Citation Nr: 19123795 Decision Date: 03/29/19 Archive Date: 03/29/19 DOCKET NO. 12-05 494 DATE: March 29, 2019 ORDER Entitlement to service connection for dry eye syndrome is granted. REMANDED Entitlement to service connection for dermatophytosis is remanded. Entitlement for service connection for left hand numbness in the fingers is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include adjustment disorder with anxiety and depressed mood and depression, is remanded. FINDING OF FACT The Veteran’s dry eye syndrome had its onset in service. CONCLUSION OF LAW The criteria for service connection for dry eye syndrome have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from January 1983 to January 2009. This matter comes before the Board of Veterans Appeals (Board) on appeal from a July 2010 rating decision of the Department of Veterans Affairs (VA), Regional Office (RO). In a March 2017 decision, the Board remanded the issues for further development. In its July 2010 rating decision, the RO denied service connection for depression because the records did not reflect a diagnosis or a nexus between depression and service. However, the Board notes that the Veteran has been diagnosed with depression as well as adjustment disorder with anxiety and depressed mood. Furthermore, the Veteran did not file a claim to receive benefits only for a particular diagnosis, but for the affliction (symptoms) associated with any psychiatric disorder. See Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009). Pursuant to the holding in Clemons, the Board will consider the Veteran’s claim as more broadly encompassing a claim for an acquired psychiatric disorder. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Lay persons may provide evidence of diagnosis and nexus under 38 U.S.C. § 1154(a). See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In relevant part, 38 U.S.C. § 1154(a) (2012) requires that VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). “[L]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (“[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence”). Th Veteran contends that he has dry eye syndrome that is due to or related to service, to include due to exposure to environmental hazard while deployed in Saudi Arabia for 90 days beginning in December 1996. Service treatment records (STRs) in 2008 document a diagnosis of dry eye syndrome. VA treatment records in October 2014 indicate dry eye syndrome on the medical problem list. A May 2017 VA examination report diagnosed dry eye syndrome with a date of onset in April 2008. The Veteran reported that the condition began while on deployment with light sensitivity and infections in the eyes, and that it had worsened over time. The examiner opined that the condition was less likely than not due to service but stated in the rationale that “records show dry eye syndrome throughout condition persists.” In a December 2017 addendum, the examiner opined that “dry eye was not related to service. May have come from environment or something else but it is not related to service.” Based on the evidence of record, the Board finds that service connection for dry eye syndrome is warranted. As noted, service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service. This includes a situation in which a disease had its onset in service even though it was not actually caused by something in service. 38 C.F.R. § 3.303(a) (“service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces”). Reading the opinions as a whole and in the context of the evidence of record, it appears to the Board that the examiner was saying that although the Veteran’s current dry eye syndrome had its onset in service, it was not specifically caused by something that happened in service. Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012). However, such a causation mechanism is not necessarily required to grant service connection. Given that the examiner indicated that the Veteran’s current dry eye syndrome began in service, entitlement to service connection under 38 C.F.R. § 3.303(a) is warranted. REASONS FOR REMAND 1. Entitlement to service connection for dermatophytosis is remanded. The Veteran contends that he has dermatophytosis related to or incurred in service. STRs document several skin problems throughout service, to include tinea, dermatitis, eczema, and lichen planus. The Veteran is currently service-connected for lichen planus. A June 2017 VA examination report diagnosed lichen planus and dermatophytosis, with a date of onset of the symptoms in 2007. The Veteran stated that his skin conditions began insidiously. The examiner found that the Veteran had intermittent occurrence of dermatophytosis without current symptoms and did not provide an opinion regarding the condition. Given the VA examiner’s diagnosis of dermatophytosis, the Veteran’s in-service diagnoses of skin conditions, and the intermittent nature of the disease, the Board finds that a remand is required to obtain a VA examination and opinion on the nature and etiology of the Veteran’s dermatophytosis regardless of whether the Veteran is currently experiencing an occurrence of the condition. See Barr, 21 Vet. App. at 30. 