Citation Nr: 21015237 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 15-20 490 DATE: March 17, 2021 ORDER Service connection for hair loss of the scalp is denied. Service connection for a skin condition of the legs and arms is granted. VETERAN’S CONTENTIONS The Veteran contends that his hair loss of the scalp started during his active service and continued thereafter. Alternately, the Veteran contends that he has hair loss of the scalp related to in-service exposure to herbicide agents including Agent Orange. The Veteran contends that his skin condition of the legs and arms started during his active service and continued thereafter, at least intermittently. Alternately, the Veteran contends that he has a skin condition of the legs and arms related to in-service exposure to herbicide agents including Agent Orange. FINDINGS OF FACT 1. The Veteran’s hair loss of the scalp was not shown in service or for many years thereafter, and is not otherwise related to service, including herbicide exposure. 2. The Veteran’s skin condition of the legs and arms had its onset during service and continued thereafter, at least intermittently. CONCLUSIONS OF LAW 1. The criteria for service connection for hair loss of the scalp, to include as secondary to herbicide exposure, are not met. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. § 3.303. 2. The criteria for service connection for a skin condition of the legs and arms are met. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1966 to March 1968. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a March 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan. Jurisdiction is currently with the RO in Des Moines, Iowa. The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) via videoconference in October 2018. The transcript of the hearing has been associated with the claims file. These matters were previously before the Board at which times they were remanded for further development. Service Connection Generally, service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. This means that the facts establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). Additionally, a veteran who, during active service, served in the Republic of Vietnam (Vietnam) during the period beginning on January 9, 1962 and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307 (a)(6)(iii). If a veteran is presumed to have been exposed to an herbicide during such active service, the veteran shall be service connected for the diseases listed under 38 C.F.R. § 3.309 (e) if the disability manifested to a degree of 10 percent or more at any time after active service. See 38 C.F.R. § 3.307(a)(6)(ii). Where presumptive service connection is not warranted because the claimed disability is not listed under 38 C.F.R. § 3.309(e), the Board must consider whether there is competent evidence that shows that the claimed condition was actually caused by the Veteran's active service, including herbicide exposure. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); Combee v. Brown, 34 F.3d 1039, 1042 (1994). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical evidence. VA must also consider all favorable lay evidence of record. See 38 U.S.C. § 5107(b); see also Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). 1. Entitlement to service connection for hair loss of the scalp At the outset, the Board finds that although the Veteran served in the Republic of Vietnam (Vietnam) during the Vietnam era, service connection for hair loss of the scalp is not warranted on a presumptive basis as due to herbicide exposure, including Agent Orange, because the herbicide presumption set forth in 38 U.S.C. § 1116 and 38 C.F.R. § 3.307 does not apply. Hair loss of the scalp is not an enumerated disability that is presumed due to herbicide exposure listed under 38 C.F.R. § 3.309(e). Turning to the issue of direct causation, in addressing the criterion of a current diagnosis, the evidence of record includes a November 2019 VA Skin Diseases report of examination in which the examiner diagnosed the Veteran with male pattern baldness. In addressing in-service incurrence, the Veteran's military personnel records confirm service in Vietnam. The RO conceded herbicide exposure in its October 2014 rating decision. The Veteran's service treatment records (STRs) are void of complaints of or treatment for hair loss of the scalp and/or related symptoms. In addressing nexus, to the extent that the Veteran has stated that he has hair loss of the scalp attributable to service, the Board finds that he is competent to report on his symptoms and that of which he has personal knowledge, but he is not competent to provide an opinion as to the etiology of his disabilities because such a question is not answerable by the application of knowledge within the realm of a lay person. See Layno, 6 Vet. App. at 469-70; Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Therefore, the Board finds that the Veteran is not competent to relate his hair loss of the scalp to his service or to any incident therein. The evidence of record otherwise includes an opinion from a November 2019 VA examiner that the Veteran’s hair loss was less likely than not related to service, including exposure to herbicides. The examiner reasoned that the Veteran’s hair loss was of the normal male pattern baldness; no areas of alopecia were seen. The examiner further reasoned there was no mention of hair loss in service, specifically no mention of alopecia. In September 2020 the Board remanded the Veteran’s claim for an addendum opinion and an examiner again opined that the Veteran’s hair loss was less likely than not