Citation Nr: 18152149 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 18-32 967 DATE: November 21, 2018 ORDER Entitlement to service connection for a skin disorder is denied. REMANDED Entitlement to service connection for a low back disorder is remanded. Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a left shoulder interstitial granuloma is remanded. FINDING OF FACT The Veteran does not have a current skin disorder. CONCLUSION OF LAW The criteria for entitlement to service connection for a skin disorder have not been met. 38 U.S.C. §§ 1111, 1131, 1132, 5103(a), 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1999 to February 2004. In October 2018, the Veteran applied for advancement of his appeal on the docket due to financial hardship caused in the wake of Hurricane Florence. 38 C.F.R. § 20.900(c). The Board finds this to be sufficient cause in this case, and the motion to advance the case on the docket is granted. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). Service Connection The Veteran is seeking service connection for a skin condition claimed as a body rash. Entitlement to service connection for a skin condition The Veteran asserts service connection for a skin disorder. Service connection for a skin disorder is denied because there is no current disability. 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). Here, a current skin disorder cannot be diagnosed. The Veteran’s most recent VA examination report, dated November 2015, specifically notes the absence of a current chronic skin disorder. While the author of this report admits to not having access to the Veteran’s separation examination, the author reviewed the Veteran’s claims file and service records, and was not able to diagnose the Veteran with a current skin disorder. The Board concedes that a rash on the Veteran’s left hand was noted in service in a September 1999 record. However, that incident had resolved by the time of the Veteran’s December 2003 separation exam. Accordingly, the presence or absence of a notation of a skin disorder in service or upon separation is not relevant to the Veteran’s claim for service connection for a current condition. Moreover, the right wrist lesion documented in a March 2016 dermatology note does not qualify as a current disability because there is no showing of record that it is a chronic disability, rather than an abrasion incurred in the course of daily life. Absent a current disability, service connection is not available. See 38 U.§ 1110 (2012); Rabideau v. Derwinski, 2 Vet. App. 141 (1992); See also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Because the Veteran does not have a currently diagnosed skin disorder, service connection is not warranted. REASONS FOR REMAND Entitlement to service connection for a left knee disorder, a low back disorder, and a left shoulder interstitial granuloma are remanded. Unfortunately, a remand is required to allow the Veteran every chance to receive service connection, if it is warranted. Regarding the Veteran’s left knee claim, he states in his VA Form 9, dated May 2018, that MRI films taken at the Tallahassee VAMC show a soft tissue injury that would not have shown up on x-rays taken during service. The Veteran further asserts that the MRI may have detected evidence of long-standing injuries that had their onset in or were caused by service. A remand is necessary to obtain these records. Further, the Veteran, in a statement dated May 2017, asserts that an MRI of the spine taken at the VAMC in Tallahassee shows cysts along the spine caused by degeneration of the joints. The report of this MRI scan is not of record. A remand is required to attempt to obtain the MRI reports referenced by the Veteran’s May 2017 statement, and to assess the likelihood that the Veteran’s current symptoms are related to service. Back The Veteran asserts that his back disability stems from a fall in service during training, as well as a back strain incurred during a run. A remand is required to fully assess this issue. The Veteran has a current diagnosis of lumbosacral strain, according to his 2015 Compensation and Pension examination. Further, his statements of record contain competent and credible assertions of current low back pain. Next, service treatment records show that upon enlistment, the Veteran had asymptomatic scoliosis, and no other back symptoms. Further, he complained of back symptoms in service, beginning with an upper back strain incurred in August 1999 and lasting approximately six months. He also states in his May 2018 VA Form 9 that he sustained another back injury while stationed in Korea after tripping over another servicemember who fell in front of him during a running formation. Thus, service connection can be granted if the Veteran’s current lumbosacral strain symptoms are either etiologically related to his in-service upper back strain, separate and apart from the congenital scoliosis; or, if the Veteran sustained a “superimposed” injury on top of his scoliosis – that is, an injury that is more severe than it would have been had the Veteran not had scoliosis; or, that the scoliosis made him more susceptible to a back injury resulting in a current back disability. Either alternative would warrant service connection. The Board notes the Veteran’s November 2015 VA examination in which the examiner opines that it is less likely than not that the Veteran’s back strain is service connected. However, this opinion does not address the Veteran’s self-reported injuries. VA’s duty to assist requires VA to provide an adequate examination if there is any indication that the Veteran’s lumbosacral disability may be associated with service. