Citation Nr: 21064957 Decision Date: 10/22/21 Archive Date: 10/22/21 DOCKET NO. 16-30 184 DATE: October 22, 2021 ORDER Entitlement to service connection for atopic dermatitis with lichen simplex chronicus, seborrheic dermatitis, and possible neurodermatitis (claimed as skin condition (neck, arms, chest)) is denied. FINDING OF FACT The preponderance of the evidence is against finding that atopic dermatitis with lichen simplex chronicus, seborrheic dermatitis, and possible neurodermatitis began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for atopic dermatitis with lichen simplex chronicus, seborrheic dermatitis, and possible neurodermatitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the United States Air Force from June 1964 to October 1968, including service in the Republic of Vietnam. This matter comes to the Board of Veterans' Appeals (the Board) following an April 2015 rating decision denying entitlement to service connection for a skin condition. In May 2018, the Veteran attempted to opt into the modernized review system, also known as the Appeals Modernization Act (AMA), by submitting a Rapid Appeals Modernization Program (RAMP) election form and selecting the supplemental claim lane. However, in October 2019, the Department of Veterans Affairs (VA) informed the Veteran that his RAMP opt-in had not yet been processed and instructed him to submit a form if he still wished to participate in RAMP. The Veteran did not respond, and the appeal remains in the legacy review system. This appeal was most recently before the Board in April 2020 when it was remanded for the Agency of Original Jurisdiction (AOJ) to provide the Veteran with a new VA examination. The examination was conducted in June 2020, and the claim has now returned to the Board. Additional VA treatment records were added to the Veteran's file since the AOJ last considered the appeal in August 2020 supplemental statement of the case. The Veteran has not waived AOJ consideration of that evidence. However, as those records are either duplicative or include no relevant findings pertaining to the issue on appeal, there is no prejudice to the Veteran to proceed with appellate review. 1. Entitlement to Service Connection for Atopic Dermatitis with Lichen Simplex Chronicus, Seborrheic Dermatitis, and Possible Neurodermatitis The Veteran contends that his atopic dermatitis with lichen simplex chronicus, seborrheic dermatitis, and possible neurodermatitis is related to exposure to herbicide agents during his active service in the Republic of Vietnam. He states that he has had continuous treatment for this condition since returning from Vietnam. At the outset, the Board notes that the herbicide presumption does not apply in this case. While the Veteran did have eligible service in the Republic of Vietnam, atopic dermatitis with lichen simplex chronicus, seborrheic dermatitis, and possible neurodermatitis are not enumerated conditions for which presumptive service connection is warranted. See 38 C.F.R. §§ 3.307(a)(6)(iii); 3.309(e). Nor does the record show that the Veteran has any other skin disorder that is associated with exposure to herbicide agents under 38 C.F.R. § 3.309(e). Regardless, the Board must also consider the Veteran's claim under the theory of direct service connection. Service connection may be granted for a 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). Service connection may also be granted for any injury or disease diagnosed after discharge when the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). 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 Veteran's December 2009 private treatment records show treatment for atopic dermatitis with lichen simplex chronicus, seborrheic dermatitis, and possible neurodermatitis. Accordingly, the first element of service connectiona current disabilityis met. Shedden, 381 F.3d at 1166-67. Turning to the second element, service treatment records are negative for complaints, treatment, or diagnosis of any chronic skin disorder or rash. There are references to the Veteran seeking treatment an abrasion, a contusion, and an abscess of the groin. There are also findings pertaining to the Veteran receiving treatment for venereal disease, which included symptoms affecting his penis. However, in each instance, there were no findings pertaining to a chronic condition. An evaluation of his skin at service discharge was normal. The Veteran contends that his atopic dermatitis with lichen simplex chronicus, seborrheic dermatitis, and possible neurodermatitis is related to exposure to herbicide agents during active service in the Republic of Vietnam. His service treatment records indicate that the Veteran served in the Republic of Vietnam in 1967 and 1968. As such, it is presumed that he was exposed to herbicide agents during service, and the second Shedden element is met as well. See 38 C.F.R. § 3.307(a)(6)(iii); see also Shedden, 381 F.3d at 1166-67. The