Citation Nr: 21003443 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 14-20 931 DATE: January 21, 2021 ORDER Entitlement to service connection for a skin condition is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, his skin disability began during active service. CONCLUSION OF LAW The criteria for service connection for a skin disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1998 to October 1999. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from May 2013 rating decision which denied entitlement to service connection for a skin condition. The decision was timely appealed, and the Veteran testified at a hearing before a Decision Review Officer in February 2014. The transcript has been associated with the file. In June 2016, April 2018, and September 2020 the Board remanded the claim for additional development. Service Connection The Veteran asserts his skin condition began in service and has continued to present. Service connection may be granted when "the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service." 38 C.F.R. § 3.303(a). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA's policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). As the Board is granting this claim on direct service connection, it is not necessary to address other theories of service connection herein. Service connection is established on a direct basis when there is competent, credible, evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease of injury. 38 U.S.C. § 1110; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d).  In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of his symptoms. Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau, 492 F.3d 1372. As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran's demeanor when testifying at a hearing. Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for a skin condition The Veteran was diagnosed with eczema in May 2006 in the course of seeking treatment for his skin irritations. He was later diagnosed with tinea corporis in December 2012. VA treatment records continued to show eczema and body tinea in the list of current problems through at least February 2017. This is sufficient to establish a current disability, satisfying the first element of service connection. He asserts that his skin condition began in service and has carried through to the present. The Veteran’s entrance examination in August 1998 indicated he did not have any current skin issues but did note acne scarring on both arms. He did not report a history of skin issues. The Veteran has consistently reported and testified at hearing that his skin condition began in service. The Veteran’s service treatment records do not indicate treatment for a skin condition. However, the Veteran’s separation examination in September 1999 again indicated marks on the arms however at this time some of those marks were attributed to cysts as opposed to acne. Additionally, the Veteran testified in his February 2014 hearing that he attempted to report his skin issues while in Japan but instead was only given a topical ointment that did not alleviate his symptoms. The Veteran asserted this again in his May 2014 VA Form 9. The Veteran’s records support that during his tour of duty, he was in Japan for a period of time in 1999. The Veteran further stated in the hearing that his skin condition began in service shortly after receiving a vaccine. He describes the skin condition as a rash on his body where he will get “spots” that will come and go and come up in different areas of his body. At the time of the February 2014 hearing he currently had the spots on his belly and buttocks. At the end of the hearing, the Veteran’s attorney pointed out a red sore under the Veteran’s lip and asked if that was also what was on his back as well to which the Veteran stated it was the start of “it.” At the hearing the Veteran’s fiancée testified that she had known the Veteran for more than 18 years to include time prior to his military service. She stated that prior to his time in service, she never “knew [the Veteran] to have the skin conditions that he has now.” She asserts that when the Veteran rolls up his sleeves his arms are scarred, and they were not as such prior to service. The Veteran’s fiancée also submitted a letter on the Veteran’s behalf in February 2014 that again stated she had known the Veteran for over 18 years. She also stated again that she knew the Veteran did not have any health or skin problems before service. She specifically stated, “when [the Veteran] came home from the Navy, he had changes to his skin. Some type of rash and this rash is on his stomach and his buttocks.” She also indicated the rash will spread to his arms and has left additional scarring. While the Veteran’s service treatment records are negative for complaints of a skin condition, he is competent to report his symptoms capable of lay observation. As a result, the Veteran is competent to report a history of a skin condition that began in service. 38 C.F.R. § 3.159(a)(2); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Layno, 6 Vet. App. 465. Moreover, the mere fact that his account is not supported by contemporaneous clinical evidence does not render it inherently incredible. Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). In its capacity as a finder of fact, the Board finds the Veteran and his fiancée are credible as to their reports of the onset and recurrence of skin condition symptoms. Their accounts are internally consistent and consistent with medical evidence. Specifically, the Veteran sought treatment for a rash on his arms in May 2005 and was diagnosed with eczema in 2006, 6 years prior to his application for service connection. At the May 2006 VA primary care appointment, he reported he has had the recurring rash on his arms for years, and that it also appears on the right popliteal fossa, right hip, and left knee. See Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). Therefore, the Board finds that throughout the appeal period the Veteran competently, credibly, and consistently reported that his skin condition symptoms began during his military service and have continued to the present time. June 2016 and December 2019 VA examinations were deemed inadequate by prior Board remands. These examinations offered a negative nexus opinion however they relied on an incorrect finding of fact that the Veteran did not have a current skin condition. The Veteran’s lay evidence and the VA treatment records show that his skin rash is intermittent. The fact that there was no rash present at the precise time of the examination is insufficient to find no current disability. The Veteran’s most recent VA examination in September 2020 also gave a negative nexus opinion. Again, this examination relied on the finding that the Veteran did not have a current skin condition. The examination stated, in total, “12/22/19 skin DBQ demonstrates no active skin condition. Veteran has a previous history of tinea corporis and eczema but states that is it resolved on the 12/11/2019 DBQ.” As the appeal period stretches back to the August 2012 claim, a finding of no current disability based only on whether rashes were present at the time of VA examinations is not appropriate. This medical opinion does not give due consideration to the competent and credible lay evidence of the onset of symptoms in service and their recurrence thereafter. The examiner provided no reason for rejecting the Veteran's lay evidence. Based on the foregoing, the Board finds this opinion is not probative. As a result, the only probative evidence regarding the onset of the skin disability is the competent and credible lay evidence provided by the Veteran and his fiancée. The Board thus finds that the Veteran's competent and credible lay evidence is sufficient to establish the skin disability began in service. As the facts, shown by evidence, establish that the skin disability was incurred coincident with service, service connection is warranted. 38 C.F.R. § 3.303(a). The claim is granted. LAURA E. COLLINS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.