Citation Nr: 21072617 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 16-47 478 DATE: December 3, 2021 ORDER 1. Entitlement to service-connection for Porphyria Cutanea Tarda (hereafter porphyria or PCT), to include as due to exposure to hazardous chemicals while he was in service, is granted. FINDING OF FACT Giving the Veteran the benefit of any reasonable doubt, his porphyria is shown to be at least as likely as not (50 percent or greater) etiologically related to his military service, including as due to exposure to hazardous chemicals. CONCLUSION OF LAW The criteria for entitlement to service connection for porphyria have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from September 1962 to September 1966. This matter returns to the Board of Veterans' Appeals (Board) from our prior remand decision of August 2019 (Board Remand) which returned the matter to the Department of Veterans Affairs (VA) Regional Office (RO) which is the agency of original jurisdiction (AOJ) for additional development. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c); 38 U.S.C. § 7107(a)(2). 1. Entitlement to service-connection for Porphyria Cutanea Tarda. The Veteran asserts that his skin condition of porphyria cutanea tarda developed during or as a result of his military service, including as due to exposure to hazardous chemicals. This includes daily exposure to various cleaning chemicals, including Trichloroethylene (TCE). See Veteran's written statements, April 17, 2015, and March 24, 2019; and Board Hearing Transcript, March 2019, passim. He states that his skin developed lesions shortly after his discharge from service, which became progressively worse over time. Id. VA concedes that the Veteran has a current diagnosis of porphyria which was first diagnosed at least as early as the 1980's. See VA Skin Disease Disability Benefits Questionnaire (DBQ), July 2016; Hematologic and Lymphatic Conditions DBQ, December 2019; Private medical encounter notes, Dr. P.M., March 26, 2013. However, in the December 2019 VA examination for skin diseases, the VA examiner stated the date of onset to be 1965, while the Veteran was still on active duty. See VA Skin Disease DBQ, December 20, 2019. VA also concedes his exposure to hazardous chemicals, including TCE. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). To establish a right to compensation a Veteran must show: (1) the existence of a present disability; (2) 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. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 38 F.3d 1163, 1167 (Fed. Cir. 2004)). The Veteran submitted numerous written statements to support his claims, as well as providing testimony before the Board at his March 2019 Board Hearing. Lay witnesses, such as the Veteran, are competent to provide testimony or statements relating to symptoms or facts of events observed or experienced, and which are within the realm of his personal knowledge. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159 (a). However, without specialized medical training a lay witness is not competent to either diagnose or make a nexus opinion concerning most medical conditions. Layno v. Brown, 6 Vet. App. 465, 470 (1994). Here the Board finds the Veteran to be both competent and credible in his statements submitted to support his claim. These statements are consistent unto themselves and with the remainder of the evidence of record, and the Board finds him to be sincere. The Board finds his testimony to be highly probative. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010) ("VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to."). In support of his claim the Veteran also submitted numerous medical articles which addressed the asserted link between exposure to various hazardous chemicals, including TCE, with his condition of PCT. As part of the August 2019 Board Remand instructions, the post-remand VA examiners were specifically directed to review the entire claims file and the treatise evidence submitted by the Veteran, to include the information submitted in July 2015. The VA examiners were specifically directed to address the treatise evidence of record in his or her report. In a post-remand VA medical opinion of December 2019, the VA examiner found that the Veteran's Porphyria is at least as likely as not (50 percent or greater probability) incurred in, or caused by his exposure to chemicals, including TCE, during his period of active service. This was based on multiple documents from oncologists and dermatologists who treated the Veteran's condition of PCT, and that he does not have visible scarring due to well healed areas, and his only treatment for this condition is therapeutic phlebotomy. A later VA medical opinion was received in September 2021, prepared by a different VA examiner who did not conduct the December 2019 VA examination, nor who conducted an in-person examination of the Veteran. In this opinion, the VA examiner opined that the Veteran's condition was less likely due to his military service, including exposure to hazardous chemicals, instead finding that the condition was more likely due to the prolonged state of iron overload secondary to Hereditary Hemochromatosis (HH) and not to any service-related exposure to TCE. However, the Board finds this opinion to be inadequate as it did not specifically address the treatise evidence submitted by the Veteran, as specifically directed in the Board Remand, nor did this examiner address the Veteran's lay testimony or the previous medical opinion which did find a positive connection between the Veteran's condition and his in-a service hazardous exposure. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (finding that a medical opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). (Continued on the next page) As there are conflicting opinions, and the Board finds that they are at least equally probative, the appeal should be granted. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Here, the opinion against the Veteran's claim is inadequate, and the Board finds the preponderance of the evidence supports the Veteran's claim that his exposure to hazardous chemicals during active service was at least as likely as not the cause of his porphyria. The claim for entitlement to direct service connection for porphyria is granted. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Bannach 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.