Citation Nr: 21021376 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 17-29 586 DATE: April 12, 2021 ORDER Entitlement to service connection for a skin disability, to include as due to herbicide agent exposure, is denied. FINDING OF FACT The Veteran’s skin disability, diagnosed as hemangioma, urticaria, atopic dermatitis and seborrheic keratosis, did not have its onset in service and is not otherwise related to the Veteran’s service, to include presumed herbicide agent exposure. CONCLUSION OF LAW The criteria for service connection for a skin disability, to include as due to herbicide agent exposure, have not been met. 38 U.S.C. §§ 1110, 1116, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from March 1968 to April 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of an August 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Chicago, Illinois. In December 2019, the Veteran testified during a video conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. This matter was previously before the Board in January 2020 and January 2021, at which time it was remanded for further development. Service Connection Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). VA regulations provide that certain diseases associated with exposure to herbicide agents, including chloracne or other acneform disease consistent with chloracne, may be presumed to have been incurred in service even if there is no evidence of the disease in service, provided the requirements of 38 C.F.R. § 3.307 (a)(6) are met. 38 C.F.R. § 3.309 (e). A Veteran who, during active service, served in the Republic of 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), (d); 3.309 (e). Thus, if a Veteran meets the requirements of the herbicide agent presumption and has a current diagnosis from the list of specified diseases, VA will presume in-service incurrence and a causal relationship (nexus), and grant service connection. In this case, the Veteran did serve in Vietnam during the statutory period of January 9, 1962 to May 7, 1975, and there is no affirmative evidence to establish that the Veteran was not exposed to herbicide agents during that service. Thus, if the Veteran has a current diagnosis of chloracne or other acneform disease consistent with chloracne, the VA will presume in-service incurrence and a causal relationship (nexus), and grant service connection. Skin disability The Veteran claims that he developed a skin rash because of his service, to include as due to exposure to herbicide agents. His service treatment records, to include a January 1968 entrance examination and April 1971 separation examination, are silent for any diagnosis or treatment of any issues related to the skin. VA treatment records from the appeal period show multiple diagnoses for skin disorders, including dermatitis, dyschromia, dandruff, and dry skin. In July 2013, a dermatology consultation was sought, and a diagnosis was reported including hemangioma, which was excised, and the pathology report showed it was consistent with hemangioma, urticaria, eczema, seborrheic dermatitis and was treated conservatively. In March 2018 he was seen at VA for what was characterized as a “chronic rash.” In a May 2017 letter, B.A., a registered nurse for 30 years, explained that the Veteran’s skin rash was chloracne, which developed due to herbicide exposure. At the December 2019 hearing, she testified that it was her belief that the Veteran’s skin conditions were related to his in-service herbicide exposure. In February 2020, the Veteran underwent a VA examination. At that time, the examiner acknowledged a history of skin issues such as hemangioma, urticaria, atopic dermatitis and seborrheic keratosis. However, he determined that at the time of the examination, the Veteran did not have any present skin disorders. In a June 2020 addendum, the examiner explained that the Veteran’s skin issues were not related to his military service because they did not appear until several years after service, and that hemangioma is not considered a disease that is related to herbicide exposure. An additional VA addendum opinion was provided in February 2021. After a review of the record, the February 2021 VA examiner stated the Veteran’s skin disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted the Veteran asserts that he developed a skin rash because of his service, to include as due to exposure to herbicide agents. Service treatment records were silent for complains, issues, events, diagnosis, and treatment for a skin condition. Interim medical records from 1972-2012, which is a 40-year healthcare gap, were silent for onset and chronicity of skin dermatologic conditions. In 2013 a dermatology consultation was sought and reported a diagnosis to include hemangioma, which was excised. The pathology report was consistent with hemangioma, urticaria, eczema, seborrheic dermatitis and was treated conservatively. Veteran reports chronic skin lesions thereafter. A 2017 letter from a registered nurse which explains that the Veteran’s skin rash was chloracne was noted. However, the Veteran was clinically assessed and physically examined by a dermatologist specialist on these specific skin lesions and did not at any point correlate this with any chloracne condition. Overall review of medical records showed limited medical objective evidence to show onset and chronicity of dermatologic skin diseases in relation to service. Any skin lesions associated with herbicide exposures will demonstrate pathologic skin diseases close to date and time of exposure or within 10 years range. Hence, a nexus cannot be endorsed at this point. Therefore, it is less likely than not that any of the Veteran’s diagnosed skin disorders, including but not limited to hemangioma, urticaria, atopic dermatitis and seborrheic keratosis, had onset in, or are otherwise related to his service. With respect to a nexus between the Veteran’s skin disability and service, the Board notes that the record contains conflicting medical opinions. The United States Court of Appeals for Veterans Claims has stated that the probative value of medical opinion is based on the expert’s personal examination of the patient, the physician’s knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches. Further, the credibility and weight to be attached to these opinions are within the province of the adjudicator. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). As such, the Board may appropriately favor the opinion of one competent medical authority over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). In favor of a finding of a nexus because the Veteran has a presumptive condition, chloracne, is B.A., a registered nurse. However, as the February 2021 VA examiner pointed out, the Veteran was clinically assessed and physically examined by a dermatologist specialist on these specific skin lesions and did not at any point correlate this with any chloracne condition. The Board assigns more probative weight to the clinical diagnoses of a dermatologist specialist than the opinion of B.A., who is not shown to possess the same level of skill and training to offer a clinical diagnosis of chloracne. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Against a finding of a nexus, as well as against a finding of a diagnosis of chloracne, is the opinion of the February 2021 VA examiner. The Board finds that the February 2021 examiner’s opinions are due great probative value. The VA examiner provided the opinions based on an accurate understanding of the Veteran’s medical history and on the examiner’s own knowledge and expertise. Furthermore, the VA examiner provided a rationale that explains the conclusions and gives insight into the medical aspects of the Veteran’s skin disability. See Nieves- Rodriguez, 22 Vet. App. at 295. The Board accepts the VA examiner’s opinions as probative evidence that the Veteran’s skin disability is less likely than not related to service, to include exposure to herbicide agents. As discussed above, the Veteran served in the Republic of Vietnam during the Vietnam War era and is presumed to have been exposed to herbicide agents. However, the Veteran’s skin disability, diagnosed as hemangioma, urticaria, atopic dermatitis and seborrheic keratosis are not conditions which have been deemed associated with herbicide exposure under current VA law. Therefore, service connection cannot be awarded under the laws governing presumptive service connection based on exposure to herbicides. 38 U.S.C. § 1116 (f); 38 C.F.R. §§ 3.307 (a)(6)(iii), 3.309(e). The weight of the evidence provides that the Veteran has been diagnosed with skin disabilities other than chloracne. Even so, to be presumptively service connected under 38 U.S.C. § 1116, chloracne must manifest within one year of the Veteran’s last in-service exposure to the herbicide agents. The Veteran went decades after service without manifesting his skin condition. Presumptive service connection must be denied. While the Veteran believes the skin disability is related to service, he is not competent to provide a nexus in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives little probative weight to the Veteran’s assertions that his skin disability is due to service. In light of the above, the preponderance of the evidence is against the claim and the benefit-of-the-doubt doctrine is not for application. The claim therefore must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. St. Laurent, 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.