Citation Nr: 20005582 Decision Date: 01/23/20 Archive Date: 01/23/20 DOCKET NO. 14-15 312 DATE: January 23, 2020 ORDER Entitlement to service connection for a disability involving the feet, diagnosed as onychomycosis, to include as due to herbicide agent exposure and cleaning solvents, is denied. Entitlement to service connection for a disability manifested by cysts or lesions on both arms, to include as due to herbicide agent exposure and cleaning solvents, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that a disability involving the feet, diagnosed as onychomycosis, is related to the Veteran’s military service. 2. The preponderance of the evidence is against finding that the Veteran has ever had a disability manifested by cysts or lesions on his arms. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for disability involving the feet, diagnosed as onychomycosis, to include as due to herbicide agent exposure and cleaning solvents have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2018). 2. The criteria for entitlement to service connection for a disability manifested by cysts or lesions on both arms, to include as due to herbicide agent exposure and cleaning solvents have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from November 1966 to October 1967. This appeal to the Board of Veteran’s Appeals (Board) arose from a May 2013 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). The Veteran has perfected the appeal. See June 2013 Notice of Disagreement; March 2014 Statement of the Case (SOC); April 2014 Substantive Appeal (VA Form 9). The Veteran requested a hearing before the Board. The requested hearing was conducted in April 2017 by the undersigned Veterans Law Judge. A transcript of the hearing is associated with the file. In February 2018, the Board remanded these claims for further evidentiary development. That development has been completed, thus, the claims are ready for appellate consideration. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900 (c) (2018). 38 U.S.C.§ 7107 (a)(2) (2012). Service Connection A Veteran is granted service connection where evidence shows that an injury or disease that results in a current disability was incurred during service or was aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To be entitled to service connection, the evidence must support (1) a current disability; (2) an in-service injury or event; and (3) a nexus between the current disability and the in-service injury or event. 38 C.F.R. § 3.303(a). Service connection can also be granted for chronic disabilities, if the evidence establishes that it manifested to a compensable degree within one year after the Veteran was separated from service. 38 C.F.R. § 3.307, §3.309. Service connection for chronic disabilities can be established through a showing of continuity of symptomatology since service, as an alternative to the nexus requirement. 38 C.F.R. § 3.303(b). This option is limited to chronic disabilities listed in 38 C.F.R. § 3.309(a). When a reasonable doubt arises regarding service origin, the degree of disability, or any other point, after careful consideration of all procurable and assembled data, such doubt will be resolved in favor of the claimant. Reasonable doubt is one which exists because of an approximate balance of positive and negative evidence which does not prove or disprove the claim satisfactorily. It is a substantial doubt and one within range of probability as distinguished from pure speculation or remote possibility. See 38 C.F.R. § 3.102. 1. Entitlement to service connection for a disability involving the feet, to include as due to herbicide agent exposure and cleaning solvents. The Veteran asserts that he developed a disability involving his feet that is due to his service, specifically exposure to herbicide agents and cleaning solvents. Regarding a current diagnosis, the Veteran has been diagnosed with onychomycosis, a toenail fungus on both feet. See June 2019, VA Examination. Regarding an in-service injury or event, the Veteran asserts that he was exposed to herbicide agents during service. The Veteran does not allege he had service in Vietnam, but that he came in contact with herbicide agents while stationed in Fort Riley, due to the soldiers returning from Vietnam having herbicide agents on their clothing. The Veteran alleges that the herbicide exposures were sprayed in the U.S. as well. Alternatively, the Veteran contends that the cleaning solvents he used while cleaning the mess hall exposed him to chemicals that led to his infection. Regarding whether the Veteran was exposed to herbicide agents, the RO sent a request for any documents showing exposure to herbicides. See September 2012 Request for Information (VA 21-3101). The response to the request stated that there were no records of exposure to herbicides. See April 2013 VA 21-3101. There is no other evidence of the record that would indicate the possibility of herbicide exposure. Thus, herbicide agent exposure has not been established. Regarding exposure to chemicals while using cleaning solvents, the Veteran’s military occupational specialty (MOS) was as a cook. The Board considers the duties of cleaning the hall to be consistent with the places, types, and circumstances of his duties as a cook, so it is reasonable that the Veteran used cleaning solvents during his service. Additionally, in a July 1967 service treatment record, the Veteran complained that his boots were causing a problem over burn scars on his feet. He requested to be able to lace his boots differently than required. Whether there is any relation between the Veteran’s condition and his service, particularly any exposure to chemicals from cleaning solvents, the May 2012 VA examiner could not resolve the issue without resorting to mere speculation. The examiner noted that there were no skin problems other than scarring mentioned in the Veteran’s health records. The examiner stated that the May 2012 examination indicated that the Veteran had fungus effecting nail plates of the hallux bilateral. In June 2019, the VA examiner opined that the Veteran’s onychomycosis was less likely than not incurred in or caused by his service, including exposure to cleaning solvents while performing his duties. The examiner explained that the Veteran reported the onset of his condition to be sometime after service and is somewhat vague about when it was first noticed. The examiner explained that once the condition developed, it tends to become chronic or recurrent and is difficult to completely eradicate with medication. The examiner continued that the available records show treatment for the condition within the past 15 years. The examiner noted that in 2004, the Veteran’s condition was described as chronic, but no further details are present regarding the onset. The examiner explained that onychomycosis is a very common condition with a prevalence of about 20 percent in persons of the Veteran’s age in the early 2000’s. The June 2019 examiner went on to explain that the Veteran’s condition is not related to cleaning solvents. The cause of onychomycosis is contact with fungus