Citation Nr: 18148299 Decision Date: 11/07/18 Archive Date: 11/07/18 DOCKET NO. 13-24 824 DATE: November 7, 2018 ORDER Entitlement to service connection for a rash of the back and arms is denied. The application to reopen a claim for service connection for onychomycosis of both feet with dermatophytosis and callus formation of the right second (2nd) toe is denied. Entitlement to an effective date for service connection for concussion migraines, including migraine variants with memory loss, prior to August 16, 2011, is denied. FINDINGS OF FACT 1. A chronic rash of the back and arm of service origin is not demonstrated. 2. The Veteran did not appeal an October 1999 rating decision that denied service connection for onychomycosis of both feet with dermatophytosis and callus of the right 2nd toe and although notified in February 2008 of a rating decision that month which denied reopening of that claim he did not appeal the February 2008 rating decision; no additional relevant records were received within one year of the February 2008 rating decision nor were any additional service records received. The February 2008 rating decision is final. 3. The additional evidence received since the February 2008 rating decision denying service connection for onychomycosis of both feet with dermatophytosis and callus of the right 2nd toe includes evidence that is cumulative and redundant, and does not raise a reasonable possibility of substantiating the claim. 4. The Veteran’s original claim for service connection for headaches was denied in an October 1999 rating decision and, although notified in February 2008 of a rating decision that month which denied reopening of that claim, he did not appeal the February 2008 rating decision; no additional relevant records were received within one year of the February 2008 rating decision nor were any additional service records received. The February 2008 rating decision is final. 5. The Veteran’s application to again reopen the claim for service connection for headaches was received on August 16, 2011, which is the proper effective date for the grant of service connection for concussion migraines, including migraine variants with memory loss. CONCLUSIONS OF LAW 1. The criteria for service connection for a rash of the back and arm are not met. 38 U.S.C. § 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 2. The February 2008 rating decision which denied reopening of a claim for service connection for onychomycosis of both feet with dermatophytosis and callus of the right 2nd toe and denied reopening of a claim for service connection for migraine headaches is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2017). 3. New and material evidence has not been submitted to reopen the claim for service connection for onychomycosis of both feet with dermatophytosis and callus of the right 2nd toe. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2017). 4. The requirements for an effective date prior to August 6, 2011, for service connection for concussion migraines, including migraine variants with memory loss, have not been met. 38 U.S.C. §§ 5103, 5103A, 5107, 5110 (West 2014); 38 C.F.R. §§ 3.1, 3.102, 3.155, 3.156, 3.159, 3.400 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the U.S. Marines from July 1993 to August 1997. His military occupational specialty was a field radio operator. The Veteran testified at an August 17, 2017, hearing in support of his claim for service connection for a rash on the back and right arm before the undersigned Veterans Law Judge (VLJ), sitting at Chicago, Illinois. Notably, the Veteran had previously been provided with copies of his service treatment records (STRs). At the hearing the Veteran submitted several pages of duplicate copies of those STRs. Factual Background The Veteran’s service treatment records (STRs) include an examination for enlistment into the Marines in November 1992 which revealed that he had pes planus. On September 15, 1995, the Veteran did not attend a scheduled appointment for a rash of his arms of one-month duration. However, another STR dated September 18, 1995, shows that the Veteran presented complaining of a rash of both forearms, off and on, for over a month when he worked and sweat. The rash seemed to spread and then to slowly diminish. It also itched. He had no similar past history. On examination he had small, raised rash of the lateral aspect of the left forearm which was approximately ½ inch in height and ¼ inch in width, with no other areas of involvement. There was no scaling or drainage. The assessment was questionable tinea. He was given a cream for application to the affected area. Another STRs shows that when seen for a rash of his arms of one-month duration it was reported that the rash also involved his back. After an examination the assessment was tinea versicolor, for which he was given Selsun shampoo. A May 3, 1996 clinical record shows that the Veteran presented complaining of an unresolved rash of the arms and trunk. He had been seen once before and diagnosed as having tinea versicolor. He reported that the rash had returned and his current medication was not working. After an examination the assessment was allergic urticaria. He was given Benadryl and he was given Selsun shampoo for tinea versicolor. On May 6, 1996, it was noted that the Veteran complained of an unusual rash of his body, in that when he came into contact with a certain object he began to have a skin reaction. Also in May 1996 the Veteran was seen for an unresolved rash of his body. He reported that it seemed to get worse each time he went into the field and rubbed up against a tree. He stated that his girlfriend now had the same rash. After an examination the assessment was an unusual and possibly allergic dermatitis. Also in May 1996 the Veteran reported that he still had itching and a rash, for which he was taking Benadryl. He was also using Selsun shampoo without relief. On examination he had a rash resembling tinea versicolor, and the assessment was tinea versicolor. When evaluated at a dermatology clinic on June 19, 1996, it was reported that the Veteran had had dermatitis since mid-March involving the hands, back, waist-line, ankles, and feet. The assessment was mild dermographia. Another assessment was a scabies infection, prior onset. The Veteran’s original claim for VA compensation, VA Form 21-526, was received on July 1, 1999, in which he claimed service connection for, in pertinent part, residuals of a head injury with loss of memory and headaches, and service connection for disabilities of the toenails, calluses of his feet and toes, and for “feet problems.” The Veteran initially sought VA treatment and hospitalization in June 1999 for schizophrenic symptoms, including hallucinations. On VA examination in October 1999 the Veteran reported having had a head injury during