Citation Nr: 21068064 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 14-15 527A DATE: November 9, 2021 ORDER Service connection for a skin disability is granted. FINDING OF FACT The Veteran's skin disability had its onset during his active service. CONCLUSION OF LAW The criteria for service connection for a skin disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1993 to November 1996. In January 2021, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing has been associated with the Veteran's claims file. Then, in March 2021, the Board of Veterans Appeals (Board) remanded this matter for further development. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303(a). Service connection requires competent evidence of (1) a current disability; (2) the incurrence or aggravation of a disease or injury during service; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Additionally, service connection can also be established through application of a statutory presumption for chronic diseases when manifested to a compensable degree within a year of separation from service. 38 C.F.R. §§ 3.307, 3.309. If a chronic disease is not manifested to a compensable degree within a year of separation of service, then, generally, a showing of "continuity of symptoms" after service is required for service connection. 38 C.F.R. § 3.303(b). Furthermore, a layperson is competent to report on the onset and continuity of his or her current symptomatology. 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). In the current appeal, the Veteran contends that his current skin disability began during his active service. At his January 2021 hearing, he testified about the dermatological symptoms that he experienced and was treated for in service. Specifically, he reported that he experienced inflammation and bumps on the back of his head during basic training and that the symptoms progressively worsened over time. He testified that he was treated with creams, cortisone shots, and antibiotics for this condition while in service. Further, he testified that this treatment caused scarring and stopped hair from growing on the back of his head. The Board acknowledges that there are no service treatment records regarding the diagnosis of, or treatment for, a skin disorder in the claims file. However, during the January 2021 hearing, the Veteran asserted that significant portions of his service treatment records were missing, despite multiple attempts to obtain all of his service treatment records from active duty. To support this contention, he provided VA with a written statement from his former girlfriend, who is also a former service member. She reported that she not only witnessed the inflammation and irritation of the Veteran's skin, but that she accompanied him to several of his treatment appointments while overseas in Germany. The Veteran and VA made multiple attempts to obtain his service treatment records, but they were regrettably not available. In a case like this in which a claimant's service records are unavailable through no fault of his own, there is a heightened obligation for VA to assist the Veteran in the development of his claim and to provide reasons or bases for any adverse decision rendered without these records. O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). However, this heightened obligation does not establish a heightened "benefit of the doubt" or lower the legal standard for proving a claim of service connection; rather, it increases the Board's obligation to evaluate and discuss in its decision all the evidence that may be favorable to the Veteran. Russo v. Brown, 9 Vet. App. 46 (1996). As such, the Board finds that the Veteran's competent lay testimony supports a finding that the in-service event element of the claim has been met. Further, he has a current diagnosis of a skin disability. Thus, the only remaining issue is whether a nexus (causal relationship) exists between his current skin disorder and his active duty. Indeed, at a June 2021 VA examination, the Veteran reported that, during basic training, he developed a rash on the back of his head after receiving a haircut. The VA examiner diagnosed chronic urticaria and allergic urticaria and noted areas of hyperpigmentation on the back of the Veteran's head. The examiner also noted that, several years prior to service when the Veteran was still in adolescence, he was treated with allergy injections for allergies and rashes. Based on the Veteran's history, the examiner determined that the Veteran's allergic urticaria preexisted his service and thus was not incurred in, or caused by, his active service. The examiner noted that the Veteran's service likely aggravated his preexisting skin disorder, but ultimately determined that the skin disorder resolved during service, based on the lack of notation of skin disorders on the Veteran's separation examination. In July and August 2021, the Veteran's private family medicine physician provided two letters in support of the Veteran's claim. In these letters, the physician opined that the Veteran's presentation of symptoms and treatment plan during service was not consistent with a diagnosis of chronic urticaria (CU). Rather, she opined that the Veteran's in-service symptoms and treatment plan were more consistent with hidradenitis suppurativa (HS), and thus his skin disability developed during service. The physician explained that CU is a disturbing allergic condition of the skin that is treated with antihistamines, whereas HS is caused by a hair follicle blockage and often causes secondary bacterial infections characterized by persistent or recurrent boil-like nodules or abscesses that culminate with purulent discharge and scarring. Common treatments for HS include oral and topical antibiotics, steroid injections, and even surgical intervention. The physician noted that, after a haircut in basic training, the Veteran developed painful, inflamed lesions on his scalp with purulent drainage. The lesions were recurrent and required oral antibiotics and steroid injections into the lesions. Then, the Veteran developed alopecia and permanent scarring on his scalp. The physician explained that, not only was the Veteran's treatment plan much more consistent with the treatment of HS, but also his treatment plan was clinically more significant and drastically different from the recommended treatment of CU. Further, the physician explained that the Veteran's medical records show that he did not receive treatment for allergies or allergy injections after 1989, which suggests that the Veteran's allergies had resolved well before his in-service skin disorder developed. The physician also noted that the American Academy of Allergy, Asthma, and Immunology has stated that "allergy shots decrease sensitivity to allergens and often leads to lasting relief of allergy symptoms even after treatment is stopped." In an August 2021 written statement, the Veteran argued that the June 2021 VA opinion is speculative and that it is not supported by the Veteran's testimony, his medical records, or his former girlfriend's testimony. Furthermore, the Veteran stated that, after receiving his last allergy injections in 1989, his treating physician at that time determined that he no longer suffered from allergies and no longer needed allergy injections. While the Board cannot ignore or disregard the VA examiner's medical conclusions, the Board is free to assess medical evidence and is not compelled to accept a medical opinion. Willis v. Derwinski, 1 Vet. App. 66 (1991); Wilson v. Derwinski, 2 Vet. App. 614 (1992). Here, the Board agrees with the Veteran that there are deficiencies with the VA medical opinion. Significantly, the VA opinion failed to address all of the Veteran's reported symptoms, including scarring and hair loss. The examiner noted that the Veteran had patches of hyperpigmentation on the back of his head but made no mention of the Veteran's scarring and hair loss. Importantly, the Veteran's private physician noted the presence of widespread scarring and alopecia on the bilateral posterior of his head, spanning from the base of his hairline at his neck to approximately two inches above his hairline. Furthermore, the VA examiner concluded that the Veteran's in-service skin disorder was related to allergies, but the examiner failed to address the drastic difference in symptomatology and treatment between the Veteran's pre-service allergies and his in-service skin disorder. Additionally, the examiner failed to address the Veteran's contention, and supporting medical evidence, that his allergies resolved prior to service and that his allergy injections were therefore no longer necessary. Thus, the Board finds the VA opinion carries little, if any, probative value. Given the above, the Board finds that the weight of the evidence supports a finding that the Veteran's skin disability onset during active service. Accordingly, service connection for a skin disability is granted. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Benson, 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.