Citation Nr: 21067530 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 16-04 065 DATE: November 4, 2021 ORDER Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for bronchitis, to include as due to herbicide exposure is denied. Entitlement to service connection for a right arm skin disorder, to include as due to herbicide exposure is denied. Entitlement to service connection for a left arm skin disorder, to include as due to herbicide exposure is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran's right knee disability began during active service or is otherwise related to an in-service injury, event, or disease. 2. The preponderance of the evidence is against finding that the Veteran's bronchitis manifested during or is otherwise casually related to an in-service injury event, or disease, to include as due to herbicide exposure therein. 3. The preponderance of the evidence is against finding that the Veteran's bilateral arm skin disorder manifested during or is otherwise casually related to an in-service injury, event, or disease, to include as due to herbicide exposure therein. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 2. The criteria for establishing entitlement to service connection for bronchitis, to include as due to herbicide exposure have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 3. The criteria for establishing entitlement to service connection for a bilateral arm skin disorder, to include as due to herbicide exposure have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active service with the United States Army from February 1967 to January 1969. The Veteran received the Purple Heart Medal, the Vietnam Service Medal, and the Vietnam Campaign Medal, among other commendations. This matter is before the Board of Veterans' Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In March 2019, the Veteran and his spouse testified at a hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing has been associated with the Veteran's electronic claims file. Pursuant to an August 2019 Board decision, this matter was remanded for additional development to include a directive to consider newly submitted evidence, obtain outstanding treatment records, and schedule the Veteran for VA examinations. As the requested development is now complete, this matter has been returned to the Board for appellate consideration. Duty to Assist and to Notify VA is required to notify a claimant of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, the VA will attempt to obtain. 38 C.F.R. § 3.159(b) (2020). Copies of compliant VCAA notices were located in the claim's file. VA's duty to assist includes providing a thorough and contemporaneous medical examination, especially where it is necessary to determine the current level of a disability. Peters v. Brown, 6 Vet. App. 540, 542 (1994). In this case, neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. See Scott v McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist argument). Thus, upon careful review of the file, the Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). Presumptive Service Connection - Herbicide Exposure Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d). Generally, in order to prove service connection, there must be 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 or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Veterans who served in the Republic of Vietnam between January 9, 1962, and May 7, 1975, shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307 (a)(6). If a veteran was exposed to an herbicide agent during active military, naval, or air service, the diseases listed under 38 C.F.R. § 3.309 (e) shall be service connected if the requirements of 38 C.F.R. § 3.307 (a)(6) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307 (d) are also satisfied. The list of diseases associated with exposure to certain herbicide agents is as follows: AL amyloidosis; chloracne or other acneform disease consistent with chloracne; Type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes); Hodgkin's disease; ischemic heart disease; all chronic B-cell leukemias; multiple myeloma; non-Hodgkin's lymphoma; Parkinson's disease; early-onset peripheral neuropathy; porphyria cutanea tarda; prostate cancer; respiratory cancers (cancer of the lung, bronchus, larynx, or trachea); and soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma). 38 C.F.R. § 3.309 (e). For early-onset peripheral neuropathy, the presumptive service connection is warranted if the disorder manifested to a degree of 10 percent or more within one year after the Veteran's last exposure to herbicide agents. 38 C.F.R. § 3.307 (a)(6)(ii). Where the evidence does not warrant presumptive service connection, the United States Court of Appeals for the Federal Circuit has held that an appellant is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). That is to say, the Agent Orange presumption does not preclude a veteran from establishing direct service connection with proof of actual direct causation. Service connection may be granted for any current disability that is the result of a disease contracted or an injury sustained while on active-duty service. 38 U.S.C. § 1110, 1131 (2014); 38 C.F.R. §§ 3.303 (a), 3.304 (2018). Entitlement to service connection benefits is established when the following elements are satisfied: (1) the existence of 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 disease or injury incurred or aggravated during service (the medical 'nexus' requirement). See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); 38 C.F.R. § 3.303 (a) (2018). 