Citation Nr: 21070216 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 08-06 550 DATE: November 23, 2021 ORDER Entitlement to service condition for a skin condition, to include a rash of the face, hands, and feet, is granted. FINDING OF FACT The Veteran suffers from a skin condition, including tinea pedis, dyshidrotic eczema, onychomycosis, and dermatitis, that had its onset in service. CONCLUSION OF LAW The criteria for an award of service connection for a skin condition, to include tinea pedis, dyshidrotic eczema, onychomycosis, and dermatitis, have been met. 38 U.S.C. §§ 1110, 1117, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the United States Army from June 1982 to January 1984. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2006 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that this matter has a lengthy history. In June 2009, the Board reopened and remanded the matter for further development. In March 2010, the Board denied the claim for a skin condition, to include a rash of the face, hands, and feet. The Veteran appealed to the U.S. Court of Appeals for Veterans Claims. In an October 2010, the parties entered into a Joint Motion for Remand for further development. This matter was remanded in May 2011, April 2014, and May 2018 for further development. Once again, this matter was remanded in June 2019 for further development and has since been returned to the Board. 1. Entitlement to service connection for a skin condition, to include a rash of the face, hands, and feet The Veteran contends that he has a skin condition in his face, hands, and feet that has persisted intermittently for six to eight months at a time since service. Service connection may be granted for 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). As to a current disability, the record shows that the Veteran has several diagnoses for his skin conditions, including tinea pedis, dyshidrotic eczema, onychomycosis, and dermatitis. Therefore, the first element of service connection is met. Regarding an in-service incurrence, the Veteran's service treatment records do not reflect treatment for skin conditions apart from a July 1983 record that noted swollen eyes for two weeks that was diagnosed as allergic conjunctivitis and in October 1983 for a blister on toe in the Veteran's left foot that lasted for three days. The Veteran waived his exit examination, and the last examination during service was in October 1983 that noted no skin condition/pathology. See STR-Medical. At a Board Hearing in May 2005, the Veteran testified that he has skin rash on his hands, feet, and face that began in service. He testified he received treatment for his skin rash in Panama, Fort Leavenworth, and Fort Eustis. The Veteran stated that his skin rash has continued since service intermittently for six to eight months at a time. See Hearing Testimony. The Board finds that the Veteran is both competent and credible to identify and describe his skin condition during service. Affording the Veteran the benefit of the doubt, the Board finds that the second element of service connection is met. The remaining question is whether there is a medical nexus between the Veteran's skin condition and his active duty service. In June 1988, the Veteran was seen for an acute face rash that lasted three days and was diagnosed with contact dermatitis. See January 2016 STR Medical. In November 1988, the Veteran had complaints of a face rash. The Veteran's treatment provider indicated that he had a small papular rash all over his face. He was subsequently diagnosed with folliculitis versus heat rash. Id. In August 1989, the Veteran presented for treatment for sores on his hands and left foot. There, he reported that his sores originated five years earlier when he was serving in Panama. The Veteran was subsequently diagnosed with tinea. See January 2016 Medical Treatment Record Non-Government Facility. In September 1991, the Veteran reported that he had a re-exacerbation of the rash that he was seen for in 1989. His treatment provider noted that he had evidence of dyshydrosis as well as some slightly irritated hyper and hypopigmented areas. The Veteran was diagnosed with probable tinea pedis and probable mild dyshidrotic eczema of the palms and feet. Id. At a Board hearing in May 2005, the Veteran testified that his skin rash began in service. He indicated that he experienced skin rash on his hands, feet, and face. He also testified that he received treatment in service and that his skin rash has persisted for six to eight months at a time post-service. In May 2010, the Veteran presented with mild redness and scaling on upper eyelids as well as dry scaly skin on lateral palms and insteps of feet. He was assessed with dyshidrosis. He was also assessed with seborrheic dermatitis for his face. See August 2020 CAPRI. In September 2013, the Veteran's brother submitted a lay statement where he indicated that the Veteran had a rash after he came home from Panama in 1983 or 1984. See Buddy/Lay Statement. In July 2015, it was noted that the Veteran had a skin rash present with dermatitis on his hands, extensive tinea pedis, and onychomycosis. See August 2020 CAPRI. Regarding nexus, the Board notes that the Veteran was afforded VA examinations in September 2003, September 2009, and in February 2018. His VA examiners opined that the Veteran's skin condition was less likely than not related to military service. However, in a May 2018 Board remand, it was determined that a new VA examination was warranted, as the prior VA examiners did not adequately consider relevant evidence. The relevant VA examination