related to service. The examiner reasoned that the Veteran’s separation examination was negative for hair loss; he was determined to be in good health and his head and scalp clinical examination was unremarkable. In November 2020 and January 2021 VA addendums requested by the RO an examiner also opined that the Veteran’s hair loss was less likely than not related to service. The examiner acknowledged the Veteran’s lay statements and emphasized that the Veteran did not indicate any hair loss during service or within one year of discharge from service. His March 1968 head and scalp clinical examination was unremarkable. In determining that the hair loss was not related to service, the examiner explained that male androgenetic alopecia is a common postpubertal disorder that occurs worldwide and exhibits increasing prevalence with age and review of medical literature does not indicate that herbicide exposure is a risk factor for hair loss. The Board finds the November 2020, and January 2020 VA examiner opinions to be highly probative. The opinions were based on examination of the Veteran, a review of the claims file, relevant facts, and peer reviewed medical literature, and the examiners provided detailed rationales. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). In sum, without any competent evidence that the Veteran has hair loss of the scalp related to service, direct service connection is not warranted. The Board finds that the Veteran's hair loss of the scalp was not shown in service or for many years thereafter, and is not otherwise related to service, including herbicide exposure; therefore, service connection is not warranted. There is no doubt to be resolved in this case. 38 U.S.C. § 5107. 2. Entitlement to service connection for a skin condition of the legs and arms At the outset, the Board finds that although the Veteran served in Vietnam during the Vietnam era, service connection for the Veteran’s skin condition of the legs and arms is not warranted on a presumptive basis as due to herbicide exposure, including Agent Orange, because the herbicide presumption set forth in 38 U.S.C. § 1116 and 38 C.F.R. § 3.307 does not apply. The Veteran’s skin condition of the legs and arms is not an enumerated disability that is presumed due to herbicide exposure listed under 38 C.F.R. § 3.309(e). There is no indication that the Veteran’s skin condition of the legs and arms has been diagnosed as chloracne or other acneform disease consistent with chloracne, which is an enumerated disability that is presumed due to herbicide exposure listed under 38 C.F.R. § 3.309(e). Turning to the issue of direct causation, in addressing the criterion of a current diagnosis, the evidence of record includes June 2015 Private Treatment Records in which a clinician confirmed a current diagnosis of photosensitivity of the forearms and August 2020 VA Treatment Records in which a clinician confirmed a current diagnosis of persistent pruritus. In addressing in-service incurrence, the Veteran's military personnel records confirm service in Vietnam. The RO conceded herbicide exposure in its October 2014 rating decision. The Veteran's STRs document complaint and treatment of rash over both arms and back and a diagnosis of miliaria. As indicated above, the Veteran contends that his skin condition of the legs and arms started during his active service and continued thereafter, at least intermittently. Alternately, the Veteran contends that he has a skin condition of the legs and arms related to in-service exposure to herbicides including Agent Orange. In addressing nexus, the Veteran is competent to report on his observed symptoms and on the circumstances of his injuries during and after service. The Veteran has consistently and credibly stated that his skin condition of the legs and arms started during his active service and continued thereafter. See May 2014 Notice of Disagreement. See October 2018 Board Hearing Transcript. Post-service treatment records document the Veteran's chronic symptoms. Accordingly, the Board finds that the Veteran's report of a skin condition of the legs and arms which started during active service and continued thereafter both competent and credible. See Owens v. Brown, 7 Vet. App. 429 (1995); Elkins v. Gober, 229 F.3d 1369 (Fed. Cir. 2000); Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997); Guimond v. Brown, 6 Vet. App. 69 (1993); Hensley v. Brown, 5 Vet. App. 155 (1993); Caluza v. Brown, 7 Vet. App. 498 (1995); Wood v. Derwinski, 1 Vet. App. 190 (1991). The Board acknowledges that the evidence of record includes VA examiner opinions which conclude that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. However, the examiners continued to base their opinions on a lack of a skin condition documented on the Veteran’s separation examination or within one year of service without addressing the Veteran’s competent lay statements of continuity of symptomatology at least intermittently since service. In short, the negative medical opinions of record are inadequate. Otherwise, the evidence of record includes medical evidence which confirms an initial onset of a skin condition of the legs and arms during service and a current skin condition. As the Veteran's service treatment records, post-service medical records, and credible lay statements establish a continuity of symptomatology since service, at least intermittently, service connection for a skin conditions of the legs and arms is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). S.C. Krembs Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Smith-Jennings, 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.