Citation Nr: 21000559 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 16-45 550 DATE: January 5, 2021 ORDER Service connection for a skin condition, claimed as blisters, is denied. FINDING OF FACT The appellant is diagnosed with dermatitis and actinic keratosis; he served at Camp Lejeune for at least 30 days, but his diagnoses are not presumptive diseases; and there is no other indication that they are due to the contaminants at Camp Lejeune or otherwise attributable to service. CONCLUSION OF LAW The criteria for service connection for a skin condition, claimed as blisters, have not been met. 38 U.S.C. §§ 1101, 1131, 1154, 5103, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant served in the United States Marine Corps Reserve, with a period of active duty for training (ACDUTRA) from June 1957 to December 1957. He had another period of ACDUTRA during November 1960. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In January 2018 and again in June 2019, the Board remanded the case for further development. 1. Service connection for a skin condition, claimed as blisters Initially, the Board notes that the preliminary determination in any claim for veterans’ benefits is whether the claimant is considered a “veteran” as defined under VA law. See Dingess v. Nicholson, 19 Vet. App. 473, 484 (2006). Special rules apply to National Guard and Reserve service. Service in the National Guard, even during period of Active Duty for Training (ACDUTRA) without more, will not suffice to give one “veteran” status. Donnellan v. Shinseki, 24 Vet. App. 167, 172 (2010). A veteran is “a person who served in the active military, naval, or air service, and who was discharged or released there from under conditions other than dishonorable.” 38 U.S.C. § 101 (2); 38 C.F.R. § 3.1 (d). Active Duty for Training (ACDUTRA) is, among other things, full-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c)(1). Thus, in order to establish “veteran status” with respect to service in the Reserves or National Guard, and therefore eligibility for service connection, the record must establish that a claimant was disabled due to a disease or injury incurred or aggravated in the line of duty during a period of ACDUTRA, or that he or she was disabled from an injury incurred or aggravated in the line of duty during a period of INACDUTRA. See Mercado-Martinez, 11 Vet. App. at 419; Paulson v. Brown, 7 Vet. App. 466, 470 (1995); Biggins v. Derwinski, 1 Vet. App. 474, 478 (1991); see also 38 U.S.C. § 101 (24); 38 C.F.R. § 3.6 (a). Currently, service connection is not in effect for any disabilities. Thus, the appellant has not achieved “veteran status” for his periods of ACDUTRA service. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). A veteran, or former reservist or member of the National Guard, who had no less than 30 days (consecutive or nonconsecutive) of service at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987, shall be presumed to have been exposed during such service to the contaminants in the water supply, unless there is affirmative evidence to establish that the individual was not exposed to contaminants in the water supply during that service. The last date on which such a veteran, or former reservist or member of the National Guard, shall be presumed to have been exposed to contaminants in the water supply shall be the last date on which he or she served at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987. For purposes of this section, service at Camp Lejeune means any service within the borders of the entirety of the United States Marine Corps Base Camp Lejeune and Marine Corps Air Station New River, North Carolina, during the period beginning on August 1, 1953, and ending on December 31, 1987, as established by military orders or other official service department records. 38 C.F.R. § 3.307 (a)(7)(iii). Exposure described in paragraph (a)(7)(iii) of this section is an injury under 38 U.S.C. § 101 (24)(B) and (C). If an individual described in paragraph (a)(7)(iii) of this section develops a disease listed in §3.309(f), VA will presume that the individual concerned became disabled during that service for purposes of establishing that the individual served in the active military, naval, or air service. 38 C.F.R. § 3.307 (a)(7)(iv). For the purposes of this section, contaminants in the water supply means the volatile organic compounds trichloroethylene (TCE), perchloroethylene (PCE), benzene and vinyl chloride, that were in the on-base water-supply systems located at United States Marine Corps Base Camp Lejeune, during the period beginning on August 1, 1953, and ending on December 31, 1987. 38 C.F.R. § 3.307 (a)(7)(i). If a veteran, or former reservist or member of the National Guard, was exposed to contaminants in the water supply at Camp Lejeune during military service and the exposure meets the requirements of §3.307(a)(7), the following diseases shall be service-connected even though there is no record of such disease during service, subject to the rebuttable presumption provisions of §3.307(d). (1) Kidney cancer. (2) Liver cancer. (3) Non-Hodgkin’s lymphoma. (4) Adult leukemia. (5) Multiple myeloma. (6) Parkinson’s disease. (7) Aplastic anemia and other myelodysplastic syndromes. (8) Bladder cancer. 38 C.F.R. § 3.309 (f). The diseases listed in §3.309(f) shall have become manifest to a degree of 10 percent or more at any time after service. 