Citation Nr: 18158199 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 13-21 983A DATE: December 14, 2018 ORDER Entitlement to service connection for chronic obstructive pulmonary disease is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for a skin disorder is denied. Entitlement to service connection for a left foot disability is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran’s chronic obstructive pulmonary disease (COPD) is due to a disease or injury in service. 2. The preponderance of the evidence is against finding that the Veteran’s hypertension manifested in service or within one year of separation, continuity of symptomology is not established; and his hypertension is not otherwise etiologically related to an in-service injury, event or disease. 3. The preponderance of the evidence is against finding that the Veteran’s eczema is due to a disease or injury in service. 4. The preponderance of the evidence is against finding that the Veteran’s left foot disability manifested in service or within one year of separation, continuity of symptomology is not established; and his left foot disability is not otherwise etiologically related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for chronic obstructive pulmonary disease (COPD) have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). 3. The criteria for service connection for a skin disorder have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for service connection for a left foot disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the Army from August 1973 to April 1980 and from December 1990 to May 1991, with service in Southwest Asia. In addition, the Veteran had National Guard service. These matters come before the Board of Veterans’ Appeals (Board) from a September 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Previously, the case was most recently before the Board in June 2017, and the directives having been substantially complied with, the matter again is before the Board. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In addition, as part of the June 2017 remand, the Board also remanded the issues of entitlement to service connection for a neurologic disorder of the right and left lower extremities due to a cold injury. However, during the course of the appeal service connection was granted for right and left foot cold injury residuals in a February 2018 rating decision, effective March 18, 2010. The Veteran was informed that this action constitutes a full grant of benefits sought on appeal. Service Connection A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C. §§ 1110, 1131. To establish a right to compensation for a present disability, 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” - the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “Chronic.” When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. 3.303 (b). Service connection for a recognized chronic disease can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. In addition, the Board notes that the Veteran served in the Southwest Asia theater of operations in support of Persian Gulf War. 38 C.F.R. § 3.317 (e). Under those provisions, service connection may be established for objective indications of a chronic disability resulting from an undiagnosed illness or illnesses, provided that such disability (1) became manifest in service on active duty in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021; and (2) by history, physical examination, and laboratory tests cannot be attributed to a known clinical diagnosis. To fulfill the requirement of chronicity, the illness must have persisted for six months. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. Signs or symptoms which may be manifestations of undiagnosed illness include, but are not limited to: fatigue, signs or symptoms involving skin, headache, muscle pain, joint pain, neurologic signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper or lower), sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. 38 C.F.R. § 3.317 (b). There must be objective signs that are perceptible to an examining physician and other non-medical indicators that are capable of independent verification. There must be a minimum of a six-month period of chronicity. There must be no affirmative evidence that relates the illness to a cause other than being in the Southwest Asia Theater of operations during the Persian Gulf War. If signs or symptoms have been medically attributed to a diagnosed (rather than undiagnosed) illness, the Persian Gulf War presumption of service connection does not apply. VAOPGCPREC 8-98 (Aug. 3, 1998). For purposes of this section, a qualifying chronic disability means a chronic disability resulting from any of the following (or any combination of the following): (A) an undiagnosed illness; (B) the following medically unexplained chronic multisymptom illnesses that are defined by a cluster of signs or symptoms: (1) chronic fatigue syndrome; (2) fibromyalgia; (3) irritable bowel syndrome; or (4) any other illness that the Secretary determines meets the criteria in paragraph (a)(2)(ii) of this section for a medically unexplained chronic multisymptom illness; or (C) any diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C.A § 1117(d) warrants a presumption of service-connection. 