Citation Nr: 21026615 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 05-40 052 DATE: May 3, 2021 ORDER Entitlement to service connection for alopecia of the bilateral lower extremities is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran's currently diagnosed alopecia of the bilateral lower extremities began during active service, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for alopecia of the bilateral lower extremities are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from December 1984 to December 1987. This matter comes before the Board of Veterans' Appeals (Board) from a December 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may also be granted for any disease initially 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). 1. Entitlement to service connection for alopecia of the bilateral lower extremities The Veteran contends that his claimed for alopecia of the bilateral lower extremities condition is due to exposure to the cold during service. See August 2015 Correspondence. As to the first element of Shedden, for service connection the Veteran must show a current disability. Per the November 2020 VA examination report, the Veteran has a current diagnosis of alopecia. As such, the Board finds that the Veteran's claim meets the first Shedden element of service connection. As to the second element of Shedden, for service connection the Veteran must show an in-service incurrence or aggravation of a disease or injury. The Veteran has a conceded frostbite injury during service, and therefore the Board finds that his claim meets the second element of Shedden. See April 2015 VA Form 21-6789, Deferred Rating Decision ("...frost bite is conceded."). As to the last element of Shedden, for service connection the Veteran must show a causal relationship between the current disability and the in-service disease or injury. Weighing in favor of the Veteran's claim is an August 2015 medical statement by Dr. R.E.Z. indicating the possibility that the Veteran's diagnosed alopecia is due to cold exposure, neuropathy, or decreased blood flow. Here, the Board finds Dr. R.E.Z.'s medical opinion to be a speculative statement of mere possibility, devoid of any sort of rationale to support its conclusion, and therefore not probative on the issue of nexus. See Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992); Bloom v. West, 12 Vet. App. 185, 186-187 (1999); Stegman v. Derwinski, 3 Vet. App. 228, 230 (1992); Obert v. Brown, 5 Vet. App. 30, 33 (1993). Weighing against the Veteran's claim are VA medical opinions of record, of which the Board assigns limited probative value to the August 2019 VA examiner's, as the opinion was not based upon an in-person examination of the Veteran, and therefore did not comply with the Board's November 2018 Board remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998); October 2020 Board remand. Also weighing against the Veteran's claim is the February 2021 VA medical examiner's opinion stating that due to the lack of scarring of the Veteran's skin, and as the Veteran's medical records do not ever indicate that the conceded cold exposure caused his claimed for condition, a medical nexus cannot be made. The VA examiner added that the Veteran was seen in October and December of 2003, and that at the time, he did not have a diagnosis of alopecia. As the aforesaid VA medical examinations did not reveal a diagnosis of alopecia in 2003, they therefore weigh against finding that the Veteran's currently diagnosed condition incurred in service. 38 C.F.R. § 3.303(d). The Board acknowledges the Veteran's lay testimony of record relaying his belief that his claimed for condition is due to his conceded cold exposure during service. See August 2015 Correspondence; November 2020 VA medical examination report. While the Veteran is competent to report hair loss, as it is lay observable, he is not competent to associate those same symptoms with exposure to the cold, as the etiology of his currently diagnosed alopecia requires medical expertise to determine. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In sum, the most probative evidence of record, namely the February 2021 VA examiner's medical opinion, is against finding that the Veteran's currently diagnosed alopecia is directly related to his exposure to the cold during active duty service. Additionally, there are no other medical opinions of record linking his currently diagnosed alopecia to service. Thus, as the preponderance of the evidence weighs against the claim, the reasonable doubt doctrine is not for application, and therefore entitlement to service connection alopecia of the bilateral lower extremities must be denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.R. Fey, 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.