Citation Nr: 21074752 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 16-03 168 DATE: December 16, 2021 ORDER Entitlement to service connection for a skin and fungal rash, to include as due to exposure to herbicide agents, is denied. FINDING OF FACT The objective medical evidence shows the Veteran's skin disorder was not incurred during active service, it is not caused by an event, injury or illness, to include exposure to an herbicide agent during active service, and no presumption of service connection based on such exposure is otherwise applicable. CONCLUSION OF LAW The criteria for entitlement to service connection for a skin and fungal rash, to include as due to exposure to an herbicide agent, have not been met. 38 U.S.C. §§ 1110, 1116; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1966 to December 1968, to include service in the Republic of Vietnam. In an August 1996 rating decision, the RO denied the Veteran's claim for service connection for a skin and fungal rash because there was no evidence to show that this condition began in or was aggravated by the Veteran's service, and there was no evidence to show a relationship to exposure to herbicides. The Veteran did not appeal this decision. In July 2013, the Veteran submitted a claim to reopen his claim for service connection for a skin and fungal rash. The Board acknowledges that the previous rating decisions found that the August 1996 denial was final and that new and material evidence is required to reopen the Veteran's claim. However, a review of the record reveals that after the August 1996rating decision, additional service treatment records were associated with the claims file which showed that the Veteran had treatment for a skin rash that was located on his face, neck and trunk. Because this evidence is relevant to the Veteran's claim, 38 C.F.R. § 3.156(c) applies. In this regard, 38 C.F.R. § 3.156(c) provides that, at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim, notwithstanding paragraph (a) of the same section (which defines new and material evidence).The regulation further identifies service records related to a claimed in-service event, injury, or disease as relevant service department records. 38 C.F.R. § 3.156(c)(1)(i). As such, the Board will consider the claim on a de novo basis. Generally, service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection for a disability requires evidence of: (1) The existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Certain chronic diseases may be service connected on a presumptive basis if manifested to a compensable degree in a specified period of time after service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. That period is usually one year. 38 C.F.R. § 3.307(a)(3). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303(b). A veteran who, during active military, naval or air service, served in the Republic of Vietnam during the Vietnam era shall be presumed to have been exposed during his or her service to an herbicide agent, unless there is affirmative evidence to the contrary. 38 U.S.C.§ 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). To benefit from the presumption of service connection for diseases associated with herbicide-agent exposure, the Veteran must have one of the diseases set forth in 38 C.F.R. § 3.309(e). However, when diseases do not appear under the regulation, a veteran can still proceed to establish service connection on a direct basis. See Combee v. Brown, 34 F.3d 1039, 1045 (Fed. Cir. 1994). Entitlement to service connection for a skin and fungal rash, to include as due to exposure to herbicide agents The Veteran contends that his current skin condition is related to service, to include his exposure to herbicide agents. The Veteran's military records reflect that he has verified service in the Republic of Vietnam during the requisite time period. Thus, his exposure to herbicide agents is conceded. His service medical records contain an April 1968 entry showing that the Veteran was seen for a rash on his face, neck, and trunk. A January 2016 letter from the Veteran's VA physician indicates a diagnosis of seborrheic dermatitis. An October 2020 VA examination report diagnosed dermatitis. Thus, the Board must consider whether there is a nexus between the Veteran's current disability and service, to include his conceded in-service exposure to an herbicide agent. The Board has considered presumptive service connection in connection with the Veteran's dermatitis. 38 C.F.R. §§ 3.307, 3.309. Dermatitis, however, is neither a "chronic" disease, nor is it a disease listed as presumptively associated with Agent Orange exposure. The Board observes, however, that the Veteran may, nonetheless, establish service connection if the evidence shows that his skin condition was, in fact, caused by exposure to herbicide agents or some other incident of service, to include the April 1968 in-service notation of a skin rash. See Combee v. Brown, F.3d at 1039 (Fed. Cir. 1994). In May 2019, the Board remanded the Veteran's claim for a VA examination and opinion as to whether it was at least as likely as not that any skin condition, to include seborrheic dermatitis, began during active duty or was related to service, to include the Veteran's exposure to herbicide agents. Although an October 2020 VA examiner opined that the Veteran's chronic dermatitis was less likely than not incurred in or caused by service, to include herbicide agent exposure, the May 2019 Board remand found the opinion inadequate, as it was conclusory and did not properly address the Veteran's lay statements regarding the onset and continuous nature of his skin condition. In June 2021, the Board again remanded the claim