Citation Nr: 18153334 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 16-48 902 DATE: November 27, 2018 ORDER Entitlement to service connection for pseudofolliculitis barbae is granted. REMANDED Entitlement to service connection for sleep apnea is remanded. FINDING OF FACT The evidence is at least in relative equipoise as to whether the Veteran’s pseudofolliculitis barbae is related to active duty service. CONCLUSION OF LAW The criteria for entitlement to service connection for pseudofolliculitis barbae have been met. 38 U.S.C. §§§ 1110, 1111, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from February 2006 to February 2014. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. The RO, in the rating decision, denied service connection for, inter alia, pseudofolliculitis barbae (PFB), and sleep apnea claimed as sleep disturbances. Entitlement to Service Connection for Pseudofolliculitis Barbae 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 during active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). Generally, to establish an entitlement to service connection, a veteran must show evidence of (1) a current disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a causal relationship between the current disability and an in-service injury or disease, the so-called “nexus” requirement. All three elements must be proven in order to grant an entitlement to service connection. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). 1. Current Disability In this case, the Veteran contends that PFB began while he was in service and that it continues to remain an issue. The Veteran was first diagnosed with PFB in 2006 and prescribed a shaving waiver as recently as September 2013. The Veteran, as a lay witness, is competent to identify an ongoing condition. Accordingly, the VA is required to give due consideration to all pertinent medical and lay evidence in the process of evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay evidence can be considered as competent and sufficient to establish the diagnosis of a condition when (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 v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Here, the Veteran can identify PFB, or its common name razor burn, without difficulty due to the nature of the symptoms, which include visible red bumps along the neckline. The symptoms of razor burn are also easily identifiable in-between and after shaving facial hair. While symptoms may not be constantly present, it does not mean the condition does not exist. Therefore, the Board finds that there is a current disability for service connection purposes. 2. In-Service Event or Injury As it pertains to an in-service event or injury, it is well-documented in the Veteran’s service treatment records (STRs) that he received a diagnosis of PFB throughout his service. Due to the ongoing condition and persistent symptoms, the Veteran sought and received a shaving waiver every year of service. He received his first waiver in September 2006 and continued to receive them every year of his service. His final waiver was issued in September 2013, prior to his discharge in February 2014. The STRs indicate the Veteran tried multiple methods of shaving and saw minor results. He was prescribed various topical creams to treat the symptoms also seeing minor results. Therefore, due to the persistent symptoms and lengthy record of shaving waivers, the Board finds sufficient evidence of an in-service event or injury for service connection purposes. 3. Nexus In regard to the final element, a nexus between active duty service and the current disability, the Board has the responsibility to weigh the probative effect of evidence either for or against a claim. In a Scars/Disfigurement Disability Benefits Questionnaire dated January 1, 2015, the examiner noted, “[t]here is no diagnosis because the condition has resolved.” The Board assigns this evidence limited weight due to the prevalence of the condition throughout the Veteran’s service and the Veteran’s lay statements. Conversely, the Board affords the Veteran’s statements great probative weight. The Veteran is competent to report symptoms related to PFB from shaving because it is something he can see and feel on the skin. See Layno v. Brown, 6 Vet. App. 465, 469-471 (1994). Additionally, the Veteran is considered competent to report symptoms of a skin condition he first experienced in service that is similar to the current symptoms he is experiencing. 38 C.F.R. § 3.159(a)(2); see also Layno, 6 Vet. App. at 469. Therefore, in weighing the evidence, the Board finds that sufficient evidence of a nexus between the present disability and the in-service diagnosis and treatment for PFB has been demonstrated. 4. Conclusion The Board finds the Veteran’s lay statement sufficient to support a current diagnosis of pseudofolliculitis barbae, sufficient evidence of an in-service event or injury, and a nexus between active duty and the current disability. Therefore, in giving the Veteran the benefit of the doubt, the Board finds that service connection for pseudofolliculitis barbae is warranted. REASONS FOR REMAND Entitlement to Service Connection for Sleep Apnea is Remanded A remand is required to have the RO schedule the Veteran for an examination to determine whether the he has sleep apnea and the etiology of the disorder. See 38 U.S.C. § 5103A(d). There are four elements necessary in determining the need for a medical examination: (1) a current disability; (2) an in-service event, injury, or disease; (3) an indication that the claimed disability may be associated with the established event; and (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McClendon v. Nicholson, 20 Vet. App. 79, 81-85 (2006). The Veteran’s STRs do not reflect a diagnosis of sleep apnea or mention sleep apnea related symptoms during service. Prior to the Veteran’s discharge, however, the Veteran claims sleep apnea symptoms were witnessed by his wife such as respiratory disruption while sleeping and moving frequently while sleeping. In a statement made by the Veteran, he claims that his sleep problems are also due to in-service rotating shifts, exercises, and changes in time zones. As stated before, the Board finds the Veteran competent as to these assertions, thus satisfying the first and second elements of the McClendon test. A sleep related issue is also mentioned in a military services physical dated July 11, 2011. The Veteran reported getting less than five hours of sleep on three or more consecutive nights. On the same date, the examiner noted a “probable sleep deficiency.” Due to the sleep related issues noted while in service, and the low threshold required to meet this standard, the Board finds the third element has also been met. Lastly, the Board cannot make a fully-informed decision on the issue of sleep apnea because no VA examiner has opined whether the Veteran is currently diagnosed with disability. No VA examiner has opined whether the disability might have begun during the Veteran’s service due to rotating shifts, exercises, and changing time zone or directly considered his spouse’s observations—thus an appropriate examination is warranted. The matter is REMANDED for the following actions: Provide the Veteran with an appropriate examination to determine whether he has a diagnosis of sleep apnea and if so, the nature and etiology of the disability. The electronic claims file must be reviewed by the examiner. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. If found to have a diagnosis of sleep apnea, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that its onset occurred in service or is caused by, or related at least in part, to his period of active military service. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Christopher J. DeBoer, Law Clerk