Citation Nr: 21004299 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 15-00 235A DATE: January 26, 2021 ORDER Entitlement to service connection for nummular eczema is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s nummular eczema began during his active military service or is otherwise related to an in-service injury, disease or event. CONCLUSION OF LAW The criteria are not met for entitlement to service connection for nummular eczema. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1993 to May 1997. This appeal to the Board of Veterans' Appeals (Board) is from a December 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In May 2018 and July 2019, the Board remanded this claim back to the RO for further development. The RO, i.e., Agency of Original Jurisdiction (AOJ), since has complied – certainly substantially, with the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions); but see also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only “substantial” rather than “strict” or “exact” compliance with the Board's remand directives is required under Stegall); accord Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Entitlement to service connection for nummular eczema is denied. The Veteran contends that his nummular eczema was incurred during his service, either because it started during his service or is the result of it. The Veteran’s initial claim for a skin condition also included seborrheic dermatitis. And, while on remand, an August 2020 rating decision granted service connection for his seborrheic dermatitis; therefore, the only remaining issue before the Board is whether his nummular eczema also warrants service connection. Service connection is granted for disability resulting from disease or injury incurred in or aggravated by active military service in the line of duty. 38 U.S.C. § 1110; 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 an injury; and (3) a causal relationship (“nexus”) between the current disability and the disease or injury in service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service treatment records (STRs) confirm the Veteran was treated for dermatitis, rosea and a rash during his service, and VA treatment records confirm he has a current diagnosis of nummular eczema (meaning aside from the seborrheic dermatitis that, as mentioned, already has been attributed to his service). But, unlike his seborrheic dermatitis, there is not the required attribution of his nummular eczema to his service. See Watson v. Brown, 4 Vet. App. 309, 314(1993) (“A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service.”). In deciding this appeal, the Board is required to consider the nummular eczema, not just the seborrheic dermatitis, since both have been diagnosed and fall under the general heading of a skin disorder. Clemons v. Shinseki, 23 Vet. App. 1 (2009). In December 2011, the Veteran was afforded a VA examination – at the conclusion of which the examiner opined that the Veteran’s claimed skin disorder, then described very generally as a fungal infection, was not related to his service, although that examiner noted the Veteran had an abdominal rash with pityriases rosea during his enlistment examination and treatment for pseudofolliculitis barbae and seborrheic dermatitis during his service. The Board found that medical opinion inadequate in May 2018 and, consequently, remanded the claim for another opinion. In March 2019, the Veteran resultantly underwent another VA examination that resulted in diagnoses of eczema and atopic dermatitis. Even that additional examiner, however, determined the eczema was unrelated to the Veteran’s service because the earliest documentation of eczema was some 15 years after his discharge from service and eczema was not noted during his service.   Because, however, even that additional examiner did not also address the Veteran’s diagnosis of atopic dermatitis, still more medical comment was needed. The Board’s prior remand had pointed out that abdominal dermatitis was noted during the Veteran’s June 1993 enlistment examination. Therefore, an opinion regarding whether any pre-existing skin condition was aggravated during or by his service – meaning worsened beyond its natural progression – was also deemed necessary. Consequently, the Board again remanded this claim in July 2019, and the Veteran was provided an additional examination in January 2020. Examination findings resulted in diagnoses of seborrheic dermatitis and nummular eczema. But, after reviewing the evidence of record, this most recent examiner concluded the Veteran’s nummular eczema was less likely than not incurred in or caused by an event, injury or disease during his military service. As rationale, this examiner explained that there was no mention of nummular eczema in the Veteran’s STRs. This examiner also explained that, although nummular eczema and seborrheic dermatitis are both a form of eczema, STRs provided no specific mention of a rash or eczema on the Veteran’s lower legs (where his current rash is located), therefore making it less likely than not that his current leg rash is related to the skin conditions he was treated for during his service. In contrast, this examiner also conversely concluded that the Veteran’s seborrheic dermatitis – the more chronic form of dermatitis – was likely incurred during his service. So, as already mentioned, service connection for the seborrheic dermatitis consequently was subsequently granted in an August 2020 rating decision since issued, on remand. With regards to aggravation of any pre-existing skin disorder, this examiner also provided an addendum opinion in August 2020 indicating the Veteran’s nummular eczema is not due to or aggravated by his service-connected seborrheic dermatitis and was not otherwise worsened by his service. This examiner explained that, according to the National Eczema Foundation, “the causes of nummular eczema aren’t clear, but triggers can include very dry or sensitive skin and trauma to the skin from insect bites, scrapes or chemical burns.”   This examiner additionally noted that nummular eczema also may develop as a reaction to some other types of eczema and their triggers, such as contact dermatitis and nickel. When it appears on the legs, it can be linked to poor blood flow in the lower body and the stasis dermatitis those circulation problems can cause. While acknowledging the potential for interactions between different types of eczema, the examiner was clear that, in this specific circumstance, the Veteran’s nummular eczema, by virtue of its location on his leg, is a separate entity entirely from the now-service-connected condition of seborrheic dermatitis and unrelated to it and his service. Additionally, this examiner clarified that medical literature does not support a relationship or correlation between these two different, specific types of eczema. Taken together, the several VA opinions of record establish that the Veteran’s nummular eczema – unlike his seborrheic dermatitis, is not at least as likely as not related to an in-service injury, event, or disease, including the skin conditions noted in his STRs. The March 2019 VA examiner opined that the Veteran’s eczema was not at least as likely as not related to his in-service skin conditions, while the more recent January and August 2020 VA examiner opined specifically that the Veteran’s nummular eczema is not at least as likely as not related to the seborrheic dermatitis he incurred during his service. The combined rationale indicates his nummular eczema was neither incurred in nor aggravated by his active service, either by his service, itself, or by his service-connected seborrheic dermatitis. 38 U.S.C. §§ 1111, 1153; 38 C.F.R. §§ 3.304, 3.306, 3.310. The examiners’ opinions, especially in combination, are probative because they are based on an accurate medical history and provide explanation containing clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). While the Board acknowledges the Veteran’s contention that his nummular eczema is related to his service, he is not competent to ascribe his symptoms to a particular skin condition diagnosis and, in turn, relate this diagnosis to events that took place during his service (to include treatment he received during his service). These critical determinations are beyond his lay competence. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the VA examiners’ medical opinions than to his lay reports and pleadings regarding this determinative issue of causation. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (indicating lay evidence must demonstrate some competence and affirming the Court's conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert's opinion more probative on the issue of medical causation). The Board sincerely thanks the Veteran for his service but concludes the preponderance of the evidence is against finding entitlement to service connection additionally for his nummular eczema (meaning in addition to his seborrheic dermatitis). Therefore, in this circumstance, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. See also Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Because the evidence does not demonstrate a sufficient nexus between the conditions for which he was treated during his service and his eventual diagnosis, the Board finds service connection unwarranted for this additionally claimed skin condition. KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. B. Kucera 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.