Citation Nr: 21031521 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 13-07 250 DATE: May 24, 2021 ORDER Service connection for a skin disorder is granted. REMANDED Entitlement to service connection for prostate cancer is remanded. Entitlement to service connection for diabetes mellitus is remanded. FINDING OF FACT It is just as likely as not the Veteran's skin disorder began during his service. CONCLUSION OF LAW Resolving all reasonable doubt in his favor, the criteria are met for entitlement to service connection for a skin disorder. 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 military service from May 1973 to June 1994. Service Connection Service connection for a skin disability is granted. The Board finds that service connection for a skin disability is warranted. The service treatment records (STRs) reflect that the Veteran had multiple instances of skin rashes and irritations during his many years of service. For instance, in February 1976, he was treated for a groin rash. In April 1987, he was treated for tinea cruris, so for the same thing since that is the medical term for a groin rash. In January 1988, he was seen for a red rash on his chest and buttocks, diagnosed as folliculitis with keratosis. In February 1988, he was treated for folliculitis. In March 1988, he reported symptoms of skin peeling. In June 1989, he was treated for a rash on his scalp, diagnosed as impetigo. In July 1992, he was treated for actinic keratosis of the scalp. His military service ended in June 1994. In December 2018, a VA examiner conducted a physical examination of the Veteran and reviewed the file. The examiner observed the Veteran suffered from numerous rashes in service. The post-service treatment records also showed continued treatment for the same symptoms. However, because there was no rash at the time of that VA examination, there was no then current skin disorder to in turn relate or attribute to the symptoms the Veteran had experienced on the several occasions during his service. However, the U. S. Court of Appeals for Veterans Claims (Veterans Court/CAVC) has recognized how skin rashes by their very or inherent nature, wax and wane, therefore are sometimes more apparent than at others. See, e.g., Ardison v. Brown, 6 Vet. App. 405, 408 (1994) (requiring that VA examine a Veteran during an "active stage" of the disease, when the skin condition at issue is cyclical in manifestation, in other words waxes and wanes, meaning it should be evaluated during an eruption or exacerbation of it as opposed to when dormant). Moreover, since that examination, there has been additional evidence associated with the record showing the Veteran has suffered from ongoing rash symptoms including referable to his groin, chest, and scalp, so involving the very same areas of his body that were affected during his service. In May 2019, he was treated for lesions on the forehead and scalp. During his January 2020 VA examination, he was diagnosed with seborrheic dermatitis and scattered seborrheic keratoses. In January 2021, a VA examiner concluded the Veteran's skin rashes were not related to exposure to herbicides in service, but that is not the only premise of relating them back to his service. See Stefl v. Nicholson, 21 Vet. App. 120 (2007); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994); and McCartt v. West, 12 Vet. App. 164, 167 (1999). On a direct basis, the December 2018 VA examiner found a relationship between the skin symptoms in service and the continuous skin symptoms since service. And, but for a lack of symptoms at the time of that examination, it appears the December 2018 VA examiner likely (or certainly as likely as not) would have provided a positive nexus opinion. Given that there since has been evidence of a diagnosis of the same disorders as were shown in service, also realizing that skin disorders sometimes are more apparent than at others because of their inherent nature, the Board finds that service connection for the Veteran's skin disability is warranted when resolving all reasonable doubt in his favor. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to service connection for prostate cancer is remanded. 2. Entitlement to service connection for diabetes mellitus is remanded. The Veteran contends that his prostate cancer and diabetes mellitus were caused by exposure to herbicides, including especially the dioxin in Agent Orange, while in service. He also contends these conditions are from exposure to commercial herbicides that he handled and/or other toxins to which he was exposed during his service, both at Anderson Air Force Base in Guam and while stationed at Barksdale Air Force Base in Louisiana, such as 'elephant snot,' which has been described as a lubricant for mechanical work on airplanes, and such chemicals as aircraft fuels, solvents, pains, abrasive materials and other environmental hazards. In August 2019, the Joint Services Records Research Center (JSRRC) responded that there was no evidence that unit personnel assigned to the Veteran's units at either Barksdale Air Force Base or Andersen Air Force Base were exposed to Agent Orange or tactical herbicides during his service. Thus, although he has submitted lay statements and other articles stating a belief that he was exposed to Agent Orange and tactical herbicides in these locations, that has not been verified by any service agency or other competent authority. The question nonetheless remains whether the Veteran's prostate cancer and diabetes mellitus were directly caused by his service including owing to exposure to the many listed toxins. In April 2014, his private physician submitted a statement concluding the Veteran's prostate cancer is likely related to probable Agent Orange exposure/herbicides. This opining physician noted that the Veteran was diagnosed with prostate cancer at age 50. While this opinion has some probative value, because it relies heavily on the assumption that the Veteran was exposed to Agent Orange in service, which has not been verified by any service agency or other competent authority, still more medical comment is needed addressing whether the Veteran's prostate cancer and diabetes mellitus are attributable to his service. Accordingly, these claims are REMANDED for the following action: Schedule the Veteran for a VA examination for his prostate cancer and diabetes mellitus. The examiner must review the claims file for the pertinent history of these conditions. The examiner is asked to provide a response to the following: Is it at least as likely as not the Veteran's prostate cancer and/or diabetes mellitus is etiologically related to his service, including to exposure to reported commercial herbicides used to spray vegetation (as opposed to tactical herbicides) and other toxins such as 'elephant snot,' which has been described as a lubricant for mechanical work on airplanes, and such chemicals as aircraft fuels, solvents, paints, abrasive materials and other environmental hazards? In responding, the examiner should consider and address the April 2014 private medical opinion. KEITH W. ALLEN Veterans Law Judge Board of Veterans' Appeals R. Erdheim, Attorney for the Board Department of Veterans Affairs 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.