Citation Nr: 21040307 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 15-04 692 DATE: July 3, 2021 ORDER Service connection for a skin rash, to include as due to exposure to herbicide agents, is denied. FINDINGS OF FACT 1. The Veteran served in the Republic of Vietnam during the Vietnam era; therefore, he is presumed to have been exposed to herbicide agents therein. 2. Nummular eczema and pityrosporum (malassezia) folliculitis are not among the diseases that are presumed to be associated with exposure to herbicide agents. 3. The preponderance of the evidence is against finding that the Veteran has skin rash that began during active service, or is otherwise related to an in-service injury or disease, to include exposure to herbicide agents therein. CONCLUSION OF LAW The criteria for service connection for a skin rash, to include nummular eczema and pityrosporum (malassezia) folliculitis, to include as due to exposure to herbicide agents, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active service from February 1968 to December 1971. In February 2018, the Veteran testified at a videoconference hearing at the Regional Office (RO), before the undersigned Veterans Law Judge. In July 2018, June 2020, November 2020, and March 2021, the Board remanded this issue for further evidentiary development. Entitlement to service connection for a skin rash, claimed as jungle rot, to include as due to exposure to herbicide agents. The Veteran contends he has had a rash off and on since his service, and also contends the skin rash is related to his exposure to Agent Orange in service. Service connection may be granted for disability which is the result of disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. The Veteran's exposure to herbicide agents is presumed, as service records show he served in Vietnam, during the Vietnam era. 38 C.F.R.§ 3.2(f). Certain diseases, but not nummular eczema or pityrosporum (malassezia) folliculitis, may be service-connected if the Veteran was exposed to an herbicide agent during service even though there is no record of such disease in service, provided that the requirements of 38 C.F.R. § 3.307(a)(6) are met. 38 C.F.R. § 3.309(e). Direct service connection can also be established if the record contains competent medical evidence of a current disease process related to exposure to herbicide agents in service. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). After review of the record, the Board concludes the preponderance of the evidence is against the grant of service connection for a skin rash. In November 2019, a VA examiner noted current diagnoses of nummular dermatitis (eczema), an allergic skin condition, and pityrosporum folliculitis or malassezia, due to a fungal infection. Thus, the Veteran has a current disability. However, because neither nummular eczema nor pityrosporum (malassezia) folliculitis are among the diseases presumed to be associated with exposure to herbicide agents, there must be competent evidence establishing a connection between herbicide agents exposure and the claimed condition. In that regard, the Board finds that the record does not contain medical or other competent evidence indicating that a current skin condition may be related to service, to include herbicide agents exposure therein. Service treatment records do not contain any report or finding of a skin rash. Post-service VA treatment records show that on March 19, 2004, the Veteran was seen in urgent care for hive-like lesions covering his entire body. The assessment was allergic reaction to unknown etiology, and he was prescribed Solumedrol. On March 20, 2004, he was seen again in urgent care and it was noted that he still had a rash all over his back, neck, arms, and trunk. He had several doses of Solumedrol, but the rash came back each time. It was noted that he had a history of recurrent urticaria. He was admitted to the hospital overnight and the assessment was urticaria. In April 2004, the Veteran was seen for a two week follow up, and it was noted that his rash had completely resolved. The assessment was tinea corporis and urticaria had resolved. In December 2004, the Veteran reported a history of skin rash (fungus) from Vietnam that usually presented on the feet and ankle, and that he now just used Lamisil cream. In November 2011, he reported a rash since Vietnam that was flaring up again, that it was currently on his back, legs, and scalp, but "pops up" in different areas. In January 2012, a diagnosis of dermatitis was noted when the Veteran was seen for a history of skin rash of the legs and ankles. He reported the rash came and went, and showed up on different places on his body, and that he developed the rash since being in Vietnam. In February 2012, the diagnoses included pityrosporum (malassezia) folliculitis and nummular eczema. In March 2013, the Veteran was treated for seborrheic dermatitis. In July 2017, it was noted that the Veteran's prior rash/folliculitis diagnosis continued intermittently, but he had no current problems. Examination revealed scattered skin tags. While VA treatment records describe the diagnosis and treatment of various skin conditions, including nummular eczema or pityrosporum folliculitis, these records do not indicate that any such skin condition is etiologically related to the Veteran's service, to include his exposure to herbicide agents therein. Instead, these treatment records only document the Veteran's reports that he believes he has a skin condition related to his service in Vietnam. A VA disability benefits questionnaire (DBQ) opinion was obtained, and in April 2021, a VA examiner opined that the Veteran did not have a current rash or skin condition, to include nummular eczema or pityrosporum folliculitis, related to Agent Orange (herbicide agent) exposure or his time in service. For rationale, the examiner acknowledged that the Veteran was competent to report the presence of a rash since service, but noted that his report of a continuous rash since service was not supported by the VA treatment records reviewed, noting that when the Veteran was treated in March 2004 for an episode of severe urticaria, an acute allergic reaction, he did not mention a rash reoccurring continuously for the last 30 years and there was no significant dermatologic history noted prior to the urticaria. The examiner also explained that the presentation of urticaria differs from the reported rash of the Veteran's feet during service, noting that his urticaria was diffuse throughout, was attributed to environmental exposure given the Veteran's history of hay fever, and eventually subsided after treatment with steroids. The examiner noted that in 2011 when the Veteran was seen for a rash that he reported was present since Vietnam, the diagnosis was nummular eczema and pityrosporum folliculitis. The examiner indicated that based on a review of the medical treatment records and the Veteran's lay statements, the described clinical history of persistent rash since service was inconsistent with the manifestations and onset of the dermatologic conditions noted in the treatment records. The examiner noted that at the time of consult in 2004, the Veteran was assessed and the lesions were not consistent with the noted lesions in 2011, that the diagnosed skin conditions were unrelated, and that the treatment records did not show a skin condition that was present in 2004 and manifested again in 2011 to support the Veteran's statement of a continuous skin condition since leaving service in 1971. The examiner further opined that the Veteran's current skin conditions were not related to exposure to Agent Orange, and that there was no established relationship between exposure to Agent Orange and development of nummular eczema and pityriasis folliculitis. The Board notes that there have been several VA examinations/opinions rendered during the course of the appeal. While prior opinions were found to have discrepancies, the Board finds the 2021 VA examiner's opinion to be probative and persuasive, as it is based on an accurate understanding of the Veteran's medical history and provides an explanation that contains clear conclusions and supporting data. Moreover, the examiner acknowledged the Veteran's report of experiencing rash/skin symptoms since service as well as VA treatment records since 2004 which showed the Veteran was treatment and diagnoses for skin conditions at various times, and based the negative opinion primarily on the Veteran's described history of persistent rash since service as being inconsistent with the manifestations and onset of the dermatologic conditions noted in the treatment records. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Veteran has not submitted any competent (to include medical) evidence to the contrary. The Board acknowledges the Veteran's contentions in this appeal. In February 2018, he testified that a rash first appeared on his feet in 1969, in Vietnam, and that he went to sick bay where they called it jungle rot and gave him cream which cleared the itch, but not the rash. He testified the rash never went away after that because it would clear up in one spot and come out in another. He reported that one year after service he went to a doctor for the rash, and was hospitalized in 1990s for a rash all over his body. He also stated that a dermatologist had told him that his Agent Orange exposure "answers lots of questions". While the Veteran's reports regarding skin rash symptoms he has experienced since service are considered credible lay evidence, his statements are not considered competent or probative evidence of an actual diagnosis of a skin disability and/or of a nexus to service, to include herbicide agents exposure therein. In that regard, the Board notes that the Veteran is not competent, as a layperson, to provide an opinion as to matters involving medical diagnosis or etiology. The issue is medically complex and is therefore outside the competence of the Veteran because the record does not show he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Moreover, as addressed above, the 2021 VA examiner also considered the Veteran's statements in the formulation of her medical opinion and found them to be not supportive of a finding that the current skin rash had its onset in service or is otherwise related to military service. As for the Veteran's testimony that a dermatologist has told him that his exposure to Agent Orange answers a lot of questions, the Veteran has not provided any records or a statement from this treatment provider, and therefore the Board is unable to evaluate properly the probative value of such statement. Consequently, the Board gives more probative weight to the VA examiner's opinion. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Casula 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.