38 C.F.R. § 3.317(a)(2)(i). For purposes of this section, the term medically unexplained chronic multisymptom illness means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multisymptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii). For purposes of this section, “objective indications of chronic disability” include both “signs,” in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Compensation shall not be paid under this section, however, if there is affirmative evidence that an undiagnosed illness was not incurred during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War; or if there is affirmative evidence that an undiagnosed illness was caused by a supervening condition or event that occurred between the Veteran’s most recent departure from active duty in the Southwest Asia theater of operations during the Persian Gulf War and the onset of the illness; or if there is affirmative evidence that the illness is the result of the Veteran’s own willful misconduct or the abuse of alcohol or drugs. 38 C.F.R. § 3.317 (c). 1. Entitlement to service connection for chronic obstructive pulmonary disease The Veteran contends that his COPD is related to service and specifically his service in Southwest Asia in support of the Persian Gulf War. The Veteran contends he was exposed to environmental hazards while serving in Southwest Asia which resulted in his difficulty breathing and coughing. The Veteran is competent to describe his ongoing symptoms, in-service duties and his statements are credible. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not caused by an in-service injury or disease. The Veteran has a diagnosis of COPD. The Veteran contends that while serving in Southwest Asia he was exposed to environmental hazards that resulted in his current COPD. The Veteran’s DD 214 notes service in support of Operation Desert Shield/Storm in Southwest Asia from January 1991 to April 1991. Service treatment records (STRs) have been associated with the claims file. At separation in April 1991 on the report of medical history the Veteran denied shortness of breath and a chronic cough. The examiner noted that the Veteran had no medical problems related to Desert Shield/Storm. An August 1994 report of medical examination during the Veteran’s National Guard service noted normal evaluation of the lungs and chest. On report of medical history, the Veteran denied shortness of breath and a chronic cough. In light of the Veteran’s consistent statements and the evidence of record, including service in Southwest Asia, there is credible evidence indicating a possible in-service injury from exposure to environmental hazards while serving in Southwest Asia. However, the service records do not support an onset of the Veteran’s current COPD during active service. At separation the Veteran denied shortness of breath and a chronic cough and the examiner noted no medical problems related to his service in Desert Shield/Storm. The issue is whether the Veteran’s current COPD is caused by service. The Veteran was afforded a VA examination in April 2010. The Veteran reported difficulty breathing which began in-service with difficulty breathing on exertion since serving in Southwest Asia. The examiner noted military exposure to smoke and dust and civilian exposure to dust. The Veteran reported smoking half a pack of cigarettes every day for the last 12 years. The examiner noted the Veteran was employed as a truck driver and his current breathing problem does not affect his work, as he is not exerting while driving. The examiner noted that the Veteran’s breathing problem does impact his activities of daily living such as cutting the grass. The examiner noted dyspnea on exertion. Then, the Veteran was afforded a VA examination in March 2011. The examiner noted review of the Veteran’s claims file and pulmonary functioning testing noted a severe obstructive ventilatory defect with significant improvement after bronchodilator, with increased residual volumes suggest mild air trapping and mildly decreased diffusion capacity. The examiner noted abnormal pulmonary testing since 1994, with a progressive worsening of his pulmonary function overtime. The examiner noted the Veteran’s dyspnea on exertion is a diagnosable chronic multisystem illness with a partially explained etiology; and is less likely than not related to his specific environmental exposures while serving in Southwest Asia. Next, the Veteran was afforded a VA examination in October 2015. The examiner noted a diagnosis of chronic obstructive pulmonary disease. The Veteran reports his COPD and shortness of breath and coughing is related to his exposure to environmental hazards while serving in Southwest Asia. The examiner noted the Veteran has a history of smoking cigarettes and of an acute inferior myocardial infarction in 2012. The examiner noted that COPD is a condition with a clear and specific etiology and is less likely than not a result of exposure to environmental hazards while serving in Southwest Asia. In addition, in an August 2016 supplemental opinion the examiner noted that in-service the Veteran was treated for several upper respiratory infections, however there is no evidence of an onset of COPD in-service. Lastly, in a July 2017 VA supplemental opinion the examiner found the Veteran’s COPD is less likely than not related to environmental hazards while