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 (2014); 38 C.F.R. § 3.102 (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the benefit of the doubt will be given to the Veteran. Id. The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). Rather, the Board's analysis below will focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant). Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). When considering whether lay evidence may be 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); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue. 1. Entitlement to service connection for a right knee disability The Veteran contends that he is entitled to service connection for a right knee disability. In analyzing the Veteran's claim, the threshold inquiry before the Board is whether he 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 current diagnosis of bilateral knee osteoarthritis, the preponderance of the evidence weighs against finding that his condition began during or is otherwise related to an in-service injury, event, or disease. Service treatment records are silent for complaints of a knee injury, pain, or any related diagnosis. No upper respiratory, skin, or bilateral knee abnormalities were identified at enlistment or separation. In a report of medical history at separation, the Veteran denied any problems with chronic or frequent colds, upper respiratory symptoms, a trouble or trick knee, joint deformity, or skin condition in January 1969. Post-service treatment records confirm complaints of bilateral knee pain. In March 2005, the Veteran was evaluated for right knee pain with tenderness along the medial and lateral joint-line. Moderate effusion was observed on physical examination. Steroid injections were prescribed to treat pain. Magnetic resonance imaging (MRI), conducted in April 2005, revealed linear tears of the posterior horns of both the lateral and medial menisci of the right knee. In May 2005, the Veteran underwent arthroscopic surgery. A follow-up evaluation noted status-post (s/p) right knee arthroscopy with chondroplasty of the medial femoral condyle and chondroplasty of the patellar femoral articulation. Other diagnoses included grade 3 or 4 changes diffusely throughout the medial compartment and a full thickness chondral loss in the patellar femoral joint with loose flaps of the right knee. The listed abnormalities were debrided arthroscopically. Years later, the Veteran was re-evaluated for right knee pain and discomfort in January 2014. A physical examination revealed crepitus and swelling. X-rays of the bilateral knees revealed mild degenerative changes of in both knees. A physical therapy consultation, dated October 2015, noted chronic bilateral knee pain with worsening symptoms in the right knee. Range of motion of the left knee revealed flexion limited to 135 degrees and extension to -3. Increasing pain was endorsed with weight-bearing. Range of motion of the right knee revealed flexion limited to 125 degrees and extension to -10. Frequent swelling and giving way impacted the right knee only. The Veteran also reported difficulty bending the right knee. Evidence of crepitus was observed; bilaterally. Pain ranged between a 2 and 6 on a 10-point scale. The diagnostic impression listed bilateral knee osteoarthritis, with a right knee osteochondral defect. Use of a knee brace provided minimal relief of the Veteran's symptoms. In February 2019, a private orthopedic clinical opinion was associated with the claim's file. Therein, the physician acknowledged a history of treatment for bilateral knee pain beginning in March 2016. The Veteran reported worsening symptoms in the right knee than the left. A diagnosis of osteoarthritis of bilateral knee was indicated. During a Board hearing in March 2019, the Veteran reported an onset of right knee with intensive physical training and related activities, to include crossing creeks and streams, stepping in holes, and carrying heavy equipment. He contends that his official duties included jumping from helicopters. According to military personnel records, the Veteran's official military occupation was listed as an infantryman, machine gunner, and rifleman. Post-service, he performed steel work for approximately 30 years. Pursuant to an August 2019 Board decision, the Veteran's claim was remanded to schedule a VA examination. On examination in August 2020, a current diagnosis of right knee meniscal tear, s/p arthroscopic surgery with degenerative joint disease was indicated. During the clinical interview the Veteran reported an in-service injury to the right knee following stepping into a hole while stationed in Vietnam. Following the incident, he experienced pain and swelling. The Veteran contends that he was evaluated by a medic and an ace wrap was applied. Thereafter, gradual improvement was reported, and the Veteran denied seeking further treatment. Post service, an onset of knee pain with related treatment reportedly began on or about 2001. Prescribed treatments included steroid injections. In 2005, the Veteran was treated for an acute flare up of right knee pain. An MRI revealed a right knee meniscal tear, and he underwent arthroscopic surgery. Years later, X-ray findings revealed degenerative arthritis of the bilateral knees in 2013. Physical therapy treatments were unable to resolve