Citation Nr: 20002477 Decision Date: 01/14/20 Archive Date: 01/10/20 DOCKET NO. 18-14 493 DATE: January 14, 2020 ORDER Service connection for a skin disorder is granted. FINDINGS OF FACT 1. The Veteran had active service from April 2003 to April 2007. 2. A current skin disorder has been associated with service. CONCLUSION OF LAW A skin disorder was incurred in service. 38 U.S.C. §§ 1110, 1111, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSION Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Turning to the evidence, the first element of service connection – a current disability – is met, as a private medical professional diagnosed the Veteran with acne keloid nuchae (AKN) in 2009. This diagnosis was confirmed by a November 2009 private dermatologist and a November 2017 VA examiner. Next, the second element of service connection – an in-service incurrence – is also met, as the service treatment records (STRs) show a diagnosis of and treatment for a skin disorder. Specifically, March 2006 records show that the Veteran presented to sick call complaining of razor bumps on the back of the neck area. He was diagnosed with black heads and acne and given hydrocortisone to apply to the area. In an October 2019 affidavit, the corpsmen who treated the Veteran in service reiterated that he was treated for a condition on the back of his head, diagnosed as folliculitis caused by the combat helmet he wore during service in Iraq, and that despite extended treatment with hydrocortisone, it did not improve. The RO made a formal finding of unavailability of some of the Veteran’s STRs during the later portion of his service, but this affidavit supports the Veteran’s testimony that once the skin disorder was diagnosed it did not resolve during service. This is further confirmed by his April 2008 post-deployment health reassessment, in which razor bumps were listed as a condition. As such, the second element of service connection is met. The third element of service connection – a medical nexus – is in conflict. On one hand, a November 2017 VA examiner found that a skin disorder was not due to the Veteran’s service in the Southwest Asia theater of operations but did not also provide an opinion determining whether service connection was warranted on a direct basis. On the other hand, the Veteran claims he has been treated by multiple private physicians who have told him that his current AKN diagnosis was due to service; however, none of these medical opinions are included in the claims file. In September 2009, a private physician posited that the papules diagnosed as folliculitis in service may be AKN and thereafter referred him to a dermatologist for further treatment. In November 2009, a dermatologist stated that the bumps on the nape of the Veteran’s neck, which had been present for three years and were diagnosed as pseudofolliculitis barbae (PFB) in service, were in fact AKN. This medical evidence supports a finding that the current diagnosis of AKN was related to service. As such, the medical evidence supports the appeal. The Board has considered the Veteran’s lay statements and sworn testimony and the testimony of his father that his skin disorder was caused by service. His father testified that he noticed the papules on his son’s neck as soon as he returned from active service. The Veteran also reported that he saw a family doctor in the year directly following service who treated his skin disorder, but who had destroyed the medical records by the time he initiated his claim. Collectively, lay and medical evidence show that the skin disorder identified in service is related to the skin disorder current shown. As such, the appeal is granted. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Brendan A. Evans, 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.