serving in Southwest Asia. The examiner noted the Veteran has a history of smoking and smoking is known to cause COPD. The vast majority of cases of COPD are attributable to cigarette smoking, and the Veteran’s COPD is most likely related to his history of smoking. The examiner found the Veteran’s COPD represents a diagnosable condition with a clear and specific etiology and is less likely than not related to service. The examiner considered the VA examiner’s opinion from March 2011 which noted the Veteran’s dyspnea is a diagnosable chronic multi system illness with a partially explained etiology. However, the VA examiner noted that the Veteran’s symptoms are indicative of COPD, and not an unexplained respiratory illness. VA and private treatment records have been associated with the claims file. Treatment records note ongoing shortness of breath on exertion and an intermittent cough. These treatment records do not contradict the VA examinations and are absent indications of a relationship between the Veteran’s current COPD and in-service events. After consideration of all the evidence of record, the Board finds that the preponderance of the evidence is against finding that service connection for COPD is warranted. The Board concludes that service connection is not warranted as the Veteran’s current COPD did not begin during service and is not attributable to service. The Veteran’s statements regarding his current symptoms and in-service events are credible. While the Veteran reports his current symptoms of shortness of breathing and coughing are related to service and his in-service duties while serving in Southwest Asia, the record does not reflect that he has the requisite training or expertise to offer a medical opinion linking a current disability to service decades earlier and he is not competent to provide a nexus opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board notes that the medical evidence is more probative and credible than the lay opinions of record. The Board gives more probative weight to the competent medical evidence specifically the July 2017 VA opinion which found it is less likely than not that the Veteran’s COPD is related to environmental hazards while serving in Southwest Asia. The examiner noted the Veteran has a history of smoking and smoking is known to cause COPD. The vast majority of cases of COPD are attributable to cigarette smoking, and the Veteran’s COPD is most likely related to his history of smoking. The examiner found the Veteran’s COPD represents a diagnosable condition with a clear and specific etiology and is less likely than not related to service. In addition, the Board finds the clinical examination at separation in April 1991 noting no disease or injury was found attributed to the Veteran’s service in Desert Shield/Storm is entitled to probative weight. The Board has considered the Veteran’s lay statements however, the Board gives more probative weight to the competent medical evidence specifically, the 2017 VA examination. In addition, although the Veteran served during the Persian Gulf War, he cannot establish service connection for an undiagnosed illness under 38 C.F.R. § 3.317, because there is no indication of an undiagnosed illness, rather the Veteran’s symptomatology has been attributed to COPD a known chronic disability. As noted above the claimed condition has been shown to be have a clear diagnosis with conclusive pathophysiology and etiology and not part of a medically unexplained chronic multi symptom illness in this Veteran’s case. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for COPD. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55–57 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. 2. Entitlement to service connection for hypertension The Veteran contends that his current hypertension began in-service and has continued since. Specifically, the Veteran contends that his exposure to environmental hazards while stationed in Southwest Asia resulted in his current hypertension. The Veteran is competent to describe his ongoing symptoms, in-service duties and his statements are credible. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event or disease. The Veteran has a diagnosis of hypertension. The Veteran contends that his hypertension began in-service and is related to his service in Southwest Asia. The Veteran’s DD 214 notes service in support of Operation Desert Shield/Storm in Southwest Asia from January 1991 to April 1991. STRs have been associated with the claims file. At separation in April 1991 on the report of medical history the Veteran denied high or low blood pressure. The examiner noted that the Veteran had no medical problems related to Desert Shield/Storm. An August 1994 report of medical examination during the Veteran’s National Guard service noted normal evaluation of the heart and blood pressure was 122/80. In light of the Veteran’s consistent statements and the evidence of record, including in-service duties there is credible evidence indicating some form of a possible in-service injury from exposure to environmental hazards while serving in Southwest Asia is satisfied. However, the service records do not support an onset of the Veteran’s hypertension during active service. At separation the Veteran denied high blood pressure and the examiner noted no medical problems