Citation Nr: 21004108 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 16-39 591 DATE: January 26, 2021 ORDER Service connection for an eye condition is denied. Service connection for a skin condition of the face, to include facial burns and dermatitis is denied.   FINDINGS OF FACT 1. The Veteran’s eye condition did not have its onset during service and is not otherwise related to service. 2. The Veteran’s skin condition of the face did not have its onset during service and is not otherwise related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for eye condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for skin condition of the face have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1966 to April 1968. The case is on appeal from an August 2015 rating decision. In May 2019, the Veteran testified at a Board hearing. In June 2019, the Board remanded the claim for additional development. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). In addition, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Service connection for an eye condition. The Veteran is seeking service connection for an eye condition. He contends he has a current eye condition that is related to an incident in which hot antifreeze sprayed into his face after he removed a radiator cap. See Board Hr’g. Tr. at 2. Initially, the evidence of record establishes that the Veteran has a current disability pertaining to his eyes. A January 2020 VA examination reflects that the Veteran is diagnosed with eye conditions including a macular scar of the left eye, bilateral pseudophakia, bilateral dry eye syndrome, bilateral vitreous degeneration, bilateral blepharitis, and a left eye visual field defect. Accordingly, the Board finds the current disability requirement is established. In addition, the evidence of record also establishes the occurrence of an in-service injury, particularly when reasonable doubt is resolved in the Veteran’s favor. The Veteran contends he injured his eye while on duty when he had trouble with his vehicle. He asserts that upon removing a radiator cap, hot antifreeze sprayed into his face and into his eye. He also contends that as a result of this incident, he saw an Army optometrist who told his eye would be sensitive to sunlight and was provided with prescription sunglasses. See Board Hr’g. Tr. at 3. In this regard, the Veteran’s service treatment records (STRs) reflect that in March 1968, he was diagnosed with first degree burns of the right hand and face after antifreeze blew in his face. There are no explicit references to an eye injury at this time noted in the Veteran’s STRs. The Board notes that any references in the Veteran’s STRs related to seeing an optometrist, took place prior to this incident and are limited to a January 1967 notation reflecting that the Veteran was seen by an optometrist after breaking his glasses and a new pair of glasses was ordered. However, the Board finds that it is at least as likely as not that the Veteran’s eye was exposed to some amount of hot antifreeze as he contends. Thus, the question becomes whether there is a nexus between the Veteran’s current eye condition(s) and his in-service injury. In this regard, the evidence of record includes the opinion of an examiner who provided the January 2020 VA examination. The examiner concluded the Veteran does not have an eye condition that is related to his in-service eye injury or was incurred during service. The examiner addressed the various diagnoses of the Veteran’s eyes. In this regard, the examiner explained the Veteran’s retinal scarring of the left eye is consistent with ocular histoplasmosis. He also noted that the Veteran reported that he was told that the scars increased in size in recent years. The examiner commented that scarring due to trauma is unlikely to progress, particularly many years after the incident that caused the trauma. The examiner also commented that the noted localized visual field defect is less likely than not caused by the in-service incident. He explained that the visual field defect is consistent with retinal scarring that is caused by ocular histoplasmosis. The examiner attributed the Veteran’s blepharitis to the buildup of oil and bacteria around the eyelid, instead of to the in-service incident. He also stated that the diagnoses including the Veteran’s bilateral pseudophakia, which is the condition of the Veteran’s eye post cataract surgery; dry eye syndrome, and vitreous degeneration are consequences of aging, also noting that the Veteran’s dry eye syndrome can be exacerbated by blepharitis. The Board acknowledges the Veteran’s contention that he has an eye condition that is related to his in-service antifreeze incident. The Board also acknowledges that the Veteran contends that he does not have an ocular histoplasmosis diagnosis. See Board Hr’g. Tr. at 8. In this regard, although the Veteran is competent to report his symptoms, to include that he has vision problems, diagnosing an eye disability is not subject to lay observation. Although lay persons are competent to provide opinions on some medical issues, the issue in this case falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Thus, the Veteran is not competent to diagnose an eye disability and/or provide an opinion as to causation for this particular claim. Consequently, the Board gives more probative weight to the VA opinion described above. The opinion is persuasive with a complete rationale and is based on a thorough review of the record and the Veteran’s lay statements. The examiner established clear conclusions with supporting references to the medical and lay evidence of record, as well as the Veteran’s service records. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In addition, with regard to the Veteran’s ocular histoplasmosis diagnosis, the January 2020 VA examiner’s conclusions are consistent with other evidence of record including December 2016 and December 2018 VA treatment records also noting a diagnosis of ocular histoplasmosis. Moreover, there is no similar medical opinion of record weighing in favor of a nexus. The Board also notes ocular histoplasmosis is an infection from breathing microscopic fungus found in bird and bat droppings that enters the air when soil is disturbed from plowing fields, sweeping chicken coops, or digging holes. It starts as a lung infection that later moves to the eye through the blood stream. The infection is often so mild that it produces no symptoms or symptoms similar to a common cold. People who have lived in states in the Ohio and Mississippi River Valley are at higher risk for developing the infection. American Academy of Ophthalmology (Histoplasmosis), https://www.aao.org/eye-health/diseases/what-is-histoplasmosis. See 38 C.F.R. § 20.908(b)(2). As the Veteran’s sole theory for service connection is that his eye condition is related to hot antifreeze hitting his face, and whether ocular histoplasmosis is related to service is not expressly raised or reasonably raised by the record, the Board will not further consider that matter. In reaching the conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, service connection is not warranted for an eye condition. 2. Service connection for a skin condition of the face, to include facial burns and dermatitis. The Veteran is seeking service connection for skin condition of the face. He similarly contends he has a current skin condition of the face that is related to an incident in which hot antifreeze sprayed into his face. See Board Hr’g. Tr. at 2. He also asserted that the incident caused “knots” to form on his forehead. Initially, the evidence of record establishes that the Veteran has a current disability pertaining to the skin on his face. An August 2015 VA examination reflects that the Veteran is diagnosed with scars or dermatitis over the forehead and temples. The examiner stated the areas “appear[ed] to be more dermatitis than scars.” In addition, a January 2020 VA examination reflects a diagnosis of basal cell carcinoma neoplasm of his mid nose and right temple although noting the absence of dermatitis or scars. Accordingly, the Board finds the current disability requirement is established. In addition, as detailed above, the evidence of record also establishes the occurrence of an in-service injury. The Veteran’s STRs reflect that on March 13, 1968, the Veteran sought emergency treatment after an incident in which antifreeze exploded in his face. The Army provider noted a mild erythema and mild irritation in his right cheek with tenderness. A second visit in connection with the antifreeze accident was recorded on March 14, 1968. The Veteran complained of burning sensation on his face and hands. The health provider noted first degree burns on the Veteran’s right hand and face and recommended light duty for two days. As such, the occurrence of an in-service injury is established. Thus, the question becomes whether there is a nexus between the Veteran’s current skin conditions of the face and his in-service injury. In this regard, the evidence of record includes the opinion of the examiner who provided the August 2015 VA examination and the examiner who provided the January 2020 VA examination. The examiner who provided the August 2015 VA examination concluded that it less likely than not that the Veteran’s dermatitis of the forehead and temples was related to the claimed in-service injury. He explained that the Veteran’s STRs indicated first degree burns to the right cheek were mild, and there is no scarring of the right cheek noted. He also noted that there was no indication in the Veteran’s STRs of any burns to the forehead. The Board remanded the claim in June 2019 for an additional examination and opinion. The Veteran underwent an additional VA examination in January 2020. The examiner concluded that it is less likely than not that the Veteran’s claimed condition incurred in or caused by the hot antifreeze spraying in the Veteran’s face. She explained that the Veteran’s STRs state that he only had mild irritation secondary to the antifreeze, and the first degree burns on his right hand and right cheek were resolving on the second day post injury. She also noted that at separation, the Veteran’s reported that his skin was normal. The Board acknowledges the Veteran’s contention that he has a skin condition related to hot antifreeze spraying in his face during service. The Board notes that although the Veteran is competent to report his symptoms pertaining to his skin conditions, a determination as to whether there is a nexus between the Veteran’s current skin conditions and his service are complex matters requiring related medical expertise. See Jandreau, 492 F.3d at 1377; see also Kahana, 24 Vet. App. at 435. As the Veteran has no known or reported medical expertise, he is not legally competent to opine on a relationship between his eye conditions and in-service injury; thus, his opinion lacks probative value, and an opinion by a qualified medical expert is required to decide the claim. Consequently, the Board gives more probative weight to the VA opinions described above. The opinions, cumulatively, are persuasive with a complete rationale and are based on a review of the record and the Veteran’s lay statements. The examiners established clear conclusions with supporting references to the medical and lay evidence of record, as well as the Veteran’s service records. See Nieves-Rodriguez, 22 Vet. App. 304. Moreover, there is no similar medical opinion of record weighing in favor of a nexus. The Board also acknowledges that the January 2020 opinion does not address whether there is a nexus between the Veteran’s basal cell carcinoma and the Veteran’s service. For definitional purposes, basal cell carcinoma is a type of skin cancer. May Clinic (Basal cell carcinoma), https://www.mayoclinic.org/diseases-conditions/basal-cell-carcinoma/symptoms-causes/syc-20354187 (last visited January 19, 2021; see 38 C.F.R. § 20.908(b)(2). For this condition, there is not even an indication that basal cell carcinoma is related to antifreeze sprayed in his face during service. As the Veteran’s sole theory for service connection is that his skin condition is related to hot antifreeze hitting his face, and whether basal cell carcinoma is related to service is not expressly raised or reasonably raised by the record, the Board will not further consider that matter. In reaching the conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, service connection is not warranted for a skin condition of the face. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Gray, 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.