his symptoms. Current symptoms include worsening pain, particularly during cold weather. Functional impairments included difficulty kneeling, bending, trouble with prolonged walking and sitting, with impaired sleep due to pain. Range of motion of the right knee revealed flexion and extension limited to 100 degrees. Pain was noted with flexion, extension, and weight-bearing. There was no objective evidence of localized tenderness or pain to palpation. Favorable findings of crepitus were noted. No additional functional loss or loss of range of motion was observed with repetitive use testing. Pain limited the Veteran's functional ability over time with repetitive use. No additional loss of range of motion was indicated. With flareups, pain and fatigue limited the Veteran's functional ability over time. It resulted in an additional loss of 10 degrees of flexion and extension. No additional factors were listed as contributing to the Veteran's right knee disability. Muscle strength and joint stability testing yielded normal findings. There was no evidence of muscle atrophy or ankylosis. No additional factors were listed as contributing to the Veteran's right knee disability. A prior surgical history included right knee arthroscopic meniscal debridement and chondroplasty in 2005, with residual pain and degenerative joint disease. The Veteran reported occasional use of a cane for gait support due to his right knee disability. Considering the current severity of his right knee disability, the examiner suggested that the Veteran would be unable to perform physical labor, to include tasks requiring prolonged walking or standing. Considering the Correia Factors, pain was noted with non-weight bearing. Passive range of motion could not be performed due to pain. Following the clinical evaluation, the examiner opined that it was less likely than not that the Veteran's right knee condition was causally related to active service. In support of the stated conclusion, the examiner noted service treatment records were silent for any complaints of knee pain or related treatment for a knee injury. Post-service, the Veteran worked at a steel plant for 30 years prior to his retirement in 2000. Moreover, at separation, his weight was listed as 175 pounds (lbs.); the Veteran's current weight is listed as 250 lbs. Post-service treatment records confirm that the Veteran was evaluated for acute knee pain in March 2005. At that time, there was no reference to a military related injury. X-ray films revealed normal findings. In April 2005, an MRI revealed medial and lateral meniscal tears of the right knee with no evidence of degenerative changes. Thereafter, the Veteran underwent a right knee arthroscopy with debridement of a meniscal tear and chondroplasty in May 2005. The post-operative report made no reference to chronic changes which might suggest residual from an injury that occurred 35 years earlier. Full range of motion with no complaints of pain were noted during a post-surgical follow-up evaluation. Thereafter, the next indication of worsening right knee pain was noted in 2013. Osteoarthritis of the bilateral knees was suggested in July 2014. A private orthopedic physician acknowledged a history of treating the Veteran's bilateral knee pain dating back to March 2016. While the examiner acknowledged medical evidence of a current diagnosis of degenerative joint disease of the right knee, the record is silent as to any basis for relating his current condition to active service. In making all determinations, the Board has fully considered all medical evidence and lay assertions of record. Generally, the Veteran is presumed competent to report on the onset of current symptoms, their impact on daily living and employment, and such reporting is deemed credible. However, as to the etiology of a particular claimed disability, the issue of causation is a medical determination outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In the instant case, there is no evidence that Veteran possesses the required training to diagnose a right knee condition or opine as to its etiology. Moreover, the Board notes that the Veteran's lay statements regarding an in-service injury are accorded little probative weight, as the medical evidence documents an initial reference to symptoms on or about 2005, decades after separation from active service. On review of the record, the Board finds that the evidence fails to show a causal linkage between the Veteran's right knee condition and active service. Specifically, service treatment records are silent for complaints symptoms or related treatment. Post-service treatment records document complaints of symptoms beginning on or about 2005; decades after separation. Moreover, the Veteran's post-service employment history included years of employment as a steel worker. Position related duties likely included heavy lifting, prolonged walking and standing, kneeling, and bending. Accordingly, as the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107 (b) regarding reasonable doubt are not applicable. Thus, the Veteran's claim of entitlement to service connection for a right knee condition must be denied. 