related to his service in Desert Shield/Storm. Additionally, treatment records in 1994 during his National Guard service note blood pressure readings within normal limits. The issue is whether the Veteran’s current hypertension is related to service. The Veteran was afforded VA examination in October 2015. The Veteran has a diagnosis of hypertension. The Veteran contends he was diagnosed with hypertension soon after service and his hypertension is due to exposure to environmental hazards during service in Southwest Asia. The examiner noted that hypertension is a condition with uncertain etiology, however, presents with well-defined risk factors and commonly occurs in the U.S. The examiner found it was less likely than not that his hypertension was related to exposure to environmental hazards while serving in Southwest Asia. Then, in a September 2016 VA opinion the examiner noted that while hypertension is a condition with uncertain etiology, it presents with well-defined risk factors and commonly occurs in the U.S. The examiner noted that there is no reason to find that the Veteran’s service in Southwest Asia and exposure to environmental hazards would have resulted in an increased risk of the Veteran acquiring hypertension and it is less likely than not that his hypertension resulted from exposure to environmental hazards during service in Southwest Asia. In addition, the Veteran was afforded a VA opinion in July 2017. The examiner noted it is less likely than not that the Veteran’s hypertension first manifested in 1990-1991 and that his hypertension is a result of his exposure to environmental hazards during service in Southwest Asia. The examiner noted that hypertension is a diagnosable condition with an uncertain etiology, but with well-defined risk factors and very commonly occurs in the U.S. As hypertension is very common in the U.S. the examiner noted no reason to suspect that service in Southwest Asia would result in an increased risk of the Veteran developing hypertension. The examiner noted that the Veteran’s STRs are absent indications of hypertension, and in-service rigorous exercises required during active duty would reduce the risk of hypertension. The examiner found no theoretical basis to conclude that the Veteran’s current hypertension is causally related to his active service. VA and private treatment records have been associated with the claims file. These treatment records do not contradict the VA examinations and are absent indications of a relationship between the Veteran’s current hypertension and in-service events. After consideration of all the evidence of record, the Board finds that the preponderance of the evidence is against finding that service connection for hypertension is warranted. The Board concludes that service connection is not warranted as the Veteran’s current hypertension did not begin during service and is not attributable to service. The Veteran’s statement regarding his current symptoms and in-service events are credible. While the Veteran reports his hypertension began in service and is related to his service in Southwest Asia, the record does not reflect that he has the requisite training or expertise to offer a medical opinion linking a current disability to service decades earlier and he is not competent to provide a nexus opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board notes the medical evidence is more probative and credible than the lay opinions of record. The Board gives more probative weight to the competent medical evidence, specifically the July 2017 VA examination which finds it is less likely than not that the Veteran’s hypertension first manifested in 1990-1991 and that his hypertension is a result of his exposure to environmental hazards during service in Southwest Asia. The examiner noted that hypertension is a diagnosable condition with an uncertain etiology, but with well-defined risk factors and very commonly occurs in the U.S. As hypertension is very common in the U.S. the examiner noted no reason to suspect that service in Southwest Asia would result in an increased risk of the Veteran developing hypertension. The examiner noted that the Veteran’s STRs are absent indications of hypertension, and in-service rigorous exercises required during active duty would reduce the risk of hypertension. The examiner found no theoretical basis to conclude that the Veteran’s current hypertension is causally related to his active service. Further, the Board notes that the clinical examination at separation in April 1991 noting no disease or injury was found attributed to the Veteran’s service in Desert Shield/Storm is entitled to probative weight. The Board has considered the Veteran’s lay statements however, the Board gives more probative weight to the competent medical evidence specifically, the July 2017 VA examination. Although the Veteran served during the Persian Gulf War, he cannot establish service connection for an undiagnosed illness under 38 C.F.R. § 3.317, because there is no indication of an undiagnosed illness, rather the Veteran’s symptomatology has been attributed to hypertension a known chronic disability. As noted above the claimed condition has been shown to be have a clear diagnosis with conclusive pathophysiology and etiology and not part of a medically unexplained chronic multi