service. After an examination the diagnosis was status post minimal head injury without loss of consciousness and essentially normal neurological examination. On VA examination of the Veteran’s feet in October 1999 the Veteran complained of a loss of toenails since his military service and calluses on his right foot. On examination there was a circular soft callus over the dorsal surface of the “MIP” joint of the right 2nd toe. Examination of his toenails revealed onychomycosis of the “left greater hallux second toe and fifth toe” and the right fifth toe, with mild scaling of the sole and the sides of both feet. The onychomycosis was restricted to the mid to distal nailbeds. The diagnosis was dermatophytosis with bilateral onychomycosis, and small, soft superficial callus of the right 2nd toe. It was noted that calluses were usually the result of poor-fitting footwear. On VA psychiatric examination in October 1999 it was reported that the Veteran was estimated to be a relatively poor historian because his responses were vague and lacking in detail. An October 26, 1999 rating decision denied service connection for a psychosis and for residuals of a head injury, to include headaches and memory loss. It also denied service connection for bilateral onychomycosis of the feet with dermatophytosis and callus of the right 2nd toe, noting that service treatment records included a July 24, 1994 notation of a partial loss of a toenail of the right 5th digit due to being stepped on during a basketball game, but there was no evidence of any chronic skin or nail condition of the feet, including calluses, during service. The Veteran was notified of that decision by RO letter of November 10, 1999, but he did not appeal that decision. VA outpatient treatment (VAOPT) records of 1999 and 2000 reflect treatment only for psychiatric symptoms. A VA Form 21-4138, Statement in Support of Claim, was received on March 13, 2006, in which the Veteran applied to reopen claims for service connection for residuals of a head injury, and bilateral feet problems. A VA Form 21-4138, Statement in Support of Claim, was received on June 26, 2006, in which the Veteran stated that “I no longer wish to persue [sic] my claim for head injury or feet at this time.” The RO acknowledged the withdrawal of his claims in a July 26, 2006 letter. In another VA Form 21-4138, Statement in Support of Claim, also received on June 6, 2006, the Veteran requested a copy of all of his service records. The RO forwarded the requested records to the Veteran with an accompanying letter of March 20, 1997. VAOPT records show that in February 2006 the Veteran complained of a problem with toenail fungus and he desired to have the nails removed. On examination he had thickened great and 2nd toenails, bilaterally. The assessment was onychomycosis. In January 2008 his chief complaint was of thick painful toenails which he had had for a long time. The assessment was onychomycosis, and he was referred to a podiatry clinic for trimming of his toenails. In VA Form 21-4138, Statement in Support of Claim, received on October 2, 2007 the Veteran applied to reopen claims for service connection for “foot and head injury.” By RO letter of February 26, 2008, the Veteran was notified that his application to reopen claims for service connection for residuals of a head injury, including headaches and memory loss, and service connection for bilateral onychomycosis of the feet with dermatophytosis and callus of the right 2nd toe were denied because new and material evidence had not been submitted, even after consideration of additional VAOPT records and even though he had submitted duplicate copies of service treatment records. In correspondence from the Veteran, received on December 31, 2008, he requested a copy of his medical records. These were provided to him together with an RO letter dated May 6, 2009. In VA Form 21-4138, Statement in Support of Claim, received on June 22, 2010, the Veteran claimed service connection for a rash on his back and on his arm. With this he submitted duplicate copies of service treatment records. The Veteran appeals an October 2010 rating decision which denied service connection for a rash of the back and right arm because although there was a record of inservice treatment, no permanent residual or chronic disability was shown, and VA treatment records did not show complaints, treatment or diagnosis of such a skin condition. A November 9, 2010, VAOPT record shows that the Veteran sought treatment for a rash on his forearm and back with skin thickening and “brown/black” pigmentation “since › three years.” The relevant assessment was dermatitis. A February 24, 2011, VAOPT record reflects that the Veteran was seen for a skin rash on his arms, back, and chest which he reported had bothered him since 1995. On examination he had continuous hyperpigmentation and “poikiloderma” over the left side of his chest, left axilla, and anterior aspect of his left humerus. The assessment was dermatitis, not otherwise specified (NOS). A March 24, 2011, VA Podiatry Consultation found that the Veteran had, in part, onychomycosis and tinea pedis. An April 21, 2011, VAOPT record reflects an assessment of chronic dermatitis. A May 10, 2011, VAOPT record shows that the Veteran was always obsessed with some kind of body problem or pain. A June 16, 2011, VAOPT record shows that the Veteran had scaling and dry skin from the arches of his feet to the back of the heels and the nails of all toes were mycotic. The assessment was recurring tinea pedis. A July 28, 2011, VAOPT record shows that the Veteran had been seen in February 2008 and July 2008 for mycotic toenails. On examination there was a 6 cms. by 3 cms. patch of dermatitis of distal portion of the anterior aspect of the right tibia, which appeared to be hyperpigmented, which was possible contact dermatitis. He also had mild tinea. He had a fungal infection of the nails of both great toes, the right 5th toe and the left 2nd and 5th toes. The diagnoses were dermatitis of the anterior shin, and onychomycosis of both great toes, the right 5th toe and the left 2nd and 5th toes. An August 16, 2011, VAOPT shows that the Veteran reported that a rash on his chest and arms was improving but he still had a rash on his back. The assessment was nonspecific dermatitis. Received in October 2011 was a statement from V. Gray stating that he was a medical corpsman and recalled having treated the Veteran during service for a mild to moderate concussion. A February 23, 2012, rating decision granted service connection for concussion migraines, including migraine variants with memory loss, which was assigned an initial 50 percent rating, all effective August 16, 2011 (date of receipt of the application to reopen that claim). It was also found that there was no new and material evidence to reopen the claim for