Citation Nr: 18160032 Decision Date: 12/20/18 Archive Date: 12/20/18 DOCKET NO. 16-35 140 DATE: December 20, 2018 ORDER Entitlement to service connection for a skin condition, to include erythema multiforme, is denied. FINDING OF FACT The Veteran’s skin condition, to include erythema multiforme, is not etiologically related to active service. CONCLUSION OF LAW The criteria for entitlement to service connection for a skin condition, to include erythema multiforme, have not been met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from September 1998 to October 2005. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a December 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for skin condition, to include erythema multiforme Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. “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.” Holton v. Shineski, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting 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. 38 C.F.R. § 3.303 (b). If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. The Board notes that the U.S. Court of Appeals for the Federal Circuit recently clarified that the continuity of symptomatology language in § 3.303(b) is limited to the chronic diseases listed under 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). In making all determinations, the Board must fully consider the lay assertions of record. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159 (a)(2). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. The Veteran seeks service connection for a skin condition, namely erythema multiforme. The Veteran contends that her skin condition is potentially a result of contaminated drinking water that she ingested while on active duty in Camp Lejeune and vaccinations that were required by the military. She further contends that the onset of her currently diagnosed erythema multiforme began in service and has been misdiagnosed over the years. The Veteran states that her condition has worsened since service and is only mitigated with the prescribed medications for erythema multiforme. The Veteran has a current diagnosis for erythema multiforme. VA treatment records associated with her claims file indicate that a diagnosis of erythema multiforme was provided by a private physician, Dr. Manion, in 2009. See April 2016 VA examination. The Veteran underwent a VA examination in May 2015. At the time of the exam, the Veteran was 3 months pregnant and received a routine check-up. The examiner opined that the Veteran’s erythema multiforme was associated with her herpes simplex virus (HSV) diagnosis. The Veteran informed the examiner that she had been diagnosed with HSV after a skin biopsy but had not experienced any breakouts. See May 14, 2015 VA examination. The Veteran underwent a VA examination in connection with this claim in April 2016. The examiner reviewed all of the Veteran’s available medical records and found that the current erythema multiforme diagnosis was less likely than not related to or caused by the Veteran’s military service. The examiner opined that a review of the Veteran’s service treatment records (STR) does not affirm a skin condition clinically consistent with erythema multiforme. Additionally, the Veteran’s medical records from a civilian dermatologist established the onset of the current skin condition, erythema multiforme, approximately two years after her separation from service. The preponderance of the probative evidence does not indicate that the Veteran’s current diagnosis of erythema multiforme is related to her active duty service. There are no competent medical opinions of record to the contrary. Because there has otherwise been presented no probative basis to discount the probative weight of the VA examiner’s opinion, the Board must rely on it to resolve the complex medical issues raised by the direct theories of entitlement. The Veteran submitted statements that she believes that her current skin condition is as a result of water she ingested during service or required vaccinations that were administered. The Board observes that, while the Veteran is competent to report symptoms that she has experienced related to her skin condition, she is not competent to provide a nexus opinion linking her current skin condition to active duty service as she is a lay person without the requisite medical training and experience to competently do so. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As such, her opinion is not adequate to rebut the VA examiner’s opinion. (Continued on the next page)   Therefore, as the evidence of record does not establish that the Veteran’s skin conditions are related to active service, service connection for all skin conditions, to include erythema multiforme, is not warranted. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Smith, Associate Counsel