Citation Nr: 21023850 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 17-64 240 DATE: April 21, 2021 ORDER Entitlement to service connection for dermatitis eczema and onychomycosis is granted. Entitlement to service connection for chloracne, to include as due to herbicide exposure, is granted. FINDINGS OF FACT 1. The competent and credible evidence of record is at least in equipoise that dermatitis eczema and onychomycosis are attributable to the Veteran’s service. 2. The competent and credible evidence of record is at least in equipoise that chloracne is attributable to the Veteran’s service. 3. The Veteran is presumed to have been exposed to herbicide agents. CONCLUSIONS OF LAW 1. The criteria to establish entitlement to service connection for dermatitis eczema and onychomycosis have been met. 38 U.S.C. § 1131 (2012); 38 C.F.R. § 3.303(d) (2019). 2. The criteria for entitlement to service connection for chloracne have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1961 to May 1965. This matter comes before the Board of Veterans’ Appeals (Board) from a March 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. In January 2020, a Board video-conference hearing was held before the undersigned Veterans Law Judge (VLJ); a transcript of the hearing is of record. In April 2020, the Board remanded the claim for additional development to include additional medical opinions. This matter has been advanced on the docket pursuant to 38C.F.R. §20.902(c). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § § 1110; 38 C.F.R. § § 3.303. Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § § 3.303(d). Service connection for a disability requires evidence of: (1) a current disability; (2) a disease or injury in service; and (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). A Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam era, and who has one of the herbicide-related diseases listed in the law, is presumed to have been exposed during such service to certain herbicide agents (ie., Agent Orange), unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. If a Veteran was exposed to an herbicide agent during military service certain skin disorders will be rebuttably presumed to have been incurred in service if manifest to a compensable degree within one year from separation, even if there is no record of such disease during service. 38 U.S.C. § § 1116; 38 C.F.R. § §§ 3.307(a)(6), 3.309(e). Chloracne is listed among the diseases presumed to be associated with herbicide agent exposure. 1. Entitlement to service connection for dermatitis eczema and onychomycosis The Veteran contends that his skin conditions are as due to service. He testified to various rashes experienced in Vietnam he called jungle rot, and what he believed was athlete’s foot. See January 2020 Hearing Transcript at p. 19 and p. 26. On remand, the VA provided an additional examination to address the inadequacies of the previous examinations to determine whether the Veteran’s skin disabilities are due to service. The January 2021 VA examination diagnosed the Veteran with dermatitis eczema and onychomycosis. The examiner found that the Veteran’s dermatitis eczema and onychomycosis began during the Veteran’s service. The examiner found and the Veteran asserts that his skin conditions have been a problem for more than 40 years. The examiner opined that a nexus could not be established because the Veteran’s conditions were not due to service because of a lack of documentation in service. These statements are inherently inconsistent and, moreover, the examiner predicates his negative opinion on a lack of documentation in service. Regardless, while the VA opinions provided were not in the Veteran’s favor, this last January 2021 examination provided a sufficient link between the Veteran’s diagnosed dermatitis eczema and onychomycosis and his service in Vietnam. The benefit of the doubt will be conferred in the Veteran’s favor and his claim is granted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 2. Entitlement to service connection for chloracne The Veteran asserts that his skin condition is due to service, to include as due to herbicide exposure. His personnel records establish that he served in the Republic of Vietnam and is, therefore, presumed to have been exposed to herbicide agents. 38 C.F.R. § 3.307 (a)(6). Chloracne and other acneform diseases consistent with chloracne are presumptively service connected for veterans exposed to herbicide agents in Vietnam where the disease becomes manifest to a degree of 10 percent or more within a year after the last date on which the veteran was last exposed to an herbicide agent during active service. 38 C.F.R. §§ 3.307 (a)(6)(ii), 3.309(e). Therefore, in order to grant service connection, the Board must find that the Veteran’s chloracne manifest to a degree of 10 percent within one year of his last presumed herbicide exposure in Vietnam. Under Diagnostic Code 7829, a 10 percent rating is assigned for chloracne with deep acne (deep inflamed nodules and pus-filled cysts) affecting less than 40 percent of the face and neck, or deep acne affecting non-intertriginous areas of the body (other than the face and neck). A 20 percent rating is assigned for deep acne affecting the intertriginous areas (the axilla of the arm, the anogenital region, skin folds of the breast, or between digits). 38 C.F.R. § 4.118, Diagnostic Code 7829. The Veteran claims that his skin condition began in Vietnam and has been continuing ever since. See January 2020 Hearing Transcript at p. 23. His service treatment records do not include any diagnoses of chloracne in service. He testified to having what looked like a cluster of moles on his head. Id. at p. 19. While this is not a specific diagnosis of chloracne, it supports the Veteran’s assertions of a skin disorder while in Vietnam and within the one-year period thereafter. A January 2021 VA examiner evaluated the Veteran’s skin and determined that he had chloracne with “lesions on his neck and shoulder that fall under the descriptive diagnosis of chloracne as they are cysts with dilated pores with blackheads”. He also agreed that it was as due to herbicide exposure, but found that it was not to a compensable degree. While there is no contemporaneous medical evidence of the Veteran’s chloracne within one year of his service in Vietnam to a compensable degree, his assertions and the VA examiner’s agreement that it is due to herbicide exposure are sufficient for the Board to find that the evidence is, at a minimum, in equipoise regarding the question of whether his chloracne began within one year of his last herbicide exposure to warrant presumptive service connection. The benefit of the doubt will be conferred in the Veteran’s favor and his claim is granted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kelsey Love, 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.