service connection for bilateral onychomycosis of the feet with dermatophytosis and callus of the right second toe (now claimed as right first toe). It was stated that "[t]his claim was previously denied because the condition was not shown to be incurred in or caused by service, as service treatment records show no evidence of the condition while in service. In order to reopen this claim you must submit evidence that pertains to this fact." On March 8, 2012, the Veteran’s NOD to the February 23, 2012 rating decision was received, stating that the effective date for service connection for his migraines should be when he had originally filed his service connection claim in July 1999. He also disagreed with the denial of reopening of the claim for service connection for bilateral onychomycosis. A March 21, 2012 VA examination for residuals of traumatic brain injury (TBI) found that the Veteran’s headaches syndrome started in 1999 at least more than 5 years after his alleged and undocumented inservice head injury. Typical "post traumatic headaches" or" post traumatic memory problems" were bad initially after the injury and improved with time. The Veteran’s headaches started in 1999 several years after the head injury and were not related to the injury. He was in the service for at least 3 more years after the alleged head injury and there was not a single documentation of the headaches or the memory problems in his claim file. His headaches were not related to the alleged head injury that he was now claiming. Moreover, he did not suffer any psychiatric illness in the service. His mental or psychiatric deterioration clearly started several years after the separation from the service. A letter dated in March 2012 from the Veteran’s mother, and received in June 2012, states that the Veteran developed a condition of his feet during service and was now always complaining about his feet. A May 31, 2012 rating decision granted service connection for a psychosis for the limited purpose of VA treatment because a psychosis had been diagnosed on June 18, 1999, within two years of his August 11, 1997 discharge from the Marines. In June 2012 a VA medical opinion was requested noting that the Veteran was service-connected concussion migraine, including migraine variants, with memory loss, mainly based on an opinion at a January 2012 VA examination which stated that the Veterans headaches and memory loss were at least as likely as not caused by his mild/moderate concussion that occurred in 1994, and this opinion was also based in part on an August 2011 buddy statement. However, a VA TBI examination in March 2012 found that the Veteran did not have a TBI, yet the examination did indicate the existence of some symptoms. Thus, an opinion was requested as to whether the Veteran had a TBI that caused memory loss or if any of the symptoms found at the March 2012 VA TBI examination were attributable to an inservice TBI. In response, a VA physician reviewed the claim file and reported that a review of medical records in the claim file revealed differing comments and opinions. The Veteran’s explanations to various providers had changed over time. His histories did not appear to be consistent. Medical rationales had been provided by physicians, although a nurse practitioner who saw the Veteran had provided a positive opinion. Regardless, other physician providers have mentioned unusual findings and non-consistency with the Veteran's explanation of events and symptoms. There was no specific documented head injury noted, other than the buddy statement from the corpsman. Therefore, based on these inconsistencies, the examiner felt that it was less likely as not that there was a true TBI during service. The reasoning was clearly noted by the concerns the provider had on March 21, 2012. Additionally, the findings noted during the TBI examination were also less likely due to any specific TBI. On VA general medical examination of August 8, 2012, it was found that the Veteran had areas of dry skin on the plantar aspect of both feet with onychomycosis of great toenails of both feet. He had a history of treatment by a podiatrist. On December 5, 2012, a Statement of the Case (SOC) was issued addressing whether new and material evidence had been submitted to reopen a claim for service connection for onychomycosis of both feet with dermatophytosis and callus of the right 2nd toe, and which also addressed service connection for concussion migraines, including migraine variants, with memory loss (claimed as residuals of a head injury). Although not formally listed as an issue on appeal, in essence that SOC addressed the matter of the proper effective date for the grant of service connection for concussion migraines. The Veteran’s VA Form 9, Appeal to the Board of Veterans’ Appeals was received on December 13, 2012, and perfected the appeals as to those matters. In that VA Form 9, the Veteran did not request a hearing. On VA skin examination of December 12, 2012, the Veteran’s claim file was reviewed and an examining VA physician reported that the Veteran did not now have a skin condition. The Veteran reported that he had a skin condition during service and also in 2010, for which he had seen a VA dermatologist. He reported having a skin condition on his arms and back but the examiner stated that no current skin problems were found. However, he had an ongoing prescription for topical antifungal agents for more than the last six (6) weeks. The examiner reported that the Veteran did not currently have dermatitis, eczema or skin infections. The examiner stated that: [A] [d]iagnosis of a dermatological condition is made by the description of the skin lesion and the distribution of the skin lesions on the body. In the absence of any skin lesions [the examiner could not] make a diagnosis of a skin disorder. [The examiner had] reviewed [the claim file] and [the Veteran’s] CPRS records very carefully and found that he was seen on 3 different occasions for skin condition in the service with various diagnosis and he was referred to dermatologist who made a diagnosis of [s]cabies infection 06/19/1996. He was not seen for skin condition after that. In the VAMC he was again referred to Dermatologist and was seen on 02/24/2010 with a diagnosis of Dermatitis NOS. Dermatologist is the highest authority on skin conditions. His skin disorder that he had in the service is not the same he had in 2010. He does not have any skin condition to make a diagnosis at this time. The examiner further stated that: The claimed condition is less likely than not less than 50% probability that it [was] incurred in or caused by the claimed in service injury or illness. The rationale for this opinion is based on the review of his [claim file] and his CPRS records. He did not have any skin condition at this time. However he was referred to