Citation Nr: 22014448 Decision Date: 03/12/22 Archive Date: 03/12/22 DOCKET NO. 18-37 094 DATE: March 12, 2022 ORDER Entitlement to service connection for adiposis dolorosa/Decrum's disease, to include neurological manifestations and scars, is granted. FINDING OF FACT The Veteran's adiposis dolorosa/Decrum's disease (skin disorder), to include neurological manifestations and scars, is reasonably found to be of service origin. CONCLUSION OF LAW Resolving all doubt in the Veteran's favor, the criteria for service connection for adiposis dolorosa/Decrum's disease, to include neurological manifestations and scars, have been 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 duty service from December 2000 to December 2004. This matter is before the Board of Veterans' Appeals (Board) from a July 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared at a hearing before the undersigned Veterans Law Judge in October 2021. At the hearing, the Veteran granted a waiver of initial consideration by the RO of any additional evidence received. The Veteran submitted a Substantive Appeal (VA Form 9) in April 2019 and requested a hearing on the issues of whether new and material evidence has been submitted to reopen the claim for service connection for a heart condition, and entitlement to a rating higher than 30 percent for posttraumatic stress disorder. The matter required administrative action before proceeding with scheduling the hearing requested. The administrative process is complete, and the Veteran and his representative will be notified of the date of the hearing. Service connection is granted on a direct basis when there is competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 38 U.S.C. § 1110; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Veteran contends that service connection is warranted for adiposis dolorosa/Decrum's disease because symptoms of the skin disease was first manifest during service. Specifically, the Veteran states that in 2004 he noticed a lump on his left elbow. He was in Afghanistan at the time and showed the lump to a corpsman. He acknowledges that there is no documentation of this. Since service separation, he has complained of multiple painful lipomas and nerve pain. He has had surgical excision of the lipomas and was diagnosed with having Decrum's disease. In June 2018 the Veteran underwent a VA-contract skin diseases examination. Following examination he was diagnosed with having Decrum's disease/adiposis dolorosa. Exposure was not on hands, feet, neck and head. The examiner noted the Veteran's skin disease caused scarring; scars were from removal of the lipomas. The examiner opined that the Veteran's claimed skin disorder was less likely than not incurred in or caused by the claimed inservice injury, event, or illness. The rationale for the opinion was that the Veteran states he has had multiple removals over the years, and he continues to develop new ones. He had a lump on his left elbow in service, but the records are silent. Additionally, there is no buddy statement to attest to the lump. A VA-contract scars examination was also conducted in June 2018 related to his diagnosed Decrum's disease/adiposis dolorosa by the same examiner who conducted the skin examination. The Veteran reported having 5 or more scars on his trunk and extremities from removal of the lipomas; the scars are painful. He states the pain is a burning type of pain. He described having 1 to 8 linear scars on his right wrist, elbow and forearm. The length of the linear scars ranged from .7 centimeters (cm) to 1.8 cm. He described having 1 to 6 linear scars on his left wrist, elbow and forearm. The length of the linear scars ranged from 1 cm to 1.5 cm. Scar number 4 was noted as being tender to palpation. He described having 1 to 3 linear scars on his left leg. The length of the scars ranged from 1 cm to 2 cm. The scar was tender to palpation. He had 1 linear scar on his left flank 2.5 cm in length. The diagnosis was multiple residual lipoma removal scars. The examiner noted the Veteran complains of having residual scars. A VA-contract peripheral nerves examination was conducted in June 2018 related to his diagnosed Decrum's disease/adiposis dolorosa by the same examiner who conducted the skin and scars examinations. The Veteran related a medical history of complaints of multiple painful lipomas and nerve pain. He is on Gabapentin. He did not indicate he had any symptoms attributable to any peripheral nerve disorder. On sensory examination, he had decreased sensation of the bilateral foot/toes. There was mild incomplete paralysis of the left ulnar nerve; and right and left mild incomplete paralysis of the sciatic nerve. The diagnosis was adiposis dolorosa/Decrum's disease. The