Citation Nr: 21076245 Decision Date: 12/23/21 Archive Date: 12/22/21 DOCKET NO. 17-04 859 DATE: December 23, 2021 ORDER Service connection for a skin disability is denied. FINDING OF FACT The Veteran's skin disability clearly and unmistakably pre-existed his service and was clearly and unmistakably not aggravated therein. CONCLUSION OF LAW The criteria for service connection for a skin disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1968 to May 1970, to include service in the Republic of Vietnam. He is the recipient of the Vietnam Campaign Medal and the Combat Infantryman Badge. This matter is on appeal from a May 2015 rating decision. This issue was previously reopened and remanded in a July 2021 Board decision. The Board remanded this matter for an VA examination. The Veteran was afforded a VA examination in September 2021 and the Board finds substantial compliance with its remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). Service connection for a skin disability is denied. 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). If a pre-existing disorder is noted upon entry into service, service connection may be granted based on aggravation during service of that disorder. 38 U.S.C. § 1153; 38 C.F.R. § 3.306 (b); see Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). A pre-existing injury or disease will be considered to have been aggravated by active military, naval, or air service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306 (a). Clear and unmistakable evidence (obvious or manifest) is required to rebut the presumption of aggravation where the pre-service disability underwent an increase in severity during service. 38 C.F.R. § 3.306 (b). The law establishes a presumption of entitlement to service connection for diseases associated with exposure to certain herbicide agents and also provides a presumption of exposure for veterans who served in the Republic of Vietnam. See 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e). If a veteran was exposed to an herbicide agent during active military service, certain disabilities shall be service-connected, if the disorders became compensably disabling at any time after separation from active duty, 38 C.F.R. § 3.307 (a)(6); and provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307 (d) are satisfied. 38 C.F.R. § 3.309 (e). The Veteran contends that his skin disability, diagnosed as dermatitis, was caused or aggravated by his service, to include exposure to herbicides while stationed in Vietnam. The Board finds that service connection for dermatitis on a presumptive basis as related to service in Vietnam is not warranted, as this disability is not listed as a presumptive condition under 38 C.F.R. §§ 3.307, 3.309(e). Therefore, the Board will review the claim on a direct basis. In this case, the service treatment records reflect that the Veteran suffered from a skin disability upon entrance into service. Specifically, on June 1967 pre-induction examination, the Veteran was diagnosed with neurodermatitis and was shown to have a few areas of scaling on the hands. As such, because the evidence demonstrates that a skin disability was diagnosed on entry into service, and that a skin disability clearly and unmistakably began prior to service, there is no presumption of soundness at entrance into service. 38 U.S.C. § 1132; see also Wagner, 370 F.3d at 1093; Crowe v. Brown, 7 Vet. App. 238 (1994). The service treatment records document ongoing dermatitis. In October 1968, November 1968, and December 1968, the Veteran was noted to have dermatitis on the hands. In September 2021, the Veteran underwent a VA examination. The examiner conducted a physical examination and reviewed the record. The examiner concluded that the Veteran's pre-existing dermatitis was not aggravated by his service. The examiner explained that the finding of neurodermatitis found on entry to service was the type of condition that began during childhood. The examiner explained that there was no evidence in the service treatment records to show aggravation of this condition. The examiner reviewed the post-service treatment records showing an ongoing rash following the pattern of neurodermatitis. The examiner concluded that this recurrent rash affected the groin and armpits. The examiner concluded that the post-service treatment for neurodermatitis was in line with the natural pathology of the condition, rather than related to exposure to herbicides. The examiner also noted that on May 1970 separation examination, the Veteran denied any change to his skin, and no skin disability was diagnosed. (Continued on the next page) Based upon the above, the Board finds that the pre-existing skin disability was clearly and unmistakably not aggravated by his service. The thorough VA examination determined that the Veteran's pre-existing skin disability did not undergo a permanent aggravation in service. Rather, the Veteran experienced ongoing dermatitis during service and since service, which was normal for the natural progression of the disease. There is no other medical evidence to support the Veteran's claim and, in fact, the remainder of the evidence is entirely consistent with the VA examiner's opinion. The competent and probative medical evidence supports the finding that the Veteran's skin condition was clearly and unmistakably not aggravated by his service. The Veteran believes his skin disability is related to an in-service injury, event, or disease, to include exposure to herbicides. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and/or interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the 2021 VA examination opinion. Although the Veteran is competent to report symptoms such as itchy skin and rash, his reports are not consistent with the record showing that these symptoms began prior to service and were not permanently aggravated by service, and are thus considered to be less probative. Accordingly, the claim for service connection for a skin disability is denied. J. TUNIS Acting Veterans Law Judge Board of Veterans' Appeals R. Erdheim, Attorney for the Board Department of Veterans Affairs 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.