dermatologist in 02/2010 in Indianapolis VAMC. The diagnosis he had in the service made by the dermatologist is not the same as the diagnosis that was made by the dermatologist in 2010 when he had the rash. An August 1, 2013, VAOPT record it was reported that the Veteran was seen for a rash of his arms, back, and chest that had bothered him since 1995. Two years ago he was prescribed a cream at a dermatology clinic for the same rash. He now reported that the rash had never gone away despite the daily application of creams. He reported that the rash on his right arm had started during a “field op” and his skin had not “been right since.” On examination he had sparsely distributed brown macules on his back and chest, amid a general background of patchy “poikilodermatous” hyperpigmentation of the trunk and the proximal portion of his arms. He had minimally “xerotic” skin throughout. The assessment was skin dysesthesia, NOS. It was noted that the Veteran denied clear itching, burning or tingling but seem to have a nonspecific irritation of the skin. The findings did not fit any clear diagnostic category. He could possibly be having a recurrent dysesthesia of the skin related to a remote inflammatory reactive process with continued “skin memory.” Also, he might possibly have a previous folliculitis related to hygiene practices. A September 4, 2013, VAOPT record it was reported that the Veteran had rough, discolored skin on his back associated with dysesthesia, i.e., itching and burning, for 15 years. On examination he had subtle hyperpigmented patches with prominent hair follicles and a few minimally inflammatory papules on his central back. He had a few well demarcated “CALM” [café au lait macules, see STEDMAN’S Medical Abbreviations, Acronyms & Symbols, Fifth Edition] on his back. Overall, he had dry skin, especially of the extremities. The assessment was “[a]topic dermatitis/xerosis with pruritus/dysesthesia.” A March 6, 2014, VAOPT record, which was a follow-up of a left upper arm biopsy, noted that the biopsy was taken because the physician could not, on clinical grounds, make a definitive primary dermatological diagnosis, despite the Veteran’s being adamant that his skin was abnormal because he experienced tingling, pain, burning, and itching and had variation in pigmentation. The latter of symptoms and clinical signs worried the Veteran and he associated such with some exposure, as to which he was rather vague, in the form or exposure to lasers or some machine during his military service. On examination the Veteran was very anxious that he had “some terrible skin disorder” which the examiner could not discern. He had some variation in pigmentation of both upper arms which he stated had been present for over 7 years. He had been given medication for a presumed diagnosis of “confluent and reticulated papillomatosis.” Another March 6, 2014 VAOPT record it was noted that the Veteran had several concerns, which changed throughout the visit. Initially, he stated that he had burning, pain, itching and discoloration for 7 years but also reported that his skin would not stretch, thus affecting his muscles which would not grow. He believed his condition started in Japan after carrying radio equipment in the woods. The assessment was “PIH” with pruritus/dysesthesia. There was no evidence of primary lesions, currently, but he did have some underlying atopic dermatitis/xerosis. A May 22, 2014, VAOPT record by a physician noted that the Veteran had minimal hyperpigmentation of the back, and less on the arms. The assessment was “dermatitis/xerosis NOS.” A September 5, 2014, VAOPT record, by a VA resident, reflects that the Veteran related a 15-year history of dysesthesia, i.e., itching and burning pain. He reported a significant improvement in his xerosis and bumps on both upper arms since his last visit. He voiced concerns over the extent of the lesions and their hyperpigmentation, and he had several ideas about its etiology. It was noted that a February 2014 punch biopsy of the Veteran’s left arm revealed findings consistent with post-inflammatory pigmentary alteration. The overall pattern of that biopsy favored a post-inflammatory pigmentary alteration, such as post-inflammatory hypopigmentation (PIH). A review of literature regarding idiopathic progressive hypomelanosis did not reveal melanin incontinence as a typical finding in that entity. Moreover, the melanin visualized in the epidermal basal layer was typically more diminished than was identified in the current punch biopsy. Clinical and pathologic correlation was recommended. It was noted that a “PAS” stain was negative for pathogenic fungal organisms and, thus, pityriasis versicolor was unlikely. The assessment was keratosis pilaris with PIH and dysesthesia – much improved. Another September 5, 2014, VAOPT record, entered by a dermatologist (and who was a physician other than the VA physician that conducted the December 12, 2012 VA skin examination) shows that the dermatologist was present with the resident at the time of the history taking and examination of the Veteran. The dermatologist stated that the Veteran likely had an underlying sensitive skin/atopic “diathesis” but had not followed recommendations as to dry skin care measures. He kept pointing out areas of his skin, including hair follicles, that he thought were abnormal but which were completely normal on an examination. A September 10, 2014, VAOPT record shows that the Veteran had features of possible Pityrosporum folliculitis versus keratosis pilaris. It was very clear from the clinical notes that there was a “major disconnect” between the patient's concern and clinical findings by numerous physicians. The benign nature of the patient's complaints was further evident from a benign biopsy which was taken in the hope that he could be reassured that had nothing significant, dangerous, infectious or contagious. It was stated that the Veteran: may be experiencing what is known as a somatic symptom disorder whereby his complaint is causing him distress to the point of having a major effect on him and possibly causing distressing emotional, thought and possibly behavioral issues. One can also use the term Dysmorphophobia. This describes a patient who may present with no real changes on either clinically or pathologically grounds that is consistent with the patient's over concern. This may be attributed to severe anxiety, depression, obsessive-compulsiveness, mono[-] symptomatic hypochondriasis. On occasions they may be motivation to seek compensation or other hidden agendas that the patient may be wanting to resolve. On VA skin examination of February 23, 2016, by the same VA physician that conducted the VA skin examination of December 12, 2012, the Veteran’s electronic records were reviewed. The examiner reported that the current evaluation was a “scar” examination