Citation Nr: 22008069 Decision Date: 02/11/22 Archive Date: 02/11/22 DOCKET NO. 16-53 799A DATE: February 11, 2022 ORDER Entitlement to service connection for a skin rash, to include as due to exposure to herbicides, is denied. FINDING OF FACT The Veteran's claimed skin condition did not occur in service, is not the result of exposure to herbicides, and is not otherwise related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for a skin condition, to include as due to exposure to herbicides, are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from April 1966 to June 1968. The Veteran is the recipient of a Combat Infantryman Badge and a Purple Heart, among other awards. The Veteran had active service in the Republic of Vietnam and his exposure to herbicide agents, to include Agent Orange, has previously been established. These matters come before the Board of Veterans' Appeals (Board) on appeal from a September 2014 rating decision by the Agency of Original Jurisdiction (AOJ) of the United States Department of Veterans Affairs (VA). The Veteran testified at a July 2020 hearing held before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is associated with the claims file. Duty to Assist With respect to the Veteran's claims decided herein, VA has met all statutory and regulatory notice and duty-to-assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326. Neither the Veteran nor his representative has advanced any procedural arguments in relation to VA's duty to notify and assist. See Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015) (holding that "absent extraordinary circumstances...we think it is appropriate for the Board and the Veterans Court to address only those procedural arguments specifically raised by the veteran...."). Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. Service connection may also 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). In order to establish service connection on a direct basis, the record requires competent evidence showing: (1) the existence of a present disability; (2) in service incurrence or aggravation of an injury or disease; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Regarding service connection due to herbicide exposure, VA laws and regulations provide that if a Veteran was exposed to herbicides during service, certain listed diseases are presumptively service-connected. 38 U.S.C. § 1116h(a)(1); 38 C.F.R. § 3.309(e). A Veteran who served in the Republic of Vietnam between January 9, 1962, and May 7, 1975, is presumed to have been exposed to herbicide. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). 38 C.F.R. § 3.309(e) lists the diseases covered by the regulation. The Secretary of VA has determined that there is no positive association between exposure to herbicides and any other condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. See Notice, 59 Fed. Reg. 341-46 (1994); Notice, 61 Fed. Reg. 41, 442-49 (1996); Notice, 72 Fed. Reg. 32,395-32,407 (Jun. 12, 2007); Notice, 74 Fed. Reg. 21,258-21,260 (May 7, 2009); Notice, 75 Fed. Reg. 32540 (June 8, 2010). Notwithstanding the presumption, service connection for a disability claimed as due to exposure to Agent Orange may be established by showing that it was causally linked to such exposure. Combee v. Brown, 34 F. 3d 1039, 1044 (Fed. Cir. 1994), citing 38 U.S.C. § 1113(b) and 1116 and 38 C.F.R. § 3.303. Service connection for certain chronic diseases may be established on a presumptive basis by showing that the disease manifested itself to a degree of 10 percent or more within one year (three years for active tuberculous disease and Hansen's disease; seven years for multiple sclerosis) from the date of separation from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of that disease during the period of service. 38 C.F.R. § 3.307(a). The term "chronic disease" refers to those diseases listed under section 1101(3) of the statute and section 3.309(a) of VA regulations. 38 U.S.C. § 1101 (3); 38 C.F.R. § 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). A layperson is generally not capable of opining on matters requiring medical knowledge. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. The Veteran asserts that he has a rash, since his service in Vietnam, that appears when the weather starts getting warmer on his stomach, shoulders, arms, and ankles. The Veteran's service treatment records are negative for treatment for a rash or any skin disorder in service. The reports of his entrance and separation examinations are negative for a skin disorder. At his July 2020 hearing, the Veteran testified that the rash started in Vietnam and that it has been an ongoing, intermittent, and recurrent problem since that time. He treats the rash with aloe vera and hot showers. The Veteran testified that he did not notice any flare-ups of the rash when his posttraumatic stress disorder flares up. The Veteran stated that the rash was seasonal, coming in the spring. The Veteran testified that he had been treated by a private health care provider for the rash. VA medical records are negative for treatment for complaints and/or symptoms of a skin rash. The Veteran has not submitted any private medical records or authorizations for VA to obtain copies of private medical records that reflect treatment for a skin rash. The Veteran was afforded a VA skin examination in April 2021. The VA examiner noted the Veteran's diagnosis of a skin rash. The Veteran reported experiencing a skin rash in the neck area, umbilical area, axilla, groins, and flanks. The Veteran reported that these