Citation Nr: 21008401 Decision Date: 02/16/21 Archive Date: 02/16/21 DOCKET NO. 18-06 086 DATE: February 16, 2021 ORDER Service connection for acanthosis nigricans of the neck is granted. FINDING OF FACT The appellant has been diagnosed with acanthosis nigricans of the neck; it is at least as likely as not that the condition had its onset during service. CONCLUSION OF LAW Resolving reasonable doubt in the appellant’s favor, the criteria for an award of service connection for a skin disability of the neck, diagnosed as acanthosis nigricans, have been met. 38 U.S.C. §§ 101, 1131, 5107; 38 C.F.R. §§ 3.1, 3.6, 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant served in the Army National Guard of North Carolina. His service included a period of active duty for training (ACDUTRA) from January to June 1976. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an August 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. This case was previously before the Board in October 2018, when it was remanded to the agency of original jurisdiction (AOJ) for additional development. After taking further action, the AOJ confirmed and continued the prior denial and returned the case to the Board. Entitlement to service connection for a skin disability The appellant seeks to establish service connection for a skin disability. He contends that he has a skin disorder of the neck that had its onset during a period of ACDUTRA and has continued since. Service connection can be established for disability due to disease or injury incurred or aggravated in the line of duty during a period of ACDUTRA. 38 U.S.C. §§ 101(2), (22), (24), 1110; 38 C.F.R. §§ 3.1(d), 3.6(a), (c), 3.303; Harris v. West, 13 Vet. App. 509, 511 (2000); Paulson v. Brown, 7 Vet. App. 466, 470 (1995). “Active duty for training” is defined, in part, as full-time duty in the Armed Forces performed by Reserves for training purposes, or full-time duty performed by members of the National Guard of any State under 32 U.S.C. §§ 316, 502, 503, 504, or 505, or prior corresponding provisions of law. 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). A layperson is generally incapable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997), aff’d sub nom., Routen v. West, 142 F.3d 1434 (Fed. Cir. 1998). However, lay evidence can be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition, (e.g., a broken leg, separated shoulder, pes planus (flat feet), varicose veins, tinnitus (ringing in the ears), etc.), (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In essence, lay testimony is competent when it pertains to the readily observable features or symptoms of injury or illness and “may provide sufficient support for a claim of service connection.” Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also 38 C.F.R. § 3.159(a)(2). A determination as to whether medical evidence is needed to demonstrate that an appellant presently has the same condition he or she had in service or during a presumptive period, or whether lay evidence will suffice, depends on the nature of the appellant’s present condition (e.g., whether the appellant’s present condition is of a type that requires medical expertise to identify it as the same condition as that in service or during a presumption period, or whether it can be so identified by lay observation). See Barr v. Nicholson, 21 Vet. App. 303, 310 (2007). Thus, medical evidence is not always or categorically required when the determinative issue involves either medical diagnosis or etiology, but rather such issue may, depending on the facts of the particular case, be established by competent and credible lay evidence under 38 U.S.C. § 1154(a). See Davidson, supra. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. See also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). At the outset, the Board notes that the appellant’s service treatment records are unavailable. In such cases, VA has a heightened duty to explain its findings and conclusions and to consider carefully the benefit-of-the-doubt rule. See Pruitt v. Derwinski, 2 Vet. App. 83, 85 (1992); O’Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). There is no dispute that the appellant has a current skin disability of the neck. The report of a December 2020 VA skin examination clearly shows that he has been diagnosed with acanthosis nigricans. The Board is also persuaded that the appellant had a skin condition in service. He has stated that the onset of symptoms occurred during a period of ACDUTRA, when he first noticed the rash following a military training exercise. The Board finds no reason on the current record to doubt his credibility in that regard. As to the nexus, or link, between the appellant’s current disability and service, the Board notes that he is competent to provide statements with respect to the onset and continuity of skin symptoms, inasmuch as such symptoms are observable by a lay person. The Board finds, moreover, that his statements with respect to having experienced the condition of his neck since service are credible. The Board acknowledges that the VA examiner who evaluated the appellant in December 2020 offered an unfavorable opinion with respect to nexus. The Board notes that the examiner relied, in part, on the fact that no records of in-service treatment are available. As noted previously, however, VA has a heightened duty to explain its findings and conclusions when service treatment records are unavailable. On balance, and taking into account the totality of the evidence, including the appellant’s credible reports with respect to onset and continuity of symptoms, and the recent diagnosis of acanthosis nigricans in the same location, the Board is persuaded that the criteria for an award of service connection for a skin disability have been met. The evidence, at a minimum, gives rise to a reasonable doubt on the matter. 38 C.F.R. § 3.102. The appeal is granted. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Joseph T. Leonard, Law Clerk 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.