Citation Nr: 20021066 Decision Date: 03/24/20 Archive Date: 03/24/20 DOCKET NO. 17-58 157 DATE: March 24, 2020 ORDER Entitlement to service connection for pseudofolliculitis barbae is denied. REMANDED Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a lower back disorder is remanded. FINDING OF FACT The preponderance of evidence is against finding that the Veteran has a current pseudofolliculitis barbae disorder. CONCLUSION OF LAW The criteria for entitlement to service connection for pseudofolliculitis barbae have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty for training from June to August 1968 and February to April 1971. He served honorably in the U.S. Army and Army National Guard. The Board thanks the Veteran for his service to our country. The Veteran testified before the undersigned at a Board videoconference hearing in December 2019. A transcript of the hearing is of record. The record was held open for 60 days; however, no new evidence was added to the record. Entitlement to service connection for pseudofolliculitis barbae is denied. The Veteran contends that service connection for pseudofolliculitis barbae is warranted, citing his in-service history of treatment for the disorder. The Board finds that service connection is not warranted. Service connection may be granted for disability due to disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may also be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303. To substantiate a claim of service connection, there must be evidence of: (1) a current disability; (2) a disease, injury, or event in service; and (3) a nexus or causal relationship between the claimed disability and the disease, injury, or event in service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Congress has specifically limited entitlement to service-connected benefits to cases where there is a current disability. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992). The requirement for current disability is satisfied when the claimant has a disability at the time a claim for service connection is filed or during the pendency of the claim. McClain v. Nicholson, 21 Vet. App. 319 (2007). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, 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 fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Veteran’s service treatment records include multiple notations of pseudofolliculitis barbae, including a permanent profile for the disorder. In October 2016 statements, the Veteran stated that his pseudofollicular barbae surfaced in service and was agitated by shaving. In a March 2017 VA examination report, the examiner did not render a diagnosis for pseudofolliculitis barbae, instead noting under diagnosis, “Normal.” The examiner noted that the Veteran’s symptoms are subjective only, that the objective examination was normal, and that no evidence of the skin disorder was noted on examination. The examiner remarked that there is no objective evidence of a chronic condition. In a June 2017 note, in a review of systems, the Veteran reported pseudofolliculitis barbae. The skin disorder was noted in his past medical history. A review of the Veteran’s treatment records during the period on appeal reveal no diagnoses or notations of the disorder by treatment providers. At the December 2019 hearing, the Veteran testified that if he shaved, his skin disorder would return but that as long as he did not shave, it did not come back. Replying to a question of whether he had the disorder at any time in recent years or whether he had had his beard for years, he replied, “I’ve had it before” and his representative added, “Yeah, he had it in service.” In response to a question of whether he just kept the beard instead of having the disorder, he replied, “I keep the beard.” He testified that the beard itches. The preponderance of evidence is against finding that the Veteran has a current pseudofolliculitis barbae disorder. There are no notations or diagnoses of the disorder during the period on appeal and objective examination was normal and revealed that there was no evidence of the skin disorder. While the Veteran reported the disorder in a June 2017 review of systems, the contemporaneous competent medical evidence and his testimony that he had it before and not in recent years, instead keeping his beard, is afforded greater probative weight. (The Board notes that, while he reported his beard itching, there is no indication of any functional impairment.) Hence, after reviewing all the evidence of record, the Board finds that the preponderance of the evidence is against finding that service connection for pseudofolliculitis barbae is warranted. The Board has considered the doctrine of reasonable doubt, but finds that the record does not provide an approximate balance of negative and positive evidence on the merits. The claim is, therefore, denied. Gilbert, 1 Vet. App. at 55; 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND Entitlement to service connection for a left knee disorder and a lower back disorder is remanded. A remand is warranted to afford the Veteran examinations for his claimed disorders. With respect to the Veteran’s left knee, in the March 2017 VA examination report, the examiner diagnosed the Veteran with left knee anterior cruciate ligament status post arthroscopy. The examiner indicated that imaging studies of the knee had been performed and that the results were available, but that degenerative or traumatic arthritis was not documented. However, in an October 2017 imaging report, the physician noted moderate degenerative joint disease of the left knee joint. Accordingly, a new examination is necessary. Regarding the Veteran’s lower back claim, the Board notes that he has not been afforded an examination. As his hearing, the Veteran testified that he had back pain and difficulty walking and that, while seldom, he has used a cane. He testified that he has had back problems since the 1970s when he injured his knee. The Veteran is competent to report the onset of his lower back symptoms. As there is an indication this his back disorder may be related to his knee, an examination is needed. To afford the Veteran an examination and as the back claim is inextricably intertwined with the remanded knee claim, a remand is necessary. The matters are REMANDED for the following action: 1. Please secure for the record copies of complete updated clinical records (any not already of record) of all VA and non-VA treatment the Veteran has received for the disorders on appeal. Please ask the Veteran to provide the releases necessary for VA to secure any adequately identified private treatment records, including treatment records for his back. 2. After the action in paragraph 1 is determined to be complete, please schedule the Veteran for an examination to determine the nature and etiology of his throat disorder. The Veteran’s claims-file must be reviewed by the examiner in conjunction with the examination. Any indicated tests or studies should be conducted. Based on review of the record, With respect to a left knee disorder: (a.) The examiner should identify, by diagnosis, all knee disorders current during the period on appeal, including degenerative joint disease. (b.) As to each disorder identified, and to include degenerative joint disease, the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) related to service. The examiner should consider and discuss as necessary the Veteran’s report he first hurt his knee in service, that he had ongoing problems after that, and then he reinjured it in a 1996 motor vehicle accident, requiring knee surgery. With respect to a lower back disorder: (c.) The examiner should identify, by diagnosis, any back disorders and functional impairment due to back pain current during the period on appeal. (d.) As to each disorder identified (or with respect to back pain, if functional impairment is identified), the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) caused by the Veteran’s left knee disorder. (e.) As to each disorder identified (or with respect to back pain, if functional impairment is identified), the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) aggravated by the Veteran’s left knee disorder. If the examiner finds aggravation, please describe the baseline level of disability (prior to the aggravation). The examiner is requested to consider the Veteran’s lay statements of continuing symptomatology and his use of medication for pain relief. The examiner is advised that there is no legal requirement that the in-service event or injury must be the sole cause of the disorder claimed. The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. The examiner should take into consideration that the Veteran is competent to report in service and post-service symptom experiences; other witnesses are competent to report observable symptoms. If the examiner cannot provide an opinion without resorting to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Vashaw, 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.