Citation Nr: 21075503 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 17-29 295 DATE: December 20, 2021 ORDER Entitlement to service connection for skin disorder of the lower legs is denied. FINDING OF FACT The evidence does not establish that the Veteran's skin disorder of the lower legs is related to service, to include exposure to contaminants in the water supply at Camp Lejeune. CONCLUSION OF LAW The criteria for entitlement to service connection for skin disorder of the lower legs, to include as due to Camp Lejeune water contamination, have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 1154, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309(a)(f). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1975 to January 1979. This appeal comes before the Board of Veterans' Appeals (Board) from a June 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) in October 2019, and a transcript of that hearing has been associated with the Veteran's claims file. In March 2020, this claim was remanded. There has been substantial compliance with the Board's remand instructions, as the Veteran was asked to submit a completed VA 21-4142 form for any private treatment records and as an adequate VA medical nexus opinion has been obtained. See Stegall v. West, 11 Vet. App. 268 (1998). On remand, the RO granted service connection for residuals of swollen tongue and a mental health disorder. Specifically, after the RO granted service connection for a psychiatric condition, it was then determined the residuals of swollen tongue are a symptom of the now service-connected psychiatric condition, and the RO ultimately granted a higher rating of 70 percent for "conversion disorder and alcohol use disorder with psychological symptoms of swollen tongue/swallowing difficulties." See August 2021 rating decision (stating that this rating decision represents a full grant of all benefits sought on appeal for residuals of swollen tongue). Thus, these claims are no longer on appeal. See Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997) (clarifying that an appeal regarding downstream elements, i.e. the disability rating and effective date, is separate from any prior appeal regarding entitlement to service connection). In this case, the Veteran has not disputed either the effective date for the award of service connection or the rating assigned for conversion disorder and alcohol use disorder with psychological symptoms of swollen tongue/swallowing difficulties. Neither the Veteran nor his representative has raised any other issues with the duty to notify or duty to assist or with the conduct of his Board hearing. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board"); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Thus, the Board need not discuss any potential issues in this regard. In deciding a claim, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant. See Gilbert, 1 Vet. App. at 53. In making this determination, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. See Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board has thoroughly reviewed all the evidence in the Veteran's VA files. In every decision, the Board must provide a statement of the reasons or bases for its determination adequate to enable the Veteran to understand the precise basis for the Board's decision, as well as to facilitate review by the United States Court of Appeals for Veterans Claims (Court). 38 U.S.C. § 7104 (d)(1) (2012); see Allday v. Brown, 7 Vet. App. 517, 527 (1995). Although the entire record must be reviewed by the Board, the Court has repeatedly found that the Board is not required to discuss, in detail, every piece of evidence. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Dela Cruz v. Principi, 15 Vet. App. 143, 149 (2001) (rejecting the notion that the Veterans Claims Assistance Act mandates that the Board discuss all evidence). Rather, the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran. See Timberlake v. Gober, 14 Vet. App. 122 (2000). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. Generally, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The regulations at 38 C.F.R. §§ 3.307 and 3.309 were amended to provide a presumption of service connection for certain diseases associated with contaminants in the base water supply at Camp Lejeune. See 82 FR 4173-4185 (January 13, 2017). The eight diseases presumptively associated with exposure to Camp Lejeune contaminated water (CLCW) are: kidney cancer, liver cancer, Non-Hodgkin's lymphoma, adult leukemia, multiple myeloma, Parkinson's disease, aplastic anemia and other myelodysplastic syndromes, and bladder cancer. See 38 C.F.R. § 3.309 (f). The new provision applies to veterans, or former reservists or members of the National Guard, with no less than 30 days (consecutive or nonconsecutive) of service at Camp Lejeune during the period beginning on August 1, 1953 and ending on December 31, 1987. See 38 C.F.R. § 3.307 (a)(7)(iii). The amendment applies to claims received by VA on or after March 14, 2017, and claims pending before VA on that date. As the Veteran's claim was pending before VA on that date, the amended regulations apply. The Veteran contends that he first developed skin discoloration while in boot camp, where his legs turned black after running for about 10-20 miles. He claims that the dimension of skin discoloration in his lower legs has gradually expanded over time since separating from service and adds that he was diagnosed with deep vein thrombosis around 1975. He states that his legs are now halfway pitch black and that he cannot stand for long periods as it affects his balance and can barely scratch his legs without his legs bleeding. Alternatively, he