Citation Nr: 19136552 Decision Date: 05/10/19 Archive Date: 05/10/19 DOCKET NO. 07-30 849 DATE: May 10, 2019 ORDER Entitlement to service connection for a skin disorder is denied. FINDING OF FACT 1. The Veteran served in the Republic of Vietnam during the Vietnam era, and is presumed to have been exposed to herbicide agents. 2. The preponderance of the evidence is against finding that a skin disorder began during active service, or is otherwise related to an in-service injury or disease, including exposure to thimerosal and herbicides agents. CONCLUSION OF LAW The criteria for service connection for a skin disorder are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1968 to July 1970. The Board previously remanded this issue in September 2015 and August 2017 for further development. The Board finds that there has been substantial compliance with the prior Board remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The issue of entitlement to service connection for Meniere’s disease was also on appeal and remanded by the Board. However, in a December 2018 rating decision, service connection for such disorder was granted; representing a full grant of the benefit sought on appeal. Entitlement to service connection for a skin disorder The Veteran asserts that his skin disorder is due to exposure to herbicide agents while stationed in Vietnam or exposure to thimerosal in vaccinations during service. He has asserted that his skin disorder has continued since his return from Vietnam. The Veteran’s service records show that the Veteran served in the Republic of Vietnam during the applicable time period beginning on January 9, 1962 and ending on May 7, 1975. He is therefore presumed to have been exposed to herbicide agents. 38 U.S.C. § 1116(f). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Veterans exposed to Agent Orange or other listed herbicide agents are presumed service-connected for certain conditions even if there is no record of such disease during service. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307 (a)(6), 3.309(e). However, the Veteran has not been diagnosed with chloracne and the Veteran’s current skin disorder is not one such disease. However, the United States Court of Appeals for the Federal Circuit has determined that a veteran is not precluded from establishing service connection with proof of actual direct causation. Stefl v. Nicholson, 21 Vet. App. 120 (2007); see also Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of dermatitis, and evidence shows that the Veteran was exposed to herbicide agents in service, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of dermatitis began during service or is otherwise related to an in-service injury, event, or disease, to include exposure to thimerosal and herbicides agents. Although the Veteran is competent to report continuing symptoms since service, the Board finds that the Veteran’s statements of continuity of symptomatology are not credible and outweighed by the remaining evidence of record. The Veteran’s reports are internally inconsistent with his reports in contemporaneous treatment records. In this regard, service treatment records are silent with respect to any complaints or diagnoses pertaining to the skin. Importantly, a December 1971 VA examination, over a year after the Veteran’s discharge from service, showed that the skin was clinically evaluated as normal. The examination is silent with respect to any complaints pertaining to the skin. VA clinical records show the Veteran was not diagnosed with a skin disorder, which was at that time diagnosed as atypical melanocytic hyperplasia, until approximately March 2000, decades after his separation from service. Follow up clinical records show a diagnosis of dermatitis approximately in 2009, again, decades after service. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Furthermore, taken together, the April 2016 and September 2017 VA examinations establish that the Veteran’s skin disorder is not at least as likely as not related to an in-service injury, event, or disease, including exposure to thimerosal and herbicides agents. The April 2016 VA fee-based examiner opined that the Veteran’s skin disorder was not at least as likely as not related to thimerosal. The examiner rationalized that the medical records do not support remote vaccinations containing thimerosal as a probable cause of the Veteran’s ill-defined and intermittent unspecified skin rash while dermatology clinical records and repeated patch testing indicate contact dermatitis as the likely etiology. The September 2017 VA examiner also found that the Veteran’s unspecified dermatitis was not due to service as the service treatment records were silent for dermatitis/flare up rash. The Veteran’s unspecified dermatitis was not due to Agent Orange exposure as dermatitis was not a presumptive condition of Agent Orange exposure. Although the Veteran did test positive for thimerosal in former patch testing, the Veteran’s current unspecified dermatitis is not consistent with reaction to thimerosal, based on the history he described. Therefore, the Veteran’s current unspecified dermatitis is not related to prior thimerosal vaccination. The examiners’ combined opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). An April 2004 private consultation shows that the Veteran reported transient eczematous rash involving his back, abdomen, arms and legs. The rash waxed and waned with a two to three-week duration. The examiner noted that the Veteran felt his condition began after leaving Vietnam where he was exposed to various herbicides, including Agent Orange. While the examiner did not provide an opinion concerning the Veteran’s Agent Orange exposure, he did note that there was positive contactant for thimerosal, which was a possible preservative in vaccination from early years in Vietnam. However, the examiner’s opinion is couched in speculative terms and does not offer a clear rationale. As such, this opinion is outweighed by the more probative VA opinions. The Veteran believes his disability is related to an in-service injury, event, or disease. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires specialized medical knowledge. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the medical evidence. In conclusion, based on the analysis above, the Board finds that the preponderance of evidence is against the Veteran’s claim for service connection for a skin disorder. As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107(b). L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J.N. Moats 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.