that can be present just about anywhere in the environment, including the home. The examiner stated that if the condition was due to some kind of chemical during service, it would have been expected to become apparent during service or sooner afterwards. The examiner noted that the exit examination in September 1967 was negative for evidence of this condition. The examiner stated that the Veteran stated that he used to have athlete’s foot but not recently or currently and does not wish to claim that disability. The July 2004 VA treatment record the examiner references notes a diagnosis of “tinea pedis” but describes chronic toenail fungus. A different VA clinician in June 2019 opined that the Veteran did not have any other bilateral foot conditions. After a thorough consideration of the evidence, the Board finds that the preponderance of the evidence is against finding a nexus, or link, between the Veteran’s toenail fungus and his service. The June 2019 examiner stated that the cause of the onychomycosis is contact with fungus in the environment, not exposure to chemicals. The Veteran asserted the he believed he noticed the fungus about six months after service. The Veteran does not allege that it occurred during service. The Board acknowledges the Veteran’s in-service complaint regarding his boots bothering his feet. This complaint was regarding the boots causing problems over “burn scars.” At the May 2012 VA examination, the Veteran related a scar on his left foot from a copperhead bite when he was nine years old. The September 1967 examination showed normal results for his feet. No scarring was noted on any of the examinations or treatment records. The June 2019 VA examiner considered the lay and medical evidence and gave an opinion regarding the Veteran’s condition. The Board acknowledges that the examiner did not specially comment on the Veteran’s June 1967 complaints regarding his feet as instructed by the Board in the February 2019 remand directives. However, the medical history in the examination report notes the complaints regarding the boots in service, thus was considered in rendering the opinion. As discussed above, the Veteran reported his current foot condition to have occurred after service, not during service. The Veteran does not assert that his military boots caused his current condition or relates the onset of his condition to July 1967. In addition, the medical evidence shows no further notations regarding scarring on the Veteran’s feet. The Veteran’s condition does not cause any scarring. See June 2019 VA Examination Report. The Board finds that the opinion was properly based on all available evidence. The February 2018 Board’s remand order requested that the examiner ultimately make a determination about whether the Veteran suffers from a bilateral foot condition during service, specifically from exposure to cleaning solvents during service. The examiner opined about the cause of onychomycosis. The Board finds that the opinion provided sufficient information as to this determination. The Board finds that the examiner substantially complied with the Board's remand order regarding examination and nexus opinion. See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141 (1999); D'Aries v. Peake, 22 Vet. App. 97 (2008). The Board finds that the weight of the evidence is against a finding of service connection for bilateral foot condition, diagnosed as onychomycosis. The Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, the doctrine is not applicable. 2. Entitlement to service connection for a disability manifested by cysts or lesions on both arms, to include as due to herbicide agent exposure and cleaning solvents. The Veteran asserts that he developed cysts on his arms due to his service, specifically being exposed to herbicide agent exposure and cleaning solvents. Regarding a current diagnosis, VA treatment records from 2004 to 2013 document the Veteran’s complaints regarding lesions and cysts on his body, including his arms. In a July 2004 record, it was noted that there were no worrisome lesions found on the Veteran’s arms. Other records were absent any notations regarding lesions and cysts on his arms. The service treatment records are absent any complaints, diagnosis, or treatment of any lesions or cysts on his arms. The June 2019 VA examiner noted a December 2018 VA dermatology clinic note that documented the Veteran’s complaints of spots on his right forearm, duration of the spots being for one to two months. It was noted that spot had since decreased in size since and is almost gone and no longer bothersome. It was stated that the examination was negative for any lesions or cysts on the arms. In a May 2019 dermatology note, the December 2018 visit was noted. At this time, the Veteran was requesting wanting to treat bumps on his eyelids. There were no other concerns. At the June 2019 VSA examination, the Veteran reported that cysts on his arms started a little later, not during service. The Veteran confirmed that currently there were no cysts on his arms, stating that in the past that they would come “on and off”, and would last for one to six months. The examiner noted that the cysts on his arms have resolved and there are no residual or current symptoms. The examination of the upper extremities was negative for any cysts or residuals of cysts. Based on the evidence of the record, the Board finds that there is no current disability. Service connection requires a showing of a current disability. In the absence of proof of a present disability (and, if so, of a nexus between that disability and service), there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). At each doctor visit and examination, no arm lesions were ever identified by the examiner. The existence of these lesions is based on the Veteran’s statements. The current disability requirement is satisfied when the claimant has a disability at the time the claim is filed or during the pendency of the appeal even though the disability may resolve prior to adjudication. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Also, "when the record contains a recent diagnosis of a disability prior to a veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency." Romanowsky v. Shinseki, 26 Vet. App. 289, 293-94 (2013). The Board acknowledges the Veteran’s assertions that he had lesions or cysts on his arms related to his service. However, the medical evidence, including multiple examinations of the Veteran’s arms, have not established any cysts or lesions on his arm. There have been no diagnoses rendered regarding any lesions or cysts on his arms. Lesions and cysts have been found on other parts of the Veteran’s body and were noted in the treatment records. So, if there were on his arms, it would have been noted in the medical evidence. The Board finds that the weight of the evidence is against a finding of service connection for cysts on the arms. The Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, the doctrine is not applicable. DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Middleton, 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.