Citation Nr: 21025471 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 15-00 722A DATE: April 28, 2021 ORDER Service connection for a skin disorder of the left foot is granted. Service connection for a skin disorder of the right foot is granted. Service connection for a respiratory condition is granted. REMANDED Service connection for leukopenia, claimed as low white blood cell count, is remanded. FINDINGS OF FACT 1. The Veteran has a current diagnosis of a skin disorder of his bilateral feet and the reasonably credible evidence establishes that his symptoms started in service and have been recurrent since. 2. The Veteran’s respiratory condition was caused by his exposure to welding and paint fumes in service. CONCLUSIONS OF LAW 1. The criteria for service connection for a skin disorder of the bilateral feet are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for service connection for a respiratory condition are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1966 to January 1968. 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 Boston, Massachusetts. The Veteran and his spouse testified at a Board hearing before the undersigned Veterans Law Judge in March 2021. A transcript of the hearing is of record. Initially, the Board notes that the RO evaluated the Veteran’s claims for service connection for the feet as claims for arthritis, and denied his claim for a skin disorder on the ground that new and material evidence was not presented. The Veteran has clarified that he did not have arthritis of the feet, but that his skin disorder was present on his feet. Accordingly, the Board has recharacterized the claims for his feet to better reflect the Veteran’s contentions. The Board also notes that new and material evidence is not required for consideration of the claims for service connection for a skin disorder of the feet. Although a December 1982 rating decision denied a claim for service connection for a skin condition, that decision did not become final because relevant service treatment records were associated with the claims file after that decision. Any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim as opposed to requiring new and material evidence to reopen it. 38 C.F.R. § 3.156(c). Here, the record reflects that the Veteran’s service treatment records (STRs) were first added to the record in November 2014. The records are relevant to the claims for a skin condition as they reflect the Veteran’s treatment for rashes at various times during active service. Accordingly, the Board will consider the claims for service connection for a skin disorder of the bilateral feet on a de novo basis. The Veteran’s Contentions The Veteran contends that he has a skin condition on his bilateral feet that started in service and has been ongoing since. The Veteran also contends that his respiratory condition is a result of his exposure to fumes as a welder and painter in service. Alternatively, the Veteran argues that his conditions are a result of his exposure to contaminated water at Camp Lejeune. Service Connection Generally, service connection will be granted if the evidence demonstrates that a current disability resulted from a disease or injury in active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection requires evidence of a current disability, an in-service incurrence, disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). Skin Condition of Bilateral Feet The Veteran is able to establish the existence of a current disability as the VA treatment records reflect that he has been treated for a rash and the Veteran credibly testified that he experiences a rash on his feet. The Veteran claims that the skin problems started in service on his hands and eventually moved to his feet. The Veteran also testified that he has had flareups of the rash condition since his discharge. STRs confirm that the Veteran experienced rashes in service. Specifically, he was noted to have a rash on his left hand in July and August 1966 and was treated for a rash on his face in June 1967. The Veteran has consistently reported that his skin condition started in service on his hands and spread to his feet, and that it has been an ongoing problem. The Veteran’s spouse also testified that she saw the Veteran’s skin condition while he was still in service and that the condition has continued to reoccur. Post-service private treatment records reflect treatment for rashes, including on his feet, as early as 1982. An April 1982 private treatment note indicated that the Veteran had tinea pedis while in service and a December 1982 note documented lesions on both feet. A September 1982 private treatment note indicated that the Veteran’s skin complaints started in service and that he still had the condition when he left service. The treating physician opined that the condition was “service-connected.” Private treatment records from March 1997 also document skin lesions on the Veteran’s feet. The Veteran also explained that his older medical records had been destroyed. A November 2014 VA medical opinion concluded that the skin condition on the Veteran’s feet was not related to service because of the lack of any documentation of a condition in the January 1968 separation examination and the lack of any evidence of a current skin condition. The Board finds the opinion of the November 2014 VA examiner inadequate. As noted, the record reflects the existence of a current skin disorder on the Veteran’s feet. The Board declines, however, to remand for another VA medical opinion as “[t]he development of evidence in connection with claims of service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination.” 38 C.F.R. § 3.304(c); see Mariano v. Principi, 17 Vet. App. 305, 312 (2003). Here, the STRs reflect skin conditions during service, the Veteran competently and credibly testified that the skin condition on his hands in service spread to his feet and has been an ongoing problem since service. Private treatment records document the Veteran’s treatment for a skin disorder on his feet after service and note the continuous nature of the problem. The Veteran and his spouse’s lay testimony is competent to establish the presence of observable symptomatology and may provide sufficient support for a claim for service connection. See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). In light of the competent medical and lay evidence confirming that the Veteran had a skin condition in service that spread to his feet and continued after discharge, the claim for service connection for a skin disorder for the Veteran’s bilateral feet is granted. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303(a). Respiratory Condition The Veteran is also able to establish the existence of a current respiratory disability. The September 2014 VA examination noted the Veteran’s diagnosis of constrictive bronchiolitis dating to the 1980s. The private and VA treatment records confirm the Veteran’s longstanding respiratory problems. The Veteran contends that his respiratory condition started in service as a result of his exposure to gas in training and his exposure to welding and paint fumes. The Veteran testified and submitted lay statements explaining that that he worked as a welder indoors with poor ventilation and no respiratory protection. The Veteran’s military personnel records confirm his duties as a metal worker in service. As to the nexus issue, the September 2014 VA examiner noted the Veteran’s exposure in service and his episodes of bronchitis at least several times yearly over the decades following his discharge. The examiner also noted that the Veteran was a nonsmoker and had no known allergies. The VA examiner concluded that the Veteran’s respiratory condition was most likely a result of his pulmonary exposures from welding and painting in service. A November 2014 VA medical opinion concluded that the Veteran’s respiratory condition was less likely than not incurred in or caused by service because his condition appeared to involve allergies and there was no evidence of chronic breathing conditions while on active duty. The November 2014 VA examiner concluded that the Veteran’s bronchiolitis was less likely than not related to service because he was only exposed to vapors from welding and painting in service for two years and worked as a self-employed mechanic after service, with the expectation that he would be exposed to similar fumes in that capacity over a longer period of time. The Board finds the opinion of the September 2014 VA examiner probative and entitled to weight. The examiner reviewed the relevant records, examined the Veteran and provided a sufficient rationale supporting the conclusion that his condition was related to service. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Board affords less probative weight to the November 2014 VA medical opinion. That VA examiner based his opinion on the belief that the Veteran had allergies, which is not supported by the record and specifically denied by the September 2014 examiner. Moreover, the November 2014 VA examiner made a number of assumptions of the Veteran’s exposures as a mechanic that are not supported by the record. Specifically, the Veteran submitted a lay statement noting that his work post-service work as a mechanic was outdoors and did not involve welding. As the November 2014 VA examiner’s opinion is not supported by the record evidence, it is entitled to less weight. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (A medical opinion is only as good and credible as the history on which it was based, and if based on an inaccurate factual premise it has no probative value.); see also Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) (“If the opinion is based on an inaccurate factual premise, then it is correct to discount it entirely”) (citing Reonal). Based on the foregoing, the preponderance of the evidence weighs in favor of a finding that the Veteran’s respiratory condition is related to his exposures to welding and paint fumes in service. Accordingly, the claim is granted. REASONS FOR REMAND Service connection for leukopenia, claimed as low white blood cell count is remanded. The Veteran contends that his low white blood count, diagnosed as leukopenia, is related to his exposure to contaminated water at Camp Lejeune. The record reflects that he has been diagnosed with this condition by VA and private treatment providers. To the extent leukopenia is a condition involving abnormally fewer white blood cells, it is an abnormal laboratory finding that does not qualify as a “disability” for which service connection may be granted. See 38 U.S.C. § 1110; Watson v. Brown, 4 Vet. App. 189, 191 (1993). However, the Veteran and his wife testified at the Board hearing that the Veteran has had a weakened immunity system related to his low white blood count since his discharge from service. VA has conceded that the Veteran was exposed to contaminated water at Camp Lejeune during his active service. To date, the Veteran has not been afforded a VA examination for this condition and a medical opinion has not been obtained. The Board finds the lay testimony suggesting functional impairment related to leukopenia is competent to warrant a VA examination and medical opinion to determine the nature and etiology of the Veteran’s condition. See McClendon v. Nicholson, 20 Vet. App. 79, 81 (2006) (lay testimony as to continuity of symptomatology can satisfy the requirement for evidence that the claimed disability may be related to service and the threshold for finding that the disability (or symptoms of a disability) may be associated with service is low.) The Board also notes that VA treatment records suggest that the Veteran has been treated by a private hematologist for his leukopenia. VA should attempt to obtain those private records on remand. The matters are REMANDED for the following action: 1. Obtain updated VA and private treatment records, including records from any private hematologist who provided treatment to the Veteran. 2. After completing the development in item 1, schedule the Veteran for a VA examination with an appropriate clinician to determine the nature and etiology of the Veteran’s leukopenia, including any residuals thereof. The claims file (and a copy of this remand) must be made available to and be reviewed by the examiner and all necessary tests conducted. The examiner is requested to opine as to whether it is at least as likely as not that the Veteran’s leukopenia had an onset during service or is causally or etiologically related to service, to include exposure to contaminated water at Camp Lejeune. The examiner should specifically address the Veteran’s statement that he has had a weakened immune system since active service, and whether the Veteran experiences any functional impairment as a result of his leukopenia. The examiner is advised that the Veteran is competent to report symptoms and that his reports must be considered in formulating the requested opinions. If the Veteran’s reports are discounted, the examiner should provide a reason for doing so. A complete rationale for the examiner’s opinions should be provided, citing to specific evidence of record and any relevant medical literature, as necessary. If the examiner cannot provide the requested opinions without resorting to speculation, it must be stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether there was any further need for information or testing necessary to provide an opinion. Additionally, the examiner must indicate whether any opinion could not be rendered due to limitation of knowledge in the medical community at large, and not those of the examiner. S.C. KREMBS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Snyder, 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.