Citation Nr: 21010391 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 16-49 422 DATE: February 24, 2021 ORDER Entitlement to service connection for a skin disorder, to include chloracne, to include as due to exposure to herbicides is denied. Entitlement to service connection for peripheral neuropathy of the bilateral upper extremities, to include as due to exposure to herbicides is denied. Entitlement to service connection for peripheral neuropathy of bilateral lower extremities, to include as due to exposure to herbicides is denied. FINDINGS OF FACT 1. The Veteran’s is presumed exposed to herbicides while serving in Vietnam. 2. The Veteran’s claimed skin condition did not occur in service, is not the result of exposure to herbicides, and is not otherwise related to service 3. There is no diagnosis of peripheral neuropathy of the upper or lower extremities. CONCLUSIONS OF LAW 4. The criteria for service connection for a skin disorder are not met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 5. The criteria for service connection of peripheral neuropathy of the bilateral upper extremities are not met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 6. The criteria for service connection of peripheral neuropathy of bilateral lower extremities are not met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from October 1968 to August 1970. The Veteran is a recipient of an Army Commendation Medal with V device, Purple Heart, and Combat Infantryman Badge, among numerous other awards. These matters come before the Board of Veteran’s Appeals (Board) on appeal from a January 2015 rating decision by the Nashville, Tennessee, Regional Office (RO) of the United States Department of Veterans Affairs (VA). The Board previously remanded the Veteran’s claims in January 2020 to obtain VA examinations, relevant private treatment records, outstanding VA treatment records. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). These issues are now back before the Board. The Veteran testified at an October 2019 videoconference hearing held before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is associated with the claims file. Service connection will be granted if it is shown that the Veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish service connection on a direct basis, the record must contain competent evidence of: (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. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Some chronic diseases may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C.A. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). Organic diseases of the nervous system are among the listed conditions, with a presumptive period of one year following service. As was noted in the January 2020 Board remand, exposure to tactical herbicides is established based on the Veteran’s Vietnam service. 38 C.F.R. § 3.307(a)(6). For Veterans exposed to tactical herbicides, service connection may be presumed for certain listed diseases, including certain neuropathic and skin conditions. 38 C.F.R. § 3.309(e). Effective September 6, 2013, VA amended its adjudication regulations concerning presumptive service connection with regard to herbicide agents. 78 Fed. Reg. 54736 (Sept. 6, 2013). As amended, peripheral neuropathy still needs to become manifest to a degree of 10 percent or more within one year after the date of last exposure to herbicides in order to qualify for the presumption of service connection, but it no longer needs to be transient. Id. Chloracne and porphyria cutanea tarda, the skin conditions listed at 38 C.F.R. § 3.309(e), must also manifest to a compensable degree within the first year following exposure to herbicides. Delayed onset peripheral neuropathy is not listed among the diseases presumed to be associated with Agent Orange exposure; only early-onset peripheral neuropathy is listed. 38 C.F.R. § 3.309(e). The Veteran’s complaints of neuropathic pain, of the right leg and of the right hand, first noted in 2012, do not fall within the applicable presumptive periods for either chronic or herbicide-related disease, and hence service connection on a presumptive basis is not warranted. With regard to a claimed skin condition, no presumptive condition is currently diagnosed, nor has such been diagnosed at any point. The Veteran does have a history of acne vulgaris, or common acne (pimples, blackheads, and whiteheads, e.g.) and epidermal cysts, but both have resolved with treatment and neither is a chloracne or disease consistent with such. Accordingly, presumptive service connection of a skin condition as an herbicide-related disease is not warranted That notwithstanding, the Veteran may still establish service connection on a direct basis by showing that the claimed disability is at least as likely as not causally linked to herbicide exposure. See Brock v. Brown, 10 Vet. App. 155, 162-64 (1997); Combee v. Brown, 34 F.3d 1039, 1044 (Fed. Cir. 1994). Skin Following remand from the Board, the Veteran was given a VA examination to determine the nature and etiology of any skin disorders. The exam was conducted in January of 2020. The examiner indicated that the Veteran’s VA e-folder was reviewed in connection with the examination. The examiner indicated that the Veteran’s claimed condition 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 opined that the small black/dark moles/spots on the Veteran’s face are common with dermatosis papulosa nigra, a benign skin condition common in African Americans and those with darker skin tones that usually runs in families. Additionally, the examiner said the acne vulgaris and epidermal cysts the Veteran had previously been treated for were resolved with no evidence of recurrence, progression, or residuals. In other words, there is only a hereditary disease present, and hence no nexus to service on any basis. The Veteran has presented no evidence, other than his bare assertion, of a nexus between a current skin disorder and service. As a layperson, he is competent to describe observable manifestations of skin problems, and to report their onset, but he lacks the specialized training and knowledge needed to render an opinion on causation, as he did not observe such. Layno v. Brown, 6 Vet. App. 465 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Accordingly, the sole competent evidence of record is against the claim. Service connection on a direct basis is therefore not warranted. There is no doubt to resolve. 38 C.F.R. § 3.102. Peripheral Neuropathy The Veteran is also seeking service connection for peripheral neuropathy of the upper and lower extremities. The Board remanded the Veteran’s claims for a VA examination to determine the nature and etiology of the claimed neuropathy conditions, as some forms of neuropathy are known to be related to herbicide exposure. Mclendon v. Nicholson, 20 Vet. App. 79 (2006). VA treatment records show that in In July 2012, the Veteran reported right leg numbness for a week, following a stent placement for his kidneys. He stated the pain was relieved with urination. He also complained of his right leg feeling heavy when he walks and slightly numb/painful. The provider related the Veterans complaints to bladder spasms and suspected claudication. The Veteran complained of right-hand numbness in April 2016. He stated that his felt like his fourth and fifth finger on his right hand were numb for two to three months. The emergency provider’s impression was suspected mild distal right ulnar neuropathy/entrapment. The emergency provider also noted the Veteran had full range of motion and saw improvement with pain medication. A VA examination was afforded the Veteran in February 2020. The Veteran’s file was reviewed by the examiner. The VA examiner found no diagnosis related to a peripheral nerve condition or peripheral neuropathy. During the examination, the Veteran’s sensory, affected nerves, and muscular strength exams were all normal. The examiner recognized the Veteran’s subjective complaints but found no objective evidence of any peripheral neuropathy conditions. Therefore, the examiner found no current diagnosis of upper or lower bilateral peripheral neuropathy. The Veteran’s treatment records are silent for 45 years after leaving the service, and even then the identified symptoms were associated with acute conditions, which resolved with treatment. In no instance was a peripheral neuropathy diagnosed. Even the right hand numbness, for which neuropathy was considered, was apparently associated with a physical nerve entrapment, and not a chronic condition. Without a formal diagnosis of peripheral neuropathy there can be no medical nexus. The Board recognizes the Veteran’s subjective and competent reports of neuropathic symptoms. However, his lay statements are outweighed by the medical evidence based on formal testing, observation, and opinions from a person having additional applicable knowledge and training. Further, the Veteran, as with his skin, is not competent to render a diagnosis. Layno v. Brown, 6 Vet. App. 465 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). As no peripheral neuropathies are diagnosed, service connection cannot be granted, and the claims must be denied. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Nolan, Shane D. 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.