Citation Nr: 18145149 Decision Date: 10/30/18 Archive Date: 10/26/18 DOCKET NO. 10-27 084 DATE: October 30, 2018 ORDER Service connection for a skin condition (claimed as dermatitis) is denied. Service connection for a cervical spine condition, to include as secondary to a skin condition, is dismissed. Service connection for migraine headaches, to include as secondary to a skin condition, is dismissed. FINDINGS OF FACT 1. The Veteran’s current dermatitis did not begin during active service and is not otherwise related to an in-service injury or event (to include conceded chemical exposures). 2. In February 2018, the Veteran expressly withdrew the appealed service connection claims for a cervical spine condition and headaches. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for dermatitis have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for the withdrawal of the appealed service connection claims for migraine headaches and a cervical spine condition have been met. 38 U.S.C. § 7105(b)(2), (d)(5); 38 C.F.R. § 20.204. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1991 to August 1993. This case has a long procedural history and has been before the Board previously. Most recently, in December 2013, in pertinent part, the Board denied service connection claims for a skin condition, headaches, and a cervical spine condition. The Veteran appealed those denials to the U.S. Court of Appeals for Veterans Claims (CAVC or the Court). In January 2015, the parties filed a Joint Motion for Partial Remand (JMPR) requesting vacatur of the 2013 Board decision’s denials of those service connection claims and a remand for further development and re-adjudication. (The JMPR also expressly stated that the parties did not wish to disturb the remainder of the December 2013 Board decision.) Specifically, regarding the service connection claims for dermatitis and headaches, the JMPR directed the Board to develop the theory of alleged in-service exposure to the chemical hydrazine. The JMPR also directed the Board to discuss how VA satisfied the duty to assist in developing that theory. In a January 2015 Order, the Court granted the JMPR and remanded the service connection claims for a skin condition, a cervical spine condition, and headaches for action consistent with the JMPR. Accordingly, in June 2015, the Board remanded those issues for development pursuant to the JMPR. The Board finds that the Regional Office (RO) substantially complied with the Board’s 2015 remand instructions and an additional remand is not required. See Stegall v. West, 11 Vet. App. 268 (1998). The Veteran then testified before the undersigned Veterans Law Judge during a February 2018 video conference hearing and transcript of that proceeding is of record. He was given a 90-day period to submit additional evidence, but nothing further was received. In a June 2018 statement, the Veteran moved for an extension of time to submit additional evidence. In a July 30, 2018 letter, the Board granted the motion and permitted him to submit additional evidence within 60 days of that letter. The extension period has elapsed and he has not submitted any additional evidence. The Board has thoroughly reviewed all the evidence in the Veteran’s VA files. In every decision, the Board must provide a statement of the reasons or bases for its determination, adequate to enable an appellant to understand the precise basis for the Board’s decision, as well as to facilitate review by the Court. 38 U.S.C. § 7104(d)(1); see Allday v. Brown, 7 Vet. App. 517, 527 (1995). Although the entire record must be reviewed by the Board, the Court has repeatedly found that the Board is not required to discuss, in detail, every piece of evidence. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Dela Cruz v. Principi, 15 Vet. App. 143, 149 (2001) (rejecting the notion that the Veterans Claims Assistance Act mandates that the Board discuss all evidence). Rather, the law requires only that the Board address its reasons for rejecting evidence favorable to the appellant. See Timberlake v. Gober, 14 Vet. App. 122 (2000). 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 appellant must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See id. Pertinent regulations for consideration were provided to the Veteran in the April 2010 Statement of the Case (SOC) and will not be repeated here in full. Service Connection The Veteran seeks service connection for a skin disability. Specifically, he contends that his current seborrheic dermatitis is related to in-service exposure to the chemical hydrazine during his verified military occupational specialty (MOS) duties as an aircraft maintenance specialist. Alternatively, he contends that his current seborrheic dermatitis is related to an in-service incident when airplane soap splashed into his face.   