Citation Nr: 20051968 Decision Date: 08/05/20 Archive Date: 08/05/20 DOCKET NO. 12-05 463 DATE: August 5, 2020 ORDER Entitlement to service connection for skin conditions is denied. FINDING OF FACT The Veteran’s current skin conditions, which have occurred during the relevant time frame, have not been otherwise related to or etiologically linked to an in-service event, injury, or disease. CONCLUSION OF LAW The criteria for service connection for a skin condition are not met. 38 U.S.C. §§ 1110, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had honorable active service with the United States Army from January 1966 to February 1968. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a May 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). When this entitlement first came before the Board, the issue was whether there was new and material evidence to reopen the claim for entitlement to service-connection for a skin condition affecting the face, claimed as a rash or acne, to include as due to herbicide exposure. The Board reopened the claim and remanded the claim for development. See BVA decision dated May 2015. The Board notes that service connection for a scar on the Veteran’s chin was granted in the May 2015 Board decision, and thus the Veteran’s chin scar will not be discussed further. Id. In July 2018, when the Board again remanded the claim of entitlement to service connection for a skin condition, the Board found that the statements and treatment records encompassed skin conditions affecting the neck, torso, and extremities. The issue remanded was broadened to include entitlement to service connection for a skin condition. The most recent VA examination was in August 2019. The claim of entitlement to service connection for a skin condition was remanded for a new and adequate VA medical expert opinion. A new opinion was provided and in June 2020, the RO provided the Veteran with a supplemental statement of the case (SSOC) and returned the entitlement claim to the Board. The Veteran contends that he did not have any acne or skin conditions prior to service. He reported that he started to have acne and trouble shaving while he was in Vietnam. Due to difficulty shaving, he often kept a beard on his face. He also reported pustules over his body while in Vietnam. At the hearing, the Veteran specifically alleged skin conditions including pseudofolliculitis barbae, and acne vulgaris. See Hearing Transcript dated February 2014. Generally, service connection will be granted for a disability resulting from an injury or disease caused or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). A grant for service connection for a disability requires: (1) a present disability or persistent or recurrent symptoms of a disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (“nexus”) between the present disability and the in-service event, injury, or disease. 38 U.S.C. § 1110; 38 C.F.R. § 3.303; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including the evidence pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Additionally, service connection may be granted for specified chronic diseases when shown in service with subsequent manifestations at a later date, however remote, unless clearly attributable to intercurrent causes. 38 C.F.R. §§ 3.303(b), 3.307. As the Veteran, in this case, served in the Republic of Vietnam during the Vietnam era, exposure to herbicide agent has been conceded and presumptive service connection due to a chronic skin condition has been considered. See 38 C.F.R. §§ 3.303, 3.307. For presumptive service connection for diseases associated with exposure to certain herbicide agents, the disease must manifest to a degree of 10 percent or more within any time after service, but for chloracne or other acneform diseases consistent with chloracne, porphyria cutanea tarda, and early-onset peripheral neuropathy, the disease has to manifest to a degree of 10 percent or more within one year after the last date on which the veteran was exposed to an herbicide agent during active service. See 38 C.F.R. § 3.307(a)(6)(ii). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the Veteran. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Board determinations with respect to the weight and credibility of evidence are factual determinations going to the probative value of the evidence. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno, 6 Vet. App. at 465. Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 C.F.R. § 3.159; see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. In this case, the Board has reviewed all the evidence of record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate and the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim on appeal. The Board has considered direct service-connection for the entitlement claim for skin conditions. The Board also considered whether there was a link between the Veteran’s current disabilities and his herbicide exposure. For direct service connection, first the Veteran must have a current disability. The Veteran’s treatment records reflect various intermittent skin conditions since he filed his claim. For example, in January 2010 the Veteran had some treatment with a dermatologist at the VA for skin lesions. See Medical Treatment Records-Government Facility received January 2010. He had some skin rashes in October 2010. See Medical Treatment Records-Government Facility received July 2011. In August 2014, the Veteran had dry flaking skin noted on examination. See CAPRI received August 2015. In January 2020, a VA medical examiner stated that the Veteran’s VA treatment records included treatment for atopic dermatitis, ichthyosis vulgaris, fungal infection, dry skin, dermatosis papulosis nigricans, seborrheic dermatitis, xerosis, and seborrheic keratosis. See C&P Exam received January 2020. The Board notes that the record does not clearly show an ongoing reoccurrence of pseudofolliculitis barbae, or acne vulgaris. The record also does not well support that the Veteran had a chronic skin condition since service, but instead the record appears to show various intermittent skin conditions. Considering the totality of the records, the Board finds that the Veteran has current skin disabilities documented since his filing, and that this evidence meets the first part of the direct service connection test. Next the Board considered whether the Veteran had an in-service event, injury or disease. In January 1966, the Veteran’s induction examination was normal, with the exception, of pes planus and a scar or tattoo on the wrists. See STR received March 1984. At separation, the Veteran had a normal examination except for a scar on his chin and right leg. Id. On the Report of Medical History at separation the Veteran reported that he was crushed by a truck and could not walk for 30 days. On the medical history the Veteran did not report skin conditions during service or while in Vietnam. Id. In fact, he specifically denied a history of skin disease in his report of medical history. The service treatment records do not otherwise document any skin conditions during