Citation Nr: 20059983 Decision Date: 09/11/20 Archive Date: 09/11/20 DOCKET NO. 13-21 047 DATE: September 11, 2020 ORDER Entitlement to service connection for a skin disorder is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran has or has had a skin disorder during the period on appeal that was incurred in or otherwise related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for a skin disorder have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1969 to February 1971. This appeal to the Board of Veterans’ Appeals (Board) arose from an October 2012 rating decision issued by the Department of Veterans Affairs (VA). See January 2013 Notice of Disagreement (NOD); May 2013 Statement of the Case (SOC); July 2013 Substantive Appeal (VA Form 9). The Veteran testified before the undersigned Veterans Law Judge in a December 2015 hearing. See December 2015 Hearing testimony. His spouse, D M, also testified. See id. In March 2016, the Board remanded the claim for further development. March 2016 Board decision. In August 2018, the claim was back before the Board and remanded again for further development. The Board directed that the Agency of Original Jurisdiction (AOJ) attempt to obtain evidence of skin cancer treatment referenced by Veteran and his spouse during the December 2015 Board hearing. See December 2015 Hearing testimony; August 2018 Board decision. The AOJ developed the evidence and then continued the denial of the Veteran’s claim. June 2020 Supplemental Statement of the Case. The claim is now back before the Board. Entitlement to service connection for a skin disorder. The Veteran asserts entitlement to service connection for skin cancer. February 2012 VA Form 21 526. The Veteran testified that he does not remember having skin problems during service but has had skin problems since separation. December 2015 Hearing testimony. Service connection may be established for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Service connection is established when there is competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). 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(d). In determining whether service connection is warranted for a disability, 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 preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). As an initial matter, the Board finds that there has been substantial compliance with its March 2016 and August 2018 remand directives. The AOJ obtained a copy of the Veteran’s relevant Social Security Administration (SSA) claim evidence and afforded the Veteran VA examinations for his claimed conditions. See March 2016 Board decision; Medical treatment records furnished by SSA, received in July 2016; November 2019 VA examinations. The AOJ also obtained additional VA treatment evidence, including a 2014 treatment note showing a diagnosis for squamous cell carcinoma. July 2014 VA treatment evidence. The AOJ attempted to obtain any private treatment evidence for a skin disorder, but no private treatment evidence was received. August 2018 Board decision; February 2019 Subsequent development letter. The Veteran’s spouse related that the Veteran no longer wanted to provide additional information and that a decision can be issued with the available evidence. March 2019 Lay statement. The Board finds that its remand directives have, thus, been substantially complied with. The Board finds that the Veteran has, or has had during the period on appeal, skin disorders diagnosed as squamous cell carcinoma and keratosis. See July 2014 VA treatment evidence; November 2019 VA examination for skin diseases. The Board also finds that having at least some in service sun exposure is consistent with the time, place, and circumstances of the Veteran’s service. The remaining question for the Board is whether the Veteran’s squamous cell carcinoma or keratosis was incurred in or is otherwise related to service. After careful and thorough review of the evidence, the Board finds that neither the Veteran’s squamous cell carcinoma nor keratosis was incurred in or is otherwise related to service. The medical treatment evidence is against finding that the Veteran’s current skin disorder, diagnosed as squamous cell carcinoma and keratosis, was incurred in or otherwise related to service. The Veteran’s service treatment records show no report or treatment for a skin disorder. Other than a tattoo on his arm, the Veteran’s medical examination during separation found normal skin condition and no noted defects. November 1970 Service treatment record. The earliest of medical evidence of treatment for a skin disorder was not until a May 2011 treatment for seborrheic keratosis, about 40 years after separation. May 2011 VA treatment evidence. The Veteran was afforded two VA examinations for his skin disorders. The June 2016 VA examiner opined that it is less likely than not that the Veteran’s keratosis was incurred in or caused by sun exposure while stationed at Fort Bliss and Fort Huachuca during service. June 2016 VA examination for skin disease. The June 2016 VA examiner’s rationale is that the Veteran’s service records show no treatment for a skin condition and he worked several years after separation as a farmer, which would have involved more sun exposure than his service. See id. In addition, the VA examiner noted that the medical literature shows no clear cause for seborrheic keratosis. Id. Conversely, the November 2019 VA examiner opined that squamous cell carcinoma and seborrheic keratosis are caused by excessive sun exposure. November 2019 VA examination medical opinion. While the November 2019 VA examiner did not provide an opinion on whether the Veteran’s skin disorders were caused by service, as noted by the June 2016 VA examiner, the Veteran had years of sun exposure after separation. The Board finds the VA examiners’ findings and opinions to be probative as they are from medical professionals qualified to evaluate the cause of the Veteran’s current skin disorders. The Board also considered the lay statements about the Veteran’s skin disorders and service. A lay witness is competent to testify as to the occurrence of an in-service injury or incident where such issue is factual in nature. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Additionally, where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Charles v. Principi, 16 Vet. App. 370, 374 (2002). In this case, the Veteran testified that most of his service was in Germany, which did not have much sun exposure. December 2015 Hearing testimony. The Veteran also testified that he does not remember having skin problems during service. Id. The Board finds these statements to be probative as they relate to facts or symptoms the Veteran personally experienced and is competent to report. The Veteran also testified to having treatment for a skin disorder after separation, but appeared unsure about when. See id. This uncertainty reduces the probative value of this statement. The Board also considered the Veteran’s spouse’s testimony that the Veteran had a skin biopsy for cancer the year prior to the December 2015 Board hearing. December 2015 Hearing testimony. This would be more than 40 years after separation and against finding that the condition was incurred in or otherwise related to service. Based on the more probative lay and medical evidence, the Board finds that the preponderance of the evidence is against finding that the Veteran’s skin disorders, diagnosed as squamous cell carcinoma and seborrheic keratosis, was incurred in or is otherwise related to service. (Continued on next page)   Accordingly, entitlement to service connection for a skin disorder is not warranted. DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Lin, M 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.