Citation Nr: 20036463 Decision Date: 05/28/20 Archive Date: 05/28/20 DOCKET NO. 15-11 806 DATE: May 28, 2020 ORDER Entitlement to service connection for a skin condition is denied. REMANDED Entitlement to service connection for a headache condition is remanded. FINDING OF FACT The Veteran did not have a skin disability for VA purposes during the appeal period. CONCLUSION OF LAW The criteria for entitlement to service connection for a skin condition have not been met. 38 U.S.C. §§ 1131, 5107(b) (2012); 38 C.F.R. §§ 3.303, 3.310(a), (b) (2018); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had qualifying service from June 2001 to February 2003. In June 2018, the Board remanded for further development. 1. Service Connection for a Skin Condition Direct service connection generally requires evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability; thus, in the absence of proof of a present disability, there can be no valid claim. Brammer, 3 Vet. App. at 225; Rabideau, 2 Vet. App. at 143-44. Notably, laypersons are competent to report lay-observable symptoms; however, laypersons without a medical background are not competent to render diagnoses that are not lay observable or to opine regarding the etiology of a disability that is not lay observable. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994). The Veteran generally contends that she has a skin condition that is etiologically related to her service. See October 2010 VA Form 21-526 (the Veteran contended that her skin condition resulted from in-service use of her boat’s soap); see also October 2019 VA skin diseases examination (the Veteran contended that, during service, she began developing a pruritic rash on both hands [due to working in the mess hall, washing dishes, and using cleaning supplies] and also began treatment for tinea pedis [due to wearing military boots for extended periods]). The February 2001 entrance examination contained no pertinent abnormalities and the Veteran indicated ‘no’ for past or current symptoms of skin diseases. The available service treatment records (STRs) are negative for complaints, treatment, or diagnoses regarding the skin. A March 2013 VA Memorandum found that other STRs are unavailable and that further attempts to obtain them would be futile. A March 2005 Medical Examination Report for Commercial Driver Fitness Determination from Family and Urgent Care Clinic documented that the Veteran indicated ‘no’ for having any illnesses or injuries in the last five years. In August 2007, the Veteran was treated on only one occasion by Dr. RHB for diagnosed bilateral tinea pedis of approximately one-year duration. See November 2010 Letter by Dr. RHB. A May 2010 record from Family and Urgent Care Clinic diagnosed fungal dermatitis. On October 7, 2010, VA received a VA Form 21-0820, which initiated this claim and the current appeal period. The June 2018 Board Remand noted that the August 2007 and May 2010 diagnoses were prior to the current appeal period, but found it necessary (due to the heightened duty to assist the Veteran in development because of missing STRs) to afford the Veteran an opportunity to identify any treatment for a skin condition during the appeal period (so that VA could assist her in obtaining those records) and to afford the Veteran a VA examination to assess the nature, severity, and etiology of any skin condition. Upon remand, the agency of original jurisdiction (AOJ) sent development letters to the Veteran on March 18, 2019, and August 29, 2019, requesting that she identify any private treatment records and complete VA Forms 21-4142a so that VA could obtain those records for her; however, the Veteran never responded. The AOJ also attempted to obtain any VA treatment records, but none were available as of the date of the March 2020 Supplemental Statement of the Case (SSOC). Accordingly, the AOJ scheduled the Veteran for a VA examination with medical opinion, which was conducted on October 1, 2019. During the October 2019 VA skin diseases examination, the Veteran contended that, during service, she began developing a pruritic rash on both hands (due to working in the mess hall, washing dishes, and using cleaning supplies) and also began treatment for tinea pedis (due to wearing military boots for extended periods). The Veteran further contended that her hands still “bump up, blister, and itch” and that she has to take Benadryl daily to help with itching. The examiner noted previously resolved skin conditions of tinea pedis and contact dermatitis; however, upon examination, the examiner found no contemporaneous findings, signs, and/or symptoms to support a diagnosis of a skin condition. Because the examiner found no active skin condition on examination, the examiner opined that the Veteran’s