symptom illness in this Veteran’s case. In addition, the Board concludes that, while the Veteran has hypertension, which is a chronic disease under 38 U.S.C. § 1101(3)/38 C.F.R. § 3.309(a), it was not chronic in service or manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. Hypertension was not “noted” during service or within one year of separation. See Walker, 708 F.3d 1331. At separation in April 1991 on the report of medical history the Veteran denied high or low blood pressure. The examiner noted that the Veteran had no medical problems related to Desert Shield/Storm. An August 1994 report of medical examination during the Veteran’s National Guard service noted normal evaluation of the heart and blood pressure was 122/80. In light of the Veteran’s consistent statements and the evidence of record, including in-service duties there is credible evidence indicating some form of an in-service injury is satisfied. However, the service records do not support an onset of the Veteran’s hypertension during active service. At separation the Veteran denied high blood pressure and the examiner noted no medical problems related to his service in Desert Shield/Storm. Additionally, treatment records in 1994 during his National Guard service note blood pressure readings within normal limits. See 38 U.S.C. § 1154; 38 C.F.R. § 3.303(a). However, based on the probative evidence of record the Board finds that the Veteran’s hypertension did not manifest within the one-year period after service and service connection is not warranted on a presumptive basis. VA treatment records note the Veteran was not diagnosed with hypertension until at the earliest 2004, over a decade after service. In addition, in weighing the evidence of record the Board finds the competent and credible evidence of record is against finding continuity of symptomatology. As a result, service connection based on continuity of symptomology is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for hypertension. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55–57 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. 3. Entitlement to service connection for a skin disorder The Veteran contends that service connection is warranted for a skin disorder which began in-service and has continued since. The Veteran contends that his current eczema began in-service and is related to environmental exposures while serving in Southwest Asia. The Veteran is competent to describe his ongoing symptoms, in-service duties and his statements are credible. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event or disease. The Veteran has a diagnosis of eczema. The Veteran contends while serving in Southwest Asia he was exposed to environmental hazards that resulted in his current eczema. The Veteran’s DD 214 notes service in support of Operation Desert Shield/Storm in Southwest Asia from January 1991 to April 1991. STRs have been associated with the claims file. October 1974 and April 1977 treatment records note the Veteran was seen for a rash on his back, neck, arms and stomach in large blotches. The Veteran reported itchiness and the examiner noted a diagnosis of tinea versicolor. One examiner diagnosed “dry skin.” At separation during the Veteran’s first period of service in April 1980 on the report of medical examination clinical evaluation of the skin was normal. In August 1985, the Veteran was treated for cellulitis on the neck that resolved. During the Veteran’s second period of service at separation in April 1991 on the report of medical history the Veteran denied skin disease. The examiner noted that the Veteran had no medical problems related to Desert Shield/Storm. In light of the Veteran’s consistent statements and the evidence of record, including in-service duties, there is credible evidence indicating a possible in-service injury from exposure to environmental hazards while serving in Southwest Asia. However, the service records do not support an onset of the Veteran’s eczema during active service. At separation the Veteran denied skin disease and the examiner noted no medical problems related to his service in Desert Shield/Storm. Additionally, treatment records in August 1994 during the Veteran’s National Guard service noted a normal clinical evaluation of the skin. The issue is whether the Veteran’s current eczema is caused by service. The Veteran was afforded a VA examination in April 2010. The Veteran reported an ongoing skin rash with dry skin on his leg which is nonpainful but pruritic and began after serving in Southwest Asia. The examiner noted atopic dermatitis, with an eczematous rash involving the right distal leg measuring 3.6% of total body surface area. Then, the Veteran was afforded a VA examination in March 2011. The examiner noted that the Veteran’s atopic dermatitis and eczematous rash involving the right distal leg is a disease with a clear and specific etiology and diagnosis. The examiner found the Veteran’s atopic dermatitis and eczematous rash was less likely than not related to a specific exposure experienced by the Veteran while serving in Southwest Asia. The examiner noted the Veteran was not diagnosed with atopic dermatitis until 2004, many years after service in Southwest Asia and Gulf War exposure. In addition, the Veteran was afforded a VA examination in June 2013. The examiner