Citation Nr: 21002524 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 13-14 926 DATE: January 13, 2021 ORDER Entitlement to service connection for a disorder manifested by chest pain, to include as due to gastroesophageal reflux disease (GERD), is denied. Entitlement to service connection for a skin condition of the face is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran suffers from a condition manifested by chest pain, to include as due to GERD, that was incurred in or due to his time in service. 2. The preponderance of the evidence is against finding that the Veteran’s skin condition of the face began during active service or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for a condition manifested by chest pain, to include GERD, have not been met. 38 U.S.C. §§ 1110, 5107, 5121; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection for a skin condition of the face have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1976 to December 1977. This matter was previously before the Board in May 2020, at which time it was remanded to the Department of Veterans Affairs (VA) Regional Office (RO) for further development. The RO most recently readjudicated the appeal in an October 2020 supplemental statement of the case. The Board finds that VA has substantially complied with the June 2018 Board remand. SERVICE CONNECTION Generally, to prevail on a claim of service connection on the merits, there must be competent evidence of (1) a current disability, (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury, and (3) medical evidence or other competent evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Entitlement to service connection for a disorder manifested by chest pain The Veteran has alleged that he suffers from a chest disability manifested by pain, which he asserts is etiologically related to his active duty service. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of 38 U.S.C. §§ 1110 and 1131 as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Veteran alleged that he suffered from chest pain during active service. A review of the Veteran’s service treatment records shows that, at enlistment in May 1976 his heart, lungs, and chest were deemed normal and did not report any issues in the accompanying report of medical history. In July 1976, the Veteran was evaluated for productive cough and slight edema, but the chest was found to be within normal limits. In March 1977, the Veteran reported sudden onset of chest pains. Lungs were found to be clear and no murmur was detected. On separation Following several failed attempts at scheduling VA examinations for his condition, the Veteran finally underwent VA examinations in October 2020 for esophageal conditions, respiratory conditions, and heart conditions. Following thorough examinations, to include necessary testing, and a review of the Veteran’s claims file the examiner found no evidence of any respiratory condition, cardiac condition or musculoskeletal condition of the chest to account the for the Veteran’s current claimed symptoms of recurrent substernal chest pain. The only diagnoses the examiner found during the battery of VA examinations in October 2020 were GERD and a hiatal hernia, both of which were diagnosed in 2016, nearly four decades after his separation from service. The examiner noted that the Veteran himself attributes his chest pains to GERD, which is supported by treatment records that include esophagogastroduodenoscopy (EGD) results confirming esophagitis/GERD. The examiner opined that it was less likely that not that the Veteran’s current esophageal conditions were incurred in or caused by an in-service injury, event or illness. The examiner explained that the Veteran’s service treatment records are vague regarding the Veteran’s in-service complaints of chest pain and his separation examination is also silent as to any chest, lung, respiratory or digestive issues. The examiner also noted that there are no post-service treatment records within one year of the Veteran’s separation in December 1977 to endorse continuation of symptoms. Moreover, the examiner highlighted that a March 2015 EGD did not reveal esophagitis/GERD or a hiatal hernia, with the same being revealed by a subsequent EGD in March 2016. Accordingly, the examiner found no evidence of continuity of symptomology between service and the Veteran’s current conditions. The Board finds the opinion of the October 2020 examiner is the most probative evidence of record, because it is based on thorough medical examination, review of the record and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). A review of available treating records does not indicate a continuity of symptomology as the record does not contain any complaints or diagnoses during the decades from separation to the Veteran’s diagnoses. Even if we assume that this disability exists, the service and post-service records, overall, provide evidence against this claim, indicating a problem that began many years after service. While the Veteran believes that his disability is related to service, as a lay person, the Veteran has not shown that he has specialized training sufficient to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the diagnosis and etiology of esophageal conditions is a matter not capable of lay observation, requiring medical expertise to determine. Accordingly, his opinion as to the diagnosis or etiology of his esophageal conditions are not competent medical evidence. In making this determination the Board has considered the applicability of the benefit of the doubt doctrine. However, as a preponderance of the evidence is against the Veteran’s claims, that doctrine is not for application and service connection must be denied. 