left index finger. No other in-service records indicate skin symptomatology or treatment, and on separation examination in August 1994 Veteran's skin was normal. The Veteran's reports of skin symptomatology are competent to the extent that they relate to observable symptoms. Jandreau, at 1376-77. However, as with his bilateral knee disability, the Veteran's statements that the claimed skin symptomatology began in, and has been present since service are inconsistent with his own statements and are not credible. The Board reiterates that, in spite of the Veteran's April 2010 contention that he was unable to seek medical attention for his claimed skin disorder due to time and social constraints, service treatment records reflect that he sought out medical attention multiple times for other conditions throughout service, including for skin-related disorders of the upper trunk, forearm, and groin in 1991 and 1992. Additionally, the Veteran was seen in a dermatology clinic at Camp Pendleton in 1994 for a period of ongoing treatment. The Board finds it to be not credible that the Veteran would seek out treatment for one skin disorder, and multiple other disorders, but fail to mention another disorder that he had at the same time. Finally, at service separation, the Veteran's skin was normal on examination. Further weighing against the credibility of the Veteran's recent statements of onset of skin disorder in service is the fact that, as with his claimed knee disorder, it was not until the Veteran submitted a claim for compensation that he began endorsing a shin skin condition. The Board recognizes the Veteran's competent assertions of in-service onset of a skin disorder, but finds them not to be credible. In light of the lack of credible evidence of an in-service disease or injury in the service treatment records, and the Veteran's contemporaneous in-service statements regarding his then-current history, the Board finds that the Veteran did not sustain a disease or injury of the left shin skin in service or experience the onset of left shin skin disorder symptoms during service. While his recent statements of in-service skin symptomatology are competent, the Board finds that the Veteran is not credible with respect to such statements. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (2006) (the lack of contemporaneous medical records may be a fact that the Board can consider and weigh against a veteran's lay evidence, but may not be the only fact); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (VA cannot ignore a veteran's testimony simply because the veteran is an interested party; personal interest may, however, affect the credibility of the evidence). Thus, the Board finds that the weight of the evidence demonstrates there was no in-service incurrence of the claimed left shin skin disorder, including no disease or injury during service. For these reasons, service connection cannot be granted on a direct basis. 38 C.F.R. § 3.303(a),(d). The Board now considers entitlement service connection on a presumptive basis stemming from service in Southwest Asia. As stated, service connection may be granted for certain illnesses manifested by one or more signs or symptoms such as those listed in 38 C.F.R. § 3.317(b), including signs and symptoms involving skin. 38 C.F.R. § 3.317 (2012). In order for service connection in these cases to be granted, the symptoms must have become manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2016. Id. In order to determine whether the Veteran's left shin skin disorder has been 10 percent disabling for any six month period since service, the Board looks to the schedule of ratings. Disorders of the skin are rated according to the Diagnostic Codes (DCs) under 38 C.F.R. § 4.118. The Board has considered all potentially applicable DCs and finds that the evidence of record does not show that the Veteran's claimed left shin skin disorder has been 10 percent disabling at any time. The Veteran has not alleged that the skin condition is painful; the lay and medical evidence shows no complaints or findings suggesting the shin skin disorder is productive of any symptomatology or impairment, only the finding of three spots of lightened skin with light-colored hair. DC 7804 requires that scars are painful or unstable in order to meet the criteria for a 10 percent rating. The evidence does not show that the Veteran's claimed skin condition has manifested in scarring that is painful or unstable. 38 C.F.R. § 4.118, DC 7804. With regard to DC 7806 for dermatitis or eczema, a 10 percent rating requires evidence to show that at least 5 percent, but less than 20 percent of the entire body, or at least 5 percent but less than 20 percent of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12 month period. 38 C.F.R. § 4.118, DC 7806. A review of the record reveals no evidence of intermittent systemic therapy for the skin. Furthermore, the Veteran has supplied an image of his left shin that shows that the area affected by the claimed disability does not amount to 5 percent of the entire body or 5 percent of the exposed areas affected. The Board has also considered whether the Veteran's claimed disorder may be 10 percent disabling under any other Diagnostic Codes, but finds that none of the applicable criteria have been met. Specifically, no evidence of record indicates that the claimed left shin skin condition represent, or is analogous to, burn scars (DC 7800-7802). The evidence of record also does not show that the left shin skin disorder is similar to any of the diseases or disorders in Diagnostic Codes 7807 through 7833. The weight of the competent evidence shows no objective indications of a qualifying disability manifested to a compensable degree for any six-month period since service. The Board finds that a qualifying chronic disability of the left shin skin did not manifest during service or to a compensable (10 percent) degree since service. Thus, service connection cannot be granted on a presumptive basis. See 38 U.S.C.A. § 1117; 38 C.F.R. § 3.317. Based on the foregoing the Board finds that the preponderance of the evidence is against the claim for service connection for a left shin skin disability. Having reviewed the entire record, the Board finds that the evidence shows that in-service incurrence due to disease or injury did not occur; that the weight of the evidence indicates that the Veteran's skin disorder did not become manifest to a degree of 10 or more since separation from service. The Veterans claim of entitlement to service connection for a left shin skin disability cannot be granted, and must be denied. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. ORDER Service connection for a bilateral knee disorder is denied. Service connection for a left shin skin disorder is denied. ____________________________________________ J. PARKER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs