Citation Nr: 22016189 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 14-09 222A DATE: March 21, 2022 ORDER Entitlement to service connection for a skin condition, to include nummular dermatitis, is denied. FINDING OF FACT The evidence of record persuasively weighs against finding that the Veteran's skin condition began during active service, or is otherwise related to an in-service injury or disease, to include herbicide exposure. CONCLUSION OF LAW The criteria for service connection for a skin condition are not met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1969 to September 1971. This matter is before the Board of Veterans' Appeals (Board) on appeal from a June 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran was afforded a hearing in October 2020 before the undersigned Veterans Law Judge. In April 2021 and October 2021, the Board remanded the issue of entitlement to service connection for a skin condition to include nummular dermatitis for further development. Service Connection Service connection is established 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 of 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). 1. Entitlement to service connection for a skin condition, to include nummular dermatitis, as a result of exposure to herbicide agents. The Veteran asserts that his current skin condition is a result of exposure to herbicide agents while in service. The Veteran was diagnosed with nummular dermatitis in May 2009. This diagnosis was confirmed in a June 2021 VA examination. As a result, the first element of service connection, a current disability, has been met. The Veteran's military personnel records demonstrate that he was stationed in Vietnam during active service from March 1971 to September 1971. See DD Form 214. Thus, in-service herbicide agent exposure is legally presumed. 38 U.S.C. § 1116 (f); 38 C.F.R. § 3.307 (a)(6)(iv). This satisfies the second element of service connection, an in-service injury. Turning to the third element of nexus, in some circumstances, a disease associated with exposure to certain herbicide agents will be presumed to have been incurred in service even though there is no evidence of that disease during the period of service at issue, unless there is affirmative evidence to establish that the disease is due to an intercurrent injury or disease. 38 U.S.C. § 1116 (a); 38 C.F.R. §§ 3.307 (a)(6), 3.307(d)(1), 3.309(e). Nummular dermatitis is not one of the enumerated diseases. 38 U.S.C. § 3.309(e). As a result, this presumption does not apply, and service-connection is not warranted on a presumptive basis. The Veteran may still establish nexus on a direct basis. The Veteran's service treatment records show the Veteran did not report any issues regarding his skin during his June 1969 entrance examination nor his September 1971 separation examination. In January 1970 the Veteran reported a rash near his penis, however, in February 1970 the provider indicated this was a wart for which the Veteran continued to receive treatment for through May 1970. The Veteran has not asserted that his condition began in service. Rather, he contends that his skin condition was caused by his conceded in-service herbicide exposure. The Veteran's private treatment records show he was being treated for a skin condition from July 2004 to May 2009. In January 2005 he reported having a rash for the past 3 to 4 months. Additional records were received in June 2021 that show the Veteran's skin was noted to be "unremarkable" in June 2013. In October 2013 the Veteran was again treated for "seborrheic dermatitis" and "nummular eczema." The Veteran underwent a VA examination in May 2010. Here, the examiner noted the Veteran had a current diagnosis of nummular dermatitis for which the Veteran was receiving treatment. The examiner also noted in reference to the Veteran's inservice warts that "penile warts resolved. No recurrence after service." The examiner concluded that the Veteran's current skin condition was not related to his in-service reports of penile warts as the warts were treated in service without any recurrence since that time. The Board finds this opinion probative, as it provided a clear conclusion with supporting data, and reasoned medical explanations connecting the two. Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). During the October 2020 hearing the Veteran asserted that his skin condition began 35 years prior, approximately 15 years after his separation from service. The Veteran asserts the environment in Vietnam to include exposure to herbicide agents caused his skin condition. He contends that he did not have skin issues prior to his time in service. The Board notes that the Veteran asserted he received treatment in the early 1990s for his skin condition. However, VA was notified that there were no additional medical records pertaining to the Veteran's skin condition from that period in a March 2021 third party correspondence. Additionally, treatment as early as 1990 would still result in the onset of his skin condition 19 years after his separation from service. The Veteran underwent a VA examination in June 2021 in which the examiner confirmed his diagnosis of nummular dermatitis. The examiner then found that his current skin condition was not a result of his active-duty service. However, as the examiner did not consider the Veteran's exposure to herbicide agents while in service in the opinion, the Board finds the June 2021 examination is inadequate for rating purposes. Nieves-Rodriguez, 22 Vet. App. 295. As a result, an addendum opinion was obtained in November 2021. Here, the examiner explained that the cause of the Veteran's skin condition is "incompletely understood." However, there are a number of factors that could contribute to the development of such a condition. The examiner stated issues such as xerosis, contact allergies to some metals, and sensitivity to environmental factors, for example dust mites, could result in his condition. The examiner also explained that issues such as cutaneous lipid production, Staphylococcus aureus colonization, medication such as isotretinoin, and patients with hepatitis C infection who are treated with interferon-alpha-2b and ribavirin can also cause this skin condition. The examiner concluded by stating that while there are a number of known instances and conditions that can result in the development of nummular dermatitis, based on the reviewed and up to date medical literature, exposure to herbicide agents is not one of the known causes. As a result, the examiner found that the Veteran's current skin condition is less likely than not incurred in or caused by his exposure to herbicide agents while in service. The Board finds this opinion probative, as it provided a clear conclusion with supporting data, and reasoned medical explanations connecting the two. Stefl, 21 Vet. App. 120; Nieves-Rodriguez, 22 Vet. App. 295. At the hearing, the Veteran also testified that he believed the skin condition was due to the "bad weather, hot weather" in the Republic of Vietnam. However, no other evidence has been submitted that indicates a relationship between the weather in Vietnam and the Veteran's skin condition. VA has not obtained a medical opinion for this theory, and the Board does not find an opinion is warranted, because a conclusory lay statement of causation is not sufficient to trigger the duty to assist in providing an examination. Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010) (rejecting appellant's argument that his "conclusory generalized statement that his service illness caused his present medical problems was enough to entitle him to a medical examination under the standard of [38 U.S.C. § 5103A(d)(2)(B).]"). As a lay person who is not trained in the field of medicine, the Veteran is not medically competent to offer a medical opinion that any current diagnosed nummular dermatitis condition is related to herbicide or weather exposure in service. While the Veteran is competent to report the symptoms he experiences, the etiology of nummular dermatitis is medically complex as it has multiple possible etiologies, as explained in the November 2021 opinion. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). As a result, the Veteran's assertions regarding the etiology of his skin condition are not competent nexus evidence and are afforded no probative weight in this matter. (Continued on the next page) Based on the foregoing, the Board finds that the competent and credible evidence is neither evenly nor approximately balanced as to whether service connection for the Veteran's skin condition is warranted. Rather, the evidence persuasively weighs against a finding that the Veteran's current skin condition is directly related to service. The benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107(b), Lynch v. McDonough, __ F.4th __, No. 2020-2067, 2021 U.S. App. LEXIS 37312 (Fed. Cir. Dec. 17, 2021) (holding the benefit-of-the-doubt doctrine is not for application when the evidence is persuasively for or against the claim). The claim is denied. LAURA E. COLLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Associate Counsel, S. Conti 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.