Citation Nr: 21000531 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 17-11 991 DATE: January 5, 2021 ORDER Entitlement to service connection for atopic dermatitis and eczema is granted. FINDING OF FACT It is not shown by clear and unmistakable evidence that atopic dermatitis and eczema both pre-existed military service and was not aggravated during military service. CONCLUSION OF LAW The criteria for service connection for atopic dermatitis and eczema have been met. 38 U.S.C. §§ 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from June 1978 to December 1978. In March 2020, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been reviewed. The Board previously remanded this matter for additional development in April 2020. Service connection for atopic dermatitis The Veteran seeks service connection for atopic dermatitis. At the Board hearing, the Veteran testified that he had dermatitis in service. The Veteran testified that he was told that he was allergic to wool. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). A veteran will be considered to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable evidence demonstrates that an injury or disease existed prior thereto and was not aggravated by service. 38 U.S.C. § 1111. Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304 (b). Where such defects, infirmities or disorders are not noted when examined, accepted, and enrolled for service, pursuant to 38 U.S.C. § 1111 and 38 C.F.R. § 3.304, in order to rebut the presumption of soundness on entry into service, VA must show by clear and unmistakable evidence both that the disease or injury existed prior to service and that the disease or injury was not aggravated by service. See Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004); VAOPGCPREC 3-03. Service treatment records show that tinea versicolor was noted upon enlistment examination in May 1978. An August 1978 entry in the service treatment record noted a rash on the arms and back for two months. In November 1978, the Veteran was put on profile for atopic eczema. The profile restricted the Veteran to cotton socks and rubber sneaker type shoes. A November 1978 physical evaluation Board examination noted that the Veteran had been seen in the dermatology clinic several times with equivocal benefit from topical steroids and antihistamines. He gave a history of atopic dermatitis as a child but reported that he had not been troubled until his most recent exacerbation. Physical examination showed an eruption over the boot area, the arm surfaces, and about the neck. The Veteran was diagnosed with atopic dermatitis, moderate to severe, existing prior to service. In a July 2017 statement, the Veteran asserted that his skin rashes are related to wool exposure, hygiene in service, and exposure to chemicals in a gas chamber. His post-service treatment records reflect diagnoses of eczema and atopic dermatitis. The Veteran had a VA examination in September 2020. The examiner diagnosed atopic dermatitis and eczema. The examiner opined that the claimed condition, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression in service. The examiner reviewed the Veteran’s service records and noted that he had a history of atopic dermatitis after entering service in 1978. In November 1978, he reported that he had atopic dermatitis in childhood. The examiner noted that eczema and atopic dermatitis is a chronic, intermittent pruritic inflammatory skin disease that occurs most frequently in children but also affects adults. The examiner indicated that a multiplicity of factors are involved in the pathogenesis of atopic dermatitis. The examiner noted that most patients with dermatitis have a cutaneous hyperreactivity to various environmental stimuli, including exposure to food and inhalant allergens, irritants, changes in physical environment (including pollution, humidity, etc.) and stress. The examiner opined that eczema/atopic dermatitis is a waxing and waning condition dependent on exposures to triggers/specific allergens. The examiner noted that the Veteran had an episode of dermatitis that was triggered by his uniform. The examiner opined that the condition should have resolved once the allergen was removed, only to be reaggravated by further exposure to allergens. The Veteran’s July 2017 statement indicates that he continued to experience skin symptoms, such as scarring and skin loss, since service, and has been treated for his skin condition since 1978. The September 2020 examiner did not consider the Veteran’s statement about his skin symptoms after separation from service, which indicates that his skin condition symptoms have continued. VA treatment records dated in July 2017 noted a history of eczema since service, which was treated with ointment. The July 2017 treatment record indicates that the Veteran had continuous symptoms since service. The Board finds that the presumption of aggravation has not been rebutted by clear and unmistakable evidence demonstrating that the Veteran's pre-existing tinea versicolor did not undergo a permanent worsening beyond normal progression during active service. Clear and unmistakable evidence means evidence that "cannot be misinterpreted and misunderstood, i.e., it is undebatable." Quirin v. Shinseki, 22 Vet. App. 390 (2009). The September 2020 medical opinion indicates that his skin condition resolved after service. VA treatment records indicate that the Veterans dermatitis and eczema condition did not resolve, particularly the 2017 VA treatment records noting a history of eczema since service. The Board finds that there is clear and unmistakable evidence that a skin condition pre-existed service. However, it is not shown by clear and unmistakable evidence that the pre-existing skin disability was not aggravated by service. As such, the Board finds that the evidence is at least in equipoise as to whether the Veteran's preexisting skin disability was aggravated by during active duty service beyond the natural progression of the disorder. Therefore, service connection for atopic dermatitis and eczema, based on aggravation of his skin disability, is warranted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert, 1 Vet. App. 49. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Catherine Cykowski 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.