Citation Nr: 21025984 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 15-42 366 DATE: April 29, 2021 ORDER Entitlement to service connection for right foot condition is denied. Entitlement to service connection for left foot condition is granted. Entitlement to service connection for skin condition is denied. FINDING OF FACT The probative evidence of record does not show that the Veteran’s bilateral foot condition and skin condition are related to his active duty service, to include exposure to herbicides. CONCLUSIONS OF LAW 1. The criteria for service connection for right foot condition have not been met. 38 U.S.C. §§ 101, 1131; 38 C.F.R. §§ 3.6, 3.303, 3.304, 3.307, 3.309. 2. The criteria for service connection for left foot condition have been met. 38 U.S.C. §§ 101, 1131; 38 C.F.R. §§ 3.6, 3.303, 3.304, 3.307, 3.309. 3. The criteria for service connection for skin condition have not been met. 38 U.S.C. §§ 101, 1131; 38 C.F.R. §§ 3.6, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty in the United States Army from September 1969 to April 1971. The Veteran was provided a hearing with the undersigned Veterans Law Judge and a transcript of the proceeding is of record. The claims were brought before the Board in July 2019 and October 2020 and were remanded for further development. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). In order to establish service connection, the record must show competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d, 1362, 1366 (Fed. Cir. 2009). When considering such a claim for service connection, the Board must consider on a case-by-case basis, the competence and sufficiency of lay evidence offered to support a finding of service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 Fed. Cir. 2007)). The mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). The law provides that diseases associated with exposure to certain herbicide agents used in support of military operations in the Republic of Vietnam (Vietnam) during the Vietnam era will be considered to have been incurred in service. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.307(a)(6). A veteran is presumed to have been exposed to herbicides if he or she served in Vietnam between January 9, 1962, and May 7, 1975, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). The presumption of service connection requires exposure to an herbicide agent and manifestation of the disease to a degree of 10 percent or more within the time period specified for each disease. 38 C.F.R. § 3.307(a)(6)(ii). Entitlement to Service Connection: Bilateral Foot Conditions and Skin Condition The Veteran contends that he suffers from a bilateral foot condition and skin condition that are related to his active duty service. As an initial matter, the Board acknowledges that the Veteran has been diagnosed with peripheral polyneuropathy and calluses of the feet, as well as seborrheic dermatitis of the face. Further, the Veteran had qualifying service in the Republic of Vietnam, and therefore, exposure to Agent Orange is presumed. While peripheral polyneuropathy, calluses, and seborrheic dermatitis are not listed as herbicide-related diseases subject to presumptive service connection under 38 C.F.R. § 3.309(e), the availability of presumptive service connection for a disability based on exposure to herbicides does not preclude a veteran from establishing service connection with proof of direct causation, or on any other recognized basis. Combee v. Brown, 34 F.3d 1039 (Fed Cir. 1994). Thus, the issue turns upon whether there is evidence of a nexus between the said in-service event or injury and the present diagnosed disabilities. See 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Board finds there is not. In December 2020, VA opinions were obtained. The examiner opined that the claimed conditions were not related to the Veteran’s active duty service, to include herbicide or Agent Orange exposure. Regarding the Veteran’s feet, the examiner rationalized that the Veteran’s separation examination was silent for any foot injury or calluses. The examiner further noted that his service treatment records do not show a foot injury, to include consideration of the Veteran’s reports of dropping a pot on his right foot. The examiner noted the Veteran wasn’t seen for plantar calluses until April 1976. The examiner explained the Veteran was noted again as having a callus on the right great toe in 1982 and was treated for a fungal infection of the feet and groin. The examiner also noted the Veteran had a diagnosis of peripheral neuropathy in August 2016; however, the etiology was stated as unknown but possibly due to alcohol or metabolic disorder. The examiner explained that the Veteran has been seen for calluses, which are thickened hardened latera of skin that develop as a protective mechanism in response to friction or pressure and often occurs with ill-fitting shoes. The examiner stated that this condition is not related to herbicides or Agent Orange. The examiner further noted that although the Veteran reports dropping a pot of potatoes on his foot, this injury is not documented. Further, such injury would not cause callus formation on the feet. The examiner additionally found there is no evidence to support that the Veteran’s calluses are associated with his active duty and the evidence does not show documentation or treatment for calluses until 1976, which is five years after the Veteran’s service. The examiner lastly noted that there is no evidence that the Veteran had early onset peripheral neuropathy (which is an herbicide-related disease under 38 C.F.R. § 3.309(e)), and there is no documentation of the condition prior to 2016. Regarding the Veteran’s skin condition, the December 2020 examiner rationalized that the Veteran’s service treatment records, to include his separation examination, were silent for any skin condition. The examiner noted the Veteran was seen for a fungal infection in 1982 and then there was no diagnosis of a skin condition until 1997. In 1997, the Veteran was seen for rash on his face and scalp, which was diagnosed as seborrheic dermatitis. The examiner further noted the Veteran was seen again in 2001 for a facial rash stated to possibly be contact dermatitis. The examiner explained that seborrheic dermatitis is a very common skin condition that is not associated with herbicide exposure. The examiner stated that the exact cause is unknown, but it is thought to be related to stress, irregular response of the immune system, and excess oil build up in the skin. The examiner lastly noted that while chloracne is related to herbicide exposure, seborrheic dermatitis is not. The Board notes that while VA treatment records show occasional treatment for a facial rash, as well as treatment for calluses and a notation of peripheral neuropathy, none of the records relate the Veteran’s conditions to his active duty service, to include exposure to herbicides or Agent Orange. Further, the Veteran’s records do not show treatment for a foot condition until five years after his service in 1976, and his records do not show complaints of a rash until 1995, 25 years after his active duty service. Therefore, the Board finds the December 2020 VA opinions to be of significant probative value in determining that the Veteran’s skin condition and bilateral foot conditions are not related to his active service. The Board notes that the probative value of medical opinion evidence is based on the medical experts’ personal examination of the patient, their knowledge, and skill in analyzing the data, and their medical conclusion. As is true with any piece of evidence, the credibility and weight to be attached to these opinions are within the province of the adjudicator. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Whether a physician provides a basis for his or her medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Here, the reviewing physician’s opinions were based on review of the Veteran’s lay contentions, his reported medical history, and review of the medical evidence of record. Further, a complete and thorough rationale was provided for the opinions rendered and is consistent with the medical evidence of record. The Board acknowledges the Veteran’s assertions that his skin condition and bilateral foot conditions are related to his active duty service. The Board also recognizes that lay persons are competent to provide medical opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, although the Veteran is competent to report his symptoms, any opinion regarding whether any skin disability or foot disability is related to his service, to include exposure to Agent Orange, requires medical expertise that the Veteran has not demonstrated since skin disabilities and foot disabilities can have many causes. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (2007). Further, the Board again notes that the Veteran was not diagnosed with a foot condition until 1976, five years after service, and there were no complaints for a facial rash until 1995, which is 25 years after his service. In light of the foregoing, the Board concludes that the preponderance of evidence is against the claims and the benefit of the doubt doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Negron, 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.