Citation Nr: 18116366 Decision Date: 07/06/18 Archive Date: 07/05/18 DOCKET NO. 15-20 948 DATE: July 6, 2018 ORDER Entitlement to service connection for vitiligo, to include as due to exposure to herbicides is denied. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran’s vitiligo, was caused by or is etiologically related to active service, to include exposure to herbicides. CONCLUSION OF LAW The criteria for entitlement to service connection for vitiligo, to include as due to exposure to herbicides have not been met. 38 U.S.C. §§ 1110, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served from May 1967 to January 1970. The issue of entitlement to service connection for severe peripheral neuropathy was previously on appeal. However, the RO granted service connection effective January 30, 2013 in a May 2017 rating decision. Therefore, that issue is not presently before the Board. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence 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, 1166 -67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). VA must give due consideration to all pertinent medical and lay evidence in a case where a veteran is seeking service connection. 38 U.S.C. § 1154(a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the veteran. 38 U.S.C. § 5107(b). A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. If a veteran was exposed to an herbicide agent during active military, naval, or air service, the list of diseases provided in 38 C.F.R. § 3.309 (e) shall be service-connected if the requirements of 38 U.S.C. § 1116, 38 C.F.R. § 3.307 (a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113, 38 C.F.R. § 3.307 (d) are also satisfied. In this case, the record reflects that the Veteran served in Vietnam during active military service. The Veteran is therefore presumed to have been exposed to herbicidal agents, to include Agent Orange. 38 U.S.C § 1116 (f). A presumption of service connection based on exposure to herbicides to include Agent Orange used in the Republic of Vietnam during the Vietnam era is not warranted for any condition for which VA has not specifically determined a presumption of service connection is warranted. See 72 Fed. Reg. 32, 30 (2007). Vitiligo is not a disease presumptively associated with herbicide exposure. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307 (a)(6), 3.309(e). Notwithstanding, service connection may be established with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994); see also McCartt v. West, 12 Vet. App. 164, 167-68 (1999) (providing that the provisions set forth in Combee are equally applicable in cases involving claimed Agent Orange exposure). Entitlement to service connection for vitiligo, to include as due to exposure to herbicides The Veteran is seeking service connection for vitiligo. He contends that he has vitiligo due to his herbicide exposure while in service. The Veteran’s service treatment records are negative for any treatment, complaints, or diagnosis regarding a skin condition. Specifically, his separation examination in January 1970 reflects that his skin was normal. During an examination in September 1974, the Veteran reported that over the last three and a half years he noticed progressive skin changes initially beginning on his hands and now covering most of his limbs and trunk. The treating physician diagnosed the Veteran with vitiligo and prescribed Aristocort cream for treatment. As part of this claim, the Board recognizes the Veteran’s statements regarding his history of symptoms. In this regard, while the Veteran is not competent diagnose a disorder such as vitiligo, as it may not be diagnosed by its unique and readily identifiable features, and thus require a determination that is “medical in nature,” he is nonetheless competent to testify about the presence of observable symptomatology, which may provide sufficient support for a claim of service connection, if credible, regardless of the lack of contemporaneous medical evidence. Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007). See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The Board has considered the statements of the Veteran that he has experienced skin problems since his service in Vietnam. However, the Board determines that the Veteran’s reported history of continued symptomatology since active service, while competent, is nonetheless not sound. In addition to the fact that no skin symptoms were mentioned at his separation physical examination, the Veteran reported during his examination in September 1974 that he did not begin experiencing symptoms until three and a half years prior. Therefore, continuity is not established based on the Veteran’s statements. Next, service connection may also be granted when the evidence establishes a medical nexus between active duty service and current complaints. In this case, the Board finds that the weight of the competent evidence does not attribute the Veteran’s claimed vitiligo to active duty, despite his contentions to the contrary. Per the Board remand, the Veteran was afforded a VA examination in January 2017. The examiner opined that the Veteran’s vitiligo was less likely than not due to or a result of his military service. In support of this opinion, the examiner noted that there continues to be insufficient evidence to support an association between Agent Orange exposure and the development of the skin condition of vitiligo. Additionally, the examiner stated the available scientific and medical evidence does not support the conclusion that the condition is associated with herbicide exposure. The Board notes the January 2016 opinion of the Veteran’s private physician who opined that while he can’t say for certainty that vitiligo was caused by exposure to Agent Orange, there does appear to be a temporal relationship since vitiligo first appeared at the end of tour of duty in Vietnam. However, the Board finds the opinion of the January 2017 VA examiner to be of more probative value as his opinion was based on pertinent medical records, an examination of the Veteran, and medical literature from the Institute of Medicine’s Review(s) of Agent Orange. Moreover, as was mentioned above, the Board is unable to accept that the Veteran had vitiligo during active duty purely based on his statements. The Boards finds that the preponderance of the evidence is against the claim for service connection for vitiligo. It is not in dispute that the Veteran has a current diagnosis of vitiligo. However, as noted above, there is no evidence of complaints, treatment, or diagnosis of a skin disability during service. Therefore, service connection for a skin disability on the basis that vitiligo began during service and persisted since is not warranted. Vitiligo is not listed as a chronic disease under 38 C.F.R. § 3.309 (a); therefore, the presumptive provisions in 38 U.S.C. § 1112 for such diseases do not apply, and service connection for vitiligo on a presumptive basis as a chronic disease under 38 U.S.C. § 1112 is not warranted. The Board accepts that the Veteran is competent to report his symptoms, the onset of those symptoms, and treatment. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, in this case, the Veteran is not competent to diagnose himself as having vitiligo that is etiologically related to herbicide exposure in service, as he lacks the requisite medical training to provide a competent opinion on complex medical matters that are not susceptible to lay observation. See Andrea v. Nicholson, 492 F.3d. 1372 (2007); Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (although it is error to categorically reject a non-expert opinion as to etiology, or nexus, not all questions of nexus are subject to non-expert opinion; whether a layperson is competent to provide a nexus opinion depends on the facts of the particular case).   In summary, the Veteran’s service treatment records do not show vitiligo in service and no medical professional has ever attributed the Veteran’s vitiligo to his active duty service, to include exposure to Agent Orange, nor is the Veteran competent to make such a link. Based on the foregoing, service connection is not warranted. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Vample, Associate Counsel