but a medical opinion was requested as to a skin condition. The Veteran had scars of the eyebrows, elbows, and knees which had pre-existed his military service. He reported that during service radio equipment had fallen on his head but he had no residual scar from that injury. He had a scar from a relative recent punch biopsy. The Veteran reported that he had scars from any inservice injuries. In response to a query of whether the Veteran had a diagnosed skin condition that was at least as likely as not incurred in or caused by a rash during service, the examiner stated that the conflicting medical evidence had been reviewed. The Veteran had been followed at a VA dermatology clinic for the past 2 to 3 years. His current symptom was generalized pruritus (itching) but no cause was found. It was noted that there might be a significant psychiatric component. It had also been found that he had “keratosis pilaris (post inflammatory scarring by biopsy).” Skin examinations were mostly normal. He was also found to have dermatographism which was found in 15% of normal population, and was not a disability or a disease. The Veteran displayed to the examiner some photographs that depicted some skin lesions that the dermatology clinic had diagnosed as keratosis pilaris. He might have some allergy mediated reaction, because he was found to have mildly elevated “IgE in [the] 300 range according to [a] dermatologist.” Thus, the current examiner was unable to state whether the Veteran had or did not have any skin disease. “He never had any skin lesions when seen. His generalized pruritus may have some psychiatric component to it according to [a] dermatologist.” The report of that examination and the medical opinion rendered were signed by the VA examination on June 16, 2016. An April 28, 2016, VAOPT record reflects that the Veteran presented for an evaluation of his itching. He had a history of dermatographism and pruritus, keratosis pilaris, PIH, and dysesthesia with a significant psychiatric component of his disease. He reported that his entire body itched, particularly on the top of his scalp, upper back, both arms, upper chest, abdomen, thighs, calves, and lateral aspects of both feet. He stated that he got linear "welts" on his body after minor trauma, like scratching. He believed that this condition started when he was overseas and exposed to a large amount of electromagnetic equipment. He also complains of slight discoloration of his arms, stating that they looked "chalky". On examination the Veteran had dermatographism on his back. The examiner reported that the pruritus was of uncertain etiology, and although the Veteran had previously had a slightly elevated “IgE in the 300 range” this was not very concerning. As to dermatographism, the Veteran believed that this was related to electromagnetic radiation. However, this was unlikely, and it was present in up to 15% of the population. The physician attempted to reassure the Veteran about this but “he was fixated on this idea.” In VA Form 21-4138, Statement in Support of Claim, in January 2017 the Veteran alleged that the February 23, 2016 VA examination was inadequate, stating that the report of the examination had not been submitted until June 6, 2016 and, so, could not properly render a medical opinion after such a long delay. A VAOPT record reflects that the Veteran presented on February 3, 2017, requesting that a Disability Benefits Questionnaire (DBQ). He reported having had skin itching and welts during service which he thought were due to some type of exposure when overseas. He reported having had a recurrent rash since 1995. On examination he had some hyperpigmented areas on both shoulders consistent with keratosis pilaris and he had a raised, red area where he had scratched his skin. The assessment was keratosis pilaris/dermatitis/dermatographia. The February 2017 Skin Diseases DBQ states that the Veteran now had a skin disability and the diagnoses were “dermatitis/xerosis” and dermatographic urticaria, the date of diagnoses of each being in September 2013, and keratosis pilaris, the date of diagnosis being September 2014. It was reported that the Veteran related having skin itching and a rash since 1995, during his military service, with welts of his skin. He had been seen on multiple occasions at a dermatology clinic and had had a skin biopsy. There was also a psychological component. There had also been a diagnosis of atopic dermatitis. There were no systemic manifestations, and he had been treated in the past with oral or topical medications. He had keratosis pilaris on his shoulders and arm. He had not had any recent flare-ups of urticaria or dermatitis. In a February 9, 2017, VA Form 646, Statement of Accredited Representative, addressing service connection for a rash of the back and arm was, it was noted that in a VA Form 21-4138, Statement in Support of Claim received on January 30, 2017 the Veteran contested the adequacy of a VA examination in February 2016. In that VA Form 21-4138, the Veteran stated that the examination was not accurate and stated that the examiner had not “enter my Exam notes until 6/6/16.” He requested a new examination with a different examining physician. A March 2, 2017, VA examination for “skin diseases” was actually limited to an evaluation of the loss of the nail of the right 5th toe from an inservice injury. A March 29, 2017, VAOPT record shows that the Veteran reported “that that he had a heart attack in 1999, but was never diagnosed with a heart attack, he just knows that because of how he felt.” A June 2017 rating decision denied service connection for xerosis and confirmed and continued denials of reopening of the claim for service connection for bilateral onychomycosis of the feet with dermatophytosis and callus of the right second toe (also claimed as foot condition) and confirmed and continued denials of reopening of the claim for service connection for keratosis pilaris and dermatographic urticaria (previously claimed as rash, back and right arm). A July 2017 VAOPT record shows that the Veteran reported hearing voices. A July 10, 2017, VAOPT record shows that had debridement of all toenails due to onychomycosis of all toenails. The Veteran presented testimony at an August 2017 travel Board hearing as to the issue of service connection for a rash of the back and arm. He testified that he first developed a rash when stationed at Camp Lejeune which he had noticed after being in field operations. Pages 2 and 3. The rash was on his right arm, near the elbow, and up that arm to his back and caused sensations of itching and burning. It was characterized by unusual coloring. He then went to the base hospital. Page 3. At the base hospital he was given ultraviolet light therapy, and it was diagnosed as scabies. However, the Veteran had informed the base medical personnel that prior