Citation Nr: 21039719 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 18-35 028 DATE: July 1, 2021 ORDER Service connection for a skin disability, claimed as a rash, to include as due to exposure to environmental hazards and chemicals and/or toxins is denied. FINDING OF FACT A current skin disability was not present during service or for years thereafter, and is not etiologically related to service, including exposure to environmental hazards and chemicals and/or toxins. CONCLUSION OF LAW The criteria for service connection for a skin disability have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1989 to December 2003. The Veteran testified before the undersigned at a February 2020 Central Office hearing. The hearing transcript is of record. In March 2020, the Board remanded the case for further development. The case has been returned for further appellate action. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires (1) evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303. Service connection may be granted for any disease 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). With chronic diseases shown as such in service, or within the presumptive period after service, so as to permit a finding of service connection, subsequent manifestation of the same chronic disease at any later date, however remote, are service-connected unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303 (b). Section 3.303(b) does not apply to any condition that has not been recognized as chronic under 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Under 38 C.F.R. § 3.317, a Persian Gulf Veteran who exhibits objective indications of a qualifying chronic disability may be service connected, provided that such disability became manifest either during active military, naval, or air 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 by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. A "qualifying chronic disability" has been defined to mean a chronic disability resulting from any of the following (or any combination of the following): (1) an undiagnosed illness; or (2) medically unexplained chronic multisymptom illnesses that are defined by a cluster of signs or symptoms (specifically chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, or any other illness the Secretary determines meets the criteria of a medically unexplained chronic multisymptom illnesses). 38 C.F.R. § 3.317 (a)(2). The evidence establishes that the Veteran in this case served in the Persian Gulf during the requisite time period under 38 C.F.R. § 3.317. However, as discussed below, the Veteran has been diagnosed with eczema. As such, the Board finds that the regulations pertaining to undiagnosed illness for Persian Gulf Veterans do not apply to the issue being adjudicated at this time. Nonetheless, the Board will review the claim to assess whether service connection may be appropriate on a direct basis under 38 C.F.R. § 3.303. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (2012); 38 C.F.R. § 3.102 (2019); see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), (citing Gilbert, 1 Vet. App. at 54). 1. Service connection for a skin disability, claimed as a rash, to include as due to exposure to environmental hazards and chemicals and/or toxins The Veteran contends that he has a skin disability that is related to his service, to include exposure to environmental hazards during the Veteran's Persian Gulf service. At his February 2020 Board hearing, he testified that he has been diagnosed as having eczema on the upper chest and about two-thirds of his body. He also reported having sores on various spots of his body since 2007. Initially, the Board notes that as the Veteran has been diagnosed with a skin disability, namely eczema, despite his status as a Persian Gulf veteran, presumptive service connection based upon a qualifying chronic disability due to undiagnosed illness is not warranted. See 38 C.F.R. § 3.317. Service treatment records show in August 1989, the Veteran reported bumps on the face, chest, arms, legs, and abdomen after being out in the field the night before. In July 1998, he complained of itching and reported red bumps and patches on the arms, legs and back after coming out of the field. He was diagnosed with pseudofolliculitis. No other skin disability was diagnosed during active duty and no diagnosis was noted at discharge. The post-service medical evidence shows that the Veteran was diagnosed with a skin disability many years after his discharge. Specifically, VA treatment records include an August 2011 report which indicates findings consistent with seborrheic dermatitis with a possible secondary infection. A June 2018 report indicates a diagnosis of a severe chronic skin condition with an enlarged lymph node of the scalp. A November 2015 VA skin diseases disability benefits questionnaire (DBQ) shows the Veteran presented with a history of eczema, and complained of a skin condition on his back and chest. An April 2020 VA examiner also diagnosed eczema. However, the evidence does not indicate that the diagnosed skin disability is due to any event or incident of the Veteran's period of active duty. In this regard, the April 2020 VA examiner noted that the Veteran had been diagnosed with eczema, a disease with a clear etiology. The examiner opined that the claimed skin disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In rendering his opinion, the examiner noted that the Veteran's history and service treatment records reflect recent treatment for eczema since August 2011, and otherwise, previous examinations reflect a history of reporting a single occurrence in July 1998 of treatment for folliculitis. He also noted that the report of medical history in December 2002 on discharge is devoid of any skin complaints. The examiner concluded that given no documentation in service of a chronic condition, no nexus is reasonable. The examiner also opined that the diagnosed eczema is less likely than not due to any specific exposure event experienced by the Veteran during service in Southwest Asia because eczema is a common ailment that does not have a bearing on exposure events. The examiner also stated that the Veteran did not relay a history that is commensurate with exposure events. The Board notes that the Veteran's skin complaints during active duty were reported after coming out of the field, not in relation to being exposed to jet fuel or other hazardous chemicals. However, he has also reported being exposed to JP8 jet fuel during service while working as a 13B Cannon Crewman and a 92F Petroleum Supply Specialist, cleaning equipment and burning trash and other items with this fuel. See January 2021 claim and March 2021 statement from the Veteran. Therefore, the examiner's finding that his reported history is not commensurate with exposure events is not completely accurate. However, this inaccuracy does not negate the remainder of the examiner's findings and conclusions. There is no contradictory medical opinion of record, and no other medical evidence suggesting that the Veteran's current skin disability is related to his active military service. Furthermore, the Board notes that service connection is possible for disabilities first diagnosed after service, and the lack of evidence of a disorder in the service treatment records is not fatal to a claim for service connection. However, given the lack of evidence of a skin disability at discharge, and the years-long gap between service and the first notation of a skin disability, the Board does not find the Veteran's accounts of a skin disability since service to be credible. As such, the Board finds the April 2020 VA examiner's opinion is supported, and another examination is not necessary. The Board acknowledges the Veteran's assertion that his skin disability is due to events during his active service. The Veteran is competent to report the observable symptoms of a disability, and in certain situations a lay person may be competent to establish the etiology of a disability. However, the Board finds that in the present case, the Veteran is not competent to provide a nexus between his currently diagnosed skin disability and his active service or events therein, as it would require medical expertise to say that the current skin disability, identified after service, is the result of an in-service disease or injury. The Veteran, as a layperson, is not qualified to render an opinion concerning the medical cause of his skin disability. 38 C.F.R. § 3.159 (a)(1), (2) (2019). For the reasons and basis stated above, the Board finds that service connection for a skin disability is not warranted. In reaching this decision, the Board has considered benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is the against the claim, that doctrine is not applicable. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board F. Yankey, 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.