Citation Nr: 20002736 Decision Date: 01/14/20 Archive Date: 01/13/20 DOCKET NO. 17-08 021 DATE: January 14, 2020 ORDER Entitlement to service connection for contact dermatitis, on eyelids (claimed as eye condition) is granted. FINDING OF FACT The Veteran’s contact dermatitis, on eyelids (claimed as eye condition) began during active service. CONCLUSION OF LAW The criteria for service connection for contact dermatitis, on eyelids (claimed as eye condition) are met. 38 U.S.C. §§ 1110, 1117, 1118, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.317 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from March 2004 to August 2004, from August 2005 to November 2008 and from May 2009 to July 2010. He received the Combat Action Badge, among other decorations, for this service. This matter comes before the Board of Veterans Appeals (Board) on appeal from a March 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In October 2019, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript has been associated with the electronic claims file. Service connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: "(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 or aggravated during service." Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be established for a Persian Gulf War veteran who exhibits objective indications of a qualifying chronic disability resulting from an undiagnosed illness or medically unexplained chronic multi-symptom illness that became manifest either during active service in the Southwest Asia Theater of operations during the Persian Gulf War or to a degree of 10 percent or more not later than December 31, 2021, and by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. See 38 U.S.C. § 1117; See also 38 C.F.R. § 3.317 (a)(1)(i)(ii). An "undiagnosed illness" is one that by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 C.F.R. § 3.317 (a)(1)(ii). A qualifying chronic disability can be a chronic disability resulting from a medically unexplained chronic multi-symptom illness that is defined by a cluster of signs of symptoms, such as chronic fatigue syndrome and fibromyalgia. 38 C.F.R. § 3.317 (a)(2)(i)(B). VA regulation consider other signs or symptoms which may be manifestations of undiagnosed illness or medically unexplained chronic multi-symptoms illness such as fatigue, signs or symptoms involving skin, headaches and signs or symptoms involving the respiratory system. 38 C.F.R. § 3.317 (b)(1)(2)(3)(8). "Objective indications of chronic disability" include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317 (a)(3). Non-medical indicators include evidence such as time lost from work, the veteran having sought treatment for his symptoms, and changes in the veteran's appearance, physical abilities, and mental or emotional attitude. Joyner v. McDonald, 766 F.3d 1393, 1395 (Fed. Cir. 2014). In the case of any veteran who engaged in combat with the enemy in active service with a military, naval, or air organization of the United States during a period of war, campaign, or expedition, the Secretary shall accept as sufficient proof of service-connection of any disease or injury alleged to have been incurred in or aggravated by such service satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such incurrence or aggravation in such service, and, to that end, shall resolve every reasonable doubt in favor of the veteran. Service-connection of such injury or disease may be rebutted by clear and convincing evidence to the contrary. The reasons for granting or denying service-connection in each case shall be recorded in full. 38 U.S.C. § 1154 (b): 38 C.F.R. § 3.304 (d). Where the evidence does not warrant presumptive service connection for Gulf War Illness, a veteran is not precluded from establishing service connection for disability with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1041 (Fed. Cir. 1994). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154 (a). Lay 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). After the evidence is assembled, it is the Board's responsibility to evaluate the entire record. See 38 U.S.C. § 7104 (a) (2012). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107 (2012); 38 C.F.R. §§ 3.102, 4.3 (2018). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (Court) stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. 1. Entitlement to service connection for contact dermatitis, on eyelids (claimed as eye condition) As a threshold matter, service personnel records reflect that the Veteran had active military service in the Southwest Asia theater of operations during the Persian Gulf War, pursuant to 38 C.F.R. § 3.317. The law and regulations pertaining to undiagnosed illness incurred due to Persian Gulf service, discussed above, are thus applicable in this case. In addition, the Board notes the Veteran's combat service as part of Operation Enduring Freedom and an Iraq Campaign Medal was awarded in that period. The Veteran contends that his contact dermatitis, on eyelids (claimed as eye condition) had its onset in service. The Veteran asserts that in June 2006 while serving in Iraq he was driving under a sand storm; his eyes were red and puffy, and his eyelids were chaffed and he has had blisters and irritation in the area, ever since. A review of the Veteran’s service treatment records show that he was treated in April 2004 with an optical ointment. In January 2006, the