Citation Nr: 21073176 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 14-00 414 DATE: December 7, 2021 ORDER Service connection for a skin disability, to include chloracne, is denied. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has had a skin disability to include chloracne, for which service connection has not already been established, at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for a skin disability (other than the already service-connected tinea pedis, tinea cruris, and folliculitis of the face), to include chloracne, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from August 1969 to March 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2012 rating decision of the Department of Veterans Affairs (VA), Regional Office (RO), in Nashville, Tennessee. This matter was previously before the Board in October 2017 and April 2019 at which time it was remanded for additional development. It is now returned to the Board. The Veteran's claim was initially developed and adjudicated as a claim of service connection for chloracne, to include as due to Agent Orange exposure. The issue was then expanded to encompass other skin diagnoses. Service connection for bilateral tinea pedis was established in February 2012. During the pendency of this appeal, by rating action dated in August 2021, service connection for tinea cruris and for folliculitis of the face was established. Therefore, this decision will address the remaining issue of service connection for chloracne, and any other identified skin disorders for which service connection has not been established. 1. Entitlement to service connection for a skin disability, to include chloracne. The Veteran asserts that he has a skin disability, to include chloracne, that is due to disease or injury in service. Having carefully considered the evidence of record, the Board must conclude that service connection is not warranted. The preponderance of the competent medical evidence does not demonstrate that the Veteran has a current skin disability for which service connection has not already been established, to include chloracne, that is etiologically related to his period of active service. A Veteran who, during active service, served in the Republic of Vietnam during the Vietnam era shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307 (a)(6)(iii). If a Veteran was exposed to an herbicide agent during active service, certain enumerated diseases shall be service connected if the requirements of 38 U.S.C. § 1116, 38 C.F.R. § 3.307 (a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113; 38 C.F.R. § 3.307 (d) are also satisfied. 38 C.F.R. § 3.309 (e). Chloracne or other acneform diseases consistent with chloracne are among the diseases presumptively associated with such exposure. 38 C.F.R. § 3.309 (e). Chloracne or other acneform disease consistent with chloracne shall have become manifest to a degree of 10 percent or more within one year after the last date on which the Veteran was exposed to an herbicide agent during active service. The last date on which such a Veteran shall be presumed to have been exposed to an herbicide agent shall be the last date on which he or she served in the Republic of Vietnam during the Vietnam era. In addition to the presumptive regulations, a Veteran may establish service connection based on exposure to Agent Orange with proof of actual direct causation. See Stefl v. Nicholson, 21 Vet. App. 120 (2007) (the availability of presumptive service connection for some conditions based on exposure to Agent Orange does not preclude direct service connection for other conditions based on exposure to Agent Orange); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994); Brock v. Brown, 10 Vet. App. 155 (1997). VA has conceded exposure to herbicides based on the Veteran's duty or visitation to the Republic of Vietnam. The Veteran's service treatment records are negative for any treatment for or findings suggestive of chloracne. The service treatment records do show that in January 1972, he was treated for bumps from shaving and also a rash on his chest and back; tinea versicolor and acne were diagnosed. In March 1970, he had a fungal infection of his feet. A March 1972 report of medical examination, completed at the time of separation from service, shows that clinical evaluation of the skin was normal. Following service, VA outpatient treatment records show intermittent treatment for variously diagnosed skin conditions. In 2005, the Veteran had sebaceous cysts removed from his right shoulder and left side of neck by surgery. In October 2007, he reported itchy skin and a rash in the groin area. He was also said to have been treated by a podiatrist for tinea pedis. He was noted to have dry and scaly skin. In April 2015, a skin lesion of the left shoulder, diagnosed as pigmented seborrheic keratosis, was excised by a dermatologist. Post-service medical treatment records are silent for a diagnosis of chloracne. A VA examination report dated in October 2018 shows that the Veteran was diagnosed with dermatitis, tinea cruris, and tinea pedis. The examiner noted that the Veteran reported intermittent patches of dry, flaky skin, and that these might be eczema or non-specific dermatitis, but ultimately opined that it was less likely than not that he had a skin condition related to active service. The examiner also explained that there was nothing on examination or in the medical history to suggest that the Veteran had chloracne. A VA examination report dated in December 2019 shows that the Veteran was diagnosed with seborrheic dermatitis, tinea pedis, tinea versicolor, facial lesions, and excision of benign skin lesions. The examiner explained that tinea pedis was already service connected with the condition diagnosed and treated in the service. The examiner explained that tinea pedis was the most common dermatophyte infection and was frequently accompanied by tinea unguium, tinea cruris, or tinea manum. Thus, based on the medical literature, it was at least as likely as not that the Veteran's tinea cruris would be related to the dermatophyte