Citation Nr: 18151776 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 16-43 571 DATE: November 20, 2018 REMANDED Entitlement to service connection for a skin disability, to include vitiligo, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1976 to February 1979. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an January 2014 rating decision. In June 2014, the Veteran submitted a new Appointment of Veterans Service Organization as Claimant’s Representative (VA Form 21-22) appointing the representative listed on the title page above. The Board recognizes this change in representation. In May 2017, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a video-conference hearing. A transcript of that hearing is of record. 1. Entitlement to service connection for a skin disability, to include vitiligo, is remanded. The Veteran’s VA treatment records indicate that he has a current diagnosis of a skin disability, vitiligo. At the time of his entrance examination in February 1976, it was noted that he had skin pigmentation, diagnosed as pseudo-vitiligo of the skin. The remainder of his service treatment records are unavailable. However, the Veteran asserts that during service during he was hospitalized due to skin sores that arose during desert training. He stated that he experienced skin sores, cracks, and blisters due to extreme heat. Additionally, the he advised that he was ordered to wear soft fatigues and that he used skin creams and utilized oil and milk baths to treat his symptoms. Every veteran is presumed to have been in sound condition when he or she was examined, accepted, and enrolled for service, except as to defects, infirmities, and/or disorders noted at the time of the examination, acceptance, and enrollment. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). When a defect, infirmity, or disorder is noted on a claimant's entrance examination, he or she has the burden of showing that there was an increase in disability during service to establish the presumption of aggravation. Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). If the claimant demonstrates an increase during service, the disability is presumed to have been aggravated in service, and the burden is on the Secretary to rebut that presumption. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. To rebut that presumption, the Secretary must show, by clear and unmistakable evidence, that the worsening of the condition was due to the natural progress of the disease. 38 U.S.C. § 1153. On remand, a VA examination and opinion must be provided to make an informed decision on this claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (the Board is not competent to substitute its own opinion for that of a medical expert). Related, while the Veteran’s service treatment records not demonstrate complaints of or treatment for a skin disability, the Board notes that he is competent under the law to describe what he experienced while in military service. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (holding that a Veteran is competent to report what occurred during service because he is competent to testify as to factual matters of which he has first-hand knowledge); Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007) (holding that lay testimony is competent to establish the presence of observable symptomatology); Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The VA medical opinion must consider the Veteran’s competent statements concerning his skin disability during his active service. As noted, it appears that many of the Veteran’s service treatment could not be located. The Veteran stated during his May 2017 video-conference hearing that he was hospitalized during his active service in order to treat his skin disability. He provided a written statement in November 2014, which advises that he was hospitalized at the “San Francisco Military Hospital” in 1977-78 for skin sores that arose during desert training. A March 2013 Request for Information Needed to Locate Medical Records shows that the Veteran indicated that received medical treatment at Fort Ord, California from March 1978 to February 1979. These clinical records may have been filed separately. A remand is required to allow VA to request these potentially relevant records, as well as the Veteran’s complete records related to his service in the Colorado Army National Guard. The matter is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records from November 2016 to the present. 2. Obtain records of any inpatient treatment (i.e., clinical records) of the Veteran during his active service, including from Letterman Army Medical Center, Presidio, California, and U.S. Army Hospital, Fort Ord, California in 1978 and 1979. Document all requests for information as well as all responses in the claims file. 3. Obtain the Veteran’s complete medical treatment and service personnel records associated with his service in the Colorado Army National Guard (ARNG). 4. After the above development is completed, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any skin disability. (a.) The examiner must identify all current skin disabilities, i.e., vitiligo, etc. (b.) The examiner must provide an opinion as to whether it is at least as likely as not (50% or greater probability) that the Veteran’s pseudo-vitiligo of the skin, which was noted on his February 1976 enlistment examination, was aggravated (non-temporary increase in severity) during service. In providing this opinion, the examiner should specifically consider the Veteran’s statements concerning his in-service skin symptomatology (sores, cracks, and blisters), as well as his exposure to extreme heat during desert maneuvers. (c.) If the examiner finds that the Veteran’s pseudo-vitiligo of the skin was aggravated (non-temporary increase in severity) during service, then he/she must provide an opinion as to whether the worsening of the condition was clearly and unmistakably (undebatable) due to the natural progress of the disease. (d.) For any other diagnosed skin disorder (including acanthotic squamous epithelium with regenerative changes removed from the lip), the examiner must provide an opinion as to whether it is at least as likely as not (50% or greater probability) that it had its clinical onset during service or is related to any incident of service, to include extreme heat exposure during desert maneuvers and/or the Veteran’s reported in-service skin symptoms of skin sores, cracks, and blisters. All examination findings, along with the complete rationale for all opinions expressed, must be set forth in the examination report. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Mussey, Associate Counsel