Citation Nr: 22014375 Decision Date: 03/12/22 Archive Date: 03/12/22 DOCKET NO. 17-33 911 DATE: March 12, 2022 ORDER Entitlement to service connection for hair loss/scalp dermatological disorder is denied. FINDING OF FACT The evidence of record persuasively weighs against finding that the Veteran has had a scalp dermatological disorder at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for a scalp dermatology disorder have not been satisfied. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from June 1991 to December 1991. She served a period of active duty for training from June 1983 to November 1983. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In December 2018, the Board remanded the matter to the Agency of Original Jurisdiction (AOJ) for additional development, and it has since returned for further appellate review. In the December 2018 remand, the Board directed the AOJ to obtain any outstanding service records and schedule the Veteran for an examination to address the nature and etiology of her scalp dermatological disorder. Adequate attempts were made to obtain any outstanding service record. Furthermore, the Veteran was afforded an adequate September 2021 examination with an accompanying medical opinion that addressed the nature and etiology of the scalp dermatology disorder claim. As such, the Board finds that there was substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). The issue of service connection for a psychiatric disorder was also on appeal. During the development phase, an October 2021 rating decision granted service connection for a psychiatric disability. Since the issue of psychiatric disability has been granted in full, it is no longer on appeal. 1. Service Connection for Scalp Dermatological Disorder As an initial matter, the Veteran's claim of service connection for a scalp dermatological disorder was initially denied in a November 1992 rating decision. The December 2018 Board remand found that relevant service records had been obtained and reconsidered the Veteran's claim under 38 C.F.R. § 3.156(c). As such, the period on appeal for this claim goes back to the Veteran's initial claim for benefits received in February 1992. The Veteran contends that she has a scalp dermatological disorder that was caused by her active duty service. Specifically, the Veteran reports having hair loss from the center to the middle section of her head. See June 2013 Report of General Information. She began noticing the loss of hair during active service when she was wearing a flying helmet that was hot and eventually leading to hair loss. See June 2017 Substantive Appeal. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 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 related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have any current disability for scalp dermatology disorder 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). Service treatment records show a December 1991 report where the Veteran complained of having dandruff and itching of the scalp. After evaluation, it was determined that the Veteran had seborrheic dermatitis. Post service, in a February 2010 VA treatment, it was noted that the Veteran did not have any significant skin problems. The Veteran was afforded a VA examination in April 1992. The Veteran complained of hair loss on the top of her head. She explained that the hair on the top of her head seems to fall out and that she occasionally had some itching on the scalp. On physical examination, the VA examiner inspected her scalp which revealed an area of about 2.5cm in diameter at the top of her head, where the hairs were about 1 inch long, compared to the rest of the scalp "as though someone had snipped out a bunch of hair at the top of her head." The VA examiner determined that there was no scalp disease found. The examiner further opined that the scalp was normal, the rest of her hair appeared normal, and there were no bald spots. The Board finds that the physical examination findings made by the examiner are highly probative for the determination of whether the Veteran had a current disability in 1992. However, the opinion is found inadequate to the extent the examiner failed to provide an adequate medical opinion regarding a nexus between any scalp dermatology disorder and service since the Veteran's service treatment records were not available at that time for review. See December 2018 Board Remand. The Veteran underwent a VA examination in April 2017, at which time the Veteran reported that while in flight school and wearing a helmet, she began noticing hair loss. She reported that the scalp condition has stayed the same since service, with a quarter sized area of hair loss that itched. She stated that she does not seek medical treatment for her scalp, but goes to a salon for cap and braiding to cover the area. Upon examination, the examiner opined that a review of the record does not reveal a diagnosis of hair loss during service or other dermatologic disease. The examiner opined that the Veteran does not a have current hair loss condition that was due to service. However, the examination findings have been deemed inadequate as the examiner failed to perform a physical examination of the Veteran's head. See December 2018 Board Remand. The April 2017 examination is afforded no probative weight. Most recently, the Veteran presented for a VA examination in September 2021, at which time she was interviewed by the examiner who also reviewed the pertinent medical history and performed an examination. The Veteran reported that after wearing a flight helmet during service, she noticed some hair loss, thinning hair, and scalp itching. She reported that since service, her hair thinning has extended her hair with a weave. She reported not seeing a clinician for a scalp condition. Her current symptoms included occasional minor scalp skin itching. She reports seeing a private hair stylist to clean and work on her hair weave. She did not take any medications, seek treatment, or go for evaluations. Upon examination, the examiner opined that the claimed skin condition was not incurred in or caused by the claimed in-service injury, event, or illness. In support of this conclusion, the examiner evaluated the Veteran and determined that the Veteran does not have a current skin condition or any resolved skin condition. The examiner remarked that there was no skin scalp diagnosis because physical examination was negative for any skin scalp. The examiner further explained that while there were occasional minor scalp itching and a hair weave, such conditions do not meet any medical criteria for a skin or scalp diagnosis or disability. The examiner opined that there was no functional impact of any reported skin condition. The Board finds this opinion highly probative as it was made by a medical professional with consideration of the specific facts in this case and after examination of the Veteran. The opinion is also supported by other evidence of record. There is no medical opinion or competent and credible evidence in significant conflict with the VA medical opinion. Based on the foregoing, the Board finds the most persuasive evidence of record weighs against a finding of a current scalp dermatological disorder at any time during the appeal period. In that regard, the Board acknowledges the Veteran's report of hair loss on her scalp and occasional scalp itching. However, VA examiners in April 1992 and September 2021 interviewed the Veteran and conducted physical examinations of the Veteran's scalp and determined that she did not have a current scalp dermatological disability. The April 1992 examiner noted that while there was hair loss at some part of her scalp, the examiner determined that there was no scalp disease found. Moreover, the examiner opined that her scalp and the rest of her hair was normal, and there were no bald spots observed. Furthermore, the September 2021 VA examiner reviewed the Veteran's record, including her service treatment record, and still found that she did not have current scalp disability or a resolved scalp disability. The Board has considered the Veteran's statements, to include her assertions that she has a current hair loss disability that began during service. In Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the Federal Circuit held that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. A review of the record has not revealed any indication from the Veteran that her condition has resulted in any functional impairment. Notably, examination findings have found no functional impact related to any reported scalp dermatological disorder. The Board acknowledges the Veteran's Military Occupational Specialty (MOS) during service was that of a Medical Specialist, meaning she is not a layperson. She has not provided a diagnosis for her condition, other than to describe symptoms, without stating that they cause functional impairment of earning capacity. The most persuasive evidence such as objective medical examinations of the Veteran's scalp consistently found no evidence of a current scalp disability or symptoms that result in functional impairment of earning capacity. Consequently, the Board ultimately assigns greater probative weight to the medical evidence of record, to include the opinions rendered by trained medical professionals based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. To the extent the Veteran asserts a continuity of symptomatology beginning during service, the Board finds these statements to be less probative as the April 1992 VA examination conducted about 5 months after separation where the examiner found the Veteran's scalp to be normal with no evidence of a current scalp. For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for scalp dermatology disorder is warranted. Rather, the evidence persuasively weighs against finding that the Veteran has a current scalp dermatology disorder that is related to service, and thus, the claim is denied. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application as to this claim. See Lynch v. McDonough, 21 F.4th 776, No. 2020-2067, 2021 U.S. App. LEXIS 37307 (Fed. Cir. Dec. 17, 2021) (only when the evidence persuasively favors one side, or another is the benefit of the doubt doctrine not for application). D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Mathew 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.