Citation Nr: 21070461 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 13-22 244A DATE: November 24, 2021 ORDER Entitlement to service connection for a skin rash (skin condition) (claimed as ant bites, lice/crabs in hair, dermatitis, eczema) is denied. FINDING OF FACT The Veteran does not have a current skin disability that began during service, and a skin disability has not otherwise been linked to service. CONCLUSION OF LAW The criteria for entitlement to service connection for a skin condition, to include ant bites, lice/crabs in hair, dermatitis, and eczema have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. § 3.102, 3.159, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1981 to February 1982. This matter comes before the Board following November 2018 and April 2021 Board remands. This matter was originally on appeal from a February 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. In May 2018, the Veteran testified before the undersigned Veterans Law Judge at a Board hearing. A transcript of the hearing is associated with the claims file. Service Connection Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. 38 U.S.C. § 11102; 38 C.F.R. § 3.304; see also Shedden v. Principi, 381 F.3d 1163 (Fed Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Service connection for certain chronic diseases will be presumed if they manifest to a compensable degree within one year following active military service. This presumption, however, is rebuttable by probative evidence to the contrary. 38 U.S.C. §§ 1110, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Presumptive periods are not intended to limit service connection to diseases so diagnosed when the evidence warrants direct service connection. The presumptive provisions of the statute and VA regulations implementing them are intended as liberalizations applicable when the evidence would not warrant service connection without their aid. 38 C.F.R. § 3.303(d). 1. Entitlement to service connection for a skin rash (skin condition) (claimed as ant bites, lice/crabs in hair, dermatitis, eczema) The Veteran seeks entitlement to service connection for a skin condition that she asserts began in service and has continued periodically since service. The Veteran's service treatment records (STRs) show the Veteran reported itching all over in June 1981 and was diagnosed as having lice. In the Veteran's January 1982 separation Report of Medical Examination, the examiner indicated the Veteran's skin was normal. The Veteran indicated she did not experience any skin disease in her January 1982 Report of Medical History. A March 2011 VA examination indicated that her skin was normal and appeared warm, dry, with normal color and turgor. In the March 2016 notice of disagreement (NOD), the Veteran asserted that she has a skin rash that breaks-out monthly. In an August 2013 VA Form 9, the Veteran stated that her skin rash started in the military when she was bit by an ant and lice/crabs were in her hair. At the May 2018 Board hearing, the Veteran stated that following her first episode of itching while in service, she experienced reoccurring episodes around her neck. She treats the skin rash with an ointment and the rash goes away with use of the ointment. The Veteran stated that the rash comes and goes, but she has only experienced the rash in the springtime. The Veteran was afforded a VA examination in September 2019. The examiner opined that the Veteran's skin condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated he could not render an opinion because the Veteran's skin condition resolved and there was no recurrence. The April 2021 Board remand found the September 2019 examination inadequate because the examiner failed to consider the Veteran's contentions. In July 2021 the Veteran was afforded a VA examination. The examiner indicated the Veteran's skin condition has resolved. The examiner stated the Veteran denied having any current or recurrent skin condition at the time of exam and none were identified, any condition during service has resolved. The examiner opined the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated the Veteran's records do not support a skin condition or any treatments of a skin condition post service. The examiner noted that she currently has no identified diagnosis of a skin rash, ant bites, lice/crabs hair, dermatitis or eczema, and denied having any skin issues at the day of exam. Regarding the Veteran's June 1981 complaint of itching all over and pediculosis pubis (lice) diagnosis, this was resolved in service and the Veteran had no complaints on exit exam or post service. The examiner additionally noted it is less likely as not the Veteran has a current diagnosis of recurring skin rash due to ant bites, lice/crabs in hair, dermatitis, or eczema. The examiner noted she reviewed records as set forth in the notice of disagreement received in March 2016, the August 2013 VA Form 9, and the May 2018 board hearing transcript. The Board finds this opinion to be highly probative, as it was authored by an examiner who possesses the necessary education, training, or experience to provide competent medical evidence under 38 C.F.R. § 3.159 (a)(1). See Cox v. Nicholson, 20 Vet. App. 563 (2007). It is based on review of the record and interview and examination of the Veteran. Further, it contains a rationale that includes discussion of the facts of the Veteran's case. The Veteran's post service treatment records do not show complaint or treatment for any skin condition. The only contrary opinion comes from the Veteran herself. The Board recognizes that there are instances in which a layperson may be competent to offer testimony on medical matters, such as describing symptoms observable to the naked eye or even diagnosing simple conditions. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board finds, however, that the question posed by this claim, specifically, whether manifestations of a skin disability are related to later, distinct manifestations of a skin disability, is of such complexity as to require that individuals who provide competent medical evidence on this matter possess a level of expertise that a layperson does not possess. Indeed, the Veteran raised the argument of continuity of symptomatology during her May 2018 Board hearing. However, the claimed skin condition is not a chronic condition pursuant to 38 C.F.R. § 3.309. As such, the theory of continuity of symptomatology is not applicable to this claim. The Board finds that the Veteran's current contention that she had rashes in service which continued ever since service is not credible as this is inconsistent with evidence contemporaneous to service which is more probative due to its proximity to service which showed the Veteran had no specific complaints upon her separation from service. In addition, the record does not evidence the Veteran complained of or was treated for a skin condition after service. Moreover, any relationship between a current skin disorder and symptoms of skin problems experienced in service and over the years must be established by medical evidence because skin problems may be due to many different causes thereby rendering the question of causation a matter of medical complexity requiring medical expertise to resolve. Here, the medical opinion indicates the Veteran does not currently have a chronic skin condition related to service. Thus, the Board finds that the criteria for entitlement to service connection for a skin condition, to include ant bites, lice/crabs in hair, dermatitis, and eczema have not been met. The Board has considered the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, the claim is not in equipoise. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Accordingly, the claim must be denied. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Daley, 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.