Citation Nr: 21025444 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 17-43 755 DATE: April 28, 2021 ORDER Entitlement to service connection for a skin disorder of the feet is denied. FINDING OF FACT A skin disorder of the feet did not manifest in service and is not attributable to service. CONCLUSION OF LAW The criteria for service connection for a skin disorder of the feet are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1975 to October 1979. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In March 2020, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ). The VLJ clarified the issue, determined if there were outstanding evidence and explained the concepts of service connection. The actions of the VLJ comply with 38C.F.R. §3.103. The matter was remanded to the agency of original jurisdiction (AOJ) in June 2020 for VA examination. It has been returned to the Board. Service Connection Veterans are entitled to compensation from VA if they develop a disability "resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty." 38 U.S.C. § 1110 (wartime service), 1131 (peacetime service). To establish a right to compensation for a present disability, a veteran must show: "(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 or aggravated during service"-the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service 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). In evaluating a claim, the Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1335 (2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a “competent” source. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159 (a); Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence can also be competent and sufficient evidence of a diagnosis if (1) the medical issue is within the competence of a layperson, (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. Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). If the evidence is competent, the Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this regard, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511-12 (1995). For a medical opinion (i.e., medical evidence) to be given weight, it must be: (1) based upon sufficient facts or data; (2) the product of reliable principles and methods; and (3) the result of principles and methods reliably applied to the facts. See Nieves-Rodriquez v. Peake, 22 Vet. App. 295, 302 (2008). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). Service connection for a skin disorder of the feet is denied. The Veteran testified that he has a skin condition of the feet that is related to service, specifically from wearing boots for long periods of time in hot weather during service at Camp Lejeune. The Board notes that the Veteran’s service treatment records (STRs) document treatment for dry skin in April 1979. Further, the Veteran reported current or history of foot trouble and a skin disorder on his September 1979 report of medical history in conjunction with his separation from service. However, the skin and feet were found to be normal on the corresponding separation clinical evaluation. The remainder of the STR is absent complaints of or treatment for a skin disorder that may be related to the feet. The Veteran is competent to attest to wearing boots in hot weather. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). His available service personnel and treatment records document his service at Camp Lejeune. He testified that he thinks that his skin condition of the feet is related to exposure to contaminated water during his service at Camp Lejeune. Additionally, post service treatment records document treatment for tinea pedis of the feet in 2001 which the Veteran asserted at the time had been present since his early 20’s. See a VA treatment record dated in December 2001. The Board remanded this matter to obtain a medical opinion on whether the Veteran’s present skin condition of the feet is due to service. The Board notified the Veteran that as he had submitted no proof of a relationship to contaminated water such theory would not be explored by VA examination or opinion unless he submitted competent evidence. The record reflects he has not submitted competent evidence; the theory was thus not explored in the examination that was accomplished in November 2020. The November 2020 Disability Benefits Questionnaire (DBQ) reflects a diagnosis of tinea pedis bilateral feet, which the examining physician noted was dated in 2007. In the reported history, the examiner noted the Veteran’s service dates and the reported onset of tinea pedis began in 1976, but also noted the Veteran is unsure of exact date. The examiner reported it was interesting to note the Veteran is quite disgruntled about the chronicity of his condition with little relief despite multiple medical evaluations. Details of onset were reported as the Veteran reporting bilateral athlete’s foot, but he was unsure of onset or etiology of his condition. The Veteran reported some unknown treatment from the VA hospital in Baltimore that was "not doing any good." The Veteran was described as circumferential about his condition, but he reported that the condition had progressed since onset. The Veteran reported worsening dryness and itching that occasionally wakes him up at night. He takes Ibuprofen 800 mg for vague pain symptoms. He reported he uses over the counter baby rash ointment and baby powder as well as Epsom salt soaks periodically. The examiner noted that podiatry records indicate topical terbinafine, ammonium lactate and tolnafate powder, and Lamisil cream without relief. Examination showed mild tinea pedis bilaterally between the 4th and 5th interdigit space without purulent drainage. The VA examiner opined that the claimed foot condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The rationale was: The veteran has very mild tinea pedis located within the bilateral 4th and 5th interdigit space of his toes without purulence, ulcer formation, or cellulitic changes, which responds quite well to the veteran's documented treatment modalities. However, tinea pedis can persist if there is treatment noncompliance as well as proper shoe and foot hygiene. This condition is broadly multifactorial and can occurred regardless of military service. In addition, the veteran was vague about symptomatology and etiology. In addition, the condition of tinea pedis can persist if there is noncompliance or incomplete treatment. The veteran could not elaborate on the duration of each treatment. Therefore, making a direct service-connected condition would be mere speculation. First, we find that the preponderance of the evidence is against the claim that his skin condition of the feet is related to exposure to contaminated water during his service at Camp Lejeune. No competent evidence has been presented to support this theory and tinea pedis is not a disease presumptively related to such exposure. Next, the preponderance of the evidence is also against finding that a nexus exists between the Veteran’s current skin disorder of the feet and service. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Here, the weight of the evidence is against finding that the currently diagnosed tinea pedis, first noted in treatment years after service, is related to service. There was no medically chronic skin disorder of the feet in service, rather, STRs reflect the feet and skin were clinically normal at separation despite the Veteran’s unsubstantiated report of skin diseases and foot trouble. Also, the VA the examiner in 2020 observed that a connection could not be anything more than speculation based on the record and the Veteran’s reports. This opinion is competent and credible as it is made by a VA physician who examined the record and the Veteran, and provided well-supported conclusions. While the Veteran’s testimony about marching in boots for many miles in the heat is informative as to the circumstances of his service, we find the 2020 opinion of the VA examiner, which was made based upon a thorough review of the claims folder and is well-supported with references to the record, to be more probative as to the issue of whether any current skin disorder of the feet is related to service, to include the reported marching in boots in service. The Board has carefully considered the Veteran’s assertions. Unfortunately, the Veteran’s contentions as to a relationship pale in comparison to the opinion of a trained medical professional. The VA examiner considered the Veteran’s theory as to a relationship and provided sound reasons for ultimately rejecting it. See Owens v. Brown, 7 Vet. App. 429, 433 (1995); Wray v. Brown, 7 Vet. App. 488 (1995) (the Board may adopt a particular independent medical expert’s opinion for its reasons and bases where the expert has fairly considered the material evidence of record). The opinion is adopted. The benefit sought on appeal is denied. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. RIPPEL, 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.