Citation Nr: 21076797 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 20-15 112A DATE: December 27, 2021 ORDER New and material evidence having been received, the claim for service connection of psoriasis is reopened. Entitlement to service connection for psoriasis is granted. FINDINGS OF FACT 1. The Veteran's claim for service connection for psoriasis was denied by rating decision in November 2007, for lack of an in-service event to which it could be connected. The Veteran did not appeal, nor submit new and material evidence. 2. The Veteran sought to reopen his claim in a statement received by VA in June 2010. The claim was denied in November 2013, based on a finding of no new and material evidence. The Veteran did not appeal, nor submit new and material evidence. 3. In October 2015, the Veteran again sought to reopen his claim. In a January 2016 rating decision, the Regional Office reopened the claim and confirmed the denial of service connection. The Veteran appealed this decision. 4. Evidence received since the last final denial in November 2013 is both new and material and therefore is sufficient to reopen the claim for service connection of psoriasis. 5. The Veteran's psoriasis manifested during his period of active duty, has continued since his separation from service, and is more likely than not caused by his military service. CONCLUSIONS OF LAW 1. The criteria for new and material evidence sufficient to reopen the claim for service connection of psoriasis have been met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.104 (a), 3.156 (a), 20.1103. 2. The criteria for entitlement to service connection for psoriasis have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304 REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served active duty in the United States Navy from October 1993 to October 1996. This matter comes to the Board of Veterans' Appeals (Board) on appeal of a January 2016 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO). In November 2021, the Veteran presented testimony in a videoconference hearing before the undersigned Veterans Law Judge. New and Material Evidence Under the legacy system of appeals (i.e., appeals of decisions issued by VA prior to February 19, 2019, when the Appeals Modernization Act became effective), reopening a claim for service connection which has been previously and finally disallowed requires that new and material evidence be presented or secured since the last final disallowance of the claim. 38 U.S.C. § 5108. New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). For purposes of determining whether to reopen a claim, the credibility of the recently submitted evidence will be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). In determining whether new and material evidence has been received to reopen a claim, there is a low threshold for determining whether evidence raises a reasonable possibility of substantiating a claim. See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). In determining whether this low threshold is met, VA should not limit its consideration to whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead should consider whether the evidence could reasonably substantiate the claim were the claim to be reopened, including by triggering VA's duty to obtain a VA examination. Id. at 118. If VA determines that new and material evidence has been added to the record, the claim is reopened, and VA must evaluate the merits of an appellant's claim in light of all the evidence, both new and old. Manio v. Derwinski, 1 Vet. App. 140 (1991). 1. New and material evidence sufficient to reopen the claim for service connection of psoriasis The Veteran's claim was originally denied for lack of in-service evidence in a November 2007 rating decision of the RO. The Veteran did not appeal or submit new and material evidence within one year of that decision, and therefore, it became a final decision. In June 2010, the Veteran filed to reopen his previously denied claim. The RO determined the Veteran did not submit sufficient new and material evidence to reopen the claim and issued. The Veteran again filed to reopen his claim for service connection for psoriasis in October 2015. The RO reopened the claim but denied entitlement based on a lack of nexus relationship. The Board finds that the evidence submitted or acquired since the most recent final denial contains evidence that is both new and material sufficient to reopen the claim for service connection. 38 C.F.R. § 3.156. The acquired evidence includes a March 2020 letter of a private clinician containing a discussion of an in-service onset of symptoms as shown by the Veteran's medical history, thorough explanation in support of a nexus to service, and an etiology opinion supported by medical literature. Additionally, the Veteran provided Board testimony further indicating continued symptoms since service and testimony regarding use of over-the-counter medication and the lack of treatment records immediately following separation from active duty. The opinion and Veteran testimony were not a part of the record prior to the previous decision; therefore, the evidence is new. The statements are neither cumulative or redundant of previous medical opinions or lay statements of record. The evidence is also material as it directly substantiates previously undetermined facts, specifically, an in-service onset and positive nexus relationship. As evidence is presumed credible for the purpose of determining whether it is material, the Board finds the evidence gives rise to a reasonable likelihood of substantiating the Veteran's claim. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). Therefore, the claim to entitlement for service connection of psoriasis is reopened. 38 C.F.R. § 7105. Service Connection 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). 