Citation Nr: 18147615 Decision Date: 11/05/18 Archive Date: 11/05/18 DOCKET NO. 16-38 394 DATE: November 5, 2018 ORDER Entitlement to service connection for asthma, to include respiratory issues and chest pain, is granted. REMANDED Entitlement to a higher rating for service-connected pseudofolliculitis barbae is remanded. FINDING OF FACT The Veteran has a current diagnosis of asthma and uses an inhaler on a daily basis. CONCLUSION OF LAW The criteria for service connection for asthma, to include respiratory issues and chest pain, have been met. 38 U.S.C. §§ 1101, 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1999 to March 2008 and from February 2014 to August 2014. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Asthma Service connection is awarded for disability that is the result of a disease or injury in active service. 38 U.S.C. § 1110. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004), citing Hansen v. Principi, 16 Vet. App. 110, 111 (2002); see also Caluza v. Brown, 7 Vet. App. 498 (1995). A Veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. See Fagan v. Shinseki, 573 F.3d 1282, 1287-88 (2009); see also Walker v. Shinseki, 708 F.3d 1331, 1334 (Fed. Cir. 2013). In making its ultimate determination, the Board must give a veteran the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. See Fagan, 573 F.3d at 1287 (quoting 38 U.S.C. § 5107 (b)). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). A lay witness is competent to testify as to the occurrence of an in-service injury or incident where such issue is factual in nature. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In some cases, lay evidence will also be competent and credible on the issues of diagnosis and etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Specifically, lay evidence may be competent and sufficient to establish a diagnosis where (1) a 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. Jandreau, 492 F.3d at 1377; see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Veteran asserts that his respiratory issues and chest pain are related to his service. Specifically, he asserts that his exposure to sand storms and burn pits while stationed in Iraq and Kuwait caused these issues. The Board concludes that the Veteran has a current diagnosis of asthma that began during active service. 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). October 2016 VA treatment records show the Veteran has a current diagnosis of exercise induced asthma and reactive airway disease, and the January 2016 VA examiner opined that the Veteran’s respiratory issues and chest pain are at least as likely as not related to the Veteran’s exposure to sand storms and burn pits while in service. The rationale was that the timing of the onset of symptoms was in close proximity to the Veteran’s in-service exposure to smoke and sand storms. Further, a March 2018 primary care letter states that the Veteran used multiple inhalers on a daily basis. As such, service connection for asthma is warranted.   REASONS FOR REMAND Entitlement to a higher rating for service-connected pseudofolliculitis barbae is remanded. The Veteran’s diagnosis of dermatitis was confirmed during an October 2015 VA examination. At that time, less than 5 percent of the Veteran’s total body area and none of the exposed body area was affected. In a January 2016 VA examination, the Veteran’s diagnosis was clarified as tinea versicolor and pseudofolliculitis barbae. At this time the examiner indicated that no part of the Veteran’s body was affected. However, pseudofolliculitis barbae rated by the percentage of exposed or total body area affected. In an August 2018 examination, the Veteran was no longer diagnosed with dermatitis or tinea versicolor. Rather, without examining any records, the Veteran was diagnosed with pseudofolliculitis barbae and urticaria. The examiner noted that the Veteran did not have any hives present on that day, thus was basing her diagnosis on the Veteran’s self-reported symptoms alone. Further the examiner indicated that the Veteran’s pseudofolliculitis barbae, a condition that affects the beard area, affected between 5 and 20 percent of the Veteran’s exposed areas and 20 to 40 percent of the total body area. As there is great confusion as to the nature and extent of the Veteran’s diagnoses and symptoms, the matter warrants remand to conclusively determine the issue. The matter is REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected skin condition. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. If the Veteran’s pseudofolliculitis barbae is determined not to cover 20 to 40 percent of the Veteran’s total body area, the examiner should provide detailed reasoning as to why such a determination was previously made. If the Veteran is diagnosed with urticaria, a detailed reason behind this diagnosis should be included in the examiner’s opinion—to include the location of the urticaria. In other words, was the Veteran erroneous diagnosed with pseudofolliculitis barbae? The examiner is asked to separately determine the area affected by his service-connected pseudofolliculitis and the area affected by any other skin disorder. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Uller, Associate Counsel