Citation Nr: 21074679 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 17-47 562 DATE: December 16, 2021 ORDER Service connection for a skin disability is granted. REMANDED Entitlement to service connection for left lower extremity (LLE) peripheral neuropathy is remanded. Entitlement to service connection for right lower extremity (RLE) peripheral neuropathy is remanded. Entitlement to service connection for left upper extremity (LUE) peripheral neuropathy is remanded. Entitlement to service connection for right upper extremity (RUE) peripheral neuropathy is remanded. FINDING OF FACT The Veteran's current skin disorder, diagnosed as seborrheic dermatitis, is as likely as not attributable to in-service exposures while in Southwest Asia during active service. CONCLUSION OF LAW With resolution of reasonable doubt in the Veteran's favor, the criteria for entitlement to service connection for a skin disability have been satisfied. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1990 to June 1994 to include service in the Arabian Sea in the Southwest Asia Theater of operations. In March 2020, the Board remanded the appeal for additional evidentiary development. The issue of entitlement to service connection for androgenetic alopecia was granted in an April 2021 rating decision, which represents a full grant of the benefits sought so it is no longer on appeal before the Board. The remaining issues on appeal have been returned to the Board for appellate review. There was substantial compliance with the March 2020 remand directives for the issue on appeal discussed below on the merits. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Specifically, the AOJ attempted to obtain any outstand service treatment records and the Veteran was provided a VA Disability Benefits Questionnaire (DBQ) examination and medical opinion for skin disability in April 2021. Th examination report and medical opinion were adequate as they were based on a review of the history, examination, and sufficient information was provided to allow the Board to render an informed determination. This issue was also readjudicated in a July 2021 supplemental statement of the case (SSOC). Entitlement to service connection for skin disability Service connection may be granted for any current disability that is the result of a disease contracted or an injury sustained while on active-duty service. In general, service connection requires competent evidence showing: (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. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A medical nexus of a relationship between the condition in service and the present condition is required. Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). In this case, the Board finds that the Veteran is a Persian Gulf Veteran as his service personnel records reflect that he served in the Southwest Asia theater of operations, specifically the Arabian Sea. See 38 U.S.C. § 101 (33); 38 C.F.R. § 3.317(e)(2). Nevertheless, as discussed below, the Veteran is currently diagnosed with seborrheic dermatitis. This is a known clinical diagnosis and, therefore, not a qualifying chronic disability. As such, the undiagnosed illness presumptive provisions of 38 U.S.C. § 1117 do not apply and other provisions of a qualifying chronic disability do not provide an exception. This claim on appeal will be discussed on a direct basis below. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In April 2015, the Veteran requested service connection for dermatitis. During the course of the appeal, review of the evidentiary record shows the Veteran has a current diagnosis of seborrheic dermatitis during the appeal period, as noted in the September 2015 and April 2021 VA examination reports for skin diseases. Next, the Veteran asserts exposure to environmental hazards while in the Persian Gulf during his period of active service, as note din the September 2015 VA examination report. Review of the Veteran's service personnel records documents his period of active service includes foreign service in Southwest Asia, as previously noted. As a result, the Board finds the element of an in-service occurrence has been met in this case. Lastly, review of the April 2021 VA medical opinion shows that after the in-person examination and review of the electronic VA claims file, the examiner explained why the Veteran's seborrheic dermatitis is at least as likely as not related to his active service, including exposure to fumes from fuels while aboard the USS America. As previously noted, the Veteran served about the USS America during his service in Southwest Asia. The Board finds this opinion was based on an accurate factual history and there is no probative contrary medical opinion of record. As noted in the March 2020 Board remand, the September 2015 VA medical opinion of record addressing this claimed disability on appeal lacks probative value because based on the lack of any service treatment record corroborating the Veteran's statements regarding his observable symptomatology. As a result, the Board finds the element of a nexus between the Veteran's skin disability, diagnosed as seborrheic dermatitis, and his in-service exposures while in Southwest Asia during active service has been met in this case. For the reasons and bases discussed above and after resolving all reasonable doubt in favor of the Veteran, the Board finds that service connection is warranted for a skin disability on a direct basis. See 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS FOR REMAND 1. Entitlement to service connection for LLE peripheral neuropathy 2. Entitlement to service connection for RLE peripheral neuropathy 3. Entitlement to service connection for LUE peripheral neuropathy 4. Entitlement to service connection for RUE peripheral neuropathy In remanding these matters, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. A May 2016 VA examination diagnosed bilateral upper and lower extremity peripheral neuropathy. See C&P Exam (May 2016). No diagnostic testing is of record. At the time, the Veteran's service-connected fibromyalgia was untreated. Id. February 2020 VAMOs found that pain in the knees, wrists, and hands were associated with fibromyalgia pain. See C&P Exam (February 2020). The March 2020 Board decision found the May 2016 VA examination was inadequate because it was based partly based on the Veteran's unverified report of exposure to contaminated water in service. See BVA Decision (March 2020). The Board remanded the claim for a review of deck logs spanning "multiple 60-day record searches." Here, although record review was requested, the March 2020 BVA decision did not request an adequate VA examination be obtained upon completion of the records request. To ensure that VA has met its duty to assist, remand is required. The matters are REMANDED for the following actions: 1. Obtain a medical opinion from an appropriate clinician regarding the Veteran's peripheral neuropathy of the bilateral upper and lower extremities. The entire claims file, to include a copy of this REMAND, should be made available to the clinician. The opinion should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). If there is a medical basis to support or doubt the history provided by the Veteran, the clinician must indicate this in the examination report and provide a rationale for that determination. Any and all studies, tests and evaluations deemed necessary by the examiner should be performed. The examiner should elicit a complete history, the pertinent details of which should be included in the opinion. The clinician is asked to opine: (a). Whether the Veteran's diagnoses (as rendered in the May 2016 VA examination report) of peripheral neuropathy of the bilateral upper or lower extremities are separate and distinct from his service-connected fibromyalgia. (b). If so, whether these diagnoses of peripheral neuropathy of the bilateral lower and upper extremities, did it at least as likely as not (1) begin during active service, (2) manifest within one year after discharge from service, (3) noted during service with continuity of the same symptomatology since service, or (4) related to an in-service injury, event, or disease, including in-service exposures while in Southwest Asia during active service. NOTE (1): A negative medical opinion should not be predicated solely on the absence of documented complaints, findings, or diagnoses in service. 2. Ensure that the VA medical opinion obtained includes a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. Then, readjudicate the claims. If any decision is adverse to the Veteran, issue a Supplemental Statement of the Case and allow the applicable time for response. Then, return the case to the Board. T. Blake Carter Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Edwards 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.