Veteran presented rash on his upper eyelids and itchy, swollen eyes. He was diagnosed with dermatitis and treated with hydrocortisone and Allegra. In August 2009, he was treated for a fungal infection around eye and eye irritation. In May 2010, the Veteran reported rash in his right eyelid. Additionally, sworn buddy statements also attest to the Veteran complaining of his eyes and receiving treatment for them while deployed. The Board concludes that the Veteran has a current disability that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Thus, the question becomes whether the current disability is related to service. On this question there are probative opinions in favor of and against the claim. In August 2014, medical records note the Veteran reported symptoms of persistent papular or nodular skin rash. The record notes transient papular pruritic rash on forearms and on eyelids, eyelids turn purple and have pruritic papular rash. Significantly, at the time of treatment, which was prior to the Veteran’s filing of his claim, he reported that these rashes had occurred since 2006. The Veteran was afforded VA examinations for an eye condition in February 2016 and for a skin condition in March 2016. The VA examiner for the eyes opined that the Veteran “appears to have an eczema like lesion or contact dermatitis on the superior eyelid of the left eye”. The examiner noted that the Veteran “eye condition causes functional impact when flared as the irritation and itchiness may make it more challenging to do any work outside since it is worsened outside”. The VA examiner remarked that the Veteran’s condition was documented as contact dermatitis and a fungal infection in the military in 2006 and 2009, and further opined that based on the timeline of when he started having complaints of this issue in the military it appears that this condition was likely caused by his time in the military. The examiner added that she would defer to dermatology for a more specific diagnosis. The VA examiner for the skin condition diagnosed the Veteran with dermatitis since January 2006. The Veteran reported recurrent blistering over his eyelids since he was in Iraq in 2005 and indicated it worsened when outside. The blisters cause itching, burning and irritated eyes. The VA examiner for the skin opined that the Veteran’s skin rash on eyelids is less likely than not caused by the dermatitis of the eyelid treated during service. The rationale provided by the examiner is that there is no evidence that suggests chronicity of eyelid condition until September 2014 and that although there is a record of treatment in service for the claimed condition, no permanent residual or chronic disability or service-related aggravation is shown by service treatment records or demonstrated by evidence following service. The Veteran testimony at the October 2019 Board hearing, reflect that he has been treating his skin condition with ointments, creams, moisturizers, eye drops, pills, allergy medication between 2006 and 2014 when the condition worsened, and he went to the VA doctors to seek treatment. The Veteran’s squad leader in 2005, Mr. F.C.E., testified at the Board hearing that while in Kuwait the Veteran “had really bad puffy eyes, and they were --really looked like road rash. And like he said, he just kept getting eye drops and ointments. Over the years of being with him, his eyes just kept getting worse. And he kept telling me that he kept seeing doctors and everything, but nothing was working for him”. In a June 2006 sworn statement, Mr. F.E.C., declared that he was with the Veteran on the road when a sand storm overpowered their visibility. The Veteran was driving with his googles on and complaint about a feeling of sand or small objects in his eyes. He also declared that five days after the sand storm, the Veteran reported to him with “his eyes all red and puffy, both eyelids looked chaffed, road rash type skin. I took him to see the Medics and none of the Doctors knew what it was, so the Doctors handed him a tube of ointment for both of his eyelids with a bottle of eyedrops.” In a statement associated to the file in September 2019, the Veteran’s mother stated that his son has experienced eye problems since returning from his deployment in Iraq. She noticed that his eyes would seem bruised, irritated, blistered, peeling, and sometimes swollen shut and that he has tried to remedy his symptoms with no resolution. The Board takes into consideration the Veteran’s, his mother and buddy lay statements in support of his claim. After considering their arguments, particularly in regard to the onset of his current disability, the Board finds them persuasive, convincing and credible. Additionally, the Board finds the VA examiner's opinions persuasive and consistent with the Veteran's testimony. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. at 49 (1990). In light of the findings and the evidence discussed above, the Board finds that the Veteran's contact dermatitis, on eyelids (claimed as eye condition) is related to service. This is particularly so when reasonable doubt is resolved in the Veteran's favor. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Therefore, service connection for his contact dermatitis, on eyelids (claimed as eye condition) is warranted. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Romero-Sanchez, 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.