Citation Nr: 21010712 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 14-41 348A DATE: February 25, 2021 ORDER Entitlement to service connection for tinea cruris, to include as due to an undiagnosed illness, is denied. Entitlement to service connection for a left knee disability, to include as due to an undiagnosed illness, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran’s claimed for tinea cruris condition began during active duty service, or is otherwise related to an in-service injury or disease, to include as due to an undiagnosed illness. 2. The preponderance of the evidence is against finding that the Veteran’s claimed for left knee disability was shown as being chronic in service or manifested to a compensable degree within the applicable presumptive period; continuity of symptomatology is not otherwise shown; and the disability is not otherwise etiologically related to an in-service injury or disease, to include as due to an undiagnosed illness. CONCLUSIONS OF LAW 1. The criteria for service connection for the Veteran’s claimed for tinea cruris condition, to include as due to an undiagnosed illness, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for the Veteran’s claimed for left knee condition, to include as due to an undiagnosed illness, are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from January 1982 to May 1982, and from November 1990 to June 1991. This matter comes before the Board of Veterans’ Appeals (Board) from an August 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran’s claims were remanded in February 2019 in part to notify the Veteran that his claims remain on appeal and to provide him with an opportunity to submit any additional pertinent evidence in support of his claims. Upon review of the record, the Board finds there has been substantial compliance with its aforesaid remand directives. See October 2019 VA Subsequent Development Letter. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Under 38 U.S.C. § 1117(a)(1), compensation is warranted for a Persian Gulf Veteran who exhibits objective indications of a "qualifying chronic disability" that became manifest during service on active duty in the Armed Forces in the Southwest Asia Theater of operations during the Persian Gulf War, or to a degree of 10 percent during the presumptive period prescribed by the Secretary. Effective October 16, 2012, VA extended the presumptive period in 38 C.F.R. § 3.317(a)(1)(i) through December 31, 2016 (for qualifying chronic disabilities that become manifest to a degree of 10 percent or more after active duty in the Southwest Asia Theater of operations). See 77 Fed. Reg. 63225 (2012). Furthermore, the chronic disability must not be attributed to any known clinical disease by history, physical examination, or laboratory tests. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a), (b). As the Veteran served in the Southwest Asia Theater of Operations from January 1991 to May 1991, he is a Persian Gulf veteran within the meaning of the applicable statute and regulation. See Military Personnel Records. Lastly, service connection may also be granted on the basis of a post-service initial diagnosis of a disease, where the physician relates the current condition to the period of service. See 38 C.F.R. § 3.303 (d). In such instances, a grant of service connection is warranted only when, "all of the evidence, including that pertinent to service, establishes that the disease was incurred during service." Id. 1. Entitlement to service connection for tinea cruris, to include as due to an undiagnosed illness As to the first element of Shedden, for service connection the Veteran must show a current disability. Per the August 2012 VA examination report, the Veteran has a diagnosis of tinea cruris, and therefore the Board finds that his claim meets the first element of Shedden. As to the second element of Shedden, for service connection the Veteran must show an in-service incurrence or aggravation of a disease, injury, or event. The Veteran had qualifying service in Southwest Asia, and therefore, relative to his claimed for undiagnosed illness, the Board is willing to concede that the Veteran’s claim meets the second element of Shedden. See Military Personnel Records. As to the last element of Shedden, for service connection the Veteran must show a causal relationship between the current disability and the in-service disease or injury. Upon review of the record, the Board does not find any medical evidence of record linking the Veteran’s currently diagnosed tinea cruris condition to service. Weighing against the Veteran’s claim is the August 2012 VA examiner’s opinion stating that it is less likely as not (less than 50/50 probability) that the Veteran’s tinea cruris was incurred in or caused by service in Southwest Asia as the Veteran did not have a diagnosis of tinea cruris while on active duty, while his separation examination of the skin was normal. Additionally, relative to the Veteran’s claim for service connection for an undiagnosed illness as due to his service in Southwest Asia, the VA examiner