Citation Nr: 21041198 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 16-41 306 DATE: July 8, 2021 ORDER Entitlement to service connection for a skin disability is denied. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has had a skin disability at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for a skin disability are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from November 2000 to December 2006. Only the Veteran's period of service from November 13, 2000 to November 23, 2004 is considered honorable service. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2018 and June 2020, the Board remanded the claim for further development, which has been completed. Entitlement to service connection for a skin disability The Veteran seeks service connection for a skin disability. He contends that his condition developed while on active duty, he has continued to need treatment, and he has a current diagnosis. He asserts that the condition is worse than the examinations show and is more likely than not due to his active service. The representative contends that the Veteran has been prescribed hydrocortisone for a current skin condition, and continues to report that he suffers from a skin condition. The representative contends that the skin condition is intermittent, but that it is an ongoing chronic disability that is related to active service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. VA treatment records show intermittent skin notations. In March 2007, the Veteran sought treatment for penile papules. In October 2008, the Veteran reported persistent papular or nodular skin rash. In July 2010, treatment notes reflect that the Veteran was prescribed Clotrinazole. An August 2010 mental health note indicated a history of psoriasis. Subsequent treatment records, however, do not contain notable skin complaints. See treatment records dated December 2016, July 2017, April 2018, or April 2019. The Veteran was afforded a VA examination in August 2013. The Veteran reported a history of multiple erythematous papules and some small pustules on both arms and chest. The examiner assessed folliculitis in 2002, since resolved. No positive clinical findings were noted on physical examination. The examiner indicated that an opinion was not warranted, since the claimed condition resolved without residuals. The Veteran was afforded a VA examination in July 2019. The examiner opined there was not skin condition. The examiner noted that the medical records showed the Veteran was prescribed hydrocortisone cream. However, no skin condition was documented, and the Veteran had not been evaluated for a skin condition since that time. The Veteran did not have skin lesions at the VA examination. Thus, the examiner concluded there was no information to determine a diagnosis for the Veteran's claimed skin condition in available medical records or on examination. In June 2020, the Board remanded the claim for an addendum opinion to determine whether the Veteran has a current skin disability that is related to service. In July 2020, a VA examiner offered an addendum opinion. The examiner opined the Veteran did not have a current diagnosed skin condition. The examiner noted treatment for penile lesions in 2007, which was treated and resolved based on the record. No other findings or treatment before or after 2007 for penile lesions were noted, and thus the examiner concluded the penile lesions were not a current skin disorder. The Veteran noted the Veteran was prescribed Clotrinazole topical for tinea cruris, but there were not clinical findings or other documentation to indicate a chronic skin condition. The examiner indicated that though the Veteran was prescribed topical medication, he denied any skin complaints at visits in 2008, 2009, 2013, 2016, 2017, 2018, and 2019, with associated lack of any skin diagnoses or skin findings. Therefore, the examiner concluded, though dermatological medications were prescribed in 2012, the record did not contain information to establish a specific skin diagnosis for the Veteran, acute or chronic, at that time or any other time. The Board concludes that the Veteran does not have a current diagnosis of a skin disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Board is mindful of Saunders v. Wilkie, 886 F.3d 1356, 1364-65 (Fed. Cir. 2018), in which the Federal Circuit explained that where pain alone results in functional impairment that affects earning capacity, even if there is no identified underlying diagnosis, it can constitute a disability. However, in this case, there is no showing of impaired earning capacity due to a skin disorder. The June 2020 VA examiner evaluated the Veteran and determined that, while he experienced subjective symptoms, he did not have a diagnosis of a skin disability. Further, despite medication treatment in 2012, VA treatment records do not contain a positive clinical findings or treatment of a chronic or acute diagnosed skin disability. While mental health providers stated in August 2010 that the Veteran had psoriasis, there is no indication that the mental health provider performed a physical examination or any diagnostic tests to confirm the presence of psoriasis. Instead, the statement appears to be based on the Veteran's self-reported medical history, which is inconsistent with physical VA medical records that show medication prescription, but no diagnosis or positive clinical findings of a skin disability. Consequently, the Board gives more probative weight to the detailed June 2020 VA examiner's findings. (Continued on the next page) While the Veteran believes he has a current diagnosis of a skin disability, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. There is no competent evidence of a current skin disability for which service connection can be granted. The Veteran has not asserted, nor provided any supporting evidence of, impaired earning capacity due to a skin disability. Thus, the preponderance of the evidence is against the claim and there is no doubt to be resolved. Service connection for a skin disability is not warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. L. Chu Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Lauritzen, Associate 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.