Citation Nr: 19196462 Decision Date: 12/27/19 Archive Date: 12/27/19 DOCKET NO. 14-24 638A DATE: December 27, 2019 ORDER Entitlement to service connection for a skin disability is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s skin disability was incurred in or otherwise related to service. The preponderance of the evidence is against finding that the Veteran’s skin disability is proximately due to or aggravated by her service-connected complex regional pain syndrome. CONCLUSION OF LAW The criteria for service connection for a skin disability have not been met 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from February 1993 to November 1995 and from November 1997 to December 1998. Entitlement to service connection for a skin disability The Veteran contends that her skin disability, to include solar radiation dermatitis and facial lesions, are related to service, and are alternatively related to her service-connected complex regional pain syndrome due to right foot injury with neuroma and related treatment for this disability. At the July 2019 VA examination, the Veteran contended that after a 2006 surgery for neuroma on the Veteran’s right foot, she started to have sores and breakdown of her skin throughout her body. The Veteran attributed changes in her facial skin color due to her complex regional pain syndrome. In a July 2019 statement, the Veteran contended that the July 2019 VA examination was inadequate, because the examiner stated that she was not familiar with the Veteran’s disability, the examiner used inadequate medical knowledge in conducting the examination, the VA examiner inappropriately compared her own skin to that of the Veteran, the VA examiner missed several pertinent pieces of information regarding the Veteran’s disability, and because the examiner lacked empathy for the Veteran’s disability. In the case of competent medical evidence, VA benefits from a presumption that it has properly chosen a person who is qualified to provide a medical opinion in a particular case. It is presumed that VA followed a regular process that ordinarily results in the selection of a competent medical professional. Viewed correctly, the presumption of competence is not about the person or a job title; it is about the process. Further, the provisions of 38 C.F.R. § 3.159(a)(1) state that competent medical evidence is evidence provided by a person who is qualified through education, training or experience to offer medical diagnoses, statements, or opinions. Here the examiner held the degrees in Master of Science in Nursing and Advanced Registered Nurse Practitioner. Accordingly, the Board finds that the examiner was qualified through education, training or experience to offer medical diagnoses, statements, or opinions. With regard to the examination and related opinion, the Board finds that the information collected was fact-based and did not contain any personal commentary or apparent bias from the examiner, and generally matched the findings of VA treatment records. The opinion was based upon objective medical information and supported by a well-reasoned rationale. Accordingly, the Board finds that the July 2019 VA examination is adequate, and VA has fulfilled the duty to assist with regard to the Veteran’s contentions. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for a skin disability. The reasons follow. The Veteran has been diagnosed with a skin disability. For example, in a July 2019 VA examination, the Veteran was diagnosed with solar radiation dermatitis. Thus, there is evidence of a current disability, and the Veteran meets first element of a service-connection claim. As to an in-service disease or injury, the service treatment records (STRs) show that the Veteran was found to have atopic dermatitis in January 1996; eczema and contact dermatitis in May 1998; yeast dermatitis in July 1998; and dermatitis in both axillae, which the examiner opined was related to contact from the Veteran’s deodorant in October 1998. Although the January 1996 finding of atopic dermatitis is not shown to be during a period of active service or ACDUTRA, the remaining records support a finding of complaints or symptoms related to a skin disability during service, and the in-service disease or injury element is met. As to evidence of a nexus between the current disability and service, the Board finds that the preponderance of the evidence is against such a nexus. For example, in a July 2019 VA examination, the examiner opined that the Veteran’s skin disability was not related to or otherwise incurred in service. The examiner provided the rationale that this skin condition, namely solar radiation dermatitis, was not found in service, therefore it was less likely than not related to service. This opinion establishes that a skin disability is not related to service. Although the Veteran claims that a skin disability is related to service, she is not medically trained, and is therefore not qualified to competently opine about medical etiology. In certain instances, lay testimony may be competent to establish medical etiology or nexus. However, the diagnosis of a skin disability requires specialized training for determinations as to diagnosis and causation, and is therefore, not susceptible to lay opinions on etiology. The origin or cause of the Veteran’s skin disability is not a simple question that can be determined based on mere personal observation by a lay person, the Veteran’s lay assertion is not competent to establish a nexus. Therefore, as the evidence does not support a relationship between a skin disability and service, the nexus element is not met. As to secondary service connection, in a January 2015 skin diseases disability and benefits questionnaire, the examiner noted that the Veteran had a current diagnosis of trophic changes consistent with complex regional pain syndrome and noted that the Veteran was undergoing medical treatment for related symptoms. In a September 2015 VA treatment record, the Veteran was found to have complex regional pain syndrome with trophic changes in skin. Although these records tend to associate the Veteran’s service-connected complex regional pain syndrome with the Veteran’s skin disability, the Board affords them no probative value, as they do not offer any rationale for how the two disabilities are related. In a July 2019 VA examination, the examiner opined that the Veteran’s skin disability is not proximately due to or aggravated by her service-connected complex regional pain syndrome (CRPS). The VA examiner provided the rationale that although medical literature supports that complex regional pain syndrome can cause changes in the skin, the literature does not support that a systemic skin disability would be caused by this syndrome. The VA examiner also stated that CRPS in the right lower leg would not cause body wide skin variances, such as those found with solar radiation dermatitis, or lesions in the face. This opinion establishes that a skin disability is not proximately due to or aggravated by service-connected complex regional pain syndrome due to right foot injury with neuroma. In sum, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for a skin disability. The benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107(b) is not applicable, as there is no approximate balance of evidence. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Husain, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.