Initially, the Board concedes the presence of a current skin disability, seborrheic dermatitis. See, e.g., January 2013 VA dermatological examination; August 2012 VA dermatology consult. The Board also concedes that the Veteran likely was exposed to chemicals such as hydrazine sulfate and aircraft soap during active service based on his verified MOS duties and service records. See DD Form 214 (noting MOS as aircraft maintenance specialist); June 1992 service treatment record (emergency care note documenting incident when Veteran splashed aircraft soap in his right eye; diagnosing irritative, chemical ocular condition); 2016 VA medical opinion (summarizing articles explaining that chemical hydrazine sulfate is used as a fighter jet fuel); 2018 Board hearing testimony (describing MOS duties, including cleaning aircrafts with special soaps; competently and credibly reporting in-service incident when soap splashed in his face; explaining that this is same in-service incident that was basis of grant of service connection for eye condition). However, service connection for a skin disability must be denied because the weight of the most competent and probative evidence does not show that his current seborrheic dermatitis was incurred in or is otherwise related to active service, including conceded, in-service exposures to the chemical hydrazine or aircraft soap. Seborrheic dermatitis is not listed among the conditions to which the chronic disease presumption provisions apply. Accordingly, the Board need not address whether he is entitled to presumptive service connection under those provisions. See 38 C.F.R. § 3.309(a). For the same reason, the provisions of 38 C.F.R. § 3.303(b) regarding continuity of symptomatology do not apply. See Walker v. Shinseki, 708 F.3d 1331, 1338-39 (Fed. Cir. 2013). The Veteran's service treatment records note at least one isolated skin complaint. See September 1992 note (noting complaints of three transient, non-painful, tiny bumps on Veteran’s lower lip lasting one day each). However, there is no indication that military medical providers diagnosed him with seborrheic dermatitis or suggested that his noted skin complaints may have been seborrheic dermatitis symptoms. To the contrary, the September 1992 military provider diagnosed his skin issues as transient allergic reaction vs. viral syndrome. Also, the June 1992 service treatment record summarized above (verifying reported incident when aircraft soap splashed into and irritated his right eye) makes no mention of any skin complaints or treatment at that time. Had the Veteran indeed had skin symptoms after this documented incident, it is reasonable to expect that he would have reported it then, when he reported other symptoms that arose due to this incident. The fact that he did not weighs against the contention that this in-service incident resulted in skin symptoms. Nor did the September 1992 note from a few months later (diagnosing skin complaints as “transient” allergic reaction vs. viral syndrome) reference the June 1992 soap exposure incident, or suggest that his reported skin symptoms may have been due to any chemical exposure. The Board affords the 2013 and 2016 VA examiners’ negative nexus opinions great probative value because their respective findings included thorough medical rationales based on accurate reviews of the Veteran’s pertinent medical history and relevant medical literature. Specifically, the 2013 VA examiner competently and persuasively found that the Veteran’s current seborrheic dermatitis was less likely than not incurred in or caused by the claimed in-service injury or event, i.e., exposure to airplane soap. The 2013 VA examiner considered pertinent medical records, including a January 2001 VA emergency room note (indicating Veteran’s report that his seborrheic dermatitis began in August 1993 [i.e., during or very soon after service]), and the September 1992 service treatment record summarized above (diagnosing transient bumps of the low lip and diagnosing allergic versus viral etiology). The examiner explained that the lesions noted during active duty did not appear to be seborrheic dermatitis based on cited medical literature describing the clinical manifestations of this specific skin condition. In addition, the cited medical literature explained that the exact pathogenesis of seborrheic dermatitis is unclear. Moreover, the 2016 VA examiner competently and persuasively concluded that the Veteran’s current seborrheic dermatitis was less likely than not incurred in or caused by the claimed in-service injury or event, including specifically exposure to the chemical hydrazine sulfate. The examiner cited articles discussing the possible health effects of exposure to hydrazine sulfate and noted that this chemical can cause skin irritation; however, the examiner stressed that these are acute and transitory reactions, and the medical literature does not report that this chemical causes seborrheic dermatitis. Moreover, like the 2013 VA examiner, the 2016 VA examiner also reasoned that the skin condition described during active duty did not have the clinical picture of seborrheic dermatitis. In addition, the 2016 VA examiner noted that the Veteran’s seborrheic dermatitis was diagnosed years after active duty. The Board considered the Veteran’s post-service VA treatment records showing post-service complaints of and treatment for seborrheic dermatitis as early as the late 1990s, including various notes showing the Veteran reported recurrent dermatitis since 1992 or 1993, i.e., since active service. See, e.g., January 2001 VA note (referencing problem list noting the reported onset date of seborrheic dermatitis as August 1993); February 2007 VA dermatology note (noting complaints of seborrheic dermatitis since 1992-1993); March 2009 dermatology note (noting Veteran attributed dermatitis to in-service exposure to hydrazine; noting Veteran was seen in service around 1992 for skin