Citation Nr: 21014051 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 11-30 711 DATE: March 11, 2021 ORDER Service connection for a skin disorder is granted. FINDING OF FACT It is just as likely as not the Veteran’s skin disorder is related or attributable to his active military service. CONCLUSION OF LAW Resolving all reasonable doubt in his favor, the criteria are met for entitlement to service connection for a skin disorder. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from June to September 1981, from June 1983 to July 1992, from January to June 2003, and from February to October 2004. Service connection for a skin disorder is granted. The Board finds that service connection for a skin disorder is warranted. In so finding, the Board has weighed both the positive and negative VA medical opinions of record and determined there is no legitimate reason to give more probative weight to one versus another. In this circumstance of relative balance of evidence for versus against a claim, this reasonable doubt is resolved in the Veteran’s favor and the claim granted rather than denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Veteran contends that his current skin condition (including lupus, specifically) onset during or close in time to his service in Afghanistan in 2004. His service treatment records (STRs) from during that portion of his active service do not document treatment for a skin condition of any sort. However, he reports that he was experiencing intermittent (on and off) skin rashes while in Afghanistan and then shortly after returning home from that deployment. His family members also have submitted statements attesting to this same course of events. The post-service treatment records reflect the Veteran’s indication that he had first experienced a skin rash in 2003; this is recounted in his May 2010 and May 2011 VA treatment records. In fact, prior to filing his claim for service connection in 2009, a November 2008 VA treatment record shows he had malar rashes diagnosed as lupus. At that time, he stated that he was confused about the symptoms because he had been covered up while deployed. His physician explained that sometimes lupus does not show up until later in life. Subsequent VA treatment records reflect a differential diagnosis between lupus and Jessner’s lymphocytic infiltrate. In April 2019, a VA examiner concluded that it is at least as likely as not the Veteran’s skin condition, which at that time had not been clearly diagnosed, met the criteria for an undiagnosed illness and was due to exposure related to his service in the southwest Asian Theater of Operations. Service in Afghanistan is not considered service in Southwest Asia for the purpose of presumptive service connection under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317(a). See Cox v. McDonald, 28 Vet. App. 318 (2016).   This distinction, however, does not totally weaken this supporting medical opinion, as the examiner was stating that there is no other likely etiology of the Veteran’s skin disorder other than some sort of exposure while in service. To that extent, the opinion is bolstered by an August 2020 VA opinion also finding that it is at least as likely as not the Veteran’s skin condition is due to his service. This examiner explained that, according to the record, and particularly the dermatologist notes, the Veteran’s skin condition began in 2003, so during his time in service. This examiner considered the Veteran’s statements and completed physical examination, thus, following proper protocols prior to providing this supporting opinion. The Board finds that these opinions, along with the Veteran’s statements and post-service VA treatment records, tend to establish the required etiological link between his skin condition that initially was diagnosed after conclusion of his service and the conditions, circumstances, and hardships of his last period of active service in Afghanistan. See 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(d). The Board has considered the opinions also of record that conversely do not tend to support the claim but finds they are of lesser probative value in this instance or certainly no more probative than the opinions contrarily supporting the claim. Specifically, although the same VA examiner who provided the August 2020 positive opinion also provided a negative opinion that, because the Veteran did not have a current skin condition, there is no nexus, this ultimately does not bear weight and is not dispositive. Even if the Veteran currently is not exhibiting symptoms, he has had symptoms of skin rash and received treatment for lupus versus Jessner’s during the appeal period – which, in turn, is sufficient to conclude he has this claimed disability, even if it has resolved before adjudication of this claim. See McLain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Moreover, the November 2020 VA opinion appears to reach the same conclusion that, since the Veteran was not then currently displaying symptoms of a skin rash, a nexus to his service could not be established. But, for the same reasons, the Board finds this conclusion ultimately less probative because it does not answer the question of whether the skin rash shown during the appeal period, even if now resolved, is related or attributable to the Veteran’s service. Moreover, courts have recognized how skin rashes – by there very or inherent nature, wax and wane, therefore are sometimes more apparent than at others. See, e.g., Ardison v. Brown, 6 Vet. App. 405, 408 (1994) (requiring that VA examine a Veteran during an "active stage" of the disease, when the skin condition at issue is cyclical in manifestation, in other words waxes and wanes, meaning it should be evaluated during an eruption or exacerbation of it as opposed to when dormant). Finally, the Board has considered the April 2010 VA opinion concluding the Veteran’s skin rash of uncertain etiology is not related to his service. However, the examiner provided little to no rationale for that conclusion, stating only that there was no documentation of a skin rash in service or within one year following service separation. However, as already discussed, the Veteran has reported experiencing skin rash symptoms – albeit intermittently, since his service. These statements do not appear to have been considered by the VA examiner. Accordingly, the Board finds that service connection for a skin disorder is warranted. KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Erdheim 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.