2. Entitlement to service connection for bronchitis, to include as due to herbicide exposure The Veteran contends that he is entitled to service connection for bronchitis, to include as due to herbicide exposure. As a preliminary matter, the Board observes that the Veteran's military personnel records confirm a period of service in the Republic of Vietnam. His official military occupation was listed as an infantryman. Accordingly, exposure to certain herbicides and herbicidal agents, including Agent Orange, is presumed. Under 38 C.F.R. § 3.309(e), presumptive service connection for exposure to herbicides or herbicidal agents applies to a specific list of disabilities. These disabilities do not include bronchitis, squamous cell carcinoma, or dermatofibroma. Accordingly, the Veteran is not entitled to service connection for bronchitis, a left arm skin disorder, or a right arm skin disorder. Nevertheless, even if a claimant is not entitled to a regulatory presumption of service connection for a given disability, the claim must be reviewed to determine whether service connection can be established on a direct basis. See Stefl v. Nicholson, 21 Vet. App. 120 (2007); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994); McCartt v. West, 12 Vet. App. 164, 167 (1999). Review of service treatment records document treatment for flu symptoms including a runny nose, cough, and sore throat in March 1967 and again, in September 1968. The diagnostic impression listed a possible upper respiratory infection. Prescribed treatments included Cepacol throat lozenges and cough medicine. No complaints of a skin irritation, infection, or lesions were documented in service. No chronic upper respiratory or skin conditions observed during a physical examination at separation. Post-service private treatment records confirm a diagnosis of bronchitis beginning in November 2005 through November 2013. Complaints of coughing, chest congestion, sneezing, headache, with periodic bouts of nausea was documented in January 2006 and intermittently through 2019. During a March 2019 Board hearing, the Veteran testified regarding exposure to Agent Orange while stationed in the Republic of Vietnam. He suggested a correlation between his frequent bouts with bronchitis and active service. Considering the above, the Veteran's claim was remanded pursuant to an August 2019 decision. The opinion noted that presumptive service connection was not warranted, however, a VA opinion was required to consider the possibility of service connection on a direct basis. On examination in August 2020, a current diagnosis of chronic bronchitis. During the clinical interview, the Veteran noted that he was not treated for bronchitis during active service. Post-service treatment records document exertional dyspnea and complaints of a frequent productive cough beginning on or about 2005. Thereafter, episodic bouts with bronchitis occurred 2-3 times per year. Previously, the Veteran's symptoms were managed with steroids, inhaled medications (twice per week), and antibiotic medication, Azithromycin. A history of excessive smoking was reported since the age 17. The Veteran's habit included upwards of 2 packs per day. In additional to bronchitis, the Veteran also has a current diagnosis of COPD. A referral to a pulmonary specialist is pending. On examination, the Veteran's current symptoms included coughing and wheezing. Corticosteroid medications were not required to treat the Veteran's symptoms. Intermittent use of inhalational bronchodilator therapy and inhalational anti-inflammatory medication. Intermittent use of antibiotic medication, Azithromycin, was used to treat bronchitis. No outpatient oxygen therapy is required. Other pulmonary conditions include chronic bronchitis related to a lengthy history of tobacco abuse, COPD, and recurrent bacterial infections. Chest x-rays obtained in January 2021 failed to document any active disease. Pulmonary function testing was mild to moderately abnormal. The examiner concluded that the Veteran would be unable to perform strenuous physical labor. Following the clinical evaluation, the examiner opined that it was less likely than not that the Veteran's bronchitis was causally related to active service. In support of the stated conclusion, the examiner noted that the Veteran was initially diagnosed with chronic bronchitis in June 2005. Treatment records note a history of excessive smoking; to include a habit of approximately 50 packs per year. Bronchitis is an inflammation of the bronchial passages which increases susceptibility to bacterial infections. The condition is commonly associated with abuse tobacco. There is no evidence that the condition is causally related to his active service, to include as due to herbicide exposure. On review of the record, the Board finds that service connection is not warranted for the Veteran's bronchitis. In support of the stated concluded, the Board notes that service treatment records confirm only two instances of treatment for flu-related symptoms. However, there was no evidence of a chronic respiratory condition at separation. Post-service treatment records document complaints of symptoms beginning on or about 2005; decades after separation. Intermittent recurrence of bronchitis and other respiratory symptoms were reported thereafter. While the Board recognizes the Veteran's subjective belief that his bronchitis is causally related to active service, he is not competent to provide an etiological opinion in this case. Moreover, the Veteran's medical history has been thoroughly reviewed by skilled clinicians and no etiological linkage between his bronchitis and active service was demonstrated. Accordingly, as the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107 (b) regarding reasonable doubt are not applicable. The Veteran's claim of entitlement to service connection for bronchitis must be denied. 