Citation Nr: 1321022 Decision Date: 06/28/13 Archive Date: 07/05/13 DOCKET NO. 10-14 315 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston-Salem, North Carolina THE ISSUE Entitlement to service connection for a skin disability, claimed as skin rashes to the chest, neck, bilateral elbows, and bilateral shins. ATTORNEY FOR THE BOARD C. Ferguson, Counsel INTRODUCTION The Veteran, who is the appellant, had active service from September 1982 to January 2009. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) as part of the Benefits Delivery at Discharge (BDD) program. The purpose of the BDD program is to help ensure a smooth transition from military to civilian status by allowing service members to file pre-discharge claims for disability compensation with VA. In order to facilitate the quick processing of claims under the BDD program, the Virtual VA paperless claims processing system is utilized. Instead of paper, a highly secured electronic repository is used to store and review every document involved in the claims process. The use of this system allows VA to leverage information technology in order to more quickly and accurately decide a veteran's claim for benefits. This appeal was processed using the Virtual VA paperless claims processing system. Accordingly, any future consideration of this appellant's case should take into consideration the existence of this electronic record. FINDINGS OF FACT 1. During service, the Veteran reported skin rashes on the chest, neck, elbow, and shins and objectively demonstrated a raised rash to the chest. 2. The skin symptomatology during service was attributed to a medical diagnosis of dermatitis in 2009. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran's favor, the criteria for service connection of dermatitis are met. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Duties to Notify and Assist The claim of service connection for a skin disability has been considered with respect to VA's duties to notify and assist. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Given the favorable outcome of the appeal, which is a full grant of benefits sought, the Veteran's claim has been substantiated, obviating the need for further discussion of how VA fulfilled the duties to notify and assist in this case. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). Service Connection Legal Criteria The Board has thoroughly reviewed all the evidence in the record. The analysis below focuses on the most relevant evidence and on what this evidence shows, or fails to show, on the claim. 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). 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, 1131; 38 C.F.R. § 3.303(a). Service connection may also 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). 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). The Veteran's currently diagnosed dermatitis is not a "chronic disease" listed under 38 C.F.R. § 3.309(a); therefore, the presumptive service connection provisions under 38 C.F.R. § 3.303(b) for service connection based on "chronic" symptoms in service and "continuous" symptoms since service are not applicable. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service Connection Analysis The Veteran has claimed service connection for a skin disorder. He contends that during service since 2003 he experienced periods of itching or skin rash on the chest, neck, elbow, and shin areas. He reported that the skin rash worsened following service in Iraq. After a review of all the evidence, the Board finds that, during service, the Veteran experienced skin rashes on the chest, neck, elbow, and shins, and that later the skin symptomatology during service was attributed to a medical diagnosis of dermatitis in 2009. The Veteran's service treatment records show complaints of skin rash during service. Specifically, in March 2004, the Veteran reported a history of chest rash for the past two to three years, which had worsened since his return from Iraq. On physical examination, a raised rash to the chest was noted, and the service medical examiner wrote an assessment of rule out sarcoid secondary to rash on the chest. Later, on the March 2007 service report of medical history, the Veteran reported a history of skin rash, and explained that he had experienced skin rashes on the chest, neck, elbow, and shin areas since returning from Iraq. Prior to retiring from service in January 2009, the Veteran filed the current claim seeking compensation benefits for skin rashes to the chest, neck, elbows, and shins. See September 2008 VA Form 21-4138. At the October 2008 QTC medical examination performed prior to service retirement, the Veteran reported that he had experienced periods of itching since 2003, especially on the side of the chest. He stated that the areas became itchy and crusting, and the rashes occurred about 6 to 12 times per year. He reported that he used ointments and other antibiotics to treat the rashes. Later, at the October 2012 VA medical examination, the Veteran told the VA medical examiner that he developed a rash on the neck under the breast and on the abdomen while serving in Iraq, and the rash would come and go. He described the rash as a raised whelp that itched without pain. The Veteran explained that a private physician gave him a cream to treat the rash for which helped, and he continued to have good results. The rash was not present at that time, but the Veteran reported having flares of skin rash three to four times per year. The October 2012 VA medical examiner noted that there was evidence that the Veteran had some sort of dermatitis in 2009 and, consequently, the general diagnosis of dermatitis was given. The Veteran is competent to report having had skin rashes to the chest, neck, elbows, and shins during service, and the account of such symptomatology is deemed credible, particularly given the multiple in-service complaints of skin rashes during service, as well as the objectively demonstrated skin rash to the chest during service in March 2004. The Veteran's description of the rashes (i.e., an itchy, raised rash on different areas of the body such as the chest and neck that recur at various times throughout the year) has been consistent throughout service and since filing the claim, and is similar to the description noted by the service medical examiner in March 2004. The Board notes that there is no definitive diagnosis of a recurrent skin disorder during service; however, the Veteran told the October 2012 VA medical examiner that he had been diagnosed with dermatitis in 2009, and the Veteran is considered competent to report a contemporaneous medical diagnosis, as well as describe symptoms that later support a medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Although the Veteran has not provided private treatment records showing diagnosis of, and treatment for, a skin disability since retiring from service, he has submitted a copy of a prescription dated in March 2009 for a topical agent. The October 2012 VA medical examiner acknowledged that the prescribed topical agent could be used for a recurrent skin disability. As the competent and credible report of diagnosis of dermatitis occurred during the pendency of this VA claim, it is sufficient to establish a diagnosed disability of dermatitis, notwithstanding the absence of clinical findings at the time of the VA examinations. The United States Court of Appeals for Veterans Claims (Court) has held that the requirement of a current disability "is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim and that a claimant may be granted service connection even though the disability resolves prior to [VA's] adjudication of the claim." McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Board observes that the Veteran underwent medical examinations in connection with the appeal in October 2008 and October 2012. The October 2008 QTC medical examiner noted that there was no current pathology identified on physical examination to render a diagnosis at that time. The October 2012 VA medical examiner similarly noted that there was not sufficient information to state definitively that the Veteran had a recurrent skin condition; however, neither medical examiner considered the March 2004 and March 2007 in-service complaints of skin rashes or the demonstrated raised chest rash in March 2004 when rendering their diagnosis and medical opinions. Consequently, their diagnosis and medical opinions have little probative value. Thus, despite the inconclusive findings of the medical examinations performed in connection with the appeal regarding current disability of the skin, the evidence contemporaneous to service shows credible complaints and history of skin rashes to the chest, neck, elbows, and shins during service and a skin rash to the chest objectively demonstrated in March 2004 that show in-service onset of the skin disorder. The Veteran has also competently and credibly reported that the same symptomatology was later attributed to a diagnosis of dermatitis by a medical professional in 2009. Thus, resolving reasonable doubt in favor of the Veteran, the Board finds that a recurrent skin disability, later diagnosed as dermatitis, was incurred during service; therefore, service connection for dermatitis is warranted. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. ORDER Service connection for dermatitis is granted. ____________________________________________ J. PARKER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs