Citation Nr: 21024077 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 16-04 892 DATE: April 22, 2021 ORDER Service connection for a skin disability, including eczema and dermatitis, is granted. FINDING OF FACT Resolving all reasonable doubt in the Veteran's favor, the currently diagnosed skin disability, including eczema and dermatitis is at least as likely as not directly related to active service. CONCLUSION OF LAW The criteria for entitlement to service connection for a skin disability, including eczema and dermatitis have been satisfied. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1963 to October 1967. He had service in the Republic of Vietnam from January 1966 until January 1967. He was awarded the Vietnam Service Medal and the Air Force Good Conduct Medal, among other decorations, for this service. This matter is before the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). In August 2017, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ); a transcript of the hearing is associated with the claims file. The claim was previously before the Board in September 2018 wherein the Board, in part, denied the benefits sought on appeal. The Veteran appealed that decision to the Court of Appeals for Veterans Claims (Court), which partially vacated the decision pursuant to an October 2019 Joint Motion for Partial Remand. The Board again remanded the claim in April 2020. After a review of each remand and the request for an expert medical opinion, the Board is satisfied that there has been substantial compliance with its requested actions and no further action is necessary to comply with the remands directives. Therefore, the case is once again before the Board for appellate consideration of the issue on appeal. Stegall v. West, 11 Vet. App. 268 (1998). With regards to the claims for service connection for a skin disability, the Veteran has not raised any issues with the duty to notify or duty to assist. See Scott v McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board...to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist argument). Furthermore, given the favorable outcome in this decision that represents a full grant of these issues, further explanation of how VA has fulfilled the duties to notify and assist is not necessary. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). 1. Service Connection for a Skin Disability. The Veteran contends his currently diagnosed skin disability, to include eczema and dermatitis is directly related to service. After considering the lay and medical evidence of record, the Board finds that service connection is warranted for a skin disability, to include eczema. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, service connection for a disability requires evidence of: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). The Veteran has, in part, claimed the currently diagnosed eczema was caused by exposure to herbicides. However, here, the Veteran had in-service treatment for skin conditions, has reported continuous symptoms of the skin condition since, and the medical evidence is inconclusive on the etiology of the skin disability. Therefore, as discussed below, the Board finds the skin disability was directly incurred during service and a discussion of herbicide exposure is not necessary to the grant of the claim. First, the Board finds that the Veteran has current diagnosis of eczema and dermatitis. Specifically, May 2013 and January 2021 VA examiner have diagnosed dermatis and eczema. Further, the Veteran has reported a recurring skin disability, which the Board finds he is competent to do. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Service treatment records show the Veteran was treated in November 1964, October 1966 for a skin rash, assessed as allergy to water content. He was referred to the dermatologist who diagnosed his condition as milaria rubra (heat rash). His exit examination is silent regarding skin conditions. Post service VA treatment records show treatments in 2004 and 2006, 2007, 2008 for skin rash in legs, arms, and chest diagnosed as allergic reaction. A biopsy was performed in May 2008. The examiner observed a slightly erythematous spongiotic patch on the right medial thigh, assessed as nummular dermatitis. Current VA treatment records show a diagnosis of dermatitis. Turning to a nexus, the Board finds that the lay and medical evidence of record are in relative equipoise regarding a causal link between the Veteran's service, to include in-service treatment for a skin disability, and his current skin disability, including eczema. Specifically, while May 2013 and January 2021 VA examiner’s opined that the current skin disability was less likely than not caused by service, both examiners failed to provide an adequate rationale. However, the January 2021 VA examiner noted that the Veteran described a rash he developed just prior to return from Vietnam and states that in later 1960s private doctors diagnosed this as eczema. The examiner found the Veteran’s reports of continuous symptoms of the skin disability that began in service credible. While the examiner opined the condition was less likely than not related to service, the examiner also indicated that the etiology of eczema is poorly understood. The examiner also noted that the etiology of eczema is multifactorial and can be genetic but also noted that environment can be a factor. There can be no doubt that further medical inquiry could be undertaken with a view towards development of the claim. Specifically, the Board could seek further examination to clarify and definitively opine on the nature and etiology of the skin disability, including eczema. The January 2021 examiner stated the evidence showed chronicity. The examiner also indicated the Veteran’s report of symptoms was credible but it was difficult to get to 50% likelihood it was related to exposure to herbicides. The examiner, stating that the medical literature on a disability is poorly understood, is in itself probative here to give greater weight to the Veteran’s lay reports of continuous symptoms. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). Further the Veteran has reported that he was diagnosed with eczema in the 1960s. Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Accordingly, given the existence of evidence both for and against the claims, the Board finds that the competent evidence is in favor of finding that the skin disability, including eczema was incurred during service. Upon resolution of all reasonable doubt in the Veteran's favor, the Board concludes that service connection is now warranted for a skin disability, including eczema. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Teague, 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.