Citation Nr: 21069233 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 17-67 716 DATE: November 17, 2021 ORDER Entitlement to service connection for vitiligo as secondary to service-connected hypothyroidism is granted. FINDING OF FACT The Veteran's vitiligo is etiologically related to her service-connected hypothyroidism. CONCLUSION OF LAW The criteria for service connection for vitiligo as secondary to service-connected hypothyroidism have been met. 38 U.S.C. §§ 1110, 1131, 5107, 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1980 to July 1980, from March 1992 to August 1992, and from April 2002 to July 2002. The record also reflects over 19 years of inactive service. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2021, the Veteran presented testimony before the undersigned Veterans Law Judge. A transcript will be associated with the record. Entitlement to service connection for vitiligo as secondary to service-connected hypothyroidism is granted. Service connection is warranted for the Veteran's vitiligo as related to her service-connected hypothyroidism. Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). Service connection may alternatively be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310 (a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability. See 38 C.F.R. § 3.310 (b); Allen v. Brown, 8 Vet. App. 374 (1995). In adjudicating a claim for VA benefits, 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, 53-56 (1990). Starting with the first element of service connection, the Board notes the Veteran was diagnosed with vitiligo at her February 2015 VA examination. Available VA treatment records note the presence of the condition since May 2013, and records from the Veteran's private treating dermatologist note the continued presence of the condition in June 2020. A diagnosis has been established. As to the issues of nexus, the Veteran's dermatologist provided a positive opinion relating the Veteran's vitiligo to her service-connected hypothyroidism in treatment records from June 2020. The physician rationalized the Veteran's vitiligo is an autoimmune process that attacks pigment making cells and is associated with thyroid disease, pernicious anemia, and diabetes. Moreover, the Veteran testified at her November 2021 hearing that the skin condition, which is observable skin depigmentation, emerged only after her 1992 treatment for hypothyroidism and that it worsens when her thyroid levels change. Notably, there are no contradictory medical opinions on file except for the inadequate February 2015 VA opinion. Towards the February 2015 opinion's inadequacy, the examiner rationalized "there appears to be an increased frequency and shared genetic predisposition of vitiligo with autoimmune thyroid disease however the condition is less likely than not proximately due to or the result of the [Veteran's] service-connected condition. Vitiligo is due to an autoimmune process directed at melanocytes while autoimmune thyroid disease is a process directed at thyroid cells." While the Board recognizes the examiner's attempt to distinguish the disabilities, this does not clarify why vitiligo is generally seen at an increased frequency in populations with autoimmune thyroid disease, but not for this Veteran. Nor did the examiner address in the rationale the Veteran's reports that her observable skin condition emerged after treatment for hypothyroidism. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). Moreover, secondary service connection opinions require separate findings and rationales for proximate causation and aggravation as required by Atencio v. O'Rourke, 30 Vet. App. 74 (2018); however, this examiner only provided findings towards causation. As such, the February 2015 VA opinion is inadequate and nonprobative of the service-connection question at issue. (Continued on the next page) Accordingly, with medical evidence weighing in favor of the Veteran's vitiligo related to her service-connected hypothyroidism, service connection is warranted. The appeal is granted. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.A. Infante, 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.