Citation Nr: 18155917 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 17-02 821 DATE: December 6, 2018 ORDER Entitlement to service connection for posttraumatic stress disorder (PTSD) is granted. REMANDED Entitlement to service connection for a skin condition, to include tinea versicolor, is remanded. FINDING OF FACT The evidence of record favors a finding that the Veteran’s PTSD is at least as likely as not related to combat service in Vietnam. CONCLUSION OF LAW The criteria for service connection for PTSD are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1965 to February 1968 and from May 1968 to July 1977. He is the recipient of the Combat Infantryman Badge and the Bronze Star Medal. The Veteran’s service-connection claim for a skin disability has been adjudicated as one for tinea versicolor. The evidence demonstrates a current diagnosis of xerosis. The Board will expand the Veteran’s claim to include consideration as to whether service connection may be warranted for any diagnosed skin disability. Cf. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Entitlement to service connection for PTSD. Service connection may be established for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To establish service connection for a disability, the 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). The Veteran asserts that his PTSD is a result of his service in the Republic of Vietnam, to specifically include witnessing fellow soldiers, including close battle buddies, being wounded and killed, as well as witnessing a friend being killed by accidentally-detonated explosives. Regarding his claimed stressors, there is supportive evidence that the Veteran engaged in combat with the enemy during service as reflected by his receipt of the Combat Infantryman Badge and the Bronze Star Medal; the claimed stressors of witnessing fellow soldiers being wounded and killed is related to that combat; and the claimed stressors are consistent with the circumstances, conditions, or hardships of the Veteran’s Vietnam service. As there is no clear and convincing evidence to the contrary, the Veteran’s lay testimony alone can substantiate the claimed stressors and they are hereby accepted by the Board. 38 C.F.R. § 3.304 (f)(2); 38 U.S.C. § 1154(b). VA treatment records show that the Veteran was diagnosed with combat-related PTSD, relatively moderate degree, in August 2005 and February 2007, and endorsed symptoms such as increased startled response, feeling on guard, sleep disruptions, and nightmares. The Veteran’s ex-wife and daughter submitted buddy statements in November 2012 reporting that the Veteran suffered frequent nightmares and flashbacks, as well as daily depressive and angry moods. See November 2012 J.T. and E.W. Statements. The Veteran underwent VA examination in December 2012. The examiner acknowledged that while the Veteran was exposed to potential traumatic stressors during service, the Veteran currently reported few symptoms of PTSD or social/occupational deficits, and a diagnosis of PTSD was not warranted. The examiner noted the July 2005 PTSD diagnosis, but stated that the Veteran was not treated following the diagnosis. The examiner failed to address the ongoing symptoms set forth in the August 2005 and February 2007 VA treatment records, which were also endorsed in the November 2012 buddy statements. In May 2018, the Veteran’s Vet Center Readjustment Counseling Therapist, D.S., opined that the Veteran had a diagnosis of PTSD related to combat service in Vietnam using the DSM-V criteria. Further, the May 2018 opinion articulated symptoms requiring treatment since 2016 that were consistent with those identified by the August 2005 and February 2007 VA treatment records, as well as the November 2012 buddy statements. The Board finds the August 2005 and February 2007 VA treatment records and May 2018 Vet Center opinion to be the most competent and credible evidence of record, and affords them significant probative weight. Therefore, the Board concludes that the Veteran has a current diagnosis of PTSD that is related to his active duty service by the probative medical evidence. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The benefit sought on appeal is granted. REASONS FOR REMAND Entitlement to service connection for a skin condition, to include tinea versicolor, is remanded. The Veteran asserts that his current skin condition had its onset in or is otherwise related to his active duty service. Service treatment records indicate that the Veteran was treated in-service for exfoliative dermatitis in November 1967, superficial folliculitis in December 1968, and tinea versicolor in January 1969. The Veteran underwent VA examination in December 2012. Upon examination, he was diagnosed with xerosis. In a March 2013 addendum, the examiner indicated that xerosis was less likely as not related to the Veteran’s period of service, noting that the Veteran was seen in service for distinctly separate skin conditions. The examiner added that xerosis is a separate condition, unrelated to the infection of tinea versicolor. While it may be true that xerosis is not the same disability as dermatitis, eczema or tinea versicolor (all noted in service), the examiner provided no explanation as to why, from a medical standpoint, his current dry skin disability was not at least as likely as not related to these in-service skin problems. On remand, a new examination and opinion addressing the etiology of the Veteran’s skin disabilities should be obtained. The matter is REMANDED for the following action: 1. Obtain VA treatment records that are not already associated with the claims file beginning September 2015. 2. Schedule the Veteran for a VA skin examination. The claims file should be sent to, and reviewed by the VA examiner. The examiner should take a history from the Veteran as to the progression of his claimed disabilities. After reviewing the Veteran’s medical history, and interview and examination of the Veteran, the examiner is asked to respond to each of the following: a) Identify all current skin disabilities that have manifested during the period under review (August 2012 to the present day) b) For each disability identified, is it at least as likely as not (50 percent or greater probability) that such disability had onset in, or is otherwise related to the Veteran’s in-service skin problems, to include exfoliative dermatitis, or superficial folliculitis and tinea versicolor? A clinical explanation in support of the conclusion reached is requested. (Continued on Next Page) 3. Readjudicate the appeal. If the benefit sought is denied, issue the Veteran and his representative a supplemental statement of the case. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Bristow Williams, Associate Counsel