Citation Nr: 21069357 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 14-43 313 DATE: November 18, 2021 ORDER Entitlement to service connection for skin disorder is denied. FINDING OF FACT The preponderance of the evidence is against finding that skin disorder began during active service, or is otherwise related to an in-service injury, event, or disease, to include as due to exposure to herbicide agents. CONCLUSION OF LAW The criteria for service connection for skin disorder have not been satisfied. 38 U.S.C. §§ 1110, 1116, 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 in the United States Marine Corps from March 1968 to October 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In his December 2014 substantive appeal, the Veteran requested a hearing before the Board. He was scheduled for a Board hearing to be held on October 19, 2021. However, in an April 2021 correspondence, the Veteran withdrew his request for a hearing. The Board finds that the Veteran's hearing request is considered withdrawn. See 38 C.F.R. § 20.704(e). In September 2018 and October 2020, the Board remanded the matter to the Agency of Original Jurisdiction (AOJ) for additional development, and it has since returned for further appellate review. The Board finds that there was substantial compliance with the October 2020 Board remand. See Stegall v. West, 11 Vet. App. 268 (1998). This is because the AOJ made adequate attempts to obtain outstanding treatment records and a VA medical opinion was obtained in December 2020. The medical opinion addresses direct service connection, to include whether the Veteran's skin conditions were caused by exposure to herbicide agents. The examiner provided a well-reasoned rationale. Service Connection for Skin Disorder The Veteran contends that his skin disorder is related to his active duty service, to include as due to exposure to herbicide agents. See October 2021 Substantive Brief. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). By virtue of his service in Vietnam, the Veteran is presumed to have been exposed to herbicide agents such as Agent Orange. 38 U.S.C. § 1116, 38 C.F.R. § 3.307(a)(6)(iii). Certain diseases, such as chloracne, are presumed by VA to be related to exposure to herbicide agents. 38 C.F.R. § 3.309(e). The Veteran has a current skin disability. For example, at his March 2019 VA examination he was diagnosed with folliculitis and lipomas. Thus, the remaining question is whether the current skin disability is related to service, to include as due to exposure to herbicide agents. Service treatment records show that the Veteran in August 1969 had complained of skin problems and face rash since arriving in Vietnam. During the October 1969 separation examination, evaluation of the skin was normal. A skin disability is not shown by medical evidence until many years after the Veteran's separation from service. In an August 2001 VA treatment note, it was indicated that the Veteran had not made specific complaints related to Agent Orange but that he did have jungle rot which mostly resolved and that he occasionally had athlete's foot. During a March 2005 private treatment, the Veteran denied having any skin rashes. The Veteran had previously undergone a November 1969 VA examination, held about a month after his separation from service, where the examiner noted that there were no remarkable findings with respect to the Veteran's skin. This provides evidence against continuity of symptoms. The Veteran presented for a VA examination in March 2019 where the examiner noted that the Veteran did not seek treatment for any skin condition after being released from service and was never prescribed medication. The examiner noted that the Veteran had folliculitis (infection of skin follicles) and subcutaneous nodules (lipomas) but did not have any active rash. The examiner further noted that the Veteran was never diagnosed with chloracne and current examination did not show evidence of chloracne. Thus, the examiner opined that the Veteran's skin lesions were less likely as not incurred in or caused by his military service. In its October 2020 remand, the Board found that the March 2019 was inadequate to the extent the opinion did not take into consideration the expanded scope of the Veteran's claim for skin disorder, to include athlete's foot, folliculitis, lipomas, and other skin conditions. Notably, the Board did not discount the examiner's finding that the evidence did not show a current diagnosis for chloracne. Thus, to that extent, the Board finds the opinion probative. In compliance with the October 2020 remand, the AOJ obtained a December 2020 addendum VA medical opinion. After reviewing the pertinent medical history and available record, the examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In support of this conclusion, the examiner explained that there was no evidence of chronic foot skin or other dermatologic condition during the Veteran's active duty service. The examiner noted that the Veteran was treated for bilateral toe blisters in July 1968 with no evidence of treatment for jungle rot or tinea. The examiner noted that blisters are due to friction on the affected area and clearly resolved with drainage. The examiner noted that the Veteran's separation