Citation Nr: 20031802 Decision Date: 05/06/20 Archive Date: 05/06/20 DOCKET NO. 19-11 035 DATE: May 6, 2020 ORDER Service connection for urinary incontinence is denied. Service connection for a skin disorder is denied. FINDINGS OF FACT 1. The Veteran had active service from March 1964 to October 1965 with several periods of “time lost” noted on the DD-214. 2. Urinary incontinence and a skin disorder were not shown in service and are not causally or etiologically related to service. CONCLUSIONS OF LAW 1. Urinary incontinence was not incurred in service. 38 U.S.C. §§ 1101, 1110, 1112, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309 (2019). 2. A skin disorder was not incurred in service, nor is it due to exposure to contaminated water at Camp LeJeune. 38 U.S.C. §§ 1101, 1110, 1112, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in§ 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Service connection may also be granted on a presumptive basis for certain diseases associated with exposure to contaminated water at Camp Lejeune if a veteran, former reservist, or member of the National Guard shows: (1) that he or she served at Camp Lejeune for no less than 30 consecutive or nonconsecutive days between August 1, 1953 and December 31, 1987; (2) that he or she currently suffers from a disease associated with exposure to contaminants in the water supply at Camp Lejeune enumerated under 38 C.F.R. § 3.309(f); and (3) that the current disease manifested to a degree of 10 percent or more at any time after service. 38 C.F.R. §§ 3.307(a)(7), 3.309(f). This presumption may also be rebutted by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. §§ 3.307, 3.309. Notwithstanding the foregoing provisions regarding presumptive service connection for exposure to contaminated water, a veteran is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).   Urinary Incontinence As an initial matter, urinary incontinence is not chronic disorders under 38 C.F.R. § 3.309 (a); accordingly, presumptive service connection will not be considered. Furthermore, the Veteran has not asserted that his urinary incontinence is caused or aggravated by a service connected disability; therefore, secondary service connection is not for application; however, direct service connection will be considered. As to a current disorder, the Veteran has been diagnosed with urinary incontinence. Specifically, in a February 2019 medical treatment note, a clinician diagnosed urinary incontinence. Accordingly, a current disorder has been shown and the first element of service connection has been met as to the claim. As to an in-service incurrence, the service treatment records (STRs) reflect no complaints of, treatment for, or a diagnosis of urinary incontinence. Moreover, a September 1965 Medical Board report was silent for a diagnosis, complaints of, or treatment for urinary incontinence. As an in-service disease or injury has not been shown, the second element of direct service connection has not been met and the medical evidence does not support the claim on the basis of direct service connection. Skin Disorder As an initial matter, a skin disorder is not chronic disorders under 38 C.F.R. § 3.309 (a); accordingly, presumptive service connection on the basis of continuity of symptomatology is not for application. Additionally, the Veteran has not argued that his skin disorder is caused or aggravated by a service connected disability; therefore, secondary service connection will not be considered. However, the Veteran asserts that his skin disorder is the result of exposure to contaminated water while stationed at Camp Lejeune; as such, presumptive service connection on the basis of exposure to contaminated water will be addressed. Finally, direct service connection will be discussed. As to a current disorder, in August 2018, the Veteran was diagnosed with alopecia. Clinical records reflect on-going complaints of alopecia. Accordingly, a current disorder has been shown and the first element of service connection has been met. As to an in-service incurrence, the STRs reflect no complaints of, treatment for, or a diagnosis of alopecia or any other skin disorder. Moreover, the September 1965 Medical Board report was silent for diagnosis, complaints of, or treatment for a skin disorder. As an in-service disease or injury has not been shown, the second element of direct service connection has not been met and the medical evidence does not support the claim on the basis of direct service connection. Turning to presumptive service connection based on contaminated water at Camp Lejeune, the Veteran has confirmed service at Camp Lejeune. As such, exposure to contaminated water is conceded. However, a skin disorder, including alopecia, not included on the list of diseases associated with exposure to contaminants in the water supply at Camp Lejeune under 38 C.F.R. § 3.309(f). Therefore, service connection on this basis is not supported by the law or evidence. Notwithstanding the inapplicability of the contaminated water presumptive service regulations, the Board has considered these claims on a direct exposure basis. Combee v. Brown, 34 F.3d 1039, 1042-44 (Fed. Cir. 1994). As noted above, there were no in-service complaints of, treatment for, or diagnoses related to a skin disorder. Moreover, there is no post-service medical evidence that supports a direct relationship between alopecia and contaminated water at Camp Lejeune. Accordingly, the medical evidence does not support direct service connection based on exposure to contaminated water at Camp Lejeune. Therefore, the medical evidence does not support service connection based on exposure to contaminated water on a direct basis. The Board has considered the Veteran’s lay statements that his disorders were caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorders due to the medical complexity of the matters involved. Such competent evidence has been provided by the service records and clinical evidence obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claims for service connection and there is no doubt to be otherwise resolved. As such, the appeals are denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Grzeczkowicz 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.