Citation Nr: 21001955 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 18-33 270 DATE: January 12, 2021 ORDER Entitlement to service connection for acne is granted. Entitlement to service connection for acne scarring is granted. FINDINGS OF FACT 1. The Veteran’s preexisting acne condition was aggravated beyond its natural progression by his active service. 2. The Veteran’s preexisting acne scars were aggravated beyond its natural progression by his active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for acne have been met. 38 U.S.C. §§ 1110, 1111, 1153, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for entitlement to service connection for acne scarring have been met. 38 U.S.C. §§ 1110, 1111, 1153, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1979 to March 1983. Service Connection Establishing service connection generally requires medical or, in certain circumstances, lay evidence of: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). 1. Entitlement to service connection for acne 2. Entitlement to service connection for acne scarring The Veteran contends that his preexisting skin acne condition and acne scarring were worsened or aggravated beyond its natural progression during his active service. During the Veteran’s enlistment examination in May 1978 it was noted that the Veteran had mild facial and back acne. The issue before the Board is whether the Veteran’s preexisting mild acne condition as noted upon entrance into service was aggravated by his active duty service. The Board finds that, affording the Veteran the benefit of doubt the acne condition and acne scarring were aggravated by his active duty service; service connection is warranted. If a preexisting disorder is noted upon entry into service, the Veteran cannot bring a claim for service connection for that disorder, but the Veteran may bring a claim for service-connected aggravation of that disorder. 38 U.S.C. § 1153. A preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. The burden falls on the Veteran to establish aggravation. If the Veteran demonstrates a worsening of his condition in service, the burden then shifts to the government to rebut the presumption of aggravation by clear and unmistakable evidence. Jensen v. Brown, 19 F.3d 1413 (Fed. Cir. 1994). Service treatment records (STRs) show that the Veteran was treated for acne vulgaris on multiple occasions during his service. Despite an entrance examination documenting mild facial and back acne, there is no separation examination associated with the record. The Veteran was given a VA examination in October 2017. Although, the medical opinion was positive, it did not address aggravation of a preexisting condition. In a December 2017 addendum opinion obtained by VA, the examiner opined that the Veteran’s acne condition was not permanently aggravated by his service beyond the natural progression and that the Veteran’s acne was mild during the October 2017 examination. In June 2020, the Veteran testified at a Board hearing. The Veteran testified that his acne condition absolutely worsened during service. The Veteran described his military duties as plumber and that he had regular exposure to his face from plumbing drainage waste. He further testified that he mild normal acne upon enlistment which he never sought treatment for and did not know what a dermatologist was until after he entered service and was directed to report to one for his acne by his supervisor. The Veteran stated that his acne would form puss and bleed on documents he was preparing. In June 2020, the Veteran submitted a written statement from his sister. In her statement she recalls that her brother did not have acne on his face more than any other teenager would have. However, during the Veteran’s service she observed him with a lot of acne, to include blood and pus on his bed pillow in his barracks. When he came home on leave, he wouldn’t leave the house. The record also contains photographs submitted by the Veteran in June 2020 which he also described during his June 2020 Board hearing. The photographs show the Veteran’s face before during and after his military service showing what a lay person could see as worsening of facial acne before and during his service. In June 2020, the Veteran also submitted a May 2020 letter from his treating VA dermatologist for the previous 14 years. The letter was an opinion stating that the Veteran’s acne condition was first documented when he joined the military, worsened throughout his service and now persists well beyond the usual duration for normal acne and covers approximately 45 percent of his body surface area. The Veteran provided his dermatologist with his military records for review. The examiner interpreted the numerical acne scale that documented his acne during service. The Veteran’s dermatologist explained the empirical evidence from the Veteran’s STRs showing his acne worsened during service. The dermatologist also stated that the Veteran’s condition is ongoing and recurrent. The Board finds that competent, credible and evidence is in relative equipoise for the Veteran’s claim for service connection for acne and acne scarring. Evidence in support of the Veteran’s claim is the detailed private medical opinion diagnosing the Veteran acne; chloracne; and hidradenitis, that was aggravated or worsened beyond the natural progression by his service. The Veteran has met the burden of demonstrating a worsening condition in service. The December 2017 negative VA opinion said the acne was not permanently aggravated beyond the natural progression by his service; however, the conclusion seemed to be based on the severity of the skin condition at that time of an October 2017 examination, rather during service. That opinion is insufficient to meet the burden of rebutting the presumption of aggravation by clear and unmistakable evidence. See Jensen, 19 F.3d 1413. Thus, service connection for acne and acne scarring on the basis of aggravation is granted. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. G. Perkins, 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.