noted it is less likely than not that the Veteran’s current skin condition has been caused by his service. The examiner noted that the Veteran was noted to have a skin rash in-service which was identified as tinea versicolor, which is very different in appearance from a lichenified rash. Thus, suggesting that the Veteran’s current skin condition and his in-service rash are two separate unrelated processes. The examiner noted a review of the medical literature on dermatologic conditions supporting such a conclusion. Next, the Veteran was afforded a VA examination in October 2015. The examiner noted a diagnosis of eczema or dermatitis. The Veteran contends his current skin condition is due to environmental hazards while serving in Southwest Asia, including a rash on his face and feet. Examination noted eczema on less than 5% of the Veteran’s total body area with dry flaky patches with slight erythema on the face and feet. The examiner noted that eczema is a diagnoseable condition with a partially explained etiology which occurs commonly in the U.S. The examiner found it was less likely than not that his eczema was related to his exposure to environmental hazards while serving in Southwest Asia. Then, in an August 2016 opinion the examiner noted the Veteran had some skin complaints in-service with a diagnosis of tinea versicolor, however there was no evidence in the Veteran’s STRs to indicate the onset of his eczema was in-service. Lastly, the Veteran was afforded a VA opinion in July 2017. The examiner noted it is less likely than not that the Veteran’s current eczema is attributable to active service, to include environmental hazards exposed to in Southwest Asia. The examiner noted that eczema is a diagnosable condition with a partially explained etiology which very commonly occurs in the U.S. The examiner noted that the Veteran’s service in Southwest Asia did not result in an increased risk of acquiring eczema. Additionally, the examiner found the Veteran’s eczema is less likely than not attributable to active service, as the Veteran’s STRs are absent indications of eczema, and there is no theoretical basis to conclude that eczema would be causally related to active service without evidence of the disease occurring while on active duty. VA and private treatment records have been associated with the claims file. Treatment records note rash at times. These treatment records do not contradict the VA examinations and are absent indications of a relationship between the Veteran’s current eczema and in-service events. After consideration of all the evidence of record, the Board finds that the preponderance of the evidence is against finding that service connection for a skin disorder is warranted. The Board concludes that service connection is not warranted as the Veteran’s current eczema did not begin during service and is not attributable to service. The Veteran’s statements regarding his current symptoms and in-service events are credible. While the Veteran reports his current symptoms of ongoing rash begin while serving in Southwest Asia, the record does not reflect that he has the requisite training or expertise to offer a medical opinion linking a current disability to service decades earlier and he is not competent to provide a nexus opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board notes that the medical evidence is more probative and credible than the lay opinions of record. The Board finds more probative weight to the competent medical evidence specifically the June 2013 and July 2017 VA examination and opinions. In June 2013 the examiner found it is less likely than not that the Veteran’s current skin condition has been caused by his service. The examiner noted that the Veteran was noted to have a skin rash during his first period of active service which was identified as tinea versicolor, which is very different in appearance from a lichenified rash. Thus, suggesting that the Veteran’s current skin condition and his in-service rash are two separate unrelated processes. The examiner noted a review of the medical literature on dermatologic conditions supporting such a conclusion. Then in a July 2017 opinion the examiner found it is less likely than not that the Veteran’s current eczema is attributable to active service, to include environmental hazards exposed to in Southwest Asia. The examiner noted that eczema is a diagnosable condition with a partially explained etiology which very commonly occurs in the U.S. The examiner noted that the Veteran’s service in Southwest Asia did not result in an increased risk of acquiring eczema. Additionally, the examiner found the Veteran’s eczema is less likely than not attributable to active service, as the Veteran’s STRs are absent indications of eczema, and there is no theoretical basis to conclude that eczema would be causally related to active service without evidence of the disease occurring while on active duty. The Board has considered the Veteran’s lay statements however, the Board gives more probative weight to the competent medical evidence specifically, the June 2013 and July 2017 VA examination and opinions. In addition, although the Veteran served during the Persian Gulf War, he cannot establish service connection for an undiagnosed illness under 38 C.F.R. § 3.317, because there is no indication of an undiagnosed illness, rather the Veteran’s symptomatology has been attributed to eczema a known chronic disability. As noted above the claimed condition has been shown to be have a clear diagnosis with conclusive pathophysiology and at least a partially explained etiology but not part of a medically unexplained chronic multi symptom illness in this Veteran’s case. