Citation Nr: 21011507 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 17-19 203 DATE: March 2, 2021 ORDER Entitlement to service connection for a skin disorder, to include as due to herbicide agent exposure, is denied. FINDING OF FACT The Veteran’s currently diagnosed skin disorder was not manifest during service or for many years thereafter, and the competent and credible evidence fails to establish an etiological relationship between the Veteran’s claimed disability and his active service, including herbicide agent exposure. CONCLUSION OF LAW A skin disorder was not incurred in or aggravated by service, to include herbicide agent exposure, and may not be presumed related to service. 38 U.S.C. §§ 1110, 1111, 1131, 1132, 5103(a), 5103A (2012); 38 C.F.R. §§ 3.159, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Army from January 1967 to January 1969, to include service in the Republic of Vietnam, and is in receipt of the Combat Infantry Badge (CIB). This matter is on appeal to the Board from a November 2012 rating decision. In January 2020, the Veteran testified at a Board hearing via videoconference before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In February 2020, this matter was remanded by the Board for additional development and is now ready for adjudication. Service Connection Claim The Veteran contends that he has a skin disorder that is related to his service, including exposure to herbicide agents, during his active service. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Diseases associated with exposure to certain herbicide agents used in support of military operations in the Republic of Vietnam (Vietnam) during the Vietnam era will be considered to have been incurred in service. 38 U.S.C. § 1116 (a)(1). The presumption requires exposure to an herbicide agent and manifestation of the disease to a degree of 10 percent or more within the time period specified for each disease. 38 C.F.R. § 3.307 (a)(6)(ii). However, skin disorders are not presumptively related to herbicide agent exposure under 38 C.F.R. § 3.309 (e) (2018); see Notice, 75 Fed. Reg. 168, 53202-16 (Aug. 31, 2010). The absence of a disease from the presumptive list does not preclude a veteran from otherwise proving that his disability resulted from exposure to Agent Orange or otherwise linking his skin disorder to service. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Turning to the merits of the claim, the service treatment records (STRs) include a February 1967 clinical note which indicates a diagnosis of and treatment for a toe infection, but are otherwise negative for any diagnosis or treatment of a skin condition. In an April 2012 statement, the Veteran stated that he developed a skin reaction to wet leather shortly after service. Specifically, he complained of ongoing itching, redness, and a rash that developed with prolonged contact to wet leather, even with a layer of cloth between his skin and the leather. An April 2012 VA contract examination reflects a diagnosis of contact dermatitis, which the examiner noted began in 1970, but the disorder had not been formally diagnosed. The examiner noted the Veteran’s report of a rash, itching, and bumps whenever his skin came into contact with leather. After cortisone was applied it went away. However, no medical opinion on etiology was rendered based on the examiner’s finding of skin rash on examination. Post-service, VA treatment records dated in August 2012 indicate that the Veteran had a rash on his face, hips, and right foot. He stated that the rash on his face and right foot began 3 to 4 months ago. He also had a rash on his cheeks. Another August 2012 report indicates that the Veteran was concerned with non-healing skin lesions on his face and persistent itchy rashes on his right foot. The assessment was dermatitis. A September 2012 report shows that he presented for a dermatology consult with persistent dry and rough adherent skin lesions of the temples. He also had persistent rashes on the dorsal aspect of the right foot. For several years, he had an intermittent rash on his feet after wearing a certain type of black canvas shoe. The assessment was eczematous dermatitis, most likely 2/2 contact. Another September 2012 report indicates an assessment of SK (seborrheic keratosis) and eczematous dermatitis. The record also includes an October 2012 VA medical opinion wherein the examiner indicated that the Veteran was diagnosed with contact dermatitis of the face, but was unable to provide an opinion regarding contact dermatitis of the feet without mere speculation. VA treatment records include a July 2013 report which indicates a complaint of an intermittent rash on his feet for several years when he wore certain black canvas shoes. The assessment was dyshidrotic eczema, AK (actinic keratosis), and ringworm. An August 2013 dermatology consult indicates a referral for a dermatology consult for chronic dyshidrotic eczema of the anterior ankle and lower shin. He presented for follow up of eczematous dermatitis on his shins as well as a new rash on the right buttock. He continued to have severe rashes when working outdoors in his boots. The assessment was ACD (allergic contact dermatitis) and eczema. At the January 2020 