rashes began when he was in Vietnam. He was in the jungle for most of the time and didn't take showers often, so he developed rashes in both armpits. He reported that the rash comes and goes and seems to occur in spring or when there is a change of weather. He reported that he self-treats with neosporin and Gold Bond powder. He stated that the skin itching continues after the rash is healed. The Veteran has had no other treatments or procedures for this condition. At the time of the examination, there was no skin rash present on his body. The examiner noted the Veteran's skin was normal in appearance, with no lesions or rashes visible. The VA examiner noted that a diagnosis of skin rash was made based on the Veteran's report. The VA examiner determined that it is less likely than not that the Veteran's skin rash is related to his time in service, to include as due to exposure to Agent Orange. The VA examiner noted there is no evidence of a skin rash documented during service and post discharge. Additionally, there is no evidence of chronicity of care and the symptoms are subjective only. The VA examiner noted that there is no evidence of a diagnosis of chloracne or porphyria cutanea tarda which are approved agent orange presumptive skin conditions. The VA examiner noted that these two agent orange presumptive skin conditions do not appear years later, but within a year of toxic exposure. The Board found that this opinion was inadequate for adjudication purposes because the examiner did not consider the Veteran's statements that he experiences periods of remission and that his current treatment includes the use of creams and powders for management of his symptoms, essentially rejecting all lay evidence. The Veteran underwent a VA skin examination in November 2021. The VA examiner noted that the Veteran had no skin condition. The Veteran reported experiencing a skin rash in his bilateral armpits and groins since 1967. He stated that the rash is on and off, occurring in warm weather and most recently occurred in July 2021. The Veteran reported he had never sought medical care for it, but self-treats with hydrogen peroxide and Neosporin ointment. The VA examiner noted the Veteran had used hydrogen peroxide and Neosporin for less than six weeks in the past year. The VA examiner noted that the Veteran did not have a current skin condition with any visible characteristic lesions at the time of the examination. There was no scarring noted. The VA examiner stated that there was no objective evidence to support the claim for skin rash at the time of the examination. No diagnosis was rendered. The VA examiner determined that it was less likely than not that the Veteran's skin rash was incurred in or caused by service. The VA examiner noted that there is no objective medical evidence of record to support the diagnosis or treatment of skin rash during or after service. "Therefore, the Veteran's claim for a skin rash was less likely than not incurred or caused by skin rash as a result of agent orange exposure during service. A nexus can not be established." The VA examiner noted that it was less likely than not that the Veteran's skin rash is proximately due to or the result of a service-connected condition because she was unable to confirm a current chronic diagnosis of skin rash with current available records and/or today's exam; no nexus or plausible secondary relationship is established. The VA examiner further opined that the Veteran's skin condition was not aggravated by service as his STRs are silent for a skin rash or condition, including his entrance and separation examinations. The VA examiner noted that the only skin condition which is approved to be associated with Agent Orange is porphyria cutanea tarda, and this tends to appear and be diagnosed within a year of exposure. The VA examiner noted that the examination was negative for a skin rash and determined that a nexus has not been established. Direct service connection for a skin rash must be denied because the competent evidence of record does not show a skin rash was caused nor aggravated by service; nor does it show that the Veteran experienced symptoms of this condition that continued from service until the present. Additionally, there is no competent evidence that establishes the claimed skin condition is secondary to a service-connected disability. Finally, the Board notes that a skin rash, generally, is not one of the diseases for which a presumption of service connection is granted based upon exposure to herbicides. Although the Veteran has expressed his belief in a connection between his time in service, specifically his conceded exposure to Agent Orange, and his claimed skin disorder, he lacks the knowledge and training required to render a nexus opinion on a cause and effect relationship unobservable to a lay person. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Further, he has simply asserted his opinion, without a clear rationale or support; no probative value is given his statements beyond their worth as physical observations. No medical professional has rendered a positive nexus opinion, nor supported the position. Service connection for a skin rash, including as due to exposure to herbicides and to include service connection on a secondary basis to PTSD, is not warranted. There is no reasonable doubt to be resolved in this case. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, at 1 Vet. App. 49 (1990). WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Margaret M. Lunger, 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.