2. Entitlement to service connection for psoriasis The Veteran contends he is entitled to service connection for his psoriasis skin disorder. He asserts the disability manifested in symptoms of scaly, flaky scalp and silver patches of dry skin while in service and that they have continued to the present. The objective medical evidence supports an on-going diagnosis of psoriasis since the initiation of the Veteran's initial claim in March 2007. Therefore, the first element of service connection is met, and the Board must determine whether the two remaining elements have been satisfied. Upon review of the cumulative evidence, the Board finds entitlement to service connection for psoriasis is warranted. The Veteran was provided a September 2019 VA examination in connection with his claim. The examiner concluded the Veteran's condition was less likely than not incurred in or caused by his military service. The examiner relied on an absence of diagnosis or symptoms in the service treatment record (STR) and the length of time following separation he received a diagnosis. The Board notes these are impermissible bases to conclude that there is no relationship between the Veteran's current disability and military service exists. See Dalton v. Nicholson, 21 Vet. App. 23, 40 (2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336, n. 1 (Fed. Cir. 2006). Therefore, the opinion is afforded little to no probative value and weight. However, throughout the claims period, the Veteran has submitted private treatment records, medical opinions, and several Buddy statements in support the second and third elements of service connection. The Veteran testified and provided written Lay Statements attesting that he did not experience dandruff, dermatitis, dry skin, eczema, or psoriasis prior to entering the military and this is supported by his entrance examination. He has consistently reported his symptoms began in late 1995 as dry, scaly scalp, which progressed to dry patches of skin on various parts of his body when he returned from the Persian Gulf. This is supported by medical records that indicate the Veteran has continuously used over the counter medication to treat his symptoms, progressing to prescription medication. The Veteran submitted Buddy Statements from his father and wife in support of a finding his symptoms began in service and have continued since. His father recounts first noticing dry, flakey scalp when the Veteran visited in September 1996 and continued rashes in August 1998. He also reports helping the Veteran obtain medication to treat his symptoms throughout the years due to a lack of medical insurance. See Buddy Statement, 9/30/2015, pg. 1/1. The Veteran's wife recalls the Veteran's scaly scalp and use of dandruff shampoo since she met him in December 1995. She reports he was treated on-base for his scalp and a spot of dry skin that developed on his back, that later spread to his elbows, legs, face, stomach, and buttocks. She also notes failed attempts to retrieve these medical records as they were told they no longer exist. See Buddy Statement, 9/30/2015, pg. 2/2. The Board notes the Veteran is competent to report observable symptomology, such as skin conditions. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Further, the lay statements and Veteran testimony are credible as they are internally consistent with the remainder of the record throughout the claims period and are supported by treatment records. Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007). The Veteran also submitted a positive nexus statement that gives full consideration to the above lay testimony and the Veteran's medical history. The March 2020 letter from the Veteran's treating physician's assistant (PA), JAG, supports a positive finding his psoriasis is more likely than not related to his military service. PA JAG concluded the Veteran's condition began in service and has continued since his separation. See also, MTR- Gov, 5/4/2012. He first explains the Veteran's condition, stating that psoriasis can be triggered by environmental stressors and bacterial infections. He notes the Veteran's STR shows a June 1995 Type A streptococci diagnosis that was followed by a period of high stress while serving in the Persian Gulf. PA JAG cites medical literature linking circumstances similar to those reported by the Veteran that are shown to trigger stress-induced psoriasis, including sleep deprivation, psychological pressures, and hazardous work conditions. He reasons the Veteran's Type A infection in combination with strong environmental factors was sufficient to affect his immune system, correlating to the flare-up of symptoms he experienced a month following the illness. See STR, 7/3/204, pgs. 47, 54/111. The Veteran has consistently reported he first noticed symptoms as flaky scalp, and PA JAG indicates this is a common initial symptom of the condition and the progression of the condition thereafter is consistent with medical data. This conclusion is also supported by a September 2015 letter the Veteran's dermatologist, Dr RCN, explaining psoriasis can express itself initially as dandruff-like scalp eruption. MTR- Non-Gov, 9/30/2015. Dr RCN concluded the Veteran's report of symptoms in August 1995 were more likely than not manifestations of his psoriasis. The Board finds the cumulative medical evidence highly probative and affords it significant weight. The March 2020 clinician provided a clear conclusion with thorough explanation and basis, including a dozen medical citations and full recounting of the Veteran's medical history. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The clinician's findings are also consistent with the September 2015 physician's opinion regarding an in-service onset and manifestation of symptoms. Further, the opinion describes the disability in sufficient detail so the Board may make a fully informed decision. Id. Therefore, the cumulative private medical opinions are afforded more probative weight than the VA examiner's opinion as it does not provide an adequate statement of reasons and bases to support its conclusion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). As such, the evidence favors a finding the Veteran's in-service symptoms manifested during his period of active duty, has continued since his separation from service, and is more likely than not caused by the circumstances of his service. Accordingly, service connection is warranted and the claim is granted. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Tabitha Chapman, 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.