issues). However, the earliest documented diagnosis of seborrheic dermatitis was in a September 1999 VA primary care note. To the extent that the Veteran subjectively reported that he has had seborrheic dermatitis since service in support of a direct service connection theory, the Board affords more probative value to the competent and persuasive 2013 and 2016 VA medical opinions summarized above. Indeed, the 2013 VA examiner expressly considered the January 2001 VA note (documenting Veteran’s report that his seborrheic dermatitis began in August 1993), and still concluded that his documented in-service skin issues did not match the clinical manifestations of seborrheic dermatitis. Indeed, the 2016 VA examiner corroborated that finding. Moreover, the VA treatment records summarized above document his subjective reports that his current seborrheic dermatitis may be related to in-service chemical exposures or his 1992 in-service skin issues. However, his VA medical providers did not validate those theories or otherwise suggest that his current seborrheic dermatitis may be related to service in any way.   The Board acknowledges the Veteran’s contentions that his current seborrheic dermatitis is related to conceded in-service exposures to hydrazine and airplane soap. He is competent to report skin symptoms he observed during and after service and to recall the nature of his MOS duties. However, he is not competent to conclude that his current specifically diagnosed skin condition is related to service because such dermatological issues are not amenable to lay opinions on etiology. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). There are many types of skin disorders that arise from a variety of causes, and only a medical professional is capable of distinguishing between different skin conditions/etiologies. Therefore, the lay statements of record cannot be accepted as competent evidence to establish service connection. The Board also considered the web articles that the Veteran submitted regarding dermatitis generally and the health effects of hydrazine sulfate, including a January 2000 article stating that hydrazine exposure “may produce” dermatitis from skin contact in humans. However, these general articles do not address his specific medical situation. Thus, they do not support a finding that his seborrheic dermatitis was incurred in service or otherwise related to any in-service event or injury. See Sacks v. West, 11 Vet. App. 314, 316-17 (1998) (holding that information contained within treatises is generally too abstract to prove the nexus element of a service-connection claim, although it is possible that a treatise might "discuss generic relationships with a degree of certainty" that would allow a finding of "plausible causality based upon objective facts."). Therefore, the Board affords more probative value to the 2013 and 2016 negative VA medical opinions summarized above, which competently and persuasively applied pertinent medical literature to the Veteran’s specific medical history. In conclusion, service connection for a skin disability is denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).   Regarding VA’s duty to assist, all necessary development pursuant to the January 2015 JMPR has been accomplished. In June 2015, in pertinent part, the Board remanded the service connection claim for seborrheic dermatitis for development consistent with the JMPR. The RO substantially complied with the Board’s remand directives by providing a December 2016 VA medical opinion that adequately addressed the Veteran’s contentions regarding in-service exposure to the chemical hydrazine. The concerns that the JMPR raised regarding VA’s duty to assist in verifying the alleged in-service exposure to the chemical hydrazine are moot because as discussed above, the Board conceded such in-service chemical exposure based on his verified MOS duties and articles confirming hydrazine’s use as fighter jet fuel. Neither the Veteran nor his representative has raised any other duty to notify or duty to assist issues since the January 2015 JMPR. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Moreover, neither the Veteran nor his representative has asserted that VA failed to comply with 38 C.F.R.§ 3.103(c)(2), and neither has identified any prejudice in the conduct of the Board hearing. As the issue has not been raised, there is no need for the Board to discuss compliance with Bryant v. Shinseki, 23 Vet. App. 488 (2010). See Dickens, supra. Regardless, the Veteran was expressly informed by the undersigned of the evidence needed to substantiate his claim (a nexus opinion) and provided several months to submit such evidence, which he has not done. Withdrawn Claims The Board may dismiss any appeal which fails to allege specific errors of fact or law in the determination being appealed. 38 U.S.C. § 7105 (West 2012). An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204 (2017). Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 20.204. Here, in February 2018, the Veteran expressly withdrew the appealed service connection claims for headaches and a cervical spine disability. As there remain no allegations of errors of fact or law for appellate consideration as to those issues, the Board does not have jurisdiction to review them and they are dismissed. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Janofsky, Associate Counsel