Citation Nr: 21015537 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 17-37 792 DATE: March 17, 2021 ORDER Entitlement to service connection for a skin condition secondary to service-connected pulmonary emboli with sleep apnea and sarcoidosis is denied. FINDING OF FACT The Veteran’s skin condition neither began during or was otherwise caused by his military service and was neither caused nor aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for entitlement to service connection for a skin condition secondary to service-connected pulmonary emboli with sleep apnea and sarcoidosis have not been met. 38 U.S.C. §§ 1110, 1111, 1153, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1975 to December 1979. This matter was previously remanded by the Board of Veterans’ Appeals (Board) in February 2019 and November 2020. In consideration of the appeal, the Board is satisfied there was substantial compliance with the remand directives and will proceed with review. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for a skin condition secondary to service-connected pulmonary emboli with sleep apnea and sarcoidosis The Veteran contends that he is entitled to service connection for a skin condition. Specifically, the Veteran asserts that his current skin condition was caused or aggravated by his service-connected pulmonary emboli with sleep apnea and sarcoidosis. 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). Service connection may be established on a secondary basis for disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Where a service-connected disability aggravates a nonservice-connected condition, a veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Id. The Veteran had an examination for his skin condition in June 2016. The examiner opined that the Veteran’s skin condition was less likely than not proximately due to or the result of the Veteran's service-connected condition. The examiner stated that “[t]here is no current diagnosis of a sarcoid skin condition, per review of current medical literature, there is no correlation/relationship between the current diagnosis of lichens simplex chronicus and sarcoidosis.” In a July 2016 statement, the Veteran stated that his skin condition is a residual of his service-connected pulmonary sarcoidosis. He further stated that he was discharged for this condition and that he has continued to suffer from this condition since separation. The Veteran had another examination for his skin condition in October 2019. The examiner opined that it was less likely than not that the Veteran’s skin condition was proximately due to or the result of the Veteran's service-connected condition. The examiner stated that the Veteran’s skin condition is lichen simples chronicus. The examiner further noted that there are no skin manifestations of sarcoidosis. Additionally, the examiner noted that the Veteran’s sarcoidosis was in remission with no signs of recurrence. An addendum medical opinion was obtained in September 2020. The examiner opined that it was less likely than not that the Veteran’s skin condition was proximately due to or the result of the Veteran's service-connected condition. The examiner stated that a review of the medical literature indicates that the Veteran’s lichen simplex chronic is not related to his service-connected conditions, including his sarcoidosis. In accordance with the November 2020 Board remand, the Veteran had another examination for his skin condition in December 2020. The examiner opined that it was less likely than not that the Veteran’s skin condition was incurred in or caused by his active duty service. The examiner noted that the Veteran was diagnosed and treated for a cutaneous sarcoid skin condition during service. The examiner stated that the Veteran does not have a current active diagnosis of cutaneous sarcoid. The examiner stated that the Veteran is currently diagnosed with Lichen Simplex Chronicus and that this condition is not related to his cutaneous sarcoid condition. Further, the examiner stated that there was no objective evidence of a current active cutaneous sarcoid skin condition. The examiner concluded that since there is no evidence of chronicity of care, a nexus cannot be established. The examiner further opined that it was less likely than not that the Veteran’s skin condition was caused by his service-connected disabilities, to pulmonary emboli with sleep apnea and sarcoidosis. The examiner stated that the conditions of Lichen Simplex Chronicus and pulmonary emboli with sleep apnea and sarcoidosis are not medically related. The examiner indicated that the Veteran’s skin condition is “a separate entity entirely from the pulmonary emboli with sleep apnea and sarcoidosis and unrelated to it.” The examiner further stated that the Veteran does not have a current diagnosis of an active cutaneous sarcoid, and the Veteran is currently diagnosed with Lichen Simplex Chronicus, which is not related to pulmonary emboli with sleep apnea and sarcoidosis. Additionally, the examiner noted that a thorough review of medical literature failed to demonstrate a causal relationship between the Veteran’s current skin condition and his service-connected pulmonary emboli with sleep apnea and sarcoidosis. Additionally, the examiner opined that it was less likely than not that the Veteran’s skin condition was aggravated by his service-connected disabilities, to include his service-connected pulmonary emboli with sleep apnea and sarcoidosis. The examiner stated that there was no evidence to support that the Veteran’s current skin condition of Lichen Simplex Chronicus was aggravated beyond its natural progression by the Veterans service-connected pulmonary emboli with sleep apnea and sarcoidosis. Upon review of the record, the Board finds that service connection for a skin condition is not warranted. The Board finds the December 2020 examiner’s medical opinion to be highly probative because it provided an adequate rationale based on the relevant evidence of record and pertinent medical literature. The examiner indicated that the Veteran’s current condition is not related to his in-service cutaneous sarcoid condition. Furthermore, the examiner indicated that the medical evidence of record did not demonstrate chronicity of care since separation. Additionally, the examiner indicated that, based on the evidence of record and the relevant medical literature, the Veteran’s current skin condition was not caused or aggravated by his service-connected disabilities. The examiner provided the underlying medical reasons for the conclusions reached. The opinion is not contradicted by the competent, probative evidence of record. To the extent that the Veteran believes that his skin condition is linked to his active duty service or was caused or aggravated by his service connected disabilities, principally his pulmonary emboli with sleep apnea and sarcoidosis, the Board notes that he is competent to provide testimony concerning factual matters of which he has fight-hand knowledge and experiences through his senses. Barr v. Nicholson, 21 Vet. App. 303 (2007). However, the question regarding the etiology of his skin condition is an issue of causation of a medical condition, which requires a medical determination outside the realm of common knowledge of any lay person. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, his lay statements alone are not sufficient to establish the required nexus in this case. The Board must then rely on the available and probative medical evidence, which have found no nexus between the Veteran’s skin condition and his military service and that it is less likely than not that his skin condition was caused or aggravated by his service-connected disabilities. In sum, the evidence preponderates against the claim for service connection for a skin disability on a direct or secondary basis. There is no reasonable doubt to be resolved, and the claim of entitlement to service connection for a skin disability, to include as secondary to service-connected pulmonary emboli with sleep apnea and sarcoidosis must be denied. 38 C.F.R. §§ 3.303, 3.310. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board David M. Sebstead, 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.