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for a skin disorder. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55–57 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. 4. Entitlement to service connection for a left foot disability The Veteran contends that his left foot disability is related to service and specifically his service in Southwest Asia. The Veteran contends he was exposed to environmental hazards while serving in Southwest Asia, and in-service underwent a cold weather injury, and an injury to his left foot after a heavy object fell on his foot. The Veteran is competent to describe his ongoing symptoms, in-service duties and his statements are credible. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event or disease. The Veteran has a diagnosis of left foot hallux valgus, metatarsalgia and arthritis. The Veteran contends that his left foot disability began in-service and is related to his service in Southwest Asia, his in-service cold injury and the falling of a heavy object on his foot. The Veteran’s DD 214 notes service in support of Operation Desert Shield/Storm in Southwest Asia from January 1991 to April 1991. As noted above service connection for a right and left lower extremity disability due to a cold injury was granted in a February 2018 rating decision. STRs have been associated with the claims file. In July 1976 the Veteran was seen for a dressing change for a laceration on his left foot, a laceration on the third toe was noted, and he returned daily for 72 hours for examination, cleaning and dressing, no gross infection was noted and he was cleared to return to duty. At separation in April 1991 on the report of medical history the Veteran denied swollen or painful joints, loss of toe or foot trouble. The examiner noted that the Veteran had no medical problems related to Desert Shield/Storm. An August 1994 report of medical examination during the Veteran’s National Guard service noted a normal clinical evaluation of the lower extremities. In light of the Veteran’s consistent statements and the evidence of record, including in-service duties there is credible evidence indicating some form of an in-service injury is satisfied. However, the service records do not support an onset of the Veteran’s left foot disability during active service. At separation the Veteran denied swollen or painful joints, loss of toe or foot trouble and the examiner noted no medical problems related to his service in Desert Shield/Storm. Additionally, treatment records in 1994 during his National Guard service noted a normal clinical evaluation of the lower extremities. The issue is whether the Veteran’s current left foot disability is caused by service. The Veteran was afforded a VA examination in March 2011. The examiner noted bilateral hallux valgus. The examiner found that hallux valgus is a disease with a clear and specific etiology and diagnosis, and is less likely than not related to the Veteran’s service in Southwest Asia and exposure to environmental hazards. The examiner noted there was no specific exposure event while serving in Southwest Asia which would explain his mild bunions. Then, the Veteran was afforded a VA examination in October 2015. The examiner noted right and left foot gout. The Veteran reported numbness and tingling in his left lower extremity, intermittently, and began after he was hit with an object on his left foot in-service. The Veteran reported 2 gout attacks in the past year or two, and during these attacks limiting his mobility. The examiner noted gout is a condition with a clear and specific etiology and is less likely than not a result from exposure to environmental hazards while serving in Southwest Asia. In addition, the Veteran was afforded a VA examination in August 2017. The examiner noted bilateral hallux valgus, metatarsalgia and arthritis. The Veteran reports in-service he injured his left foot when a heavy object fell on his foot. He reports no ongoing issues from this injury, but at noted recurrent numbness in his foot when exposed to cold temperatures. On examination the Veteran reported left foot pain and decreased weightbearing tolerance which interferes with standing. The examiner noted the Veteran’s foot disability impacts his current employment as he is unable to tolerate prolonged weight bearing. The examiner found that the Veteran’s foot disability is less likely than not related to service. The examiner noted there is no documentation, complaints or evaluation of a condition that is consistent with the Veteran’s current symptoms or diagnosis. Further, the examiner attributed the Veteran’s difficulty with weight bearing, decreased cold tolerance and numbness to his in-service cold injury in 1978. The examiner noted that the Veteran’s current symptoms are at least as likely as not related to his in-service cold injury. VA and private treatment records have been associated with the claims file. These treatment records do not contradict the VA