Citation Nr: 18158861 Decision Date: 12/18/18 Archive Date: 12/17/18 DOCKET NO. 17-00 996 DATE: December 18, 2018 ORDER Service connection for alopecia (male pattern baldness) is denied. FINDING OF FACT The preponderance of the evidence shows that the Veteran’s hair loss is attributable to a known clinical diagnosis, which was not incurred in or permanently aggravated by service, and is otherwise unrelated to active service. CONCLUSION OF LAW The criteria for service connection for alopecia have not been met. 38 U.S.C. §§ 1110, 1117, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the United States Army from February 2003 to February 2014 and is a recipient of the Combat Action Badge. The service separation form shows that the Veteran served in the Southwest Asian Theater of Operations. The Veteran also served in the Army National Guard from August 2002 to February 2003. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. 1. Service connection for alopecia Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, to prevail on a claim of service connection on the merits, there must be competent evidence of (1) a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence or other competent evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Hickson v. West, 12 Vet. App. 247 (1999); Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). In evaluating the evidence in any given appeal, the Board must provide reasons and bases supporting a decision. However, there is no need to discuss, in detail, the evidence submitted by the Veteran or on behalf of the Veteran. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence of record. The Veteran should not assume that the Board has overlooked pieces of evidence that are not explicitly discussed. Timberlake v. Gober, 14 Vet. App. 122 (2000). The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the Veteran. Equal weight is not given to each piece of evidence contained in the record. Every item of evidence does not have the same probative value. When the evidence is assembled, the Board is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran asserts his currently diagnosed alopecia is etiologically related to and aggravated by service. Specifically, the Veteran contends that intense itching of his scalp, which began while he was stationed in Southwest Asia, caused him to scratch frequently and as a result, he is now bald. The Veteran also contends that his hair loss would have been treated if he had not served in the Army and thus, as a result of being in the Army, he has more hair loss than he would have, had he never joined the Army. Service medical records from October 2013 show that the Veteran had severe dandruff that caused pruritus. As a result, the Veteran kept his head shaved and was prescribed triamcinolone lotion. He was also advised to follow up with his primary care physician. The Veteran’s October 2013 separation examination noted that the Veteran’s scalp had excoriations from scratching with no lesions noted. The Veteran was also noted to have normal male pattern balding. In September 2014 the Veteran underwent a VA examination during which he reported having severe itching of his scalp during his first deployment in Iraq. This itching caused him to scratch his scalp frequently, which he believed was the reason he became bald. The Veteran also noted being on topical medication to minimize the scalp condition since 2004 but did not remember which medication specifically. The Veteran’s skin condition was noted not to cause any benign or malignant skin neoplasms, did not cause any scarring or disfigurement, and did not have any systemic manifestations. During the examination, the Veteran was negative for scarring alopecia and alopecia areata. The examiner did not provide an opinion as to whether the Veteran’s hair loss was caused or aggravated by service. The Veteran was also not given a separate diagnosis for hair loss, but no disorder was found to impact the Veteran’s ability to work. In an October 2016 VA examination, the Veteran was found to have evidence of male pattern baldness, reportedly first diagnosed in 2013, with no patchy hair loss noted over the scalp or other parts of the body. The Veteran was found to have no scarring, disfigurement, or any listed specific skin condition. Nor was the Veteran treated for any skin disorder in the last year. The examiner concluded that the Veteran did not have any skin disorder that affected his ability to work. During this October 2016 examination, the Veteran stated that he began losing his head hair after returning from Afghanistan in 2006 and that he was using over the counter Rogaine to combat it. The examiner concluded that the Veteran’s claimed alopecia was not due to an undiagnosed illness, not a diagnosable but medically unexplained chronic multi-symptom of illness of unknown etiology, not a diagnosable chronic multi-symptom illness with a partially explained etiology, and not related to a specific exposure event/environmental hazard experienced during active service in Southwest Asia. Because the Veteran served in the Southwest Asia Theater of operations during the Persian Gulf War, service connection may be established for certain disabilities under 38 C.F.R. § 3.317. Service connection may be warranted for a Persian Gulf Veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active service in the Southwest Asia Theater of operations during the Persian Gulf War, or to a degree of 10 percent or more. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1). The chronic disability must not be attributed to any known clinical disease by history, physical examination, or laboratory tests. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a). The definition of qualifying chronic disability includes (a) undiagnosed illness, (b) a medically unexplained chronic multi-symptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs or symptoms, and (c) a diagnosed illness that the Secretary of VA determines in regulations prescribed under 38 U.S.C 1117(d) warrants a presumption of service-connection. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(2). Objective indications of a qualifying chronic disability include both signs, in a 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). Signs or symptoms that may be manifestations of undiagnosed illness or a chronic multi-symptom illness include: fatigue, unexplained rashes or other dermatological signs or symptoms, headache, muscle pain, joint pain, neurological signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the upper or lower respiratory system, sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, or menstrual disorders. 38 U.S.C. § 1117(g). The Veteran’s service personnel records show that he served in the Southwest Asia Theater of Operations. Thus, for purposes of entitlement to compensation under 38 C.F.R. § 3.317(d), his status as a Persian Gulf Veteran is confirmed. Accordingly, the Board must now consider whether service connection is warranted under 38 C.F.R. § 3.317 or under any other alternate basis for the claimed disabilities. However, based on a careful review of the evidence of record, including the Veteran’s service and post-service medical records, and, in particular, the October 2016 VA examiners’ opinions, the Board finds that the Veteran’s current symptoms is attributable to the known clinical diagnoses of alopecia (male pattern baldness). Therefore, service connection for alopecia cannot be granted due to an undiagnosed illness due to service in the Persian Gulf as those claimed disabilities are medical diagnosed. 38 C.F.R. § 3.317. Nor is service connection otherwise warranted on a direct basis for alopecia. First, with respect to the currently diagnosed alopecia, the Board finds that the preponderance of the evidence does not establish a nexus between that disability and qualifying active service. Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). On the contrary, the evidence weighs against such a finding as the October 2016 VA examiner determined that the Veteran’s claimed disability was not related to a specific exposure event or environmental hazard experienced during active service in Southwest Asia. The Board considers the VA examiners’ opinions to be highly probative and persuasive. Moreover, the Veteran has not submitted any competent medical evidence suggesting a nexus between alopecia and active service, including documented Gulf War service. Accordingly, the Board finds that direct service connection is not warranted for the claimed disabilities. Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000). In terms of the contention that the Veteran’s hair loss would be less severe had he not joined the Army because he would have treated the disorder sooner, the Board finds there to be no basis for that argument. The Veteran has produced no evidence that his male pattern baldness has not followed the ordinary course of the disorder or that it was aggravated by service. Nor is there any indication that VA or the Army failed to treat any health issue raised by the Veteran during or after service. The Veteran was provided creams for pruritis of the scalp during service. But, the VA examiner opined that the current hair loss was due to male pattern baldness and not the pruritis during service. The Board is mindful of the Veteran’s assertions that his alopecia is related to active duty. The Board finds that the Veteran is competent to report a history of hair loss symptoms, which are capable of lay observation. 38 C.F.R. § 3.307(b); Barr v. Nicholson, 21 Vet. App. 303 (2007), Layno v. Brown, 6 Vet. App. 465 (1994). However, to the extent that the Veteran relates those perceived symptoms to active service or pruritis during service, his assertions are not probative. The Board notes that under certain circumstances lay statements may support a claim for service connection by reporting the occurrence of lay-observable events or the presence of disability, or symptoms of disability, susceptible of lay observation. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, the Board finds no basis for concluding that the Veteran is competent to establish the diagnosis and etiology of alopecia in the absence of specialized training. The Board finds the examiners’ opinions more persuasive because of the medical training of the examiners. Consequently, the Veteran’s statements do not constitute competent medical evidence in support of the claim. The Veteran has provided no competent evidence that links his alopecia to service or scratching of a scalp to male pattern baldness. To the extent the Veteran’s statements are competent, the Board finds the VA examiners’ opinions more persuasive because the training and expertise of those examiners. The Board is appreciative of the Veteran’s faithful and honorable service to our country. However, the Board finds that the claim for service connection for alopecia must be denied. Accordingly, as the preponderance of the evidence is against the claim, the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Mondesir, Law Clerk