Citation Nr: 21009406 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 15-01 781 DATE: February 22, 2021 ORDER Entitlement to service connection for skin disabilities, to include scars, affecting the chest (claimed as body scars) is denied. Entitlement to service connection for skin disability, to include scars, affecting the face (claimed as body scars) is denied. Entitlement to service connection for skin disability, to include scars, affecting the legs (claimed as body scars) is denied. FINDING OF FACT The Veteran’s skin disability, to include scars, affecting the chest, face, and legs are not related to military service, to include his in-service injury. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for skin disabilities, to include scars, affecting the chest (claimed as body scars) have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for skin disabilities, to include scars, affecting the face (claimed as body scars) have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for skin disabilities, to include scars, affecting the legs (claimed as body scars) have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty from September 1981 to September 1985. This appeal previously came before the Board of Veterans’ Appeals (Board) in December 2018, at which time it remanded the issues of service connection for scars affecting the arms, chest, face, and legs. It also remanded the issue of service connection of an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD). Following that remand, in November 2019, the Regional Office (RO) issued a rating decision granting service connection of depressive disorder, which was originally claimed as PTSD. As this constitutes a complete grant of that issue previously on appeal, it is no longer before the Board for consideration. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (holding that a claim for any psychiatric disorder, to include PTSD, includes a claim for any psychiatric condition which may reasonably be encompassed by the Veteran’s descriptions of his symptoms). In March 2020, the RO issued a second rating decision, which granted service connection of right upper extremity residual scarring. This also constitutes a complete grant of that issue on appeal. The Veteran submitted a letter of satisfaction on June 4, 2020. However, he submitted a completed form 9 on the same day appealing issues of service connection for his upper and lower extremities and PTSD. Further, his representative continued to pursue the issues on appeal when he submitted a July IHP. As such, the remaining issue which has been returned to the Board involves service connection of scars affecting the face, chest and legs. Service Connection The law provides that service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may 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). Generally, establishing service connection requires medical or, in certain circumstances, lay 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. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). 1. Entitlement to service connection for skin disabilities, to include scars, affecting the chest (claimed as body scars) 2. Entitlement to service connection for skin disability, to include scars, affecting the face (claimed as body scars) 3. Entitlement to service connection for skin disability, to include scars, affecting the legs (claimed as body scars) The Veteran is seeking service connection for a skin disability to include scars affecting his chest, face, and legs. Specifically, he contends that his scars are related to sliding 25 to 30 feet from down a wooden telephone pole during service. Based on the evidence of record, the Board determines that service connection for a skin disability is not warranted. Specifically, a review of the Veteran’s service treatment records reveal that he sought emergency care and treatment after sliding down a wooden telephone pole in January 1983. The Veteran suffered multiple scrapes and open wounds with splinters in both forearms and one deep wound to his right forearm. Further, November 1983 service treatment records reveal that the Veteran suffered two lacerations on his right hand between the third- and fifth-digit knuckles. The Veteran’s July 1981 entrance examination reveals evidence of a ½ inch scar on his forehead. However, the treatment records do not reveal evidence of an injury to the Veteran’s chest, face, or legs during his service. In regard to the Veteran’s post-service evidence, the records do not reflect symptoms related to a skin disability, including scars affecting his legs until approximately May 2011 when he underwent a VA examination for scars. In regard to his skin disability, affecting his face and chest, the evidence of record does not show evidence of scars until his October 2019 VA examination. The Board notes that this is more than 26 years after the Veteran’s military service. Therefore, continuity is not established based on the clinical evidence of record. As part of this claim, the Board recognizes the Veteran’s statements regarding his history of symptoms. In this regard, while the Veteran is not competent diagnose a skin disability, as it may not be diagnosed by its unique and readily identifiable features, and thus require a determination that is “medical in nature,” he is nonetheless competent to testify about the presence of observable symptomatology, to include scars, which may provide sufficient support for a claim of service connection, if credible, regardless of the lack of contemporaneous medical evidence. Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007). See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The Board has considered the statements of the Veteran that he has experienced skin problems since active duty. However, the Board determines that the Veteran’s reported history of continued symptomatology since active service, while competent, is nonetheless not credible. In addition to the fact that the Veteran did not complain of, seek treatment for, or was diagnosed with a skin condition or scars affecting his face, chest, or legs during his military service, there are no medical records that exist showing that he sought treatment for his skin condition following service until 2011. Therefore, the Board finds the Veteran’s statements regarding continuity to be less than credible for purposes of adjudicating this claim, Caluza v. Brown, 7 Vet. App. 498 (1995) (giving factors to consider when evaluating the credibility of lay statements), and continuity is not established based on the Veteran’s statements. Next, service connection may also be granted when the evidence establishes a medical nexus between his claimed disability and either his active duty or his service-connected disability. In this case, the Board finds that the weight of the competent evidence does not attribute the Veteran’s claimed disability to active duty, despite his contentions to the contrary. The Veteran underwent a VA examination in May 2011. The Veteran reported that his thigh scar is a result of sliding down a telephone pole during service. The examiner noted a scar on the Veteran’s bilateral anterior thighs. The examiner opined that it was less likely than not that the Veteran’s thigh scar was caused by or a result of sliding down telephone pole during active service. In support of this opinion, the examiner stated that the Veteran’s service treatment records are silent for injury to the Veteran’s anterior thighs, despite seeking treatment for other injuries during that incident. Further, the examiner stated that the Veteran’s medical treatment records are silent for clinical objective evidence of bilateral anterior thigh condition in the intervening years between service and his ultimate diagnosis of a thigh scar. The Veteran underwent a new examination in October 2019 for scars. The examiner noted scars located on the Veteran’s right anterior and medial thigh, center of forehead, left corner of his mouth, and center of his chest. The examiner noted that the Veteran’s scars were not painful, unstable, and did not cause a limitation in function. In February 2020, the Veteran underwent an examination for his skin condition affecting his face, legs, and chest. He reported that he had multiple splinter wounds that resulted in the scattered hypopigmented areas that he currently has over his body on arms, chest, and anterior thighs. The Veteran also reported that he developed 100s of little tiny bumps up and down his legs, arms, chest, and side of his face. However, he denied any direct wounds to his legs. The examiner noted that the Veteran has not been treated with medications in the past 12 months. The examiner diagnosed the Veteran with idiopathic guttate hypomelanosis (IGH). The examiner opined that the Veteran’s IGH is less likely as not had onset in, or is otherwise etiologically related to his period of active duty service, to specifically include his service fall from a telephone pole. In support of this opinion, the examiner stated that evidence goes against a direct relationship between the described splinter/abrasion injuries and the current tiny hypopigmented areas which appear over Veteran’s extremities and to a lesser degree on his trunk. The Veteran’s service treatment records document direct wounds that occurred to his right upper extremity (hand/forearm) and the Veteran confirms that he had on long pants during the episode which is additional evidence again a nexus between bilateral anterior thigh skin condition and his remote injuries. The examiner stated that Veteran's skin condition of Idiopathic Guttate Hypomelanosis (IGH) is less likely as not etiologically related to Veteran's remote in-service fall from a telephone pole, and the injuries sustained or to an associated "skin reaction.” The examiner stated that a review of medical literature reveals that the precise cause for idiopathic guttate hypomelanosis is not known; however, researchers have consistently noted a relationship to aging and UV light (sun) exposure. A genetic predisposition has been identified. “Because pigmentation of the skin is due to an integration of melanocyte and keratinocyte function, an acquired defect of the epidermal melanin unit results in the observed hypopigmentation in idiopathic guttate hypomelanosis patients. Significantly fewer dopa oxidase-positive, KIT+, and melanocytes are seen in the lesions. Therefore, the Veteran’s diagnosed IGH is less likely than not incurred in, caused by, or a result of active military service. The Board finds these medical opinions to be particularly persuasive in adjudicating this claim. They were rendered by a medical specialist, following consideration of the complete medical history and claims file, to include the Veteran’s own statements and assertions, and included discussion of how the conclusions were reached, to include discussion of known medical principles and medical treatise evidence. In adjudicating this claim, the Board again has considered the statements made by the Veteran relating his claimed disabilities to service. Specifically, that his skin disability to include bumps on his face, chest, arms and legs developed after his fall from the telephone poll. The Federal Circuit has held that “[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (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.” Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007)). Although the Veteran is competent to testify that he observed skin symptoms, he is not competent to provide a medical opinion linking his skin disability to his military service. Such a medical nexus does not involve a simple identification that a layperson is competent to make. See Jandreau, 492 F.3d at 1377, n.4. Therefore, the Board finds that the weight of the competent evidence does not attribute the Veteran’s various remaining skin disabilities to military service despite his contentions to the contrary. The competent and credible medical opinions of record do not favor an etiological link between the remaining skin conditions and any incident of active service, and the evidence does not support an incurrence during service with continuity to the present. As such, the claims are denied. In reaching the above conclusion, the Board also considered the doctrine of reasonable doubt. 38 U.S.C. § 5107 (b). However, as the most probative evidence is against the claim, the doctrine is not applicable in this case. See also, e.g., Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). M. Pryce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Vample, 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.