infection of the feet (tinea pedis) and could be considered a progression of the service-connected fungal infection. The examiner added that the seborrheic dermatitis was less likely service related as there was no documentation of this condition in the service records, and the examiner was not aware of medical literature or VA directives linking it to Agent Orange exposure. Additionally, while tinea versicolor was documented in the service records, the Veteran denied recent treatment for this condition, and there were no findings on examination consistent with this condition. As to the asserted facial papular lesions, service records were said to have referred to bumps post shaving and to acne. Current examination showed minimal papules mainly in the beard area more consistent with folliculitis. Since these lesions were noted in the service records, the examiner opined that they would be at least as likely as not considered service related. As to the Veteran's excision of benign skin lesions in 2005 and 2015, the examiner indicated that these had not been documented in the service records, and the examiner was not aware of medical literature or VA directives linking them to Agent Orange exposure. Therefore, the examiner could not relate the conditions to service without resorting to speculation as the medical evidence was not sufficient to support that. A VA examination report dated in August 2021 shows that the Veteran was diagnosed with seborrheic dermatitis, tinea pedis, and tinea cruris. The examiner opined that it was less likely than not that the Veteran developed seborrhea dermatitis while on active duty. While it appeared that the condition being claimed at this time was most likely seborrhea dermatitis, it was not present on examination. By history, it would come and go, but was diagnosed on previous physical examinations in the medical records. Seborrhea dermatitis was said to be fairly ubiquitous and did not require tropical jungle conditions for involvement. There was no mention of dermatitis during active duty, thus, it was less likely that the intermittent facial seborrhea dermatitis was related to active duty. The examiner added that service connection had been established for tinea pedis and tinea cruris. The examiner noted that while it was at one time documented that the Veteran had tinea versicolor, it had resolved and was not present on examination in 2019 or on current examination. The tinea pedis and cruris was said to be active, requiring treatment. As indicated above, service connection has been established for bilateral tinea pedis, tinea cruris, and folliculitis of the face. Therefore, the remaining aspects of the claim under consideration are whether the Veteran has service-connected chloracne, seborrheic dermatitis, tinea versicolor, and sebaceous cysts that were removed in 2005 and 2015. With specific regard to the chloracne, the Veteran has expressed experiencing chloracne as a result of active service. However, there is no evidence of record that he has ever had a diagnosis of chloracne. The Veteran's service treatment records are negative for a diagnosis of chloracne, and each VA examination report referenced above specifically indicated that the Veteran did not exhibit any chloracne. Congress specifically limits entitlement to service connection benefits to cases where there is a current disability. "In the absence of proof of a present disability, there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). With specific regard to the seborrheic dermatitis and the sebaceous cysts that were removed in 2005 and 2015, the VA examiners in December 2019 and August 2021 specifically opined that they were less likely service related to service as there was no documentation of the conditions in service, and a relationship to service was not supported by the medical literature or VA directives linking such to Agent Orange exposure. The opinions of the examiners are considered probative as they were definitive, based upon a complete review of the Veteran's entire claims file, and supported by detailed rationale. The Veteran has not provided any competent medical evidence to rebut the opinions against the claim or otherwise diminish their probative weight. With specific regard to the tinea versicolor, while the Veteran's service treatment records showed reported symptoms during active service, the post-service medical evidence is entirely negative of treatment for or a diagnosis of tinea versicolor. Moreover, the VA examiners have specifically indicated that the Veteran did not have a current diagnosis of tinea versicolor. As noted above, Congress specifically limits entitlement to service connection benefits to cases where there is a current disability. Thus, in the absence of proof of a present disability, there can be no valid claim. See Brammer, 3 Vet. App. at 225. Lay assertions may serve to support a claim for service connection when they relate to the occurrence of events that are observable as a lay person or the presence of a disability or symptoms of a disability that are subject to lay observation. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a); see Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). However, while the Veteran is competent to describe his experiences, the medical findings of record are not consistent with his assertions. Given the medical evidence against the claim, it would be too speculative to conclude that the Veteran has current chloracne, seborrheic dermatitis, tinea versicolor, or sebaceous cysts that were incurred during active service, and the law provides that service connection may not be based on a resort to speculation or remote possibility. 38 C.F.R. § 3.102; Obert v. Brown, 5 Vet. App. 30, 33 (1993). Therefore, the preponderance of the evidence is against the Veteran's claim of service connection for a skin disability, to include chloracne, and the provisions of 38 U.S.C. § 5107 (b) regarding reasonable doubt are not applicable. L. B. CRYAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Orfanoudis, 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.