contends that this condition is due to his exposure to (ie. drinking) contaminated water at Camp Lejeune. It is not in question that the Veteran has a current disability, as he has been diagnosed with various skin conditions, to include lymphedema, eczema, and stasis hyperpigmentation, during the appeal period. As indicated in the June 2016 rating decision on appeal, VA has already conceded the Veteran's exposure to the contaminated water in Camp Lejeune based on his service at Camp Lejeune during a period of time known to be associated with the presence of contaminated water. Nonetheless, the Board finds that presumptive service connection is not warranted in this case, as none of his diagnosed conditions are conditions listed as presumptively associated with Camp Lejeune exposures under 38 C.F.R. § 3.309 (f). Accordingly, the Veteran is not entitled to presumptive service connection based on exposure to contaminated water at Camp Lejeune. Nonetheless, the availability of presumptive service connection does not preclude a grant of service connection on a direct basis. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994); 38 C.F.R. § 3.303 ("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"). His service treatment records show complaints of hives (March 1976 and April 1976), but his December 1978 separation examination shows all clinically normal skin conditions, except an unrelated eyelid scar condition. There are two medical nexus opinions of record addressing his alleged skin condition. The Veteran first underwent a VA examination in May 2020, and he was noted to have been diagnosed with bilateral lower extremity lymphedema of undetermined etiology. The examiner opined that the Veteran's lower extremity lymphedema is not caused by or a result of his exposure to contaminated water at Camp Lejeune. The examiner indicated the Veteran's obesity is a risk factor for lymphedema of lower extremities and further stated that review of the general medical literature, to include "ATSDR Assessment of the Evidence for the Drinking Water Contaminants at Camp Lejeune and Specific Cancers and Other Diseases" published in 2017, do not suggest lymphedema resulting from CLCW exposure. During a subsequently conducted August 2020 VA examination, the Veteran was diagnosed with eczema and stasis hyperpigmentation. He identified the onset of a black patch in his lower right leg as in service (in 1975), during boot camp, and relayed an incident where he was asked about his leg by his lieutenant during a post-shower inspection. The examiner opined that the Veteran's claimed skin condition was less likely than not incurred in or caused by his military service, to include any in-service treatment records documenting hives. In doing so, the examiner indicated that hives are a manifestation of an allergic reaction that is typically acute and temporary, rather than a condition that would turn into permanent discoloration of only the lower extremity skin. The examiner also underlined there being no further in-service complaints/treatment for progressing discoloration of the lower extremities, to include during his separation examination, after he made complaints for hives in 1976. The examiner further stated that the Veteran's current condition is associated with chronic PVD, which is known to cause skin discoloration of the lower extremities due to poor circulation, and ultimately opined that the Veteran's current skin condition is likely secondary to PVD and less likely than not related to his military service, to include hives noted in his service treatment records. The Board assigns the most probative value to these VA medical nexus opinions, as these were furnished after reviewing all pertinent records, to include his treatment records. The Board is cognizant of the Veteran's contention that he first sought treatment for DVT (deep vein thrombosis) around 1985 or 1990. However, the Veteran failed to respond to the RO's request to submit a completed VA form 21-4142a for obtaining any private treatment records. At least based on the available VA treatment records, it appears that the Veteran first complained of lymphedema in 2016, during which time he was diagnosed with "chronic lymphedema involving the legs for many years" with an undetermined etiology. However, there is no evidence suggestive of any medical etiology opinion connecting his current skin condition to his lymphedema involving lower legs "for many years". Again, the examiner stated the skin condition is due to PVD from poor circulation, and there is no suggestion in the record the PVD is related to service in any way. Although the Veteran believes that his current skin condition is related to his military service, to include exposure to water contamination in Camp Lejeune, he is not competent to provide such an opinion. While he is competent to report the symptoms he perceived directly through the senses, he has not been shown to have the appropriate medical training and expertise to offer a competent opinion on the etiology of his skin condition. As such, his lay statement is not sufficient to establish a medical nexus between his skin condition and his active service. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). To that extent, the Board assigns more value to the probative medical opinions of record. In light of above, the Board concludes that the evidence preponderates against this claim. See Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990). As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply, and the claim must be denied. MICHELLE L. KANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lee, Catherine 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.