38 C.F.R. § 3.307 (a)(7)(ii) Evidence The appellant’s December 1957 service separation examination noted normal skin. The Reserves service treatment records (STRs) show treatment in November 1960 for skin complaints involving a violaceous rash behind the right knee. The appellant underwent a dermatology consultation for these complaints. (The diagnosis is difficult to discern from the handwritten consultation notes.) The appellant was seen in June 2011 with a nine-month history of blisters on the face. He was diagnosed with pemphigoid disorder that manifested with lesions on his head and face. The appellant filed his claim for service connection in April 2014. The appellant underwent a VA examination in May 2018. He reported a three-year history of back blister. The examiner noted a left black skin lesion at the left top of the back, as well as several actinic keratosis-type skin lesions on the back. The examiner stated that the appellant had a current back blister condition that was not related to service as “there is no evident diagnosis in STR.” The examiner did not make any reference to the November 1960 skin treatment. In June 2019 the Board remanded the case to obtain another medical opinion. A VA examination was conducted in November 2019. The examiner diagnosed dermatitis of the popliteal fossa (behind the knee) and multiple actinic keratoses of the back. The examiner opined that these conditions were less likely than not (less than 50 percent probability) incurred in or caused by the claimed inservice injury, event, or illness: [Appellant] has a single STR mentioning a “Violaceous rash in posterior popliteal region of right knee” with an illegible diagnosis provided by dermatology. There are no further active duty or post-separation notes to suggest chronicity. Similar to the [Appellant]’s last skin examination… during my in-person examination I noted numerous actinic keratosis lesions on the [Appellant]’s back. Actinic keratosis and dermatitis were not noted during active duty. Furthermore, actinic keratosis is primarily associated with sun exposure. As a result, in my opinion, the [Appellant]’s claimed actinic keratosis and dermatitis were less likely than not (less than 50 percent probability) incurred in or caused by service or otherwise causally related to any event or circumstance of his service to include the treatment during service in November 1960 for skin complaints involving a violaceous rash on the right knee during service. The examiner further noted that: The [Appellant] was never diagnosed with blisters during active duty. The illegible diagnosis from the November 1960 STR does not appear to suggest “blister.” [Appellant] has a single STR mentioning a “Violaceous rash in posterior popliteal region of right knee” with an illegible diagnosis provided by dermatology. There are no further active duty or post-separation notes to suggest chronicity. This condition resolved between 1960 and 1961. Analysis Service connection for a skin condition is not warranted on a presumptive basis as related to contaminated water at Camp Lejeune. The appellant’s skin conditions, dermatitis and actinic keratoses are not presumptive diseases and there is no indication that they are otherwise due to the contaminants at Camp Lejeune. The appellant had at least 30 days of service at Camp Lejeune. He had training there from October 1957 to November 1957 for a period of approximately 44 days. Thus, he is presumed to have been exposed during such service to the contaminants in the water supply at Camp Lejeune. See 38 C.F.R. § 3.307 (a)(7)(iii). This notwithstanding, the appellant’s skin conditions are not on the list of diseases associated with his exposure. See 38 C.F.R. § 3.309 (f). And, there is otherwise no indication that his skin conditions are due to such exposure. The appellant contends that his diagnoses are due to the exposure at Camp Lejeune, but this question is not one that is capable of lay observation, within the common knowledge of a lay person, or otherwise within the competence of a non-medical expert. To the contrary, it is the subject of numerous and advanced-level scientific/medical studies. See 82 Fed. Reg. 4173 (Jan. 13, 2017) (discussing an Agency for Toxic Substances and Disease Registry (ATSDR) review and stating that “VA reviewed evidence from several internationally recognized scientific authorities, including groups other than the NRC.”). Thus, the appellant’s statements cannot constitute competent evidence tending to increase the likelihood of a nexus to service. See Fountain, 27 Vet. App. at 274-75; Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012); see also Waters, 601 F.3d at 1278. Service connection for a skin condition is not otherwise warranted on a direct basis. A chronic skin condition was not shown in service, and the current skin conditions of dermatitis and actinic keratoses were diagnosed decades after service. The Board finds the November 2019 VA examiner’s opinion highly probative in determining whether the appellant’s current skin conditions are related to his periods of ACDUTRA, as it is shown to have been based on a review of the appellant’s record and is accompanied by a sufficient explanation. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The examiner explained that the appellant’s current actinic keratosis and dermatitis were diagnosed decades after his period of ACDUTRA, and that there was nothing in the record to suggest that the violaceous rash behind the knee noted in 1960 was chronic; rather it apparently resolved in 1960 or 1961. There are no medical opinions of record contradicting the VA examiner’s opinion. The Board acknowledges the appellant’s assertions that his current skin conditions are related to the violaceous rash treated in ACDUTRA in 1960. However, as this issue is medically complex, he is not competent to provide a nexus opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The VA examiner has determined that the current skin conditions are not related to the inservice finding. In conclusion, the weight of the most credible and competent evidence does not establish that the appellant’s skin conditions are related to ACDUTRA, including exposure to contaminants at Camp LeJeune. Thus, the preponderance of the evidence is against the claim and particularly the nexus element. As such, the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Accordingly, service connection for a skin disorder is not warranted. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. G. Mazzucchelli, 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.