Citation Nr: 21009489 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 17-23 276 DATE: February 22, 2021 ORDER Service connection for a skin condition, to include as a result of exposure to herbicide agents and sun exposure in service, is denied. THE VETERAN’S CONTENTIONS The Veteran contends that he has skin cancer related to his exposure to herbicide agents, including Agent Orange, during service. He asserts that during his tour of duty in U-Tapao, Thailand from May 1970 to April 1971, he was in and around areas that are known to have been sprayed with Agent Orange. See August 2019 Informal Hearing Presentation. He explains that he launched and recovered aircraft, and that when they broke down, he went to the aircraft on “north hammerhead”. He describes the hammerhead as the area at the end of the runway and states that he would drive along the perimeter of the Airforce base to get to the aircraft. See October 2018 Informal Conference Report. He contends that he was within 25 feet of the perimeter on many occasions. See June 2018 notice of disagreement (NOD). He acknowledges that his position was not security forces, military dog handler or security forces augmentee; however, he nevertheless, contends that he was on or near the perimeter on a daily basis throughout the entire time he was in U-Tapao. See September 2017 statement in support of claim; November 2015 NOD; September 2015 statement in support of claim; August 2015report of general information. He contends that he does not have a family history of this condition. See June 2017 646. In October 2020, the Veteran stated that the July 2020 VA examination was inadequate because the evidence showed there was a diagnosed condition as he had cancerous spots removed in 2015. The Veteran also contended that the subsequent December 2020 VA medical opinions were inadequate as they did not consider Agents Blue and White, and that the condition was only considered in the presumptive sense. See February 2021 Appellate Brief Presentation. FINDING OF FACT The Veteran does not have a skin condition that had its clinical onset during service; or is shown to be causally or etiologically related to any disease, injury, or incident during service, including exposure to either herbicide agents or the sun. CONCLUSION OF LAW The criteria for service connection for a skin condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Air Force from August 1963 to August 1993. These matters come to the Board of Veterans’ Appeals (Board) on appeal from an October 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This issue was remanded by the Board in February 2020 and November 2020. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an 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 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). As an initial matter, the Board presumes exposure to herbicide agents as the Veteran’s duties brought him to the perimeter of the base in Thailand during his service. If a Veteran was exposed to herbicide agents during active service, presumptive service connection is warranted for certain specified diseases. 38 C.F.R. §§ 3.307, 3.309. The current list of diseases subject to presumptive service connection under 38 C.F.R. § 3.309(e) include skin diseases of chloracne, or other acneform diseases consistent with chloracne, and porphyria cutanea tarda, that become manifest to a degree of 10 percent within one year of exposure. 38 C.F.R. § 3.309 (e); 38 C.F.R. § 3.307 (a)(6)(ii). In this case, service connection is not warranted due to herbicide exposure under 38 C.F.R. § 3.309(e) as the Veteran does not have a diagnosis of chloracne, or other acneform diseases consistent with chloracne, and porphyria cutanea tarda during the appeal period. See July 2020; December 7, 2020; and December 30, 2020 DBQ Disability Benefits Questionnaire (DBQ); June 2002 through July 2013 private treatment records VA treatment records through February 2021. However, the unavailability of presumptive service connection for a disability based on exposure to herbicide agents does not preclude a Veteran from establishing service connection with proof of direct causation, or on any other recognized basis. Stefl v. Nicholson, 21 Vet. App. 120 (2007); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The Veteran’s service treatment records show diagnoses of excisions of skin of the right posterior shoulder dermatofibroma (benign skin growth) in November 1986, and a mass on the left buttocks which appeared to be lipoma which was excised in March 1988. Post-service private treatment records show that the Veteran had a lesion removed from the left side of his face in June 2002, which had been determined to be inverted follicular keratosis, solar elastosis of dermis, and was negative for basal cell carcinoma and other malignancy. VA treatment records from July 2016 through November 2020 show actinic keratosis lesions reoccurring on the ear, forehead, left temple, and back pruritic forearms. Further, a January 2016 VA treatment record notes that the Veteran had cancerous spots removed, and a May 2020 VA treatment record also notes that skin cancer was removed from the forehead two months ago in late 2019. The July 2020 VA examiner found that the Veteran did not have a current skin condition and specifically noted no benign or malignant neoplasm or metastases. See July 2020 Skin Diseases Disability Benefits Questionnaire (DBQ). In stating such, however, it was clear that the examiner did not consider previous diagnoses of active skin conditions, and as such, the Board remanded for an additional opinion. Pursuant to the November 2020 remand directives, additional VA medical opinions were obtained in December 2020 to clarify whether the Veteran had a diagnosis of a skin condition that was related to service. In the December 7, 2020 DBQ, after a review of the medical records, the clinician determined the Veteran’s skin conditions were less likely than not related to service. The VA clinician opined that the Veteran had actinic keratosis and other incidental benign lesions. He explained that the conditions were less as likely than not related to Agent Orange or caused by his sun exposure in Thailand. To the contrary, he explained that the condition was consistent with aging and in line with familial and genetic characteristics, such as light skin from northern European ancestry. In a December 30, 2020 DBQ, the VA clinician clarified that the Veteran did not have a diagnosis of skin cancer during the appeal period. He explained that the notation of skin cancer included in the records was from a subjective history and was not factual as far as diagnosis or timeline. He explained that there was no formal diagnosis of skin cancer in 2019 and that the lesions removed and assessed in 2016 at the VA did not have cancer noted. He stated that the skin lesions removed from the Veteran’s forehead and other areas were actinic keratosis only. He explained that actinic keratosis are aging skin changes where each lesion is independently occurring and is not due to the presence of other lesions, and that the lesions are resolved once they are removed. He again stated that the Veteran’s age, with his inherent characteristics and genetics, increased his propensity to develop those lesions more than other people. See December 30, 2020 DBQ. In other words, the examiner explained that the lesions develop irrespective of a history of sun exposure. The Board finds the December 2020 VA medical opinions to be the most probative evidence of record. The December 2020 clinician considered the Veteran’s contentions, reviewed the medical records, and provided a robust rationale for his conclusions that the Veteran did not have a current skin condition related to service. The Board is cognizant that, as noted by the Veteran’s representative, the examiner did not directly mention potential effects of exposure to agents Blue and White during service. In this case, however, the Board finds that an additional medical opinion to address potential exposure to agents Blue and White is not necessary as the examiner specifically noted that the Veteran’s current skin conditions were due to aging and genetics only and not related to service. The only contrary evidence of record is the Veteran’s contentions. To the extent that the Veteran contends that he has a diagnosis of skin cancer or another skin condition related to his service, the Board finds that there is no evidence in the record indicating that the Veteran is qualified to provide a medical diagnosis or opinion. While the Veteran, as a lay person, is competent to provide evidence regarding the symptoms he observed, he is not competent to diagnose skin cancer or another skin condition, or to offer an opinion as to the etiology of his skin conditions as this matter falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). Based on the foregoing, the Veteran’s claim of entitlement to service connection for a skin condition, to include as a result of exposure to herbicide agents and sun exposure in service, is denied. S.C. Krembs Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Samuelson, 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.