Citation Nr: 21012298 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 15-26 835 DATE: March 4, 2021 ORDER Entitlement to service connection for a skin disorder, to include chloracne, dermatitis, and psoriasis, including as a result of in-service exposure to herbicide agents, is denied. FINDING OF FACT The preponderance of the evidence fails to show that the Veteran’s skin disorder is related to his active service, including his presumed tactical herbicide exposure during his service in Vietnam. CONCLUSION OF LAW The criteria for entitlement to service connection for a skin disorder, to include chloracne, dermatitis, and psoriasis, including as a result of in-service exposure to herbicide agents, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from November 1968 to July 1971, including service in Vietnam. This matter was remanded by the Board of Veterans’ Appeals (Board) in August 2018 and July 2020 for further development. That development has been completed, and the case returns to the Board for adjudication. The August 2018 and July 2020 Board remands are incorporated herein by reference. Service connection for a skin disorder, to include chloracne, dermatitis and psoriasis, including as a result of in-service exposure to herbicide agents The Veteran contends that he has a skin condition on his hands that is related to his active service. The Board finds the evidence is against a finding that the Veteran’s current skin condition is related to his active service, including his presumed tactical herbicide exposure during service in Vietnam. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence must show: (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, 1166 -67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d). Service connection may also be established with certain chronic diseases based upon a legal presumption by showing that the disorder manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from service. Such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Service connection may be granted on a presumptive basis for certain diseases associated with exposure to certain herbicide agents, even though there is no record of such disease during service, if they manifest to a compensable degree any time after service, in a veteran who had active military, naval, or air service for at least 90 days, during the period beginning on January 9, 1962 and ending on May 7, 1975, in the Republic of Vietnam, including the waters offshore, and other locations if the conditions of service involved duty or visitation in Vietnam. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e), 3.313. This presumption may be rebutted by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. §§ 3.307, 3.309. Here, the Veteran’s service medical records do not show any complaints of, or treatment for, a skin condition, to include irritation. In a November 2012 statement the Veteran explained that he had discoloration on the back of his hands and fingers and that he associated this condition with his exposure to herbicide agents during his active service. On VA examination of the skin in September 2003, the examiner noted chronic dermatitis of the groin and the scrotum with some hypopigmentation. Otherwise, there was no rash, or discharge, on the Veteran’s body. There was extensive chronic dermatitis possibly fungal dermatitis of the skin with some hypopigmentation of the scrotum, the groin areas, and both the thighs. A referral to dermatology was indicated. In November 2005, the Veteran was treated for an upper arm rash, diagnosed as contact dermatitis. He was prescribed a steroid cream. On VA examination in July 2013, the Veteran reported a pruritic skin condition on both hands that began two years earlier. According to the examiner, the topical medication prescribed to the Veteran was common for psoriasis. On VA examination in October 2019, the examiner found that the Veteran’s skin condition was consistent with dermatitis. After examining the Veteran and reviewing the medical record, the examiner opined that the Veteran did not have a skin condition due to tactical herbicide exposure. No such skin condition was reported during service, although it was noted that the Veteran had a scrotal/thigh dermatitis due to friction. There was no mention of hand dermatitis found in the service records. The examiner diagnosed dermatitis of the Veteran’s fingers with an unknown etiology and specifically concluded that the Veteran's claimed skin condition is less likely than not incurred in, or caused by, the skin condition in service, or caused by herbicide exposure during service. Pursuant to the July 2020 Board remand, a VA review opinion was obtained. The July 2020 examiner opined that the Veteran does not have a diagnosis of chloracne and that his diagnosed dermatitis is less likely than not incurred in, or caused by, herbicide exposure. The examiner explained that dermatitis is not on the list of conditions associated with tactical herbicide exposure and that the condition developed almost 50 years after his presumed in-service exposure. Without a diagnosis of chloracne that became manifest to a degree of 10 percent or more within a year of exposure, the herbicide agent exposure presumption is not warranted for the Veteran’s claim. See 38 C.F.R. §§ 3.307(a)(6)(ii), 3.309(e). Without this available presumption, the Board must decide whether the Veteran’s currently diagnosed dermatitis warrants service connection on a direct basis. In this regard, the Board finds that the medical evidence of record is against a finding that the Veteran’s diagnosed dermatitis is related to his active duty service. Medical opinions of record note that the Veteran’s dermatitis is less likely than not related to his active service (based on his reports that his dermatitis began in 2009), including his presumed tactical herbicide exposure resulting from his service in the Republic of Vietnam. These opinions are well reasoned and, therefore, persuasive. There is no evidence of record to suggest that the Veteran’s skin condition began during, or was otherwise related to, his active service, including his presumed in-service tactical herbicide exposure. The preponderance of the evidence is against this service connection claim, and the benefit of the doubt rule is inapplicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. At 55-57. While the Veteran asserts that he has chloracne, the diagnoses of such disability requires medical expertise and cannot simply be diagnosed by lay observation alone. The Veteran is not considered competent (meaning medically qualified by training or experience) to diagnose this condition or relate any of his claimed dermatological symptoms to any incident during his active service. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, service connection for a skin disorder, to include chloracne, dermatitis, and psoriasis, including as a result of in-service exposure to herbicide agents, is denied. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.E. Lee 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.