Citation Nr: 18143166 Decision Date: 10/18/18 Archive Date: 10/18/18 DOCKET NO. 16-09 704 DATE: October 18, 2018 ORDER Service connection for a disorder affecting a finger of the right hand is denied. Service connection for a skin disorder is denied. REMANDED Service connection for a lumbar spine disorder (claimed as a low back condition) is remanded. Service connection for a bilateral knee disorder is remanded. Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and depression, is remanded. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of a disorder affecting a finger of the right hand. 2. The preponderance of the evidence is against finding that the Veteran has a skin disorder due to a disease or injury in service. CONCLUSIONS OF LAW 1. The criteria for service connection for a disorder affecting a finger of the right hand are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for a skin disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1974 to July 1976, with additional service in the Army Reserves. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. 1. Right finger disorder The Veteran contends that he sustained residuals to his right third and fourth finger from an injury in service. The Board concludes that the Veteran does not have a current diagnosis of a disability affecting the fingers of the right hand and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The Board acknowledges that the Veteran injured the right third and fourth finger during service. However, a claim for service connection requires a finding of a current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). The claim must be accompanied by evidence demonstrating the presence of a current disability. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also McClain v. Nicholson, 21 Vet. App. 319 (2007); Romansky v. Shinseki, 26 Vet. App. 289 (2013) (regarding existence of a current disability in relation to filing of a claim). Private and VA treatment records, associated with the claims file, suggest no diagnosis of a disorder of the fingers of the right hand during the pendency of the appeal. VA CWT Medical Clearances contained in the Veteran’s VA treatment record repeatedly indicated that he had no physical limitation to handling and finger dexterity. While private practitioner G.S. stated in a February 2013 treatment note that the Veteran had a sprain to the MCP joint of the right second finger, there is no indication that G.S. performed a physical examination or any diagnostic tests to confirm the presence of a disorder affecting the third and fourth fingers of the right hand. Consequently, based on the absence of a diagnosis contained within the medical evidence associated with the claims file, the Board finds that the Veteran did not have a current disability of the third and fourth fingers of the right hand. While the Veteran believes he has a finger disorder, he is not competent to provide a diagnosis in this case as he has not been shown to possess the requisite training or credentials needed to render a competent opinion as to a medical diagnosis. 38 C.F.R. § 3.159(a)(2); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As such, his lay opinions do not constitute competent medical evidence and lacks probative value. This is especially true when weighed against the private and VA treatment records, which show no objective findings or treatment to the third and fourth fingers of the right hand during the pendency of this appeal. Moreover, as there is no indication of a disorder affecting the third and fourth finger of the right hand, the threshold in McLendon has not been met. While McLendon establishes a low threshold, the holding makes abundantly clear that there is a threshold that must be met. With no indication of a currently diagnosed disorder, the Board finds that the Veteran’s lay contentions alone are insufficient to warrant a VA examination in this case. See 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 469 (1994). In sum, the Board finds that the weight of evidence is against the claim. As the preponderance of the evidence is against the claim of service connection for a disorder affecting a finger of the right hand, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Skin disorder The Veteran contends that his skin disorder is due to the tear gas chamber during basic military training, or infection from insect bites during Reserve service in 1982. The Board concludes that, while the Veteran has a current diagnosis of dermatitis and xerosis, the preponderance of the evidence weighs against finding that the Veteran’s diagnosed skin disorders are related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Service treatment records are silent as to any skin disorders in service, and no such problems were noted by the Veteran or the examiner during his separation examination. The Board acknowledges the July 1982 service treatment note regarding the Veteran complaining of mosquito bites; however, this alone is insufficient to establish a nexus to a later diagnosed skin disorder. While VA and private treatment records indicate treatment for dermatitis and xerosis, neither of these records contained a medical opinion as to a relationship between these disorders and the Veteran’s service. As there is no competent medical evidence or opinion suggesting that these disorders are related to the Veteran’s service. Therefore, direct service connection does not apply. See 38 C.F.R. § 3.303. The Board further finds that the evidence does not support any ongoing symptoms from these disorders following service, as the evidence shows that treatment first occurred in 2016 and 2017. See VA Podiatry Outpatient Consult (Oct. 2016) and VA Dermatology Outpatient Consult (Sept. 2017). The Board notes that a prolonged period without complaints or symptoms of a disability can be considered, along with other factors concerning a claimant’s health and medical treatment during and after military service, as evidence of whether an injury or a disease was incurred in service, which resulted in any chronic or persistent disability. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Although the Veteran contends that he has a skin disorder related to his service, his opinion is insufficient to provide the requisite causative etiology opinion as this requires medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board acknowledges that the Veteran has not been provided a VA examination. Generally speaking, for a VA examination to be warranted the evidence of record must “indicate” that a current disability “may be associated” with a veteran’s military service or due to or aggravated by a service-connected disability. 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79 (2006). While this is a low evidentiary threshold; there still must be evidence indicating the existence of a current disability and possible association to military service, for example, medical evidence suggesting a possible nexus or credible evidence of ongoing complaints of pain or other symptoms capable of lay observation. See McLendon, 20 Vet. App. at 83. In this case, the evidence, as summarized above, does not indicate that either dermatitis or xerosis are associated to service as to require an examination, even under the low threshold of McLendon. Rather, these disorders happened many years after service. Neither the evidence nor the Veteran have provided a plausible casual connection between these disorders and service. As such, a VA examination is not warranted to address these issues for service connection. In sum, the Board finds that the weight of evidence is against the claim. As the preponderance of the evidence is against the claim of service connection for a skin disorder, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 3. Lumbar spine 4. Bilateral knee disorder A remand is necessary to ensure that there is a complete record upon which to decide the Veteran’s claims and to afford the Veteran every possible consideration. The Veteran contends that his spine and bilateral knee disorders due to his military duties (cannoneer and assistant gunner) and tasks working with a Howitzer. The evidence of record indicates a current diagnosis of degenerative disc disease at L5-S1, and arthritis of the knees. Moreover, the VA and private treatment records indicate ongoing complaints of low back and left knee pain. Therefore, the Veteran must be given a VA examination for an opinion on whether his current spine and bilateral knee disorders are related to his service. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The examiner should address and discuss any ongoing complaints of low back and knee pain since service. 5. Acquired psychiatric disorder Evidence in the record suggests that the Veteran has been diagnosed with several psychiatric conditions; the Board will therefore recharacterize the issues of service connection for PTSD and for depression as a claim for service connection for an acquired psychiatric disability, to include PTSD and depression. Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009). The Veteran contends that his acquired psychiatric disorders are due to such stressors as having an M16 put in his face during basic training and shot at him with a blank, having a nearby Company’s gun blow up, and seeing a person “torn up” by yellow jackets. The evidence of record indicates a current diagnosis of acquired psychiatric disorders. Therefore, the Veteran must be given a VA examination for an opinion on whether he has an acquired psychiatric disorder related to his service. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). In particular, the examiner should address and discuss the March 2016 VA psychology consult. The matters are REMANDED for the following action: 1. Update VA treatment records. 2. After completing directive #1, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any lumbar spine disorder. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including his military duties (cannoneer and assistant gunner) and tasks working with a Howitzer. The examiner should address the private and VA medical treatment records reporting complaints of low back pain. 3. After completing directive #1, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any knee arthritis. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including his military duties (cannoneer and assistant gunner) and tasks working with a Howitzer. The examiner must also opine whether arthritis at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. The examiner should address and discuss ongoing complaints of left knee pain in the medical treatment records. 4. After completing directive #1, schedule the Veteran for a psychiatric examination to determine the nature and etiology of any posttraumatic stress disorder (PTSD). If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not related to his reported stressors of having an M16 put in his face during basic training and shot at him with a blank, having a nearby Company’s gun blow up, and seeing a person “torn up” by yellow jackets. The examiner is also asked to address and discuss the March 2016 VA psychology consult in formulating their diagnostic conclusions. Additionally, for any other diagnosed acquired psychiatric disorders, to include depression, the examiner must opine whether each diagnosed disorder is at least as likely as not related to an in-service injury, event, or disease, to include the above listed in-service stressors.   The Board points the examiner’s attention to a May 1980 report of medical history completed during Reserve service, during which the Veteran reported nervous trouble; less than 4 years after separation from active service. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Dellarco, Associate Counsel