service. The Veteran testified that he had pseudofolliculitis barbae, and as a result he stopped shaving during service. The Veteran also reported that he had acne while in Vietnam. See Hearing Transcript dated February 2014. While in many situations a Veteran is not competent to provide a diagnosis of his disabilities, lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 C.F.R. § 3.159; see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As such, the Veteran’s testimony may serve to support an in-service event, but even if the Veteran’s lay statements alone were sufficient to establish an in-service event, direct service connection requires that there be a link between the Veteran’s in-service event, and his current conditions. The Veteran did provide the opinion of an independent medical examiner. See Correspondence received February 2016. The independent medical examiner diagnosed the Veteran with acne vulgaris and pseudofolliculitis barbae. The doctor opined that these conditions were related to his service in Vietnam. However, the Board noted that the independent medical examiner’s actual physical examination did not describe the Veteran having any skin conditions. The doctor stated in an introduction that “In the heat of Vietnam and being of Negro descent resulted in pseudofolliculitis barbae from having to shave in service. Similarly, in the hot sweaty environment of Vietnam, he began to develop acne. It is noted that he did not have it when he was younger. He needed treatment intermittently. He has scars on his face.” The opinion stated that “It is my medical opinion that the injuries, impairments, and disabilities set forth in my diagnosis and computations of service-connected disabilities were, as likely as not, due to the consequence of this Veteran’s military service.” See Correspondence received February 2016. In review of this opinion, the Board found it unclear what service records or medical records that the examiner reviewed. Furthermore, it was unclear whether the doctor saw the Veteran with any skin conditions, as the physical examination appeared to be negative for skin conditions. Additionally, as an independent medical examiner, the doctor did not provide the Veteran treatment and has no history with the Veteran. The doctor does not appear to be a specialist in dermatology, and the doctor focused most of his examination on the Veteran’s orthopedic and neurological symptoms. Lastly, the Board found it unclear what evidence the doctor based his diagnoses of the Veteran’s skin conditions on. The Board also considered other opinions in the record. In January 2020, a VA examiner reviewed the records and provided a detailed opinion. The examiner opined that it is less likely than not that the Veteran’s skin conditions to include folliculitis barbae, acne vulgaris, skin rash with hyperpigmented papules, atopic dermatitis, seborrheic dermatitis, and xerosis had their onset in service or are otherwise etiologically related to the service to include herbicide exposure. See C&P Examination received January 2020. The doctor’s rationale was that a review of the competent medical evidence contained in the service treatment records fails to identify any dermatological condition while the veteran was active duty or within a year of separation from active duty. The doctor also noted the length of time between the Veteran’s dermatological treatment and the Veteran’s separation from the military. Additionally, the examiner explained that none of the veteran’s diagnoses are conditions that are presumptively related to herbicide exposure. The only dermatological conditions that are presumptively related to herbicide exposure are chloracne and porphyria cutanea tarda. The examiner explained that chloracne is a skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers. The doctor explained that under VA’s rating regulations, it must be at least 10 percent disabling within one year of exposure to herbicides. As for Porphyria Cutanea Tarda, that disorder is characterized by liver dysfunction and by thinning and blistering of the skin in sun-exposed areas. In sum, medical records around the time of the Veteran’s service and discharge do not indicate a diagnosis of a skin condition. See STR received March 1984. His service treatment records are silent with respect to a skin condition. In his separation examination, his skin was assessed to be normal, except for scars. At the time, he did not report concerns of an intermittent rash, acne, pseudofolliculitis barbae, or another skin condition. Id. The earliest medical documentation of any skin condition was years after service, and not within the one year required for presumptive service-connection. At the hearing in February 2014, the Veteran did not report continuous symptoms of any skin conditions, specifically acne or pseudofolliculitis barbae following discharge. He reported he had some bad facial scars from acne. He reported trouble shaving in service but did not comment on whether he continued to have trouble shaving. See Hearing Transcript dated February 2014. Other records noted that the Veteran did not report continuous symptoms. At a VA examination in December 2018, the Veteran reported that he had a rash and acne 20 years ago. The Veteran reported skin problems in 2016. See C&P received December 2018. As for his VA treatment records, they reported intermittent flares of various skin conditions with treatment as deemed necessary for each condition. The Board recognizes that the Veteran believes his skin conditions are related to his active duty service. However, he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires medical knowledge and training. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). While the Veteran can attest to observable symptomatology of a skin condition, he is not competent to diagnose any observed symptoms he may have experienced in service as the same skin conditions he currently has. Furthermore, the VA medical professionals were unable to relate the Veteran’s lay statements regarding symptoms around the time of his active duty service with his presently diagnosed skin conditions. As to the independent medical examiner, the doctor did not appear to find that the Veteran had any current skin conditions based on an examination, or through records. The Board also notes that the VA examiner considered the independent medical examiner’s report. In weighing the evidence, the Board gives more probative weight to the competent, and credible medical opinion provided by the VA examiner, denying any etiological relationship between the Veteran’s skin conditions and his service, than the Board gives to the independent medical examiner’s opinion. Based on the foregoing, the claim of entitlement to service connection for a skin condition is denied. The preponderance of the evidence is against the Veteran’s claim; thus, the benefit-of-the-doubt rule is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001). B. Mullins Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Associate Counsel, C. Parnell 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.