Citation Nr: 19194888 Decision Date: 12/18/19 Archive Date: 12/18/19 DOCKET NO. 16-30 142 DATE: December 18, 2019 ORDER Entitlement to service connection for a subcutaneous lesion is denied. FINDING OF FACT A subcutaneous lesion is neither caused by service-connected hepatitis C nor is attributable to service. CONCLUSION OF LAW The criteria for service connection for a subcutaneous lesion have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty from May 1970 to May 1972. This matter is before the Board of Veterans’ Appeals (Board) on appeal of the January 2015 and November 2018 Department of Veterans Affairs (VA) Regional Office (RO) rating decisions. The Veteran has been service-connected for hepatitis C effective December 2009. In November 2014, he applied for service connection for his subcutaneous lesion and asserted that this disability was secondary to his service connected hepatitis C. In January 2015, the RO denied service connection for the Veteran’s subcutaneous lesion. In May 2015, he filed a Notice of Disagreement. In June 2016, the RO issued a Statement of the Case (SOC) and a Supplemental SOC (SSOC), and the Veteran filed a Substantive Appeal expressing his belief that his subcutaneous lesion was caused by his hepatitis C or by the medications that he has been taking in connection with the treatment of his hepatitis C. In October 2018, the Veteran filed a VA 21 526EZ Form reiterating his belief that his subcutaneous lesion was caused by his hepatitis C. In November 2018, the RO issued a rating decision continuing the denial of his claim. In June 2019, he filed an Appellant’s Brief waiving, under 38 C.F.R. § 20.1305(c), the RO’s review of the evidence added to the record following the issuance of the SSOC. Service connection may be granted for a disability resulting from an injury or disease incurred in service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Direct service connection established on a primary basis requires evidence of a current disability, an in service event that caused an injury or triggered a disease, and a nexus, i.e., a causal connection between the in-service event and the current disability. See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). Further, a direct service connection may be granted on a secondary basis for a disorder that is a result of a service-connected disability. 38 C.F.R. § 3.310(a). To prevail under the theory of secondary service connection, there must be evidence of a current disorder, a service-connected disability, and a nexus between the two. Wallin v. West, 11 Vet. App. 509, 512 (1998). In making its determination, the Board gives a claimant the benefit of the doubt on any issue material to his/her claim when there is an approximate balance of positive and negative evidence. 38 C.F.R. § 3.102; Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009). The Board, however, considers all the evidence of record and makes determinations as to the competence, credibility, and weight of each piece of evidence. Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011). This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record. King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012). Here, the Veteran’s service-connected hepatitis C and his subcutaneous lesion are not in dispute. Therefore, for the purposes of the secondary-service-connection analysis, the Board’s inquiry is limited to a nexus between these conditions. The record demonstrates that, in January 2015, a VA examiner opined that the Veteran’s subcutaneous lesion was less likely than not caused by his hepatitis C or by the medications the Veteran has been taking in connection with the treatment of his hepatitis C. The January 2015 examiner reasoned that the Veteran’s subcutaneous lesion was a lipoma, i.e., a benign fatty subcutaneous tumor that was a common and incidental occurrence. The January 2015 VA examiner also pointed out that no credible academic studies supported a finding of a causal connection between lipomas and a treatment of hepatitis C. In December 2018, the Veteran was provided with an addendum VA examination. The December 2018 VA examiner similarly opined that the Veteran’s subcutaneous lesion was less likely than not caused by his hepatitis C or the treatment of his hepatitis C. While the December 2018 VA examiner noted the Veteran’s belief that “the medical treatment for [his hepatitis C] caused []his lipoma,” the examiner stressed that “no medical literature . . . support[ed the Veteran’s causation] theory.” The Board finds the opinions rendered by the January 2015 and December 2018 VA examiners competent, credible, and probative. Further, the Board notes that no statement in the Veteran’s treatment records related to his lipoma calls into question the January 2015 and December 2018 VA examiners’ findings. The Board acknowledges the Veteran’s disagreement with the January 2015 and December 2018 VA examiner’s findings, as well as the Veteran’s belief that either his hepatitis C or the medications he has been taking in connection with the treatment of his hepatitis C caused his lipoma. However, while a layperson may opine on a medical condition’s etiology amenable to the layperson’s observations through his/her senses, Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009), a subcutaneous lesion is not such a condition. Further, the Veteran has not been shown to possess the medical expertise necessary to opine on the etiology of his lipoma. See Layno v. Browe, 6 Vet. App. 465, 469 (1994). Therefore, the Board finds that the preponderance of the evidence is against finding that the Veteran’s lipoma was caused by his hepatitis C or the medications that he has been taking in connection with the treatment of his hepatitis C. Accordingly, the doctrine of the benefit of the doubt is not for application, and a secondary service connection for the Veteran’s subcutaneous lesion is denied. The Board, however, is mindful that the Veteran may establish service connection for his subcutaneous lesion on a primary direct basis even if he has not succeeded at establishing his claim under the secondary-service-connection theory. Notably, the Veteran has not raised a primary direct-service-connection claim. Furthermore, the Board’s review of the Veteran’s service treatment records (STRs) revealed that, in service, the Veteran neither complained of nor was diagnosed with, nor received treatment for a condition that could be construed as related to his lipoma. Hence, the Board is without a basis to conclude that the Veteran has established the in service-event element of his primary direct-service-connection claim. Moreover, the December 2018 VA examiner expressly addressed the issue of a nexus between the Veteran’s lipoma and his active duty. The December 2018 VA examiner opined that the Veteran’s lipoma was less likely than not attributable to his active service since the “[o]nset of [his lipoma] was not during service,” and the STRs demonstrated that the Veteran did not have a lipoma or a related condition in service. The December 2018 VA examiner also pointed out that the Veteran’s post-service medical treatment records showed that the symptoms associated with his lipoma “began in 2012.” The Board finds the December 2018 VA examiner’s negative nexus opinion competent, credible, and probative. Further, given that the Veteran’s lipoma was diagnosed 40 years after his separation from service, the Board is mindful of the guidance provided by the U.S. Court of Appeals for the Federal Circuit in Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000), that the passage of many years between discharge from active service and any medical complaints or documentation of a claimed disability is a factor that weighs against a claim for service connection. Therefore, the Board finds that the Veteran has not established the nexus element of his primary direct-service-connection claim. Based on the foregoing, the Board finds that the preponderance of the evidence is against finding that the Veteran’s lipoma was caused or is otherwise attributable to his active service. Accordingly, the benefit-of-the-doubt doctrine is not for application, and a primary service connection for the Veteran’s subcutaneous lesion is denied. Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Anna Kapellan 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.