38 U.S.C. § 5107; Gilbert, 1 Vet. App. 49. Entitlement to service connection for a skin disability of the face The Veteran seeks entitlement to service connection for a face rash he alleges had its onset during service. More specifically, the Veteran has alleged that the condition began while he was at sea in June 1976, more than 40 years ago. The Veteran has been diagnosed with a skin condition of the face, namely xeroderma of the face and dermatosis papulosa nigra of the face. See September 2012 and March 2020 VA skin examinations. The Veteran’s service treatment records show that, at enlistment in May 1976, the Veteran’s skin was deemed normal. In July 1976, the Veteran complained of burning and itching while shaving and was diagnosed with a shave rash that was treated with “A-balm.” In July 1977, the Veteran complained of rash on the right side of the face and was diagnosed with tinea corporis and treated with tinactin ointment. A November 1977 report of medical examination did not find any issues with the Veteran skin. Moreover, the Veteran’s skin was also deemed normal on his separation report of medical examination in December 1977. The Veteran was afforded a VA skin examination in September 2012. The Veteran reported that the onset of the face rash was in June 1976. The examiner diagnosed the Veteran with xeroderma of the face. The examiner otherwise found the examination unremarkable and noted the Veteran had not been receiving treatment for the same in the previous 12 months. The examiner opined that it was less likely than not that the Veteran’s current face rash was incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that although there were indications of a rash during service, there was nothing in the reviewed records to suggest that the rash persisted in a chronic manner. Further, the examiner noted that the examination was unremarkable except for dry skin, which the examiner explained is different from a rash. The Veteran was afforded another VA skin examination in October 2020. The examiner diagnosed the Veteran with dermatosis papulosa nigra of the face. Notably, the examiner also found that the Veteran previously had xerosis and tinea corporis which completely resolved and no longer require treatment of any type. The examiner also found that the Veteran had not been treated with medication in the past 12 months for the condition. After examining the person and reviewing the Veteran’s claims file, the examiner opined that it was less likely than not that the Veteran’s current condition is etiologically related to service. The examiner acknowledged the Veteran’s treatment for shave rash and tinea corporis while in service, as well as the xeroderma, or dry face, noted on the September 2012 examination. Nevertheless, the examiner noted that the only skin condition present at the time of the examination was dermatosis papulosa nigra, which is the first time the condition is noted in the Veteran’s record. The examiner explained that this is unsurprising because it is an asymptomatic condition similar to seborrheic keratosis and is considered primarily a cosmetic issue rather than a true pathology. Nevertheless, the examiner noted that, based on the examination, this was the condition that the Veteran is claiming he incurred during military service. Additionally, the examiner stated that the usual age of onset for the condition is adolescence, however there is no indication of this condition in the Veteran’s service or post-service treatment records. The clinical presentation of dermatosis papulosa nigra is quite distinct from shave rash or tinea corporis, so the examiner also opined that no nexus can be extrapolated to the Veteran’s in-service face rash and tinea corporis. The Board finds the opinion of the October 2020 examiner is the most probative evidence of record, because it is based on thorough medical examination, review of the record and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Here, there is no competent evidence of a nexus between the Veteran’s dermatosis papulosa nigra of the face and his service. The only evidence of record in support of such a nexus is the Veteran’s lay opinion that his condition is due to service. To the extent the Veteran’s statements are being offered to establish a nexus, such evidence fails because this determination is a complex medical matter beyond the realm of common knowledge of a layperson. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Veteran has not been shown to possess specialized training sufficient to render such an opinion. Accordingly, the Veteran’s assertions as to a relationship between his dermatosis papulosa nigra of the face, diagnosed many years after service, and service are of little probative value. It is important for the Veteran to understand that the October 2020 examination findings provide highly probative evidence against the claim that the Board cannot, unfortunately, ignore. These findings provide a clear basis for the opinion. Accordingly, the Board finds that the most probative evidence of record does not show a nexus between the Veteran’s dermatosis papulosa nigra of the face and service. Therefore, the Board finds that the Veteran’s entitlement to service connection for a skin condition of the face is not warranted. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable. See U.S.C. §5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). John J. Crowley Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board V. Woehlke 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.