Citation Nr: 21029649 Decision Date: 05/14/21 Archive Date: 05/14/21 DOCKET NO. 13-27 829 DATE: May 14, 2021 ORDER The request to reopen a claim for service connection for pseudofolliculitis barbae is granted. The request to reopen a claim for service connection for diabetes is granted. The request to reopen a claim for service connection for hypertension is granted. The request to reopen a claim for service connection for tinea corporis is granted. Entitlement to service connection for pseudofolliculitis barbae is granted. Entitlement to service connection for hypertension with cerebral vascular residuals is granted. Entitlement to service connection for tinea corporis is denied. REMANDED Entitlement to service connection for diabetes is remanded. FINDINGS OF FACT 1. In an unappealed September 2010 rating decision, the RO denied service connection for pseudofolliculitis, diabetes, hypertension, and tinea corporis based, in part, on a finding that there was insufficient evidence to establish a relationship to a current disability. 2. The evidence added to the record since the September 2010 rating decision, when viewed by itself or in the context of the entire record, relates to an unestablished fact that is necessary to substantiate the claims for service connection. 2. Pseudofolliculitis barbae was incurred in active service and has continued since. 3. The Veteran's hypertension, to include residuals of cerebral vascular incident, is related to his active duty service. 4. The Veteran does not and did not have current skin disability during the pendency of the appeal other than pseudofolliculitis barbae. CONCLUSIONS OF LAW 1. The September 2010 rating decision that denied service connection for pseudofolliculitis, diabetes, hypertension, and tinea corporis is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104(a), 3.160(d), 20.200, 20.302, 20.1103. 2. With respect to the Veteran's claim for service connection for pseudofolliculitis, diabetes, hypertension, and tinea corporis, new and material evidence has been received since the September 2010 denial. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for entitlement to service connection for pseudofolliculitis barbae have been met. 38 U.S.C. § 1101, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for hypertension with cerebral vascular residuals have been met. 38 U.S.C. § 1101, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for tinea corporis have not been met. 38 U.S.C. § 1101, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from August 1990 to July 2000. New and Material Evidence Initially, the Board notes that whenever a claim to reopen is filed, regardless of how it was characterized by the agency of original jurisdiction, the Board must make a de novo determination as to whether new and material evidence has been received. Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996) (whether new and material evidence has been submitted must be asked and answered by the Board de novo whenever a claim to reopen is filed). New evidence is defined as existing evidence not previously submitted to agency decision makers. Material evidence means evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence previously of record, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). For the purpose of establishing whether new and material evidence has been submitted, the credibility of evidence is presumed unless the evidence is inherently incredible or consists of statements that are beyond the competence of the person or persons making them. Justus v. Principi, 3 Vet. App. 510, 513 (1992); Meyer v. Brown, 9 Vet. App. 425, 429 (1996); King v. Brown, 5 Vet. App. 19, 21 (1993). 1. Whether new and material evidence has been submitted to reopen a claim for service connection for pseudofolliculitis barbae, diabetes, hypertension, and tinea corporis. The Veteran was denied service connection for pseudofolliculitis, diabetes, hypertension, and tinea corporis in a September 2010 rating decision because there was insufficient evidence that the Veteran's disability was related to service. The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is "low." Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). In determining whether this low threshold is met, consideration need not be limited to consideration of whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the VA's duty to assist or through consideration of an alternative theory of entitlement. 38 C.F.R. § 3.156(a); Shade v. Shinseki, supra. The Veteran's testimony in November 2016 and March 2021 that he had symptoms of these disabilities while on active duty and has continued to have symptoms since separation is new in that it was not previously of record. It is also material because it relates to unestablished facts necessary to substantiate the Veteran's claim for service connection. Specifically, due to the prior lack of evidence showing a relationship between the disabilities and the Veteran's service, this new evidence is material because it relates to an element that was previously not shown, an in-service incurrence. See Shade, supra. Accordingly, the Board finds that new and material evidence has been submitted, and the claim for service connection for pseudofolliculitis, diabetes, hypertension, and tinea corporis are reopened. 38 U.S.C. § 5108. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, 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." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). 2. Entitlement to service connection for pseudofolliculitis barbae The Board notes that the July 2010 VA examination report included the notation that the Veteran has a diagnosis of pseudofolliculitis barbae. Turning to an in-service incurrence, the Veteran's June 2000 service treatment record includes a notation that the Veteran was to be put on a shaving profile due to pseudofolliculitis barbae. Turning to etiology, the Veteran provided a March 2021 testimony to the Board detailing that he has suffered from pseudofolliculitis barbae since his separation from service. The Board finds the Veteran's contentions are credible and he is competent to report these symptoms. In view of the foregoing, the Board finds that with consideration of service treatment records demonstration of pseudofolliculitis barbae in service and the Veteran's competent and credible statements as to the ongoing presence of symptoms of pseudofolliculitis barbae since service that all elements of service connection have been met and service connection is warranted. 38 C.F.R. § 3.303. 3. Entitlement to service connection for hypertension with cerebral vascular residuals The Board has expanded the Veteran's claim to include residuals of his hypertension to include cerebral vascular residuals. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). In doing so, the Board recognizes that the Veteran in November 2019 provided a competent and credible statement from a private physician explaining at length how his cerebral vascular incident and now residuals are parse and parcel with his hypertension. It is with consideration of this statement that the Board has expanded the Veteran's claim accordingly. Turning to the elements of service connection, the Board notes that there is no dispute that the Veteran has a diagnosis of hypertension to include cerebral vascular residuals as noted in his November 2019 private examination. Nor is there any dispute that the Veteran had high blood pressure in service. The only remaining factor is nexus. On the issue of nexus, the Board finds that the November 2019 private examination is the probative. In so finding, the Board notes the Court of Veterans Claims has held most of the probative value of a medical opinion comes from its reasoning and the Board must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Here, the November 2019 private examination include detailed review of the Veteran's history and exhaustively applies medical principles to ultimately come to its conclusion that the Veteran's high blood pressure in service is related to his development of hypertension and by extension cerebral vascular residuals. Considering the foregoing, the Board finds that all elements of service connection have been established and service connection for hypertension to include cerebral vascular residuals is warranted. 4. Entitlement to service connection for tinea corporis The Veteran contends that he has a skin disability to include tinea corporis which began in service and has continued to this day. Unfortunately, the Board finds that outside of the Veteran's contention there is no evidence to support his contention. The Veteran applied for service connection for a skin disability to include tinea corporis the only skin disability that the Veteran was noted to have in service. The Board notes that the Veteran has not received a current diagnosis of a skin disability outside of pseudofolliculitis addressed above. In an effort to determine whether the Veteran's symptoms were related to a disability, the VA in July 2010 directed a VA examination be conducted. Following this examination, the examiner reported that he could not provide any diagnosed condition underlying this symptom at any point during the pendency of the Veteran's appeal. Furthermore, upon review of the medical evidence in the claims file, the Board was unable to identify any skin disabilities related to the Veteran's claims other than pseudofolliculitis barbae. In effect, the Board only has the Veteran's contentions that he has a skin disability. Unfortunately, the Veteran has not demonstrated any specific medical competency for the Board to rely on in determining whether the Veteran has a current skin disability other than pseudofolliculitis barbae. Therefore, the Board finds the Veteran failed the first prong of the three-prong test for service connection as he does not have a current disability which can be service connected. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (there can be no valid claim for service connection in the absence of a present disability). Accordingly, the preponderance of the evidence is against the Veteran's claim, and entitlement to service connection for a skin disability other than pseudofolliculitis barbae, to include tinea corporis, is denied. REASONS FOR REMAND 1. Entitlement to service connection for diabetes is remanded. Regrettably, the Board finds that further development is warranted before adjudication can proceed with the Veteran's claim. Namely, a VA examination should be provided to the Veteran. The claims file contains evidence that the Veteran was monitored for high glucose level while on active duty and currently is diagnosed with diabetes. The Veteran contends in March 2021 transcript that a medical professional has linked these two incidents together; however, there is no medical opinion addressing this contention. As such, the Board finds that there is sufficient evidence to provide the Veteran with a VA examination to investigate his claim. The Veteran should be also aware that he is free to submit a private medical opinion in the course of the development of his claim. The matters are REMANDED for the following action: 1. Contact the Veteran and request that he identify the names, addresses, and approximate dates of treatment for all VA and non-VA health care providers who have treated him for his disabilities. The Veteran should be requested to sign any necessary authorization for release of medical records to VA, and appropriate steps should be made to obtain any identified records. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. If the records are unavailable, notify the Veteran in accordance with 38 C.F.R. § 3.159. 2. Schedule the Veteran for an appropriate VA examination with an appropriate VA examiner to determine the etiology of the Veteran's diabetes. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner as part of the examination. A notation to the effect that this review has taken place should be made in the evaluation report. All studies, tests, and evaluations should be performed as deemed necessary by the examiner, and the results of any testing must be included in the examination report. (a) After considering the pertinent information in the record in its entirety, the examiner is asked to opine as to whether it is at least as likely as not i.e. 50 percent probability or greater, that the Veteran diabetes was incurred or aggravated by his active duty or otherwise etiologically related to his active duty, and if not, why. In providing an opinion, the examiner should take a detailed history from the Veteran regarding the onset of this disability and any continuity of symptoms since that time and address the service treatment records which demonstrate that the Veteran glucose levels on active duty warranted observation. 3. Ensure that the examination report complies with this remand and the questions presented in this request. If the report is insufficient, it must be returned to the examiner for necessary corrective action, as appropriate. 4. After completing the requested actions and any additional notification and/or development deemed warranted, readjudicate the issues on appeal. If the benefit sought on appeal is not granted, the Veteran and his representative must be furnished a supplemental statement of the case and afforded the appropriate time period for response. GAYLE E. STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Acosta, 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.