Citation Nr: 21002563 Decision Date: 01/14/21 Archive Date: 01/14/21 DOCKET NO. 15-29 586 DATE: January 14, 2021 ORDER Entitlement to service connection for a skin disorder of the face as secondary to service-connected hidradenitis suppurativa is denied. REMANDED Entitlement to an initial compensable rating for hidradenitis suppurativa is remanded. FINDING OF FACT The weight of the evidence of record is against a finding that the Veteran’s skin disorder of the face, diagnosed as dermatitis/dermatosis, is due to or worsened by her service-connected hidradenitis suppurativa. CONCLUSION OF LAW The criteria for entitlement to service connection for a skin disorder of the face as secondary to service-connected hidradenitis suppurativa have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION As a member of the Army National Guard the Veteran had active service from January 2004 to March 2005, with one year and 4 months prior active service noted on the Form DD 214. Her final tour included service in Iraq. Upon initial review of this case the Board remanded it to the Agency of Original Jurisdiction (AOJ) for additional development. See 11/19/2019 BVA Decision. As discussed further in the decision below, the Board finds substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for a skin disorder of the face as secondary to service-connected hidradenitis is denied. Applicable Legal Requirements Service connection may be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a nonservice-connected disability that is aggravated by a service-connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). In order to establish entitlement to service connection on this secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a nexus between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). In relevant part, 38 U.S.C. § 1154(a) requires that VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). A layperson is competent to report on the onset of disability and, when applicable, continuity of his or her current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994) (a veteran is competent to report on that of which he or she has personal knowledge). Discussion At the outset, the Board notes that service connection for a skin disorder of the face is not warranted on a direct basis. Indeed, relevant complaints or treatment were not shown in service. Moreover, the evidence does not reflect, and the Veteran does not contend, that the current disorder is due to service. Rather, it is contended that the skin disorder of the face is secondary to hidradenitis suppurativa. The evidence of record shows that service connection is in effect for hidradenitis suppurativa, and there is a currently diagnosed skin disorder of dermatitis, dermatosis, which manifests at the Veteran’s chin area. See 07/30/2018 Rating Decision – Narrative; 09/16/2013 CAPRI; 11/21/2018 C&P Exam, 1st Entry. Hence, the salient issue for consideration is whether there is a causative or aggravating nexus between the two. The Board finds that the preponderance of the evidence shows that there is not. The evidence of record demonstrates that the Veteran’s hidradenitis suppurativa manifests under each breast. As noted, the Board remanded for additional examinations. A December 2019 examination report notes that the Veteran reported the onset of the dermatitis, dermatosis, as 2008. See 12/11/2019 C&P Exam, 1st Entry. The examiner, a nurse practitioner, opined that it was not at least as likely as not that the disorder was due to or worsened beyond natural progression by the hidradenitis suppurativa. See id., 2nd Entry. The examiner’s rationale, however, was incomplete. Hence, the AOJ requested a review of the claims file by a physician. The report (08/23/2020 C&P Exam) reflects that the medical reviewer, a physician, reviewed the entire claims file. Based on her review of the Veteran’s claims file, the reviewer opined that it was not at least as likely as not that the Veteran’s dermatosis was due to or worsened by the hidradenitis suppurativa. The reviewer noted that the hidradenitis suppurativa manifests beneath the Veteran’s breasts. The disorder manifests typically as red painful bumps and blackheads, with possible tract or fistula formation. The reviewer opined that the dermatosis of the Veteran’s face is completely different, by description and pathophysiology. Hence, it had no relationship as to cause or aggravation from the hidradenitis suppurativa. The hidradenitis suppurativa would in no way impact the condition of the face unless primarily involved, and there is no evidence of hidradenitis suppurativa of the face. Hence, it neither causes or worsens the dermatosis. See id., P. 2. The Board finds that the VA medical examiner reviewed the Veteran’s claims file and provided a complete rationale for the opinion rendered. Hence, the Board finds the opinion highly probative and attaches significant weight to it. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Thus, the Board finds that the preponderance of the evidence of record is against the claim on both a causative and aggravating basis. 38 C.F.R. § 3.310. The Board notes the assertion of the Veteran’s representative that the medical opinion is not adequate because the physician is not a dermatologist and requests a remand for an examination by a dermatologist. See 11/18/2020 Appellate Brief, P. 2. As noted earlier, the Board finds that there was substantial compliance with the remand directs; hence, the Board rejects the representative’s non-specific assertion. The representative does not cite to any evidence that the Veteran’s skin disorder of the face is of such a nature that only a dermatologist could opine on its nature and whether it is related to the hidradenitis suppurativa. Instead, the representative does no more than make a general assertion that a dermatologist should render the opinion. The Board finds that the assertion, without a supporting basis, does not detract from the weight which the Board affords the medical opinion of the physician in this case. Since the preponderance of the evidence of record is against the claim, there is no reasonable doubt to resolve. See Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990); see also 38 C.F.R. § 3.102. REASONS FOR REMAND Entitlement to an initial compensable rating for hidradenitis is remanded. In the November 2019 remand, the Board noted the Veteran’s assertion that her dermatosis of the face should be considered part of her service-connected disability, which is rated noncompensable, and that she appealed the initial rating of the disability. See 11/03/2018 NOD. The Board declined to take jurisdiction of the undeveloped appeal at that time, as there appeared to be documentation in the claims file that the AOJ was in fact working the appeal. Hence, the Board did not remand for issuance of a Statement of the Case (SOC). Over two years have now elapsed since the Veteran’s NOD, and over a year since the remand on the service connection issue, and the AOJ has yet to issue a SOC on the issue of the initial rating of for the hidradenitis suppurativa. The Veteran is entitled to a SOC. Hence, the Board remands for that purpose. The matters are REMANDED for the following action: The AOJ shall issue the Veteran an SOC on the issue of entitlement to an initial compensable rating for hidradenitis suppurativa. Return the case to the Board only if the Veteran perfects an appeal of the issue. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board W. T. Snyder 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.