to the rash he had had welts on his face and arm and his legs which he felt might have been due to an allergy but he had not sought inservice medical treatment. It might have been due to a “new metal” on recently assigned radio equipment. Page 4. However, he did not know what actually caused it. These welts, which he felt were due to the “metal,” had cleared up. Page 5. The Veteran testified that when seen at a base hospital for a rash he had been given Selsun Blue shampoo which was to be applied to his whole body. Page 5. Since his military service he had had continuous itching and sometimes had flare-ups. Becoming nervous would cause flare-ups. He would have welts and would have pimples which would burst causing dark scab formations. Page 6. The Veteran testified that he had not sought post-service treatment for his skin condition until he went to VA in about 2009. Page 7. In the interim, he had “just dealt with it.” He had first gone to VA in 1999 in relation to a head injury, and he had had some mental problems. Page 7. The Veteran contested the adequacy of a previously administered VA examination in December 2012 (which he inadvertently indicated was in 2010) because the examiner had not turned on the light and did not write anything down, page 11, and stated that the examination was only for his feet and an inservice sprain of one of his little fingers (however, the December 2012 VA examination was for a claimed rash of his back and arm, and did not cover his feet or a sprained finger). Pages 11 and 12. It was noted that a February 2016 VA examiner had basically found that it was unclear what the Veteran’s diagnosis was and, so, no medical opinion was rendered. Page 14. The Veteran also submitted, at that hearing, a typed statement in which he reported that he had had a “rash or skin disorder” during his military service “in Japan or it could have developed while in North Carolina.” Since then he had had some type of skin disorder which caused his skin to be “chalky” at times. It caused constriction of his joints, including the elbows, and a lot of discoloration of the skin all over his body. His skin would become inflamed and his rash and welts would flare-up and become itchy and cause a burning sensation. “At some point, the pores bump up so that [h had] problems extracting natural waste.” Those areas of the skin became prickly and left a sore which would become a scar which looked like black blotches. He had difficulty sweating through his pores. The Veteran further wrote that he had notice a rash during a field operation in 1995 – 1996 and his back, head, and arms were burning and itching profusely, and he had a rash and discoloration on his right arm. When seen at the based clinic there had been a diagnosis of scabies. Prior to the field operation he had had welts on his face, shoulders, and legs but after a few days or hours they would go away. During service he used a shampoo but it had not relieved his burning inflammation. Also, doctors had applied ultraviolet light therapy because he had signs of some type of “foreign substance” on his back. However, his irritation and burning sensation and welts never resolved. It was not until 2010 that he sought VA medication attention for his rash. Law and Regulations Service connection is warranted where the evidence of record establishes that an injury or disease resulting in disability was incurred in the line of duty in active military service or, if preexisting such service, was aggravated thereby. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303(a). To establish service connection, the record must contain evidence of (1) a current disorder, (2) in-service incurrence or aggravation of an injury or disease, and, (3) a nexus between the current disorder and the in-service disease or injury. See generally Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Service connection may also be granted for a disease or disability first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease or disability was incurred in service. 38 C.F.R. § 3.303(d). The Board must determine whether the weight of the evidence supports each claim or is in relative equipoise, with the appellant prevailing in either event. However, if the weight of the evidence is against the appellant’s claim, the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski 1 Vet. App. 49 (1990). VA must reopen a finally disallowed claim when new and material evidence is presented or secured with the respect the claim and review all evidence submitted since the last final disallowance of the claim on any basis to determine whether a claim may be reopened based on new and material evidence. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. See Hickson v. west, 12 Vet. App. 247, 251 (1999). New evidence means existing evidence not previously submitted to agency decision-makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). 1. Entitlement to service connection for a rash of the back and arm Initially, the Board notes that the Veteran contests the adequacy of one or more VA dermatology examinations, and specifically examinations in 2012 and 2016. Both were conducted by the same VA examiner. The Veteran has alleged that at one of the examinations the examiner did not turn on the light in the examining room. However, the reports of each examination reflect that an actual physical examination was conducted and neither report even remotely suggests that there was insufficient lighting which would have precluded making accurate observations and evaluations. Also, the Veteran points out that as to the February 2016 examination, the report of that examination was not signed until June 2016. The Board agrees that such a delay is neither ideal nor the normal course of processing the reports of such examinations. However, merely because the report of the February 2016 examination was not signed until months later does not mean that the examiner waited to record her findings of that examination until months after the examination. Moreover, the Veteran points to no specific finding in the report of the February 2016 examination which was in error. Accordingly, the Board finds that a new VA examination, which has been requested, is not required. The Board observes that the reports of the 2012 and 2016 examinations reflect, in essence, that at the time of each examination the Veteran did not have any observable dermatological manifestations. However, this is merely consistent with the apparent episodic nature of the Veteran’s post-service dermatological manifestations. For example, the September 5, 2014 VAOPT record also shows that while the Veteran pointed at that time to areas which he felt were abnormal, those areas were completely normal on examination at that time. At the time of the 2012 examination it was stated that, based on a review of the claim