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Accordingly, a new VA examination is warranted to determine whether a relationship exists between the Veteran’s in-service symptoms and current disability. Moreover, VA is obligated to provide an adequate examination once it chooses to administer one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). In light of the foregoing, the matter must be remanded to the RO to schedule the Veteran for another VA examination to determine the likely etiology of any current back disability. Left Shoulder Interstitial Granuloma The Veteran’s left shoulder interstitial granuloma first appears in the medical evidence in a December 2015 nursing note documenting a biopsy of the area. Notably, this condition is not noted in the Veteran’s skin conditions examination report. The evidence of record, including a June 2016 addendum to a biopsy report, show that the Veteran was diagnosed with an early interstitial granuloma of the upper left back. While the Veteran’s service treatment records do not mention this condition, they corroborate his having trained in Camp Casey. In addition, the Veteran credibly states in a record dated May 2016 that there were ticks in the region where he trained in Korea. Thus, the Board must remand this issue to see if there is a medical relationship between the Veteran’s current interstitial granuloma, and likely tick exposure in Korea. The matter is REMANDED for the following action: 1. Obtain all treatment records from the VA Medical Center in West Palm Beach, Florida since December 2016, as well as from any VA facility from which the Veteran has received treatment. If the Veteran has records of private treatment, he should be afforded an opportunity to submit them. 2. Attempt to locate the low back and left knee MRI scan reports referenced by the Veteran in his May 2017 and May 2018 statements. Once found, associate these records with the claims file. 3. The Agency of Original Jurisdiction (AOJ) should request that the Veteran provide the names and addresses of health care providers who have provided treatment for his low back and left knee disorders that are not already of record, to include reports of MRI scans of his low back and left knee. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. 4. Once obtained, any studies, tests, and/or evaluations deemed necessary for a fair adjudication of the Veteran’s left knee claim should be conducted. Particular attention should be paid to whether the Veteran has a long-standing knee injury that was not detected during or within a year of service. 5. Schedule the Veteran for a VA examination to determine the nature and etiology of his lumbosacral strain and claimed knee disability. The claims folder must be made available to and be reviewed by the examiner(s). All tests deemed necessary should be conducted and the results reported in detail. The examiner should provide an opinion as to a) whether it is at least as likely as not (i.e. a 50 percent probability or greater) that the Veteran’s lumbosacral strain had its onset in, or is otherwise etiologically related to, his active service, to include the strain incurred in August 1999, as well as the fall he sustained in 2000, and any apparent spinal cysts pressing against the spinal cord; and b) whether the Veteran’s current back strain is an injury “superimposed” over the Veteran’s scoliosis. c) Whether it is at least as likely as not that the Veteran’s current left knee disability had its onset in, or is otherwise etiologically related to, his active service. The examiner should, in particular, consider the Veteran’s lay statements regarding these disorders. See, e.g., June 2018 VA Form 9. If the examiner cannot provide any of the requested opinions without resorting to speculation, he or she should provide an explanation stating why this is so. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is the result of a need for additional information or is because he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). It should be noted that the Veteran is competent to attest to observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history[,]”38 C.F.R. § 4.1, copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claim file, must be made available to the examiner for review. 6. Schedule the Veteran for a VA examination to determine the nature and etiology of his left shoulder interstitial granuloma. The claims folder must be made available to and be reviewed by the examiner. All tests deemed necessary should be conducted and the results reported in detail. (Continued on the next page)   The examiner should provide an opinion as to whether it is at least as likely as not (i.e. a 50 percent probability or greater) that the Veteran’s left shoulder interstitial granuloma had its onset in, or is otherwise etiologically related to, his active service, to include possible exposure to ticks while serving in Korea. L. B. CRYAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Z. Maskatia, Associate Counsel