Citation Nr: 18143741 Decision Date: 10/22/18 Archive Date: 10/22/18 DOCKET NO. 16-20 696 DATE: October 22, 2018 ORDER Entitlement to service connection for malaria is denied. Entitlement to service connection for a skin condition, to include psoriasis, to include as due to herbicide agent exposure, is denied. FINDINGS OF FACT 1. The Veteran does not have a current diagnosis of malaria. 2. The Veteran’s current skin symptoms are not etiologically related to active service, to include in-service herbicide agent exposure. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for malaria have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307. 2. The criteria for entitlement to service connection for a skin condition, to include psoriasis have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1965 to September 1967. Service Connection Entitlement to service connection for malaria and for a skin condition, to include psoriasis, to include as due to herbicide agent exposure The Veteran claims entitlement to service connection for malaria and for a skin condition. He asserts that both conditions began during service and have presented continuously since service. 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. Because there is no current disability of malaria, service connection for malaria cannot be granted. Service connection may only be granted for a current disability; when a claimed condition is not shown, there may be no grant of service connection. 38 U.S.C. § 1110; Rabideau v. Derwinski, 2 Vet. App. 141 (1992) (Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability). “In the absence of proof of a present disability there can be no valid claim.” Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). First, while the Veteran’s available service treatment records do mention an in-service diagnosis of malaria, his separation examination dated September 1967 indicates good health. Indeed, the first assertion of record that the Veteran has malaria is an application for service connection dated December 2010, in which the Veteran simply states that his malaria began in 1966. The Veteran also had a VA examination in July 2011. According to the Veteran’s self-reported history, he began having symptoms of chills, fever, and weakness while stationed in Vietnam. He was reportedly flown to a local hospital and admitted for one and a half months with malaria. However, the July 2011 VA examiner opined that the disease was not currently present, given the lack of splenomegaly, hepatomegaly, mental changes, renal damages, history of seizure, or any other indicator of chronic malaria. Further, the report states that malaria is spread by mosquito bites, and can be treated early in the course of the disease. Since the Veteran did not present with symptoms of malaria upon separation, it can be inferred that his in-service bout of malaria had been treated, and that any symptoms experienced since his separation from active duty are unrelated to service. Moreover, the Veteran has admitted, including to a non-VA dermatologist in August 2009, to not having fever, chills, or other symptoms of malaria. Thus, continuity of symptomatology is not shown by either the medical evidence of record or the Veteran’s statements. Diagnosis or symptoms of a current disability is the threshold requirement for both direct and secondary service connection. See Sheldon v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Here, the evidence shows that the Veteran does not currently have malaria, and a VA examiner did not find any potential residuals of the Veteran’s in-service malaria. Without a current diagnosis, or residuals of, malaria, there can be no service connection for that disease. Service connection for malaria is denied. As for a skin disorder, the Veteran contends that his skin symptoms began in service. He asserts that as a combat medic, he is competent to diagnose the symptoms he experienced in service. However, service connection must be denied because the evidence of record does not show that the Veteran’s current symptoms began in service, or are related to service, to include presumed Agent Orange exposure. As an initial matter, service connection is warranted for a veteran who has been exposed to a toxic herbicide agent during active military service (subject to the requirements of 38 C.F.R. § 3.307 (a)) for diseases such as chloracne or other acneform diseases consistent with ischemic heart disease, Type 2 diabetes, Hodgkin’s disease, non-Hodgkin’s lymphoma, porphyria cutanea tarda, multiple myeloma, prostate cancer, soft-tissue sarcomas, early-onset peripheral neuropathy, Parkinson’s disease, B-cell leukemias and chloracne and respiratory cancers. 38 C.F.R. § 3.309 (e). Here, the Veteran served in the Republic of Vietnam for one year during the Vietnam Era, and is in receipt of the Vietnam Service Medal and the Vietnam Campaign medal. He is therefore presumed to have been exposed to Agent Orange in service. However, a skin disorder such as psoriasis may not be presumed to be related to toxic herbicide agent exposure. See 38 C.F.R. § 3.309(e). Accordingly, Veteran’s skin symptoms cannot be attributed to his acknowledged herbicide agent exposure on a presumptive basis. Next, the Veteran is not precluded from establishing service connection for his skin condition with proof of actual direct causation as due to active duty service. See Combee v. Brown, 34 F.3d 1039, 1041-42 (Fed. Cir. 1994). However, service connection is also not warranted on this basis. First, aside from a bout of heel cellulitis diagnosed in October 1965, the Veteran’s service treatment records are negative for a skin condition. While the Veteran asserts in his VA Form 9 that he self-treated his skin rashes while on active duty, his separation examination dated September 1967 indicates good health, and even specifically denies a skin condition. Indeed, the first assertion of record that the Veteran has a skin condition is a non-VA cutaneous examination report from Dr. D.C., dated August 2007 – forty years after the Veteran’s service. Thus, continuity of symptomatology is not shown. Because the Veteran experienced skin symptoms during the appeal period, including a rash on his back and scalp lesions, the presence of current symptoms is conceded. See McClain v. Nicholson, 21 Vet. App. 319 (2007). The Board recognizes the Veteran’s statements that his symptoms have existed since service. However, while the Board is willing to accept that the Veteran experienced some skin symptoms during service, the Board is unable to grant service connection based solely on the Veteran’s statements regarding continuity, particularly because they are inconsistent with what he reported at the time of discharge. This weighs against his credibility. Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011) (Lance, J., concurring). The fact that the Veteran initially self-treated his symptoms with topical cream does not lend credibility to his assertions. Lastly, service connection for a skin condition may still be granted where medical evidence shows a nexus between the Veteran’s disorders and an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d). However, the preponderance of the evidence is against such a finding. As mentioned above, the Veteran’s service treatment records contain no notations regarding any of these disorders. The Veteran’s separation examination reveals no medical issues, and even specifically denies the presence of a skin condition. Thus, while the Veteran may have self-treated skin rashes in service, he specifically denied having any such skin conditions at the time of separation. Additionally, there are no treatment records establishing that the Veteran’s skin condition is related to active duty, nor has any medical professional asserted that such a relationship exists. A VA examiner in September 2011 opined that the Veteran’s current skin conditions were unrelated to service, noting that the findings in the claims file were unrelated to the Veteran’s current condition, and there is no contradictory medical evidence of record. Further, while the Veteran is competent to report an observable symptom such as a rash, since service, his statements in this regard are not consistent with his report at the time of separation. Additionally, the Veteran reported to the examiner that he thought his skin condition may be related to his in-service malaria; however, he provided no rationale or supporting evidence for this contention, and the VA examiner did not provide any such opinion. Given the findings at discharge, and the Veteran’s lack of supporting evidence to support his assertions, the Board affords greater weight to the findings of the September 2011 examiner. Without adequate basis to suggest that the Veteran’s skin symptoms are related to military service, the Board finds that the weight of the competent evidence does not attribute the Veteran’s skin symptoms to military service. In reaching the above conclusion, the Board also considered the doctrine of reasonable doubt. 38 U.S.C. § 5107 (b) (2012). However, as the most probative evidence is against the claim, the doctrine is not applicable in this case. See also, e.g., Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection for a skin disorder is denied. L. B. CRYAN Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Z. Maskatia, Associate Counsel