Citation Nr: 18155505 Decision Date: 12/04/18 Archive Date: 12/04/18 DOCKET NO. 15-33 101 DATE: December 4, 2018 ORDER Entitlement to service connection for a skin disorder involving the bilateral lower extremities is denied. REMANDED Entitlement to a rating greater that 70 percent for posttraumatic stress disorder is remanded. Entitlement to total disability rating based upon individual unemployment due to service connected disability is remanded. REFERRED ISSUE On appeal the appellant has raised the issues of entitlement to service connection for tooth losses, and residuals of a back disorder to include a slipped spinal disk. These issues are not, however, currently developed or certified for appellate review. Hence, they are referred to the RO for appropriate action. FINDING OF FACT A skin disorder involving the lower extremities was not shown in service, or for many years thereafter, nor is such a disability the result of any incident of the Veteran’s period of active military service to include his presumed inservice exposure to Agent Orange. CONCLUSION OF LAW A skin disorder on bilateral lower extremities was not incurred or aggravated in service. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from April 1966 to April 1968. These matters come before the Board of Veterans’ (Board) on appeal from an November 2011 and May 2015 decisions by Department of Veterans Affairs (VA) Regional Offices (RO). Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). To establish entitlement to service-connected compensation benefits, a veteran must show: (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. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). In this case, a review of the service treatment records reveals no complaints, findings or diagnoses of a skin disorder involving the lower extremities. At a February 1968 separation examination, the appellant’s skin was clinically evaluated as normal. A review of the post-service medical evidence reveals no competent evidence of a lower extremity skin disorder which is linked to the Veteran’s active duty service. In this regard, VA outpatient records do show a long history of venous stasis disease which requires, inter alia, the use of JOBST stockings. While this disease’s manifestations include skin ulcers/sores at the ankle region there is no competent evidence that any skin disorder involving the lower extremities, to include venous stasis disease or problems with skin ulcers, is related to the claimant’s active duty service. Moreover, while the appellant is presumed to have been exposed to Agent Orange and other herbicides as a result of his service in the Republic of Vietnam, there is no competent evidence that any lower extremity skin disorder is related to the Veteran’s active duty service. While the Veteran believes his lower extremity skin disorder is related to an in-service injury or disease, including presumed inservice exposure to Agent Orange and other herbicides, as well as alleged inservice exposure to certain tooth fillings, he is not competent to provide a nexus opinion in this case, as the etiology of his venous stasis is medically complex and requires specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The preponderance of the evidence indicates that the Veteran did not have a chronic lower extremity skin disorder in service, and there is no competent evidence showing a nexus between his current skin disability and his military service. The claim is denied. In arriving at this decision, the Board considered the doctrine of reasonable doubt. That doctrine is only invoked, however, where there is an approximate balance of evidence which neither proves nor disproves the claim. In this case, the preponderance of the evidence is against the Veteran’s claim. Therefore, the doctrine of reasonable doubt is not applicable. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. REASONS FOR REMAND The Veteran contends his posttraumatic stress disorder has worsened. A review of the claims folder reveals that the claimant was last provided a formal compensation examination in May 2015. Given the length of time since that examination, and the appellant’s continuing receipt of VA medical care for the disorder, further development is required. Consideration of the claim of entitlement to a total disability rating based on individual unemployability is deferred pending completion of the remand instructions below and adjudication of the issues referred above. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from May 2015 to the present. If the RO cannot locate such records, it must specifically document the attempts that were made to locate them, and explain in writing why further attempts to locate or obtain any government records would be futile. The RO must then: (a) notify the claimant of the specific records that it is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claims. The claimant must then be given an opportunity to respond. 2. Thereafter, schedule the appellant for a VA psychiatric examination to determine the nature and extent of his posttraumatic stress disorder. The examiner must be provided access to the claimant’s VBMS and Virtual VA/Legacy files for review. The examiner must specify in the report that these records have been reviewed. All indicated evaluations, studies, and tests should be conducted. The examiner must specifically address how the appellant’s psychiatric disorder affects his ability to work, to include whether it is at least as likely as not that the disorder precludes substantially gainful employment that is consistent with the claimant’s education and occupational experience. A complete well-reasoned rationale must be provided for all opinions that are offered. If any of the requested opinions cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training.   3. Then, after adjudicating the issues referred above, adjudicate the appellant’s entitlement to a total disability evaluation based on individual unemployability. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Anthony L. Hines Associate Attorney