prior treatment was self-resolving and without any permanent residuals or chronic disability. Based on the evidence above, the Board finds that the Veteran did not have a skin disability for VA purposes during the appeal period. The evidence does not indicate that the Veteran has the medical background necessary to competently attribute her lay-observable symptoms to a dermatological diagnosis. Jandreau, 492 F.3d 1372; Layno, 6 Vet. App. 465. Further, none of the providers who are competent to render diagnoses have found a skin disability during the current appeal period. As discussed above, the AOJ afforded the Veteran the opportunity to identify any private treatment and complete VA Forms 21-4142/a so that VA could obtain those records for her; however, the Veteran never responded. Also, as discussed above, there are no VA treatment records for this Veteran. As such, the Board must deny the claim based on the absence of proof of a present disability for VA purposes. Brammer, 3 Vet. App. at 225; Rabideau, 2 Vet. App. at 143-44. REASONS FOR REMAND Service Connection for a Headache Condition VA’s duty to assist includes providing an adequate examination when such an examination is indicated. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Once VA provides an examination, it must be adequate, or VA must notify the Veteran why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The February 2001 entrance examination contained no pertinent abnormalities and the Veteran indicated ‘no’ for past or current symptoms of frequent or severe headaches. July 2002 STRs documented the Veteran’s reports of headache with nausea, including sometimes when working outside; the provider diagnosed headaches of unknown origin, prescribed medications, and instructed the Veteran about heat exhaustion and drinking water, especially when working outside. In an October 2010 VA Form 21-526, the Veteran contended that her headaches resulted from in-service exposure to gas. During the October 2019 VA headaches examination, the Veteran contended that she began experiencing headaches while working on the flight line due to inhaling jet fumes. Crucially, the October 2019 VA headaches examiner’s etiological opinion is inadequate for failure to analyze the Veteran’s contentions. The examiner diagnosed headaches and discussed the pertinent STRs; however, the examiner rendered an etiological opinion unfavorable to the Veteran without analyzing her contentions. The examiner merely opined that, despite in-service treatment, the condition was acute only and there was no evidence of a chronic condition or permanent residual occurring during service or upon separation. However, the examiner’s rationale failed to consider the Veteran’s contended exposure to gas/fumes, which is likely consistent with her military occupation specialty as an electrical/mechanical equipment repairman. See DD Form 214. As such, the Board must remand for the AOJ to obtain an addendum etiological opinion with adequate rationale. The matters are REMANDED for the following action: 1. Obtain an addendum etiological opinion with adequate rationale for the headache condition. The opinion must consider the following evidence: (a) February 2001 entrance examination (contained no pertinent abnormalities and the Veteran indicated ‘no’ for past or current symptoms of frequent or severe headaches); (b) July 2002 STRs (documented the Veteran’s reports of headache with nausea, including sometimes when working outside; the provider diagnosed headaches of unknown origin, prescribed medications, and instructed the Veteran about heat exhaustion and drinking water, especially when working outside); (c) October 2010 VA Form 21-526 (the Veteran contended that her headaches resulted from in-service exposure to gas); and (d) October 2019 VA headaches examination (the Veteran contended that she began experiencing headaches while working on the flight line due to inhaling jet fumes). The AOJ is advised that the Board has found the October 2019 VA headaches examiner’s etiological opinion to be inadequate for failure to analyze the Veteran’s contentions (the examiner diagnosed headaches and discussed the pertinent STRs; however, the examiner rendered an etiological opinion unfavorable to the Veteran without analyzing her contentions about in-service exposure to gas/fumes, which is likely consistent with her military occupation specialty as an electrical/mechanical equipment repairman). The Board defers to the examiner’s discretion to determine whether another in-person examination is required to render the requested addendum opinion. (CONTINUED ON NEXT PAGE) 2. Readjudicate the appeal. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Daus, 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.