Citation Nr: 21031689 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 08-05 260 DATE: May 24, 2021 ORDER Service connection for eczema and dermatofibroma (skin condition) is denied. FINDINGS OF FACT 1. Objective symptoms of an undiagnosed illness or a medically unexplained chronic multisymptom illness causing a skin condition is not shown. 2. The Veteran's skin condition was not manifest in service and it may not be presumed to be attributable to Gulf War service. CONCLUSION OF LAW The criteria for service connection for skin condition have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.309, 3.310, 3.317. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active duty in the Army from August 1989 to August 1993. The issues are on appeal from an April 2005 rating decision. A hearing was held by the undersigned in June 2012 and a transcript has been associated with the claims file. The issue has been before the Board of Veterans' Appeals (Board) multiple times and was last remanded for adjudication in October 2020. Service Connection Generally, the evidence 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. 38 C.F.R. § 3.303(a); Shedden v. Principi, 381 F.3d 1163, 1166-67(Fed. Cir. 2004). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310(b). Service records show that the Veteran had service in the Southwest Asia theatre of operations and, in turn, is considered a Persian Gulf War veteran pursuant to 38 C.F.R. § 3.317. Service connection may be established on a presumptive basis for a Persian Gulf veteran who exhibits objective indications of chronic disability resulting from undiagnosed illness that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021, and which by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1) (VA has issued an interim final rule extending this date to December 31, 2021). A "qualifying chronic disability" for purposes of 38 U.S.C. § 1117 is a chronic disability resulting from (A) an undiagnosed illness, (B) a medically unexplained chronic multisymptom illness (MUCMI) (such as chronic fatigue syndrome (CFS), fibromyalgia, or irritable bowel syndrome (IBS)) that is defined by a cluster of signs or symptoms, or (C), any diagnosed illness that the Secretary determines in regulation prescribed under 38U.S.C. §1117(d) warrants a presumption of service connection. 38 U.S.C. § 1117(a)(2); 38C.F.R. §3.317(a)(2)(i)(B). Objective indications of "chronic disability" include both "signs," in the medical sense of objective evidence perceptible to a physician, and other, non-medical indicators that are capable of independent verification. To fulfill the requirement of chronicity, the illness must have persisted for a period of six months. 38 C.F.R. § 3.317(a)(2), (3). Signs or symptoms that may be manifestations of undiagnosed illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain;(6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders. 38 C.F.R. § 3.317(b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In reaching each decision, the Board has considered the applicability of the benefit of the doubt doctrine. Service connection for skin condition The Veteran contends his skin condition developed as a result of his service in Southwest Asia theatre of operations. The Veteran does not contend, nor does the evidence reflect, that he received any treatment for a skin condition while in service. Initially, the Board notes the Veteran's medical records show a diagnosis of eczema and dermatofibromas, satisfying Shedden element (1). Therefore, the question before the Board is whether the Veteran's current disability is due to active duty. Turning to the evidence, medical records reflect complaints of, treatment for, and diagnosis of a skin rash, eczema, and dermatofibromas. The Veteran was afforded a VA examination in November 2004. He reported developing a skin rash sometime after service and described the symptoms as black, slightly pruritic, nodular lesions on his lower extremities. The Veteran stated that they had been continuous since active duty and that he had undergone minimal treatment for them. The examiner diagnosed the Veteran with skin dermatitis of unknown etiology. The Veteran wrote that he had no skin conditions until after his deployment in a February 2008 statement. The Veteran testified in his June 2012 hearing that he could not recall the onset of black spots on his legs and back but knew that he did not have these problems during active duty. The Veteran was afforded VA examinations in November 2012, March 2017, and October 2017. In previous remands, the Board found these examinations and/or etiology opinions were inadequate for adjudication purposes because the examiner did not address pertinent information in the Veteran's medical history and the examiner relied on a lack of treatment in service as rationale for a negative etiology opinion. The Veteran was afforded his most recent VA examination in the December 2019 examination. He reported his symptoms began in the mid-1990's, which is consistent with a medical record reflecting his rash complaint. The Veteran stated he had not received treatment in service but was prescribed a cream after separation. The examiner acknowledged the Veteran's 2008 diagnosis of eczema and noted this was the first diagnosis of a skin condition since his separation but found no evidence of the condition during the December 2019 examination. Upon review of the Veteran's service records and after taking the Veteran's lay statements into consideration, the examiner opined that the skin condition was not related to active duty. Importantly, the December 2019 examiner found no evidence of a chronic disability pattern as defined by 38 C.F.R. § 3.317(c)(2). The examiner explained that the Veteran had a disease with a clear and specific etiology and diagnosis. However, in concluding that the skin conditions had a clear and specific etiology, the examiner did not fully nor partially explain the etiology, nor did the examiner explain the pathophysiology of the Veteran's eczema and dermatofibromas. Therefore, the Board found the December 2019 examiner's opinion on a chronic disability pattern needed further explanation. An addendum opinion was obtained in October 2020. The examiner clarified that eczema and dermatofibroma are common skin conditions and as such, they are diseases with clear and specific etiology and diagnosis. Specifically, as it pertains to the Veteran, his medical history demonstrated no evidence of a cluster of symptoms specific to the individual that merited a diagnosis of a medically unexplained illness. There was also no evidence substantiating a temporal nexus to the Veteran's active duty, to include his Gulf War service. Based on the above, the Board finds that the competent evidence was provided by service records, clinical evidence, and VA examinations obtained and associated with the claims file. The Board attaches greater probative weight to the clinical findings than the Veteran's statements, specifically those of the December 2019 and October 2020 VA examiners. Cumulatively, the December 2019 and October 2020 examiners opined that the Veteran's skin disabilities, to include eczema and dermatofibroma, were not related to active duty, are common, have a clear and specific diagnosis, and stem from a clear and specific etiology. These opinions were proffered after an in-person examination, review of the Veteran's claims file, and acknowledgement and consideration of the Veteran's lay statements regarding his symptoms. The Board has considered the Veteran's assertions that his skin condition is related to service. While he is competent to report symptoms, as this requires only personal knowledge as it comes to him through his senses, he is not competent to offer an etiology of his skin condition. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). In light of the above, the preponderance of the evidence is against the claims and there is no doubt to be otherwise resolved. As such, the appeal is denied on a direct basis. Also, the Veteran is not entitled to presumptive service connection as a Persian Gulf Veteran who served in the Southwest Asia theatre of operations. The evidence shows a clear diagnosis with a specific etiology. As the Veteran's skin condition is a diagnosed condition, it cannot be considered an undiagnosed illness. 38 C.F.R. § 3.317(a)(1)(ii). Finally, eczema and dermatofibroma are not considered a MUCMI, nor do the Veteran's symptoms demonstrate as such. 38 C.F.R. § 3.317(a)(2)(i)(B)(3); 76 Fed. Reg. 41,696 (Jul. 15, 2011); see Atencio v. O'Rourke, 30 Vet. App. 74, 83. Thus, presumptive service connection for a skin condition under § 3.317 is not warranted and the Veteran's claim is denied. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Lee 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.