Citation Nr: 20005845 Decision Date: 01/23/20 Archive Date: 01/23/20 DOCKET NO. 18-49 078 DATE: January 23, 2020 ORDER New and material evidence has been received to reopen a previously-denied claim of entitlement to service connection for a skin disability. Entitlement to service connection for lichen planus is granted. FINDINGS OF FACT 1. An August 1987 rating decision denied entitlement to service connection for a skin disability. The Veteran did not appeal this decision, and new and material evidence was not received within one year of its issuance. 2. Evidence added to the record more than one year after the August 1987 rating decision has not been previously considered and relates to an unestablished fact necessary to substantiate the Veteran’s claim for entitlement to service connection for a skin disability. 3. The Veteran’s current lichen planus is proximately due to medications used to treat her service-connected gastroesophageal reflux disease (GERD). CONCLUSIONS OF LAW 1. The August 1987 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 2. New and material evidence has been received to reopen the previously-denied claim of entitlement to service connection for a skin disability. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for entitlement to service connection on a secondary basis for lichen planus are met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from November 1981 to March 1986. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, the Board remanded the appeal for additional development. The Board herein grants the Veteran’s July 2018 motion to advance her appeal on the Board’s docket due to her financial condition and homeless status. 38 U.S.C. § 7107; 38 C.F.R. § 20.900. 1. New and material evidence has been received to reopen a previously-denied claim of entitlement to service connection for a skin disability. An August 1987 rating decision denied entitlement to service connection for a skin disability due to the absence of a current chronic disability related to her treatment of a rash in service. The Veteran did not appeal that determination, and new and material evidence was not received within one year of the issuance of the decision. Thus, the August 1987 rating decision is final. See 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. A final claim may be reopened if new and material evidence is submitted. New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with the previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. Evidence associated with the record more than one year after the issuance of the August 1987 rating decision includes a February 2015 VA outpatient record diagnosing lichen planus. Because this evidence had not been previously submitted and because it relates to an unestablished fact necessary to substantiate the Veteran’s claim, it is considered new and material, and the claim is reopened. 2. Entitlement to service connection for lichen planus is granted. Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing service connection on a direct basis requires evidence demonstrating: (1) the existence of 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 claimed in-service disease or injury. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). In addition to the elements of direct service connection, service connection may also be established on a secondary basis for a disability proximately due to or aggravated by a service-connected disease or injury. See 38 C.F.R. § 3.310; see also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). To establish secondary service connection, a Veteran must show: (1) the existence of a present disability; (2) the existence of a service-connected disability; and (3) a causal relationship between the present disability and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). Here, the Veteran seeks service connection for lichen planus on a secondary basis. As secondary service connection on a proximate cause basis is warranted, only that theory of entitlement will be addressed in the instant decision. The presence of a current skin disability, namely lichen planus, is not in dispute. See March 2015 VA Treatment Record. The Veteran is also service-connected for GERD, for which she was prescribed cimetidine from 2000-2005 and omeprazole from 2011 to 2018. See November 2000, July 2002, August 2002, March 2003, May 2004, March 2011, September 2011, August 2014, February 2015, October 2015, March 2016, March 2017, December 2017, May 2018 VA Treatment Records. Accordingly, the first two elements of secondary service connection are established. Regarding the final element of service connection, nexus, in a September 2019 VA Disability Benefits Questionnaire (DBQ), a VA examiner indicated that the Veteran’s lichens planus was not related to NSAID use for the Veteran’s service-connected chest disability, but instead was idiopathic and therefore of unknown etiology. In this regard, the examiner relied on a May 2005 VA skin biopsy report, in which the examining physician noted the Veteran’s lichen planus was “more consistent” with idiopathic lichen planus as opposed to drug-related lichen planus. However, the Board emphasizes that the results of that biopsy were not definitive, and the examining clinician at that time specifically acknowledged that use of “cimetidine could exacerbate the condition.” See April-May 2005 VA treatment records. Similarly, the September 2019 VA examiner indicated that the Veteran has “used cimetidine and omeprazole in the past, [which] are known dr[u]gs that can cause drug-erupted lichen planus,” although again finding the Veteran’s skin condition was idiopathic in nature. See September 2019 Medical Opinion DBQ. There are no other competent opinions of record addressing the etiology of the disability. Here, given the May 2005 VA physician’s finding that medications used to treat the Veteran’s GERD can exacerbate her skin disability regardless of the type of lichens planus present, the fact that idiopathic lichens planus has no known cause, and affording the Veteran the benefit of the doubt, the Board finds that the final element of secondary service connection is established, and the benefit sought on appeal is granted. S. BUSH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Ramirez, 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.