outcome of the appeal turns on whether there is a causal relationship between the Veteran's atopic dermatitis with lichen simplex chronicus, seborrheic dermatitis, and possible neurodermatitis and his active service to include presumed exposure to Agent Orange. Private treatment records show the Veteran was not diagnosed with atopic dermatitis with lichen simplex chronicus, seborrheic dermatitis, and possible neurodermatitis until December 2009, decades after his separation from service. Consideration has been given to the Veteran's statement that he has experienced bumps on his back, arms, and neck since returning from the Republic of Vietnam. While the Veteran is competent to report having experienced these symptoms consistently since returning from the Republic of Vietnam, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of atopic dermatitis with lichen simplex chronicus, seborrheic dermatitis, and possible neurodermatitis. The issue is medically complex, as it requires specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Moreover, the Veteran's report of continuous treatment conflicts with other evidence of record. During his April 2015 VA examination, for instance, the Veteran reported that he has experienced symptoms of a skin condition for 15 to 20 years rather than since his separation from service in 1968. The Veteran states that he received continuous treatment for atopic dermatitis with lichen simplex chronicus, seborrheic dermatitis, and possible neurodermatitis at a North Carolina VA medical center since returning from the Republic of Vietnam. The evidence of record does not support this contention. A review of the Veteran's file reveals no VA treatment records for the period prior to May 2006. The AOJ indicated in the February 2017 Statement of the Case (SOC) that it "completed an enterprise VAMC search for treatment records pertaining to [the Veteran's] claimed condition." This shows that the AOJ has obtained all the Veteran's VA treatment records in accordance with VA's duty to assist. See 38 U.S.C. § 5103A; see also 38 C.F.R. § 3.159(c); Sullivan v. McDonald, 815 F.3d 786, 790-91 (Fed. Cir. 2016). Thus, the weight of the evidence is against finding that the Veteran has experienced symptoms of atopic dermatitis with lichen simplex chronicus, seborrheic dermatitis, and possible neurodermatitis consistently since his separation from service. The June 2020 VA examiner also opined that the Veteran's atopic dermatitis with lichen simplex chronicus, seborrheic dermatitis, and possible neurodermatitis is less likely than not related to an in-service injury, event, or disease, including exposure to herbicide agents. Her rationale was that dermatitis is not caused by exposure to herbicide agents and that the Veteran's skin condition was not diagnosed until over 40 years after his separation from active service. The examiner's 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). The record contains a private opinion from Dr. A.C., who stated that he "[can]not rule out Agent Orange nerve damage." This opinion is too speculative, however. See Obert v. Brown, 5 Vet. App. 30, 33 (1993) (holding that medical evidence that is speculative, general, or inconclusive not be used to support a claim). It is unclear whether the Veteran's private dermatologist believed that the Veteran's atopic dermatitis with lichen simplex chronicus, seborrheic dermatitis, and possible neurodermatitis is at least as likely as not due to exposure to herbicide agents based on this opinion. Moreover, Dr. A.C. did not provide a rationale for his opinion. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a practitioner "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). Consequently, the Board gives more probative weight to the June 2020 VA examiner's negative etiological opinion. The Veteran believes his atopic dermatitis with lichen simplex chronicus, seborrheic dermatitis, and possible neurodermatitis is related to in-service exposure to herbicide agents. However, the Veteran in this case is not competent to provide a nexus opinion regarding this issue. It is medically complex, as it requires knowledge of pathology. Therefore, it is outside the competence of the Veteran here because the record does not show that he has the medical training or credentials to make such a determination. See Jandreau, 492 F.3d at 1377 n.4; see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). As such, the Board gives more probative weight to the June 2020 VA medical opinion. Accordingly, the preponderance of the evidence is against the Veteran's claim for entitlement to service connection for atopic dermatitis with lichen simplex chronicus, seborrheic dermatitis, and possible neurodermatitis. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Thus, the claim must be denied. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R.M. Sachs, 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.