Citation Nr: 22016771 Decision Date: 03/23/22 Archive Date: 03/23/22 DOCKET NO. 18-05 513 DATE: March 23, 2022 ORDER Entitlement to service connection for pseudofolliculitis barbae is granted. FINDING OF FACT The most probative evidence reflects that pseudofolliculitis barbae initially manifested during active duty. CONCLUSION OF LAW The criteria to establish service connection for pseudofolliculitis barbae are met. 38 U.S.C. §§ 101, 1101, 1110, 1131, 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.1, 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from July 1983 to July 2003. He previously served two years in the Reserve Officers' Training Corps (ROTC); however, the nature of this period of service is unverified. This matter comes to the Board of Veterans' Appeals (Board) from a June 2014 rating decision issued by Department of Veterans Affairs (VA) Regional Offices (ROs) of the Veterans Benefits Administration (VBA), which is the Agency of Original Jurisdiction (AOJ). The Veteran expressed timely disagreement with these determinations, and the present appeal ensued. In January 2021, the Veteran presented oral testimony in support of his appeal at a Board hearing that was conducted by the undersigned Veterans Law Judge (VLJ) via videoconferencing equipment. A transcript of this hearing is of record. In June 2021, the Board, among other actions, remanded the Veteran's appealed issue to ensure that VA fulfilled its duty to assist him in substantiating his appeal. The Board's prior remand directives have been substantially completed, and the Veteran's appealed issue has been returned to the Board for further appellate consideration. The Board's June 2021 remand also included petitions to reopen the Veteran's previously-denied claims to establish service connection for bilateral knee disabilities; however, in a November 2021 rating decision, the AOJ reopened the Veteran's claim and granted service connection for disabilities of the right and left knees. While the appeal period of this rating decision remains pending, the AOJ's actions represent a full grant of the benefits sought, and thus, those appealed issues have been abrogated. Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997). 1. Entitlement to service connection for pseudofolliculitis barbae Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty or for aggravation of preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). The credibility and weight of all the evidence, including the medical evidence, should be assessed to determine its probative value, and the evidence found to be persuasive or unpersuasive should be accounted for, and reasons should be provided for rejecting any evidence favorable to the claimant. Masors v. Derwinski, 2 Vet. App. 181 (1992). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. It is the Board's responsibility to determine whether a preponderance of the evidence supports the claim or whether the evidence is in relative equipoise, with the veteran prevailing in either event, or whether most probative evidence is against the claim, in which case the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Analysis The Veteran asserts that he initially experienced symptoms of pseudofolliculitis barbae during active duty, and the disability has endured to the present. The evidence pertinent to the Veteran's appeal are largely undisputed. Service treatment records reflect that he complained of symptoms congruent with pseudofolliculitis barbae, particularly skin irritation and bumps after shaving, during active duty. While the Veteran has asserted that he was placed on a shaving profile due to these symptoms, this is not reflected in the record for review; however, the Board notes that the Veteran's complete personnel file has not been associated with the record. Nonetheless, the evidence recounted above suffices element (2) to establish service connection on a direct basis. Since service separation, the Veteran has maintained a beard because doing so keeps the symptoms associated with pseudofolliculitis barbae at bay. At the Board's direction in the June 2021 remand, the Veteran was provided a VA skin examination in October 2021. After a review of the record and physical examination of the Veteran, the October 2021 VA examiner diagnosed pseudofolliculitis barbae and stated that, while such is currently asymptomatic, the disease initially manifested in 1999. While the examiner also provided a favorable medical nexus opinion, such was later recanted, and an unfavorable addendum opinion was stated in November 2021 based on a lack of medical evidence showing "continuation of treatment" after the initial diagnosis. First, although it is noted that the Veteran's pseudofolliculitis barbae is currently asymptomatic, the disability has not resolved. As such, element (1) to establish direct service connection is demonstrated. Further, the Board observes that neither medical nexus opinion is adequate for the purpose of readjudicating the Veteran's appeal, as the favorable opinion is not accompanied by a rationale and the unfavorable addendum is based on a rationale contrary to the Federal Circuit's holding in Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Notwithstanding the above, a lack of a medical nexus opinion is not fatal to the Veteran's appeal. Specifically, the evidence of record, to include the Veteran's competent and credible lay evidence and the findings of the October 2021 VA examiner establish that pseudofolliculitis barbae initially manifested during active duty and, although currently asymptomatic, remains through to the present. The Board also finds that this type of rash on the face is capable of being observed by a lay person. Therefore, giving the Veteran the benefit of the doubt, the Board finds that such evidence constitutes sufficient circumstantial evidence of the continuation of the same disability since service, and thus, service connection for the disability of pseudofolliculitis barbae is warranted. 38 C.F.R. § 3.303 (d). Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Scott W. Dale, 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.