for an addendum opinion as to the likelihood that any currently diagnosed skin condition, to include dermatitis, is related to service, to include as due to in-service herbicide agent exposure and the 1968 in-service notation of a skin rash. In August 2021, a VA examiner opined that the Veteran's dermatitis was less likely than not incurred in or caused by service, to include herbicide agent exposure. The examiner rationalized that the Veteran's rash to the face, neck and trunk, was acute only, as there is no evidence of chronicity of care and the Veteran's symptoms are subjective only. The examiner noted that the April 1968 service treatment records noted the Veteran developed a possible allergic rash to the face, neck, and trunk after undergoing soaks, three times a day (TID), for an infection from a bullet wound to the left foot, and no diagnosis was noted for a chronic skin condition. The available medical records do not note further medical evaluations for a rash to the face, neck, or trunk while on active duty. The available medical records also do not note medical evaluations, treatment, or a diagnosis for a chronic skin condition, including a chronic skin and fungal rash, while on active duty. There is a lack of sufficient objective medical evidence noted in the available medical records to confirm the chronicity of a chronic skin and fungal rash condition while on active duty. The examiner indicated the Veteran is deemed competent to provide a history of his symptoms and that he had considered the lay statements regarding the Veteran's symptoms; however, the Veteran is not capable of diagnosing the medical condition related to those symptoms. Thus, the examiner concluded, a nexus has not been established. The August 2021 examiner further indicated that dermatitis is not considered a presumptive disease associated with exposure to herbicide agents. The available scientific and objective medical evidence does not support a conclusion that dermatitis is associated with exposure to herbicide agents. Thus, the examiner concluded, there is no established causal link for dermatitis due to or the result of exposure to herbicide agents. In carefully considering the Veteran's lay reports as they appear throughout the record, the Board is well aware lay persons are competent to report on matters they observe or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which he feels and sees and there is no reason to doubt his credibility. However, the Veteran's lay evidence, without factual support and medical evidence shown in the record, demonstrates only the belief that a certain legal conclusion should be reached. What remains in the Veteran's statements are no more than the suggestion that his current skin disorder is associated with exposure. However, a suggestion is not competent evidence, as this is a complex medical question. The inference the Veteran has drawn from what he has experienced and observed falls outside the realm of his competency. The record does not show the medical or scientific education, training and experience for the Veteran to be able to identify, interpret and analyze medical evidence as it might pertain to what he felt, saw and experienced. The Board acknowledges the Veteran's representative's argument in the November 2021 Appellate Brief that his skin and fungal rush could also be due to his service-connected diabetes. The representative referenced a website that stated diabetes could cause a weakened immune system; people with this condition could develop tinea and other skin issues. The Board has carefully considered the argument and evidence submitted by the Veteran's representative, but finds that its probative value in this case is diminished because it provides only generic statements regarding a possible relationship between diabetes and a skin disorder. It does not pertain specifically to the Veteran's case or medical history. See Wallin v. West, 11 Vet. App. 509, 514 (1998). Moreover, the Board notes that such refers only to a possible connection between the two. It is well established that medical opinions that are speculative, general, or inconclusive in nature do not provide a sufficient basis upon which to support a claim. See e.g. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). For these reasons, the Board assigns this evidence limited probative value and finds that it does not outweigh the VA medical opinions discussed above. The Board therefore assigns more probative value to the August 2021 VA examination report, as it was conducted by a medical professional after the examiner reviewed the Veteran's medical history and, for the reasons stated above, exhibit sound clinical conclusions. See generally Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (noting that the central issue in assessing the adequacy of an opinion is whether the examiner was informed of the relevant facts in rendering a medical opinion). Although this medical opinion does not discuss any relationship between diabetes and a skin disorder, the record as a whole does not provide any probative evidence where such would exist. For the foregoing reasons and based on the medical evidence of record, the Board finds the preponderance of the evidence is against service connection for the claimed skin disorder, presumptive or direct. The Board has considered the benefit-of-the-doubt doctrine; however, the Board does not perceive an approximate balance of positive and negative evidence. As the preponderance of the evidence is against the claims, the doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. Saudiee Brown Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.N., 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.