Citation Nr: 21026985 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 07-22 165 DATE: May 4, 2021 ORDER Service connection for a skin disorder, claimed as a rash on the face and arms, is granted. FINDING OF FACT The Veteran has a current skin disorder, including dermatophytosis, contact dermatitis, and pruritis that began during, or was otherwise caused by, her active duty service. CONCLUSION OF LAW The criteria for service connection for a skin disorder, claimed as a rash on the face and arms, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSIO The Veteran had service in the Army National Guard with active duty from June 2004 to August 2005. She had service in Southwest Asia from August 2004 to July 2005. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2007 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in September 2011, October 2015, September 2019, and March 2020 at which times it was remanded for further development including new VA medical opinions. Service connection for a skin disorder, claimed as a rash on the face and arms The Veteran contends that her skin disorder of rash on her face and arms began in active service during her deployment. The Board concludes that the Veteran has a current skin disorder that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). As to the first element of service connection, the Board finds the Veteran has a current skin disorder. During the appeal period, she was diagnosed with various skin disorders including dermatophytosis in May 2012, contact dermatitis in October 2017, and pruritis in February 2021. The evidence also shows that the Veteran experienced in-service occurrences of a skin rash. Service treatment records show a complaint of itching to the left wrist which was diagnosed as tinea and attributed to poison ivy in August 2003. A July 2005 examination documented the Veteran to have normal skin. Within a month after the end of her active duty in September 2005, she reported that since she returned from deployment, her facial rash/acne would not clear up. In October, she continued to report acneform rash on her face that she indicated began on her return home in August. In an October 2005 post-deployment assessment, she indicated that she had skin diseases or rashes during deployment. She also reported being exposed often to DEET insect repellent applied to skin. In a November 2005 initial medical review form, the Veteran wrote that she was "suffering from face breaking out." Although the Board notes that some diagnoses seem to have been resolved or replaced by different skin disorders, service connection is warranted if a disability was present at any point during the claim period, even if it is not currently present. McClain v. Nicholson, 21 Vet. App. 319 (2007). Thus, the question becomes whether the current disability is related to service. Post-service treatment records document reports of a persistent papular or nodular skin rash on her face, arms, neck, and chest in June 2007. In December 2008, she had a pigmented nodule on her upper back. In July 2010, she had a rash described as circular, slightly scaly lesions on the back of her neck. In August and December 2010, she continued to have a rash on the right side of her face and upper back. In January 2011, it was noted that she had a history of malar rash with scaly border on the neck. In a March 2011 dermatology note, she reported having a pruritic intermittent annular rash since 2005. A biopsy revealed a superficial perivascular dermatitis. In September 2011, it was noted that she had a new onset of rash but was actually myasthenia gravis. In December 2011, it was noted that she had tinea corporis on her right wrist and forearm. In October 2013, it was noted that she did not have a rash at the time, but she had been to the dermatology clinic and the rashes came and went. In July 2020, it was noted that she had a lot of itching and she used to have rashes on her face, hand and back. Furthermore, a review of the Veteran's VA medical records show she received prescriptions for topical medications for her skin rashes. The Veteran also underwent several VA examinations. A January 2006 VA examination noted the Veteran's reports of a rash on her face and arms which cleared up with prescribed medication. There was no evidence of a rash at the time of examination. The examiner did not provide an etiological opinion. The Veteran again underwent a VA examination in May 2012. She contended that her rash and itching was due to exposures in the Persian Gulf. At that time, the examiner diagnosed dermatophytosis and opined that the skin disorder was not related to service because there was "no evidence of complaint of or treatment for skin condition while on military duty." However, the VA examiner did not address the service treatment records which document the Veteran's reports of her face breaking out during service, or her post-service lay statements detailing the existence and recurrent nature of a skin rash during and since active duty service. The Veteran underwent another VA examination in October 2017. She reported that her rash on her arms and legs was recurrent since onset and she used three different topical medications. The examiner did not provide an etiological opinion for the diagnosed contact dermatitis. At a September 2018 VA examination, the examiner opined that the Veteran's skin disorder was not related to service as the claims file denoted that the rash resolved in 2005 and there was no further rash until 2008. Additionally, she was without a rash at the time for greater than a year. However, as noted above, VA treatment records document reports of a persistent papular or nodular skin rash on her face, arms, neck, and chest in June 2007 and her lay statements indicated that she still continued to get rashes even if they were not documented in medical records. The Veteran was afforded another VA examination in October 2019. The report noted current symptoms of dry, itchy skin and noted, without explanation, that there was no current treatment with an indication that the disorder was resolved. As there were no present findings or signs, no diagnosis was made. The examiner failed to provide the requested nexus opinion because of the lack of current diagnosis. At a February 2021 VA examination, the Veteran was diagnosed with pruritis. She complained that her skin itched constantly, and she applied topical skin cream at a constant/near constant level. The examiner opined that the Veteran's skin disorder was less likely incurred in or caused by service. Her history of malar rash, dermatophytosis, tinea corporis, and contact dermatitis between September 2005 and October 2017 were documented. It was noted that there were no service treatment records available regarding any skin conditions. However, the examiner did not provide a rationale to explain why the Veteran's skin disorders that began soon after her separation in September 2005 that continued through at least 2017 were not related to service or address her competent lay statements of in-service incurrence. Based upon the above review of the evidentiary record, the Board finds that the competent evidence is in equipoise to award service connection for the Veteran's skin disorder. As discussed above, the Veteran has consistently reported that her skin disorder began during active service. In this vein, she sought and received treatment for her skin disorders, including rashes, since her separation from active service. The Board finds the Veteran's statements in this regard to be credible, as well as competent, as her various skin disorders are capable of lay observation. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a skin disorder is warranted. 38 U.S.C. § 5107. In reaching this determination, it is noted that there are the only negative medical opinions of record. However, as previously discussed, the Board has found these all to be inadequate for adjudication purposes and awards them little probative value. While the evidence is not straight forward, due to the long running appeal, there is a more complete record to evaluate and observe that the Veteran's complaints and treatment continues to the present day. To the extent that the Board made inferences and considered circumstantial evidence in its analysis of the evidence, this type of reasoning is well within the discretion of a fact finder. Bastien v. Shinseki, 599 F.3d 1301, 1306 (Fed. Cir. 2010) ("The evaluation and weighing of evidence and the drawing of appropriate inferences from it are factual determinations committed to the discretion of the fact finder."). Under the circumstances, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current skin disorder arose in service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a skin disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Cruz, 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.