file, the in-service diagnosis made by a dermatologist was not the same as the diagnosis first made after service in 2010, when he had a rash. In other words, any skin condition during service was not the same skin condition which he had after military service. In 2016, that same VA examiner stated that, after having reviewed conflicting evidence, no cause was found for his current generalized pruritus, although there might be a psychiatric component to it. In this regard, the 2016 VA examiner is not the only clinician to observe that the Veteran’s nonservice-connected psychiatric disability apparently plays a significant role in many of his dermatological complaints. The September 5, 2014, VAOPT record also shows that there was a major disconnect between the Veteran’s concerns and the clinical findings of numerous physicians, and that he might have a somatic symptom disorder, dysmorphobia or hypochondriasis. Further, there was an assessment of mild dermographia during service, but the 2016 VA examiner also stated that the Veteran had dermatographism but that this is not a disability. Moreover, while keratosis pilaris had also recently been found, there appeared to be some “allergy mediated reaction.” However, the evidence does not show that any such “allergy mediated reaction” is the same as the allergic urticaria which was observed during military service. Urticaria is "defined as vascular reaction, usually transient, involving the upper dermis, representing localized edema caused by dilatation and increased permeability of capillaries, and marked by the development of wheals [hives or welts]." Barclay v. Brown, 4 Vet. App. 161, 163 (1993). Urticaria is a vascular reaction which is usually transient. McCay v. Brown, 8 Vet. App. 378, 380 (1995). Similarly, although the Veteran had tinea versicolor during service, he is not shown to have had tinea versicolor after his military service. In this regard, the post-service evidence, beginning a number of years after his 1997 service discharge, shows that he has had tinea pedis and onychomycosis but these are fungal infections and have not affected the Veteran’s back and arms. Similarly, there was an inservice assessment of scabies. “Scabies is defined as, ‘contagious itch or mange esp[ecially] with exudative crusts that is caused by parasitic mites and esp[ecially] by a mite of the genus Sarcoptes.’ … Webster's Medical Desk Dictionary 636 (1986).” Blum v. West, 17 Vet. App. 84 (Table), 1999 WL 682856 (Vet.App.); No. 98-1032, slip op. (U.S. Vet. App. Aug. 25, 1999) (nonprecedential memorandum decision). Inasmuch as scabies is due to parasitic mites, it is by its’ very nature acute and transitory, resolving upon elimination of the mites. Significantly, following his military service, the Veteran is not shown to have had any subsequent infection by such parasitic mites. When viewed in the light of the totality of the evidence of record, the Board concludes that the opinion of the VA examiner in 2012 that the dermatological manifestations during service were not the same as those after military service is consistent with the evidentiary record as a whole. Moreover, there is no medical opinion on file which expresses a reasoned conclusion that the Veteran now has a skin disability which is the same as any skin symptoms during service or which is otherwise of service origin. In this connection, clinicians have recorded the history related by the Veteran of having continuously had a variety of skin symptoms beginning during his military service. However, a bare transcription of a lay history is not transformed into ‘competent medical evidence’ merely because the transcriber happens to be a medical professional. See also LeShore v. Brown, 8 Vet. App. 406, 409 (1995) (where a history recorded by an examiner had not filtered, enhanced, or added medico-evidentiary value to the lay history through medical expertise). Lastly, as to the Veteran’s reportedly having the same dermatological symptoms now which he had during service, the question of the etiology of any current skin disorders extends beyond an immediately observable cause-and-effect relationship and, as such, the Veteran is not competent to address etiology in the present case. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). For these reasons and bases the Board finds that the preponderance of the evidence is against the claim for service connection for a rash of the back and arm and, thus, consideration of the doctrine of the favorable resolution of doubt is not in order. 2. The application to reopen a claim for service connection for onychomycosis of both feet with dermatophytosis and callus formation of the right second (2nd) toe The basis for the original denial of service connection was that there was no evidence of onychomycosis or dermatophytosis during military service. "Onychomycosis is a ‘fungal infection of the nail plate, usually caused by species of Epidermophyton, Microsporum, and Trichophyton, and producing nails that are opaque, white, thickened, friable, and brittle’." Davenport v. Brown, 7 Vet. App. 476, 477 (1995). “Onychomycosis is a ‘fungal infection of the toenails or fingernails. It usually is seen first as white patches or pits on the surface or around the edges of the nails, followed by infection beneath the nail plate.’ DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1322 (32d ed. 2012).” Warren v. McDonald, No. 13-3161, slip op. 1, footnote 1 (U.S. Vet. App. May 10, 2006) (panel decision); 28 Vet. App. 194 (2016). Dermatophytosis is a disease (as athlete’s foot) of the skin or skin derivatives (hair or nails) that is caused by a dermatophyte or fungus. Pernorio v. Derwinski, 2 Vet. App. 625, 628 (1992). The evidence of record at the time of the most recent denial of the claim, in February 2008 when reopening of the claim was denied, included duplicate STRs which were not new. Similarly, the Veteran has again submitted duplicate copies of STRs at the Board hearing but, again, these are not new. The February 2008 denial of reopening also found that additional VA treatment records were new because they were not previously of record but they were not material because failed to show that the Veteran had the claimed onychomycosis or dermatophytosis during military service. Likewise, additionally added VAOPT records, not previously of record are new but are not material because they failed to show that the Veteran had the claimed onychomycosis or dermatophytosis during military service. The March 2012 letter from the Veteran’s mother, while new, is far too vague to constitute material evidence inasmuch as she merely reported that the Veteran had some unspecified condition of his feet during service and was now always complaining about his feet. The Veteran’s additional statements addressing onychomycosis or dermatophytosis are essentially