Citation Nr: 21007662 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 15-20 329 DATE: February 10, 2021 ORDER Entitlement to service connection for a rash disability of the back, to include eczema, is denied. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran's current rash disability had its onset during service or is otherwise related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for a rash disability of the back, to include eczema, have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Navy from May 1991 to May 1997. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a December 2013 rating decision by the agency of original jurisdiction (AOJ) denying entitlement to service connection for a rash condition, among other issues. The Board most recently remanded this matter in May 2020 in order to obtain a medical opinion on the Veteran’s current disability and the Veteran’s claims regarding onset. A VA examination took place in August 2020 and an opinion relating thereto was rendered in October 2020. There has been substantial compliance with the remand directives and the matter is again before the Board. See Stegall v. West, 11 Vet. App. 268 (1998). The Veteran is documented to have incurred a rash around his left eye during service. He has alleged that since serving in Southwest Asia during active duty in 1991, he endures a recurrent rash, primarily on his back, that he treats with the use of topical ointments. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also 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). Establishing service connection generally requires evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against an award of service connection. The reasons follow. Although the Veteran has a current disability of eczema, the preponderance of the evidence is against a nexus between the Veteran’s current skin disability and service. For example, the Veteran’s service treatment records do not show any complaints or treatment relating to a rash or skin condition until January 1996. On January 10, 1996, the Veteran sought treatment for a rash under his left eye, which he had reported experiencing for the past three to four months, periodically spreading. It was observed to be reddish and scaling, and assessed as possible blepharitis. The Veteran was prescribed an ophthalmic ointment and was scheduled for follow-up. On January 29, the Veteran’s rash was noted to be improved. A mildly scaly area was still present, but redness was improved, and the Veteran’s eye was not infected. The Veteran was instructed to continue his ointment use and to return if symptoms persisted or worsened. The Veteran did not require additional treatment relating to the rash around his eye during service and it appears to have resolved with treatment. On separation examination in May 1997, the Veteran denied a history of skin diseases. He did report a positive history of eye irritation, but he stated that he was in good health and was not using any medication. He received a normal clinical evaluation of the skin, lymphatics, and eyes. In April 1998 on an examination relating to reserve duties, the Veteran again denied any history of skin diseases, and stated that he was in excellent health with no changes in his health since May 1997. The record does not show treatment for skin symptoms for many years thereafter. In a December 2012 letter, the Veteran stated that he has had a recurrent itchy rash on his back ever since serving in Desert Storm. The Veteran would later report occasional use of a topical ointment, but the record does not show the need for ongoing monitoring or follow-up with medical professionals. The Veteran underwent a VA examination in September 2013. He reported a history of rash since his time in service, but no skin disability was visualized on examination. In an addendum opinion authored in November 2013, the reviewing practitioner stated that there was no evidence of a current skin condition on VA examination and that the location of the eye rash shown in the service treatment records would likely not be associated with his reports of a recurrent back rash, based on their physiological locations. Treatment records during this period repeatedly indicated the Veteran not to have a rash on physical examination, including in May 2013, October 2014, December 2014, and January 2016. Private treatment records in May 2015 show the Veteran’s medical history to include treatment for dozens of separate medical symptoms in the preceding seven years, but do not show treatment relating to a rash. The Board remanded the matter in December 2018, indicating that, while the 2013 VA examination indicated no present rash disability, it did not address the Veteran’s specific contentions. The Veteran again underwent a VA examination in July 2019. The examiner found no objective findings of a rash on examination, stating that the claimed condition had resolved, and that the Veteran did not have a current skin disability. The Board again remanded in May 2020, indicating that the July 2019 examination failed to address the Veteran’s in-service treatment for rash. The Veteran underwent an additional VA examination in August 2020. The Veteran was diagnosed with eczema of the right temporal region and was further assessed with a skin lesion of the right upper scapula and a skin nevus of the right temporal region, each covering less than five percent of the Veteran’s total body area. The Veteran reported intermittent use of a topical ointment for dry skin, Aquaphor, to treat his eczema. The examiner stated that it was less likely than not that the Veteran’s currently diagnosed conditions were incurred in or caused by the claimed in-service injury, event, or illness. In her rationale, the examiner stated that the Veteran’s enlistment and separation examination, as well as the service treatment records, did not note any of the conditions diagnosed during the August 2020 examination. The examiner also stated that there was no evidence to support a current diagnosis of rash under the left eye, since it was not present at the time of the examination. The examiner further noted that the rash around the Veteran’s left eye treated during service was improved by the end of January 1996 and was not mentioned on separation examination in May 1997. The examiner stated that the available evidence supported that the Veteran’s current conditions were not present during service, that there was no evidence to establish a current diagnosis of a chronic disability related to service, and that a nexus could not be established due to lack of documented symptoms, medical reports, or relevant evidence accessible in the Veteran’s claims file. In October 2020, the examiner provided an additional statement, explaining the pathophysiology of the Veteran’s currently diagnosed disabilities, which did not indicate any relation to service, and further distinguished the Veteran’s current diagnoses from the left eye rash noted during service. The examiner again noted that the Veteran’s current disabilities were not observed or diagnosed on previous examination. Although the Veteran is competent to report his observed rash symptoms, he is a lay person without appropriate medical training and expertise, and thus, is not competent to make an etiological conclusion regarding the cause of his observed symptoms. The August 2020 VA examiner is a medical expert who was able to review the longitudinal evidence of record and provided a reasoned rationale for their conclusions consistent with the evidence. Accordingly, the 2020 examiner’s opinion is found to be more probative than the Veteran’s lay statements. The weight of the evidence is against an award of service connection for the Veteran’s eczema, skin nevus, and skin lesion. For example, these disabilities were not noted in the Veteran’s service treatment records and were not diagnosed on examinations prior to 2020. The rash around the Veteran’s left eye noted during service appears to have resolved by the time of the Veteran’s discharge and was not observed in the medical treatment records thereafter. He denied any history of skin disease and received normal clinical evaluations of the skin at discharge in May 1997 and nearly a year later in April 1998. Expert medical examiners have not suggested any connection between the Veteran’s in-service left eye rash and his ongoing reports of a recurrent back rash, and instead indicate them to be distinct conditions. For all the reasons stated herein, the weight of the evidence is against the Veteran’s claim for service connection for a rash disability of the back, to include eczema. As the preponderance of the evidence is against the claim for service connection, the benefit of the doubt doctrine is not for application, and the Veteran’s claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. A. P. Simpson Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Wonderling, 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.