Citation Nr: 21022681 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 15-14 876A DATE: April 19, 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 did not have a skin disorder related to his active service. 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, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1966 to January 1968, including service in Vietnam. He died in June 2016. The appellant has been substituted for the Veteran in this appeal. See November 2018 Appeal Notification letter. This case initially came to the Board of Veterans’ Appeals (Board) on appeal from a January 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) which, inter alia, denied entitlement to service connection for skin condition/tinea versicolor. In June 2019, September 2020, and February 2021, the Board remanded the matter for further evidentiary development. In response to the Board’s February 2021 remand, a medical opinion was obtained, and for the reasons indicated in the discussion below, was adequate to decide the claim. The agency of original jurisdiction therefore complied with the Board’s remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). A veteran, who, during active military service, served in the Republic of Vietnam during the period beginning in January 1962 and ending in May 1975, is presumed to have been exposed to herbicide agents, including Agent Orange. 38 U.S.C. § 1116 (f); 38 C.F.R. § 3.307 (a)(6)(iii). Service in the Republic of Vietnam includes service both on the landmass of Vietnam and on its 12 nautical mile territorial sea. Procopio v. Wilkie, 913 F.3d 1371, 1380-81 (Fed. Cir. 2019). If a veteran was exposed to Agent Orange during active military, naval, or air service, certain listed diseases, including type II diabetes and prostate cancer, are presumptively service connected. 38 C.F.R. § 3.309 (e). Although tinea versicolor is not among the diseases presumptively associated with herbicide agent exposure, entitlement to service connection can nevertheless be demonstrated on a direct basis. See 38 U.S.C. § 1113 (b); 38 C.F.R. § 3.303 (d) (the availability of service connection on a presumptive basis does not preclude consideration of service connection on a direct basis); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994) (Radiation Compensation Act does not preclude a veteran from establishing service connection with proof of actual direct causation). 1. Skin Disorder In an April 2013 statement, the Veteran reported that he was treated for a skin condition/rash in service, and the condition may be tinea versicolor. He indicated that the skin condition affected mainly the chest and arms and may be associated with Agent Orange exposure. The Veteran’s service treatment records (STRs) shows the Veteran reported itching skin in September 1967. At his January 1968 separation examination, his skin was evaluated and noted as normal. Post-service clinical records show the Veteran exhibited a macular rash on low back and both upper arms in October 1983. An impression of probable tinea versicolor was noted. Private treatment records show the Veteran denied sores, pruritis, dryness and rash in October 2014. In November 2014, the Veteran denied having skin rash. November 2019 and September 2020 opinions were obtained that the Board found inadequate and the Board will therefore not discuss these opinions further. In a February 2021 VA medical opinion, the physician opined that the Veteran’s skin disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The physician explained that the Veteran’s service records verifies service in Vietnam, and the November 2019 VA examination report revealed no current skin disorder. The treatment record dated in October 1983 by ambulatory care shows prescription for tinea versicolor with Selsun Blue three times a week and return to clinic in one month. The physician cited literature titled, Skin diseases associated with Agent Orange and other organochlorine exposures, by A.T., July 22, 2015, which notes that physicians can assure patients that it is unlikely that their skin disease is associated with Agent Orange, while still encouraging the veteran to see their local VA environmental health coordinator for official registration if concerns persist. The physician concluded that the Veteran’s medical records do not support that any currently diagnosed condition(s) related to the Veteran’s claimed tinea versicolor is/are at least as likely as not incurred in or caused by the Veteran’s service, to include the Veteran’s presumed exposure to herbicide agents in Vietnam As the February 2021 physician explained the reasons for his conclusions based on an accurate characterization of the evidence in the record, to include addressing the October 1983 treatment record and adequately set forth the medical principles underlying the conclusion by citing the relevant conclusion of pertinent literature on skin disorders and Agent Orange exposure, his opinion is entitled to substantial probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning; threshold considerations are whether the person opining is suitably qualified and sufficiently informed). There is no contrary medical opinion in the evidence of record. Moreover, the evidence of record does not contain medical evidence or lay statements indicating continuation of a skin condition since service. In addition, to the extent that the appellant and lay witnesses assert, and the Veteran asserted, that a skin disability is related to service, lay witnesses are competent to testify as to their observations including simple medical matters such as a broken leg. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). The appellant is, and the Veteran was, not, however, competent to opine on complex medical matters such as the etiology of skin disorder, which is an internal medical process that extends beyond an immediately observable cause-and-effect relationship that is of the type that the courts have found to be beyond the competence of lay witnesses. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). To the extent that these statements are competent, the Board finds the specific reasoned opinions of the November 2019, September 2020, and February 2021 VA clinicians to be of greater probative weight than the more general lay assertions of record. For the reasons and bases set forth above, the preponderance of the evidence is against the claim of service connection for a skin disorder. The benefit of the doubt doctrine is therefore not for application and the claim must be denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Walker, 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.