repetitious of his earlier statements and, as such, are not new. In sum, the basis for the denial of the claim in 2008 was not merely the absence of a nexus between the Veteran’s current skin disorder and his military service, but the absence of persuasive evidence of onychomycosis or dermatophytosis during military service. In this regard, no new medical evidence has been submitted to establish this. The additional medical evidence of record merely shows that the Veteran continues to have onychomycosis or dermatophytosis, but does not address the matter of either incurrence during or a nexus to his military service. In sum, the Veteran’s statements are essentially the same as the history he related when the claim was finally adjudicated in 2008. His merely providing greater details as current symptoms and impairment due to have onychomycosis or dermatophytosis is not sufficiently significant, when viewed in the context of all the evidence, that there is a reasonable possibility of changing the facts that there is no evidence showing a relationship between his current onychomycosis or dermatophytosis and his military service. Thus, the Board finds that new and material evidence has not been submitted which is sufficient to reopen the claim. Since the evidence submitted after the February 2008 rating decision is not new and material, the claim for service connection is not reopened. As the Veteran has not fulfilled his threshold burden of submitting new and material evidence to reopen the finally disallowed claim, the benefit-of-the-doubt doctrine is not applicable. See Annoni v. Brown, 5 Vet. App. 463, 467 (1993). 3. Entitlement to an effective date for service connection for concussion migraines, including migraine variants with memory loss, prior to August 16, 2011 The assignment of effective dates of awards is generally governed by 38 U.S.C. § 5110 and 38 C.F.R. § 3.400. Unless specifically provided otherwise, the effective date of an award based on an original claim for service connection "shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor." 38 U.S.C. § 5110(a). If a claim for service connection is received within one year from the day following separation from service, upon a grant of that benefit, the effective date will be the day after discharge from service. 38 U.S.C. § 5100(a); 38 C.F.R. § 3.400(b)(2)(i). With exceptions not here applicable, any award based on a subsequently filed application for benefits can be made effective no earlier than the date of the new application. See 38 C.F.R. § 3.400(q), (r). Specifically, the effective date of an award of disability compensation based upon the submission of new and material evidence, other than service department records received after final disallowance, will be the date of receipt of the new claim or the date that entitlement arose, whichever is later. 38 C.F.R. § 3.400(q)(1)(ii). Any communication indicating an intent to apply for a benefit under the laws administered by the VA may be considered an informal claim provided it identifies, but not necessarily with specificity, the benefit sought. See 38 C.F.R. § 3.155(a). To determine when a claim was received, the Board must review all communications in the claims file that may be construed as an application or claim. See Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). VA medical records cannot be accepted as informal claims for disabilities where service connection has not been established. The mere presence of medical evidence does not establish intent on the part of the veteran to seek service connection for a condition. See Brannon v. West, 12 Vet. App. 32, 35 (1998); Lalonde v. West, 12 Vet. App. 377, 382 (1999) (where appellant had not been granted service connection, mere receipt of medical records could not be construed as informal claim). Merely seeking treatment does not establish a claim, to include an informal claim, for service connection. Further, the mere presence of a disability does not establish an intent on the part of the Veteran to seek service connection for that condition. See KL v. Brown, 5 Vet. App. 205, 208 (1993); Crawford v. Brown, 5 Vet. App. 33, 35 (1995). A review of the record discloses that VA received the Veteran's initial claim in July 1999 claim for service connection for headaches and it was denied in October 1999 and that he was notified of that decision. Subsequently, he applied to reopen that claim, and that application was denied by a February 2008 rating decision, of which he was also notified. No additional service records were received thereafter, and no or relevant VA treatment records were received within one year of the February 2008 rating decision. The Veteran did not appeal the February 2008 rating decision and, thus, by law, that rating decision became final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. Once a rating decision becomes final, new and material evidence is required to reopen the claim which was denied. Subsequently, on August 16, 2011, another application to reopen the Veteran’s claim was received. Upon reopening of the claim, a February 2012 rating decision granted service connection for concussion migraines, including migraine variants with memory loss, effective as of the date of receipt of the August 16, 2011, application to reopen the claim. During the interim between the February 2008 rating decision denying the claim and the receipt of an application to reopen that claim on August 16, 2011, there was no communication from the Veteran or his representative which can be construed as an application to reopen the claim. The Veteran contends that he should be granted an effective date back to the time he filed his original service connection claim in 1999. He asserts that the grant of service connection was predicated upon the subsequent submission of a buddy statement but that he had been unable to obtain such a supporting statement prior to the most recent application to reopen the claim. However, even if true, the fact remains that the buddy statement to which he refers was not of record at the time of the February 2008 denial of reopening of his claim. Moreover, such a buddy statement does not constitute a service record within the meaning of 38 C.F.R. § 3.156(c). While the Board understands the Veteran's argument that he initially claimed service connection in 1999 for the same condition that was ultimately granted in 2012, the Board must apply the law as it currently stands, which does not allow for an earlier effective date in this case. Because the claim was denied and not appealed in 2008, the effective date cannot reach back to a time prior thereto. Rather, it can only be established as of the date of the claim to reopen, which in this case was August 26, 2011. BETHANY L. BUCK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Department of Veterans Affairs