Citation Nr: 21007184 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 16-48 733 DATE: February 8, 2021 ORDER Entitlement to service connection for residual of spider bite is denied. REMANDED Entitlement to service connection for a skin disability is remanded. Entitlement to service connection for bilateral knee disability is remanded. FINDING OF FACT The preponderance of evidence weighs against finding that the Veteran has or had residual of spider bite at any time during the pendency of the appeal. CONCLUSION OF LAW The criteria for service connection for residual of spider bite have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marines Corps from December 1974 to December 1977. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. In July 2017, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. Most recently, in March 2020, the Board remanded the claims for new examinations that address the Veteran’s post-service reports of continued symptoms. Service Connection Service connection is granted for any current disability that is the result of a disease contracted or an injury sustained while on active duty service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for a disease diagnosed after discharge, where all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38C.F.R. § 3.303(d). 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 1. Entitlement to service connection for residual of spider bite. The Veteran contends that his residual of a spider bite is related to service. He testified that a spider bit him on his right hand during service and the residuals remained following service. See July 2017 Hearing Transcript. October 1975 service treatment records (STRs) notes swelling around the Veteran’s right wrist with redness around what looked like an insect bite. November 1975 STRs note cellulitis on the right hand that, upon follow-up, “seemed to be healing well.” Upon remand, the Veteran underwent a VA examination in November 2020. A June 2014 diagnosis of a scar located on the chest was noted. The examiner remarked that the Veteran’s scar appears to be a keloid on the chest, and not the right hand. The examiner explained that there is no objective evidence to support a diagnosis of scar residual for spider bite on the right hand and no diagnosis is warranted. The examiner opined that the claimed condition of residual of spider bite was less likely than not (less than 50 percent probability) incurred in or caused by the in-service spider bite. The examiner explained that the objective examination showed normal right hand and there is not a scar on right hand. Therefore, the examiner stated, no residual of a spider bite on the right hand is noted and a nexus is not established. Based on the above, the Board concludes that the preponderance of the evidence weighs against finding a current disability of residuals from a spider bite. Although, as the Veteran contends, there is evidence of a spider bite along with scarring during service, there is not a current disability to support a grant of service-connection. The examination showed a June 2014 diagnosis of scar on his chest. However, no residuals of scar were noted on the right hand, where the spider bite occurred. While the Veteran is competent to report having experienced scarring and pain, he is not competent to determine that these symptoms manifest to a current disability. Diagnosing a health condition is medically complex, as it requires professional knowledge based on observation of organ systems in the body and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Medical diagnosis involves questions that are beyond the range of common experience and common knowledge, and require the special knowledge and experience of a trained physician. Although lay symptomatology is considered, where the determinative issue involves a medical diagnosis, competent medical evidence is required. Id. Further, the November 2020 VA examiner opined that the Veteran’s claimed condition of residual of spider bite was less likely than not (less than 50 percent probability) incurred in or caused by the in-service spider bite. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Consequently, the Board gives more probative weight to the VA examiner’s opinion, as it is supported by rationale discussing the medical evidence. As the preponderance of the evidence weighs against finding the Veteran having currently diagnosed residuals of a spider bite that is related to his service, this claim must be denied. 38 U.S.C. § 1110; Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223 (1992) (generally observing that in the absence of proof of a current disability, there can be no valid claim). As the preponderance of the evidence weighs against the Veteran’s claim, service connection for residuals of a spider bite must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND 2. Entitlement to service connection for a skin condition. The Veteran contends that his skin disability is related to service. He reported chronic skin rash and abnormal skin lesions that began in 1975. See March 2015 VA examination and July 2017 Hearing Transcript. August 1975 service treatment records (STRs) show complaints of body rash for two weeks around lower abdomen that spread to upper abdomen, arms and back. The impression was a heat rash. November 1975 STRs note cellulitis on the right hand following an insect bite. July 2014 VA treatment record notes benign neoplasm of the skin. The Veteran has a diagnosis of eczema. See October 2019 VA examination. The October 2019 VA examination report described the course of the Veteran’s skin condition as an on and off rash since service. Upon remand, the Veteran underwent a VA examination in November 2020, wherein a current diagnosis of eczema was noted and appeared as red spots on skin that are described as itchy. Regarding onset, the Veteran reported that while moving barrels during service, something spilled over onto his hands and a week later, an itchy rash appeared on his hands and arms and spread to his body, torso, neck, scalp and legs. He stated that the rash continued. The examiner opined that eczema was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran reported that he has rash during summer months only and although he has a diagnosis of eczema, he did not have such diagnosis prior to March 2017 and there was no rash on examination in 2015. Further, the examiner stated that treatments for rash in August, September and October 1975 were acute during service and there were 45 years without chronicity of care. The examiner concluded that a nexus has not been established. The Board regrets the further delay but finds that a remand is necessary for an adequate opinion that provides a complete rationale to support the conclusion and addresses additional skin disabilities of record. The examiner concludes that the condition was acute during service while also acknowledging reports of a recurring rash. An addendum opinion is needed to reconcile conflicting findings by providing explanation and analysis to support a conclusion. The opinion appears to base the conclusion on the intermittent nature of the disability and lack of an earlier diagnosis, despite unavailable medical records, rather than provide a full rationale regarding etiology of the eczema. Further clarification regarding the nature and etiology of the Veteran’s skin disability, to include consideration of the benign neoplasm condition, is needed before the Board can adjudicate the claim. 3. Entitlement to service connection for bilateral knee condition. The Veteran contends that his bilateral knee condition is related to service. He reported an onset date in 1975 and reported left knee injury from doing deep knee bends and right knee injury from being kicked on the knee cap. See October 2019 VA examination. April 2015 VA treatment records show degenerative joint disease of the knees and knee pain. October 2019 VA examination noted current diagnoses of knee strain and degenerative arthritis. Upon remand, the Veteran underwent a VA examination in November 2020, wherein he was diagnosed with patellofemoral syndrome. The examiner opined that bilateral patellofemoral pain syndrome was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner referenced the Veteran’s lay statement regarding bilateral knee condition and left knee pain noted in July 1975 and October 1975, and right knee pain noted July 1975. The examiner concluded that the record is silent for etiology of bilateral knee pains. The Board regrets the further delay but finds that a remand is necessary to afford the Veteran full consideration of his claim. The November 2020 opinion does not provide a rationale regarding etiology and, instead, provides only a conclusion without supporting detail or explanation. A new opinion is needed to discuss the lay reports and provide an analysis regarding etiology. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Upon completion of the above, request an addendum opinion from an appropriate clinician to determine the nature and etiology of the claimed skin disabilities. A copy of the claims file and remand should be forwarded to the examiner for review. After such review, the examiner should opine on the following: a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s skin disability, to include eczema and benign neoplasm of the skin, is incurred in or caused by service? 3. After completing directive #1, obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of bilateral knee disability. A copy of the claims file and remand should be forwarded to the examiner for review. After such review, the examiner should opine on the following: b) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s bilateral knee disability is incurred in or caused by service? All opinions should discuss the Veteran’s lay reports and a detailed rationale, complete with analysis and explanation, should support any conclusion reached. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Wilson, 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.