examiner opined that the Veteran adiposis dolorosa/Decrum's disease was less likely than not incurred in or caused by the claimed inservice injury, event, or illness. The examiner reasoned that the Veteran has been diagnosed with Decrum's disease, also known as adiposis dolorosa. This is the same condition; they are not separate conditions. The Veteran has had multiple removals over the years. He continues to develop new ones. He states that he had a lump on his left elbow in service. However, the records are silent. Additionally, there are no buddy statements to attest to the lump. In a June 2018 statement, R.S., a fellow servicemember, who was assigned as the medical representative for the Veteran from March to June 2004, while deployed to Afghanistan. He stated that during the latter part of the deployment while the unit was embedded into the mountains, he noticed a 2-inch nodule on the Veteran's elbow. The Veteran mentioned that the nodule was painful at times and that he also had one on his left flank and could not recall how long they had been there. R.S. stated that he assessed the size and location of the two nodules and monitored them the rest of the deployment. He stated he was concerned with the occasional pain associated with the nodules. At one point the Veteran was seen at the Battalion Aid Station by a physician assistant, who recommended monitoring the nodules and wait to be seen upon return to the United States. R.S. noted that the circumstances of the deployment prevented the carrying of medical records. It was discussed that the Veteran be examined by a specialist upon returning to the United States. In a January 2019 statement, M.S., a fellow servicemember, stated that between July 2003 and December 2004 he and the Veteran were assigned to the same division and both were deployed to Afghanistan. M.S. stated that during the deployment he noticed the Veteran had a growth on his left elbow and he mentioned that it hurt. He noted that due to the location of the mission, they were unable to seek medical attention during the deployment. He stated they talked about the Veteran getting treatment upon returning to the United States. At the October 2021 hearing the Veteran's representative clarified that the Veteran's condition causes other issues than just a skin condition. He has lumps, cysts, or bumps that "pop up" and have to be removed leaving scars. They also create nerve issues and neuralgia. The Veteran testified that he first noticed a lump on his elbow and on his lower flank area during his deployment to the Middle East. He stated he notified a Navy corpsman to let him know what was going on and was told not a whole lot could be done in the desert. The Veteran stated that he has symptoms of pain, burning sensation, severe tingling, and numbness. He stated that the lipomas were growing on his arms, chest, backside, buttocks, thighs, lower back, mid stomach, and calves, but not on his face. He had some growths removed by VA. He has been prescribed Gabapentin for the neuralgia. After reviewing all the evidence, lay and medical, and resolving reasonable doubt in favor of the Veteran, service connection is warranted for adiposis dolorosa/Decrum's disease to include neurological manifestations. The Board notes that the Veteran's service treatment records are negative for any findings of adiposis dolorosa/Decrum's disease. The evidence shows that the claimed disorder is a diagnosed disease caused by painful lipomas of unknown etiology and does not fit the description of a medically unexplained chronic multi-symptom illness. However, the Board finds statements of the Veteran's fellow servicemembers, especially that of R.S. who provided medical advice to the Veteran regarding the claimed disorder, to be credible and highly probative in this matter. The Board assigns less probative weight to the negative nexus opinions by the June 2018 VA-contract examiner because the opinions were based on a lack of corroborating statements that attest to the lump on the Veteran's elbow. As noted, credible and probative evidence attesting to the claimed disorder was associated with the Veteran's record shortly after the examiner's opinion. Thus, such evidence weighs in favor of the claim. For these reasons, the Board finds that the weight of the competent evidence is at least in relative equipoise on the question of whether the Veteran's currently diagnosed adiposis dolorosa/Decrum's disease, to include neurological manifestations and scars, are related to service. Accordingly, resolving reasonable doubt in the Veteran's favor, the Board finds that service connection is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Young, 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.