2. Entitlement for service connection for left hand numbness in fingers is remanded. The Veteran contends that he has left hand numbness in the fingers due to or incurred during service. STRs in March 2004 document complaints of possible infection in warts of the left hand, third digit. The Veteran was treated with liquid nitrogen about two weeks prior for warts on the “tuft of his left index finger and palmar middle finger,” and he reported severe blood blisters days after the treatment followed by malodorous matter from the wart on the middle finger. He was seen and treated at another medical clinic where infection was suggested. He was assessed with devitalized tuft of the index fingers, not infected, currently with indication of overly aggressive treatment on middle finger. A September 2010 VA examination report for the spine reflects normal neurological examination for the upper extremities. The sensory examination to pinprick/pain, touch, position, vibration, and temperature were intact in the left hand. Reflexes were normal in the left biceps, triceps, brachioradialis, and finger jerk. In addition, the left hand dexterity was within normal limits. A June 2017 VA examination report diagnosed status post left hand laceration injury with onset of the symptoms in 2004. The examiner opined that the left hand disability was less likely than not related to service due to absence of documented limitations related to left hand symptoms or injury. The Board notes that the lack of treatment records, alone, cannot form the basis of a medical opinion. In addition, given the Veteran’s in-service treatment for warts, his complaints following the treatments, and his statements of continuity of symptomatology, the Board finds that a remand for a new VA examination and opinion on the nature and etiology of left hand numbness in the fingers is necessary. See Barr, 21 Vet. App. at 30. 3. Entitlement to service connection for an acquired psychiatric disorder, to include adjustment disorder with anxiety and depressed mood and depression is remanded. The Veteran contends that he has depression that is due to or incurred in service. STRs in January 2009 diagnosed adjustment disorder with anxiety and depressed mood. However, the Veteran told his provider that he planned on cancelling his mental health appointment because he was worried about his security clearance. Post-service treatment records in March 2010 reflect complaints of depression for two weeks and a diagnosis of depression in April 2010 with symptoms of depression, daytime somnolence, decreased functioning ability, and being upset by problems at home or work. An April 2017 VA examination report reflects the examiner’s opinion that the Veteran did not suffer from any mental health disorder. The examiner noted that the Veteran had never seen a mental health provider and had not been provided a mental health diagnosis or treatment. Further, during the examination, the Veteran denied suffering from mental health symptoms, and indicated he was not sure why he was at the VA examination. The examiner noted that there were multiple medical progress notes in the Veteran’s chart that listed “the possible diagnosis of adjustment disorder with depression.” However, since there were no mental health progress notes and the Veteran had never seen a mental health provider, “it was unclear who or when the possible diagnosis was made.” Instead, the examiner found that it was “clear that someone listed adjustment disorder as a possible entity, and this simply kept being repeated over many chart notes.” Thus, he opined that it was less likely than not that the Veteran had a mental health disorder that was due to service. As stated above, the lack of treatment records, alone, cannot form the basis of a medical opinion. In addition, when the Veteran was first diagnosed with adjustment disorder with anxiety and depressed mood in January 2009, he explained to his medical provider that he did not want to go to a mental health clinic because he was worried about his security clearance. Thus, the Board finds that a remand for a new VA examination and opinion on the nature and etiology of his acquired psychiatric disorder is necessary. See Barr, 21 Vet. App. at 30. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination with an appropriate physician to address the nature and etiology of his dermatophytosis. The physician should be provided with the Veteran’s claims file, including a copy of this REMAND. The physician should address whether dermatophytosis is at least as likely as not (i.e., a 50 percent or greater probability) related to or incurred in service, to include exposure to environmental hazards in Saudi Arabia. The physician must provide a complete rationale upon which his or her opinion is based on, and must include a discussion of the medical principles as applied to the medical evidence and facts used in establishing his or her opinion. The examiner must provide an opinion regardless of whether the Veteran exhibits symptoms of dermatophytosis at the time of the examination. 2. Schedule the Veteran for a VA examination with an appropriate physician to address the nature and etiology of his left hand numbness in the fingers. The physician should be provided with the Veteran’s claims file, including a copy of this REMAND. The physician should address whether any left hand numbness in the fingers is at least as likely as not (i.e., a 50 percent or greater probability) related to or incurred in service, to include the March 2004 assessment of devitalized tuft of the index fingers, not infected, currently with indication of overly aggressive treatment on middle finger. The physician must provide a complete rationale upon which his or her opinion is based on, and must include a discussion of the medical principles as applied to the medical evidence and facts used in establishing his or her opinion. 3. Schedule the Veteran for a VA examination with an appropriate physician to address the nature and etiology of his acquired psychiatric disorder. The physician should be provided with the Veteran’s claims file, including a copy of this REMAND. The physician should address whether any acquired psychiatric disorder, to include depression and adjustment disorder with anxiety and depressed mood, is at least as likely as not (i.e., a 50 percent or greater probability) related to or incurred in service. The physician must provide a complete rationale upon which his or her opinion is based on, and must include a discussion of the medical principles as applied to the medical evidence and facts used in establishing his or her opinion. A negative opinion cannot be based solely on the lack of post-service treatment records. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Leifert, Associate Counsel