examination was negative for any skin conditions and further explained that these exams are notably thorough especially when it comes to the feet and it is unlikely that a significant skin condition of the feet or other area would not have been noted or reported at his exit examination. The examiner indicated that there was no evidence of folliculitis, lipomas, or seborrheic dermatitis during the Veteran's service. Based on the foregoing, the examiner concluded that it is less likely than not that the Veteran's currently diagnosed skin conditions of folliculitis, lipoma, and seborrheic dermatitis had a nexus to service, to include as due to exposure to herbicide agents. In furtherance of the claim of exposure to herbicide agents, the examiner noted that any skin conditions caused by exposure to Agent Orange would have occurred at the time of exposure or proximate to the exposure. The examiner noted that there was no evidence of treatment for decades post-service for any dermatologic condition. The examiner noted that Agent Orange has not been associated with any of the Veteran's diagnoses and that current medical literature have not established Agent Orange as a cause for any of the Veteran's skin conditions. The examiner noted that tinea is a fungal infection (athletes' foot), and lipomas are benign fatty tumors, and both conditions are completely unrelated to service and exposure to Agent Orange. The examiner explained that tinea pedis was not found in the most recent examination and the Veteran's folliculitis was a late diagnosis. The examiner also pointed out that the Veteran had reported that the onset of his scalp lesions of dermatitis and folliculitis occurred many years after his service. The examiner made note that the Veteran had presented for a VA examination in November 1969, a month after his separation from service, where there were negative findings for any skin conditions. Based on the foregoing, the examiner again concluded that it is less likely than not that the Veteran's skin conditions are due to service, to include as due to exposure to Agent Orange. The Board finds this opinion highly probative as it was made by a medical professional with consideration of the specific facts in this case and supported by relevant medical literatures. The opinion is also supported by other evidence of record. There is no medical opinion or competent and credible evidence in significant conflict with the VA medical opinion. Upon review of the evidence of record, the Board finds that the preponderance of the evidence is against a finding that service connection for a skin disability due to active duty service, to include exposure to herbicide agents, is warranted. Presumptive provisions under 38 C.F.R. §§ 3.307, 3.309 are not applicable. While VA has conceded that the Veteran was exposed to herbicide agents, the evidence of record does not reflect that the Veteran has been diagnosed with chloracne. Additionally, the evidence of record such as the Veteran's separation exam was negative for any skin conditions, the examination held about a month after separation was negative for any skin conditions, and any skin conditions was not found until numerous years after the Veteran's active duty service. Of note, the December 2020 VA examiner reviewed the Veteran's claim and found that it was less likely than not that there was a direct connection between his skin disability and his military service, to include any exposure to herbicide agents. The Board acknowledges that the Veteran had complained of skin problems and rash during service to include while deployed to Vietnam. Notably, the examiner took these service records into consideration in addition to a review of medical literatures and still concluded that his skin disability is less likely related to his service. The Board has considered the Veteran's statements, to include his assertions that his skin disability began during service, or due to exposure to herbicide agents. As the Veteran is not shown to have medical education or experience, he is a lay person and is competent to report (1) symptoms that are observable to a layperson, e.g., skin rash; (2) symptoms at the time supporting a later diagnosis by a medical professional; or (3) a contemporaneous medical diagnosis. See Davidson v. Shinseki, 581 F.3d 1313 (2009). The Veteran is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition as these are medically complex issues that require understanding of impact of chemicals on the body, biological processes, and pathology. These are things that are not readily observable. The record does not show that the Veteran in this case has the experience, skills, or medical training needed to provide a competent opinion. Thus, his lay assertions do not constitute evidence upon which service connection can be granted. In any event, the Board ultimately assigns greater probative weight to the medical evidence of record, to include the opinion rendered by a trained medical professional based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. For the above reasons, the preponderance of the evidence is against the claim and service connection is denied. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Mathew 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.