hearing, the Veteran described having onset of foot fungus in service and having problems with his feet and a skin disability following separation from service. See Hearing Transcript, pp. 3-4. Post-service, the Veteran indicated he was treated on several occasions for rashes which are recurrent on his feet, face, and buttocks. Id. In February 2020, the Board remanded the claim for an appropriate medical opinion, finding that the October 2012 VA medical opinion was inadequate, because it failed to take into consideration the Veteran’s lay reports of symptoms and history of his skin disorder. Pursuant to the Board’s February 2020 remand, in a May 2020 opinion a VA examiner opined that the claimed skin disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that there is no diagnosis of a skin disorder in service and the infection of the Veteran’s great toe in 1967 appeared to have been acute and self-limited. The separation examination was negative for a foot or skin disorder. There was no evidence of a skin disorder until 2012, at which time he was diagnosed with eczema/atopic dermatitis by the dermatology department. This included lesions on the bilateral temple areas and the dorsal portions of the feet. The examiner further opined that there is no relationship between the infection of the great toe and eczema. He explained that eczema is thought to be an autoimmune disorder as opposed to a superficial skin infection that affected the toe. The great toe infection was acute, self-limited, and evidently resolved prior to separation. He stated that there was no evidence of a foot infection proximate to service or at the presentation of a skin condition in 2012 and opined that the Veteran’s eczema more likely than not represented a new disorder arising well after service. The examiner also opined that it is less likely than not that the Veteran’s claimed skin disorder was related to or caused by service or exposure to herbicide agents during service. The rationale was that any skin disorder caused by exposures would have occurred at the time of exposure or proximate to those exposures. Therefore, it is less likely than not that the Veteran’s currently diagnosed atopic dermatitis arose in service or is due to herbicide agent exposure. Additionally, there is no evidence of tinea pedis/foot fungus discussed in the STRs or post-service treatment records proximate to service. The Board finds that the claim must be denied. There is no competent medical evidence to show that the Veteran has any skin disorder, that is related to his service, to include herbicide agent exposure. Moreover, with the exception of treatment for the Veteran’s infected great toe, the Veteran’s STRs are void of any complaints or diagnosis of a skin disorder. Post-service, the record does not reflect or reference any history of a skin disorder until decades after discharge from service. The mere absence of medical records does not contradict a Veteran’s statements about his symptom history. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). However, if it is determined based upon reliable evidence that there was an extended period of time after service without any manifestations of the claimed disability, then that tends to weigh against a finding of a connection between the disability and service. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd, 230 F.3d 1330 (Fed. Cir. 2000), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); see also Horn v. Shinseki, 25 Vet. App. 231, 240 n.7 (2012). The Board finds in this case that the lack of evidence of a diagnosed skin disorder during service, with the exception of the great toe infection, coupled with the fact that a diagnosis of a skin disorder was not made until over four decades post-service, is sufficient to rebut a finding of service incurrence. In this case, the earliest post-service medical evidence of the Veteran’s skin disorder was in April 2012 which is over 43 years after service. Moreover, the Board finds that the Veteran’s statements relating his skin disorder to his service are not credible and are afforded no probative value. His contentions conflict with the absence of treatment evidence for over four decades. Finally, there is no competent medical evidence that the Veteran has a skin disorder that is related to his service, to include herbicide agent exposure. The Board has taken the contention that the Veteran has a skin disorder that was caused by service, seriously (this was the basis of the Board’s remand in order to address this medical question). The Board has also closely reviewed the medical and lay evidence in the Veteran's claims file and finds no evidence that may serve as a medical nexus between the Veteran’s service and his claimed skin disorder. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case, the etiology of his skin disorder, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). In light of the above discussion, the Board concludes that the preponderance of the evidence is against the claim for service connection for a skin disorder and there is no doubt to be otherwise resolved. As such, this claim is denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Adams, 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.