indicated that the Veteran does not have a diagnosed illness for which no etiology was established, and therefore, although the Veteran has qualifying service in Southwest Asia, the Board does not find that presumptive service connection under 38 C.F.R. § 3.317 is warranted in this Veteran’s case; the VA examiner also indicated that the Veteran does not currently suffer from signs or symptoms of a diagnosed medically unexplained chronic multi-symptom illness. The Board acknowledges the Veteran’s belief that his claimed for skin condition relates to service. See August 2012 VA examination report; July 2016 Notice of Disagreement (NOD); October 2020 Appellant’s Post-Remand Brief. However, the Board does not find him competent to associate his condition with service as the issue is medically complex, nor is there sufficient evidence of record to find that his currently diagnosed tinea cruris incurred during service. See id.; 38 C.F.R. § 3.303 (d); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As the preponderance of the evidence of record weighs against the claim, the benefit of the doubt doctrine is not for application, and the claim for service connection for a skin condition, to include as due to an undiagnosed illness, must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 2. Entitlement to service connection for a left knee disability, to include as due to an undiagnosed illness As to the first element of Shedden, for service connection the Veteran must show a current disability. Per the August 2012 VA examination report, the Veteran has a current diagnosis of patellofemoral syndrome left knee, and therefore the Board finds that the Veteran’s claim meets the first element of Shedden. As to the second element of Shedden, for service connection the Veteran must show an in-service incurrence or aggravation of a disease or injury. The Veteran had qualifying service in Southwest Asia, and therefore, relative to his claimed for undiagnosed illness, the Board is willing to concede that the Veteran’s claim meets the second element of Shedden. See Military Personnel Records. Additionally, the Board finds the Veteran’s report of having experienced pain in his left knee during basic training while on active duty to be credible. See August 2012 VA examination report. As to the last element of Shedden, for service connection the Veteran must show a causal relationship between the current disability and the in-service disease or injury. Upon review of the record, the Board does not find any medical evidence of record linking the Veteran’s currently diagnosed patellofemoral syndrome left knee condition to service. Weighing against the Veteran’s claim for service connection is the August 2012 VA examiner’s opinion that it is less likely as not (less than 50/50 probability) that the patellofemoral syndrome left knee incurred in or caused by service in Southwest Asia that occurred while in service as the Veteran’s separation examination of the “spine, other musculoskeletal” was normal. Here, the Board finds that the Veteran’s normal separation examination weighs against a finding of continuity of symptomatology since service. Additionally, the record does not reveal post-service knee complaints or evidence of treatment for knee pain following the Veteran’s discharge from service. Rather, the record reveals the Veteran indicating that he just recently began experiencing pain in his left knee. See July 2010 VA treatment record (“recently began to bother him”). Relative to the Veteran’s claim for service connection for an undiagnosed illness as due to his service in Southwest Asia, the VA examiner indicated that the Veteran does not have a diagnosed illness for which no etiology was established, and therefore, although the Veteran has qualifying service in Southwest Asia, the Board does not find that presumptive service connection under 38 C.F.R. § 3.317 is warranted in this Veteran’s case; the VA examiner also indicated that the Veteran does not currently suffer from signs or symptoms of a diagnosed medically unexplained chronic multi-symptom illness. See August 2012 VA examination report. The Board acknowledges the Veteran’s belief that his claimed for left knee condition relates to service. See August 2012 VA examination report; July 2016 NOD; October 2020 Appellant’s Post-Remand Brief. However, the Board does not find him competent to associate his condition with service as the issue is medically complex, nor is there sufficient evidence of record to find that his currently diagnosed patellofemoral syndrome left knee incurred during service. See Id.; 38 C.F.R. § 3.303 (d); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As the preponderance of the evidence of record weighs against the claim, the benefit of the doubt doctrine is not for application, and the claim for service connection a left knee condition, to include as due to an undiagnosed illness, must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). R. M. KELLY Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.R. Fey, 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.