Citation Nr: 21003390 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 11-11 141 DATE: January 21, 2021 ORDER Entitlement to service connection for a skin condition is denied. FINDING OF FACT The most probative evidence is against finding that the current skin disability is related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for a skin condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Army from January 5, 1988 to January 3, 1992, with service in Southwest Asia from September 26, 1990 to April 14, 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2009 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In December 2015 the Veteran provided testimony before the undersigned Veterans Law Judge. A transcript of this testimony is of record. This claim was last before the Board in July 2020 where it was remanded for additional development. SERVICE CONNECTION 1. Entitlement to service connection for a skin condition The Veteran is seeking entitlement to service connection for a skin condition that he alleges began in service or is related to in-service exposure to burn pits and other environmental hazards. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 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). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a currently diagnosed skin disability, the preponderance of the evidence weighs against finding that the current skin disability is related to an in-service injury, event, or disease. Service treatment records reveal no complaints or findings of a skin disability. A dental questionnaire signed in February 1990 and July 1991 showed the Veteran denying skin rashes. He also denied skin diseases on a July 1991 report of medical history and physical examination at that time revealed no skin abnormalities. On a July 1997 Persian Gulf Registry examination, the examiner noted the Veteran reported a history of ringworm off and on for two years, mostly on his arms and back, but also on his feet. He also reported bumps on the arms and face that come and go and have occurred on and off times five years. During a September 1999 VA examination the examiner noted the Veteran had episodes of ring worm or tinea corporis, a fungal infection of the skin, beginning in 1995 and first diagnosed at the Houston VA Medical Center. The examiner noted the condition occurred while the Veteran was not in the service. As a skin condition was not noted during service, competent evidence linking the current condition to service is needed to support the claim for service connection. However, on this question, the most probative medical opinions of record are against the claim. The October 2018 VA examiner noted the Veteran’s skin condition was less likely than not related to service as there is no documentation of the veteran being seen for a skin condition while in service. In an October 2019 VA addendum opinion, the examiner noted the Veteran's complaints of intermittent pruritic rash on the extremities is not consistent with possible exposure to nerve agent. The September 2020 VA examiner noted the Veteran's diagnosis is nummular eczema, which is considered an inflammatory disease, likely with an autoimmune component. The examiner concluded it is less likely than not due to exposure while in Southwest Asia. He stated that any exposure causing a skin condition would, more likely than not, manifest at the time of such exposures or proximate to them. Therefore, it is less likely than not that the Veteran's nummular eczema is due to or incurred in service, to include potential toxic exposures while in Southwest Asia. He noted the separation exam was performed in 1991, with actual discharge January 1992. This does not change the rationale as the eczema was not identified until 1999, and was not present at separation or proximate to service. The examiner further noted that per the 2018 examination there is no evidence of any other active skin condition, to include tinea pedis and corporis. The examiners’ combined opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There is no medical opinion of record linking the Veteran’s current skin disability to service. The Board notes the Veteran has reported various onset dates for his skin disability during the course of the claim. During his 1997 Persian Gulf registry examination he reported skin problems for two years, then stated they occurred on and off for five years. During a September 1999 VA examination, he reported the condition began in 1995. He testified in 2015 that he was treated during service, but in 2018, he told the VA examiner he did not seek treatment in service. Due to the varying nature of the dates of onset made over the years, the Board does not find the Veteran’s assertion that the condition began in service to be persuasive. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-1337 (2006) (the lack of contemporaneous medical records and conflicting statements of the veteran are factors that the Board can consider and weigh against a veteran's lay evidence); see also Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (“The credibility of a witness can be impeached by a showing of interest, bias, inconsistent statements”). Finally, to the extent that the Veteran believes that his current skin 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. In this regard, the diagnosis and etiology of skin disorders are matters that requires medical training and expertise to determine. Accordingly, his opinion as to the diagnosis or etiology of his skin disability is not competent medical evidence. 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). Thus, the Board finds the combined opinion of the VA examiners to be significantly more probative than the Veteran’s lay assertions. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. As the preponderance of the evidence is against the claim, the doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. N. Wilson, 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.