in this matter was given in July 2021 pursuant to a June 2019 Board remand. There, the Veteran reported having issues with skin rash while stationed in Panama where he worked under ships overseas with lead. He reported painful skin, flareups occasionally with redness, and swelling of the face, hands, and feet. The VA examiner diagnosed the Veteran with dyshidrotic eczema (1989) affecting less than five percent of the total body area and exposed area, a diagnosis of tinea pedis (1989) affecting less than five percent of the total body area, and a diagnosis of onychomycosis (2021). For dyshidrotic eczema, the VA examiner noted that the Veteran has dry, cracked scaly skin with irritation to the palms of his hands and soles of his feet. For dermatophytosis, the VA examiner noted that the Veteran has discolored and hardened toenails to all toes with dry, malodorous, flaking skin to feet, and webbing of toes. The VA examiner opined that the Veteran's condition was less likely than not (less than 50 percent probability) incurred in or caused by the claim in-service injury, event, or illness. The VA examiner indicated that the examination was positive for dyshidrotic eczema (hands and feet) and tinea pedis with onychomycosis. Notably, despite providing a negative nexus opinion, the VA examiner believed that the same symptoms were a progression from the 1989 post-service exam. The VA examiner noted that the Veteran self-reported his 1989 post-service skin diagnosis are directly related to rash in service but determined that it was "not medically prudent to delineate dates of skin diagnosis based on lay statements or subjective complaints of patients and their relatives without objective medical evidence to support such claims." The VA examiner noted that his service treatment records do not support the current diagnosed skin conditions incurred while on active duty, that objective evidence supports skin conditions were diagnosed post separation from his service, and that an October 1983 physical was negative for any skin abnormalities. The VA examiner noted that the examination today was negative for a skin condition on his face or a friction blister to his toe. The VA examiner noted that the Veteran's dyshidrotic eczema (hands and feet) and tinea pedis with onychomycosis were diagnosed after service and therefore, the current skin conditions were not related to service. Despite the negative nexus opinion from the VA examiner, the Board finds that the evidence of the record particularly the Veteran and his brother's lay statements nonetheless preponderate in favor of a nexus. The Board notes that lay evidence can be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1316 (Fed. Cir. 2009); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Here, the Veteran has competently, credibly, and consistently described symptoms of a rash on his hands, feet, and face that began during service in Panama and has continued thereafter. A review of the Veteran's post-service records note that he has sought treatment for his skin conditions as early as June 1988 for his face, as early as August 1989 for his left foot and hands, and as early as September 1991 for his feet. The Veteran testified in May 2005 that he experienced rash on his hands, feet, and face, which continued intermittently for six to eight months at a time since service. In September 2013, the Veteran's brother submitted a lay statement regarding his observations of the Veteran's skin condition after he came home from Panama in 1983/1984, which is consistent with the Veteran's service records that noted service for three months in Panama between October 1982 to January 1984. See Military Personnel Record. The symptoms on the Veteran's face have been diagnosed by medical professionals as dermatitis, seborrheic dermatitis, and folliculitis versus heat rash. The symptoms on the Veteran's hands and feet have been diagnosed by medical professionals as dyshydrosis, tinea pedis, and onychomycosis. In addition, the VA examiner acknowledged that the Veteran's symptoms of dyshidrotic eczema (hands and feet) and tinea pedis with onychomycosis were a progression from the 1989 diagnosis where he reported that they began five years prior in Panama. Therefore, the Board finds that the Veteran's reports of a rash/skin condition are capable of lay observation, see McCartt v. West, 12 Vet. App. 164, 167 (1999), and the symptoms described are the same as those that later supported diagnoses by various medical professionals, see Davidson, supra. The Board has considered remanding for another VA examination that adequately takes into account the lay and medical evidence of record. However, the Board notes that the Veteran's claim has been pending for over 15 years and that this matter has already been subject to numerous remands to obtain an adequate opinion. Moreover, the Board finds that under the facts of this case, particularly the consistent reports of rash (on his face, hands, and feet) since service, the testimony from the Veteran, the lay statements submitted by the Veteran and his brother, and medical evidence of record regarding onset and progression of the skin condition are sufficient enough to support to support a finding of nexus and subsequently puts the VA opinion at least in equipoise. Therefore, the Board finds that the evidence is at least in equipoise and that a remand is unnecessary. (Continued on the next page) The Board thanks the Veteran for his patience and for his service to our country. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Kim, 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.