3. Entitlement to service connection for a bilateral arm skin disorder, to include as due to herbicide exposure The Veteran contends that he is entitled to service connection a bilateral arm skin disorder, to include as due to herbicide exposure. In analyzing the current claim, the Board incorporates by reference, the procedure discussion and arguments noted in Section 2. Post-service treatment records confirm complaints of skin lesions. In October 2012, private treatment records show that the Veteran was diagnosed with squamous cell carcinoma in situ of the right upper arm and left arm dermatofibroma. In December 2013, an Agent Orange registry examination indicated that the Veteran's skin was without lesions or pigmentation changes on physical examination. Prior surgical scars were associated with removal of multiple lesions of skin cancer and other recurrent skin infections. During a Board hearing, the Veteran reported exposure to leeches while stationed in the Republic of Vietnam. He also experienced jungle rot. The Veteran denied seeking treatment in service. Post-service, a lesion "described as a mole" was removed from the right arm. Diagnostic testing confirmed that it was cancerous. The Veteran suggested that his skin condition likely related to exposure to Agent Orange in service. Considering the above, the Veteran's claim was remanded pursuant to an August 2019 decision. Although presumptive service connection was deemed inappropriate, a VA opinion was required to consider the possibility of service connection on a direct basis. On examination in August 2020, the examiner noted a prior history of neoplasms about the skin. Previous diagnoses included squamous cell carcinoma in situ right upper arm, s/p excision, excision dermatofibroma left upper arm in remission. During the clinical interview, the Veteran reported an initial evaluation with a dermatologist in 2013 due to pigmented lesions on his upper arms. The lesions were subsequently excised. The pathology report revealed squamous cell carcinoma in situ on the right arm and a dermatofibroma on the left arm. There is no evidence of recurrence on the right arm. To date, the Veteran has never been diagnosed with melanoma impacted use if either arm. Presently, the condition is listed as resolved. No visible characteristic lesions were noted on the date of examination. A surgical scar measuring at 1.5 centimeters (cm) by 1 cm was observed on the right upper arm and on the left upper arm, a scar measured as 2 cm by .5 cm. No functional impact or current treatments were indicated. Further, the examiner indicated that the Veteran does not have a current diagnosis of melanoma and has full function of both arms. Following the clinical evaluation, the examiner opined that it was less likely than not that the Veteran's bilateral arm skin disorder was causally related to active service, to include as due to herbicide exposure therein. In support of the stated conclusion, the examiner noted that the Veteran was initially evaluated by a dermatologist due to complaints of lesions or hyperpigmented skin on both arms in October 2012, years after separation. Thereafter, a pathology report confirmed squamous cell carcinoma impacting the right arm. Diagnostic findings for the left arm lesion revealed a dermatofibroma, a benign skin tumor. There is no evidence that the Veteran has been diagnosed with melanoma. Neither squamous cell skin carcinoma nor dermatofibroma skin tumors are causally linked to active service, to include as due to herbicide exposure. Considering the above, the Board finds the evidence insufficient to establish service connection for the Veteran's bilateral arm skin disorder. In reaching the stated conclusion, the Board notes that service treatment records are silent for any evidence of a skin condition. At separation, a physical examination of the skin revealed normal findings. No reports of an intermittent skin rash were indicated. Thereafter, the earliest documented complaints of a skin lesions on the arms occurred in 2012 or 2013. Thereafter, intermittent bouts of skin lesions about the head, face, and neck were reported without recurrence on the bilateral arms. The Board recognizes the Veteran's subjective belief that claimed skin condition is causally related to his active service. However, he is not competent to provide a nexus opinion regarding this issue as it is medically complex and requires specialized training and medical expertise. As the record fails to show that the Veteran possesses the necessary medical training or expertise, his opinion is accorded little probative weight. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). While the Board is sympathetic to Veteran's subjective belief that his skin condition is causally related to active service, the medical evidence does not support his contention. Accordingly, the claim of entitlement to service connection for a bilateral arm skin disorder, to include as due to herbicide exposure is denied. Further, as the preponderance of the evidence is against the Veteran's claim; the benefit-of-the-doubt rule is not applicable. See 38 U.S.C. § 5107 (b) (2012); 38 C.F.R. § 3.102 (2020); Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001). B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Whitaker, 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.