Citation Nr: 20006677 Decision Date: 01/27/20 Archive Date: 01/27/20 DOCKET NO. 11-23 952A DATE: January 27, 2020 ORDER Entitlement to service connection for psoriasis vulgaris and rosacea is denied. FINDING OF FACT Psoriasis vulgaris and rosacea was not manifest in service and the disability is not otherwise related to service, or service-connected disease or injury. CONCLUSIONS OF LAW 1. Psoriasis vulgaris and rosacea was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. Psoriasis vulgaris and rosacea are not proximately due to, aggravated by or the result of a service connected disease or injury. 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1965 to September 1967. This matter comes before the Board of Veterans’ Appeals (Board) from a December 2009 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2016, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing convened at the AOJ. A transcript of the hearing has been included in the record. The Board previously remanded these matters in December 2016, June 2017, and February 2018 for additional evidentiary development. 1. Service connection for psoriasis vulgaris and rosacea The Veteran aasserts that his psoriasis vulgaris and rosacea is due to service to include presumed herbicide exposure. Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service or for aggravation of a preexisting injury suffered or disease contracted in line of duty. 38 U.S.C. § 1110. In general, to establish a right to compensation for a present disability, a Veteran must show: (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 - the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). Certain chronic diseases, such as chloracne, will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service. Even if a Veteran does not qualify for the presumption of herbicide agent exposure, the Veteran may establish in-service exposure to an herbicide agent if the evidence indicates that it is at least as likely as not that such exposure occurred. See Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007) (holding that the availability of a presumption does not preclude establishing the same facts by evidence); Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Psoriasis vulgaris and rosacea is neither a chronic disease under 38 C.F.R. § 3.309(a), nor recognized as a disability associated with herbicide exposure under 38 C.F.R. § 3.309(e). Corresponding presumptions do not apply. Prior VA examinations have concluded that the Veteran’s psoriasis vulgaris and rosacea is not related to service or secondary to a service-connected disability. Here, a skin disorder was not manifest in service. Rather, at separation, the skin was normal. Furthermore, there is no credible proof of a relationship to a service connected disease or injury. However, a December 2008 physician’s letter notes that the Veteran’s “skin condition represents chloracne and is no doubt related to exposure to defoliants while serving in Vietnam.” There is also an October 2017 private opinion with clinical treatment notes from a nurse practitioner at a dermatology clinic reporting that the Veteran’s “chronic inflammatory skin condition is likely attributed to exposure to agent orange.” An issue before the Board is whether the Veteran’s skin disorder includes chloracne or other acneform disease consistent with chloracne. On remand, the Veteran was provided an examination in October 2018 in which the examiner opined that the Veteran’s current skin disorder was not incurred in or caused by any exposure to Agent Orange. The VA examiner reasoned that chloracne is the only dermatologic effect of exposure to Agent Orange and that, while the Veteran is presumed to have been exposed to herbicides while in Vietnam and service treatment records indicate a history of chloracne, the Veteran’s current psoriasis vulgaris and rosacea is distinct and unrelated to such exposure. The examiner specified that none of the Veteran’s currently diagnosed skin disorders include Chloracne or other acneform disease consistent with chloracne, despite indications of a history of chloracne. The Board concludes that the preponderance of the evidence is against finding that current disorder began during active service or is otherwise related to service to include herbicide exposure. 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. Therefore, the preponderance of the evidence is against finding that a nexus exists between the Veteran’s skin disorder and service. 38 U.S.C. § 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. Complaints that began over a decade after service have not been related to service by any competent evidence. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Moreover, the condition is not related to service as set forth by the VA examiner. The findings of this trained medical professional are more probative on this issue than the assertions of the Veteran. In sum, the most probative evidence establishes that the appellant does not have chloracne and the current disorder was first manifest after service and is unrelated to any in-service event, to include herbicide exposure. Similarly, there is no relationship (causation or aggravation) to a service-connected disease or injury. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.W. Strike, 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.