examinations and are absent indications of a relationship between the Veteran’s current left foot disability and in-service events. After consideration of all the evidence of record, the Board finds that the preponderance of the evidence is against finding that service connection for a left foot disability is warranted. The Board concludes that service connection is not warranted as the Veteran’s current left foot disability did not begin during service and is not attributable to service. The Veteran’s statements regarding his current symptoms and in-service events are credible. While the Veteran reports his left foot disability began in service and is related to his service in Southwest Asia, and an in-service injury, the record does not reflect that he has the requisite training or expertise to offer a medical opinion linking a current disability to service decades earlier and he is not competent to provide a nexus opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board notes the medical evidence is more probative and credible than the lay opinions of record. The Board gives more probative weight to the competent medical evidence, specifically the October 2015 and August 2017 VA examinations. In October 2015 the examiner noted left foot gout, and found that gout is a condition with a clear and specific etiology and is less likely than not a result from exposure to environmental hazards while serving in Southwest Asia. Then in August 2017 the examiner noted bilateral hallux valgus, metatarsalgia and arthritis. The Veteran reports in-service he injured his left foot when a heavy object fell on his foot. He reports no ongoing issues from this injury, but at noted recurrent numbness in his foot when exposed to cold temperatures. The examiner found that the Veteran’s left foot disability is less likely than not related to service. The examiner noted there is no documentation, complaints or evaluation of a condition that is consistent with the Veteran’s current symptoms or diagnosis. Further, the examiner attributed the Veteran’s difficulty with weight bearing, decreased cold tolerance and numbness to his in-service cold injury in 1978. The examiner noted that the Veteran’s current symptoms are at least as likely as not related to his in-service cold injury and not his diagnosed left foot disability. Further the Board notes that the clinical examination at separation in April 1991 noted no disease or injury was found attributed to the Veteran’s service in Desert Shield/Storm and is entitled to probative weight. The Board has considered the Veteran’s lay statements however, the Board gives more probative weight to the competent medical evidence specifically the October 2015 and August 2017 VA examinations. Although the Veteran served during the Persian Gulf War, he cannot establish service connection for an undiagnosed illness under 38 C.F.R. § 3.317, because there is no indication of an undiagnosed illness, rather the Veteran’s symptomatology has been attributed to hallux valgus, gout, metatarsalgia and arthritis all of which are known chronic disabilities. As noted above the claimed conditions have been shown to be have a clear diagnosis with conclusive pathophysiology and etiology and not part of a medically unexplained chronic multi symptom illness in this Veteran’s case. In addition, the Board concludes that, while the Veteran has arthritis, which is a chronic disease under 38 U.S.C. § 1101(3)/38 C.F.R. § 3.309(a), it was not chronic in service or manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. Arthritis was not “noted” during service or within one year of separation. See Walker, 708 F.3d 1331. At separation in April 1991 on the report of medical history the Veteran denied joint pain, toe or foot trouble. The examiner noted that the Veteran had no medical problems related to Desert Shield/Storm. An August 1994 report of medical examination during the Veteran’s National Guard service noted normal evaluation of the lower extremities. In light of the Veteran’s consistent statements and the evidence of record, including in-service duties there is credible evidence indicating some form of an in-service injury is satisfied. However, the service records do not support an onset of the Veteran’s arthritis during active service. At separation the Veteran denied arthritis, painful joints or foot trouble and the examiner noted no medical problems related to his service in Desert Shield/Storm. Additionally, treatment records in 1994 during his National Guard service note clinical evaluation of the lower extremities was within normal limits. See 38 U.S.C. § 1154; 38 C.F.R. § 3.303(a). However, based on the probative evidence of record the Board finds that the Veteran’s arthritis did not manifest within the one-year period after service and service connection is not warranted on a presumptive basis. In addition, in weighing the evidence of record the Board finds the competent and credible evidence of record is against finding continuity of symptomatology. As a result, service connection based on continuity of symptomology is not warranted. (Continued on the next page)   In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for a left foot disability. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55–57 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Kardian