Citation Nr: 22017703 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 18-48 896 DATE: March 25, 2022 ORDER Service connection for left lower extremity (LLE) dermatitis (claimed as left leg and foot injury/damage) is granted. Service connection for right lower extremity (RLE) dermatitis (claimed as right leg and foot injury/damage) is granted. Service connection for bilateral onychomycosis (claimed as leg and foot injury/damage) is denied. Service connection for bilateral tinea pedis (claimed as leg and foot injury/damage)is denied. FINDINGS OF FACT 1. The Veteran has a current diagnosis of bilateral lower extremity dermatitis, onychomycosis, and tinea pedis. 2. Symptoms of left and right lower extremity dermatitis began in service and have been present since service separation. 3. Bilateral onychomycosis was not incurred in and is not otherwise related to active service. 4. Bilateral tinea pedis was not incurred in and is not otherwise related to active service. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in the Veteran's favor, the criteria for service connection for LLE dermatitis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. Resolving reasonable doubt in the Veteran's favor, the criteria for service connection for RLE dermatitis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for bilateral onychomycosis have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for bilateral tinea pedis have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the Appellant, served on active duty from March 1934 to March 1975. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2015 rating decision from the Regional Office (RO), which, in pertinent part, denied service connection for left and right lower extremity leg injury. In the November 2015 Notice of Disagreement (NOD), the Veteran clarified that he was claiming left and right (bilateral) leg and foot conditions due to wearing military boots. In November 2021, the Veteran testified at a Board virtual hearing before the undersigned Veterans Law Judge. The hearing transcript has been associated with the record. The Board finds that the duties to notify and assist in this case have been rendered moot by the grant of service connection for bilateral lower extremity dermatitis, which is a full grant of the benefits sought on appeal. As for service connection for bilateral onychomycosis and tinea pedis, the duties to notify and assist in this case have been fulfilled. Neither the Veteran nor the evidence has raised any specific contentions regarding the duties to notify or assist. 1. Service Connection for LLE Dermatitis 2. Service Connection for RLE Dermatitis Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, service connection for a disability requires evidence of: (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 in or aggravated by service. The Veteran contends that service connection is warranted for a skin disorder of the legs, specifically, that he developed blisters on the lower legs during service due to irritation from wearing boots during basic training, sought treatment in service but was only afforded three days to heal, and during basic training continued to have blisters with bleeding and scabs on the lower legs in the area where the military boots were tied. The Veteran reported or testified that he managed on his own after initially seeking treatment, and the blisters eventually resolved after basic training, though he continued to have symptoms of redness, itching, and scratching during service and since service separation, which he treated with a home remedy of water combined with Listerine and baby oil after he separated from service. The Veteran contends that the current symptoms of redness, itching, and scratching on the lower legs are the same symptoms he experienced in service. The Veteran testified that he provided the history of the skin disorder on his lower legs during service, but the examiner was more concerned with his feet and toenails. See November 2021 Board Hearing Transcript, October 2018 VA Form 9. Initially, the Board finds evidence of a current diagnosis of bilateral lower extremity dermatitis. See November 2017 VA examination report, November 2018 VA treatment record. After a review of all the lay and medical evidence of record, the Board finds that the evidence is at least in relative equipoise on the question of whether there was an onset of symptoms of a skin disorder of the lower legs that continued after service separation, and was later diagnosed as chronic dermatitis, that is, was directly "incurred in" service. The Veteran has provided credible lay testimony of an onset of blisters and skin irritations on the lower legs, where the boots were tied during service. March 1974 service treatment records show that the Veteran was treated for blisters and sores on top of the feet caused by the boots. At the time, military physicians prescribed blister care SOP, Neosporin, and shower shoes for three days. Post-service treatment records indicate that the Veteran reported a history of problems with the military boots during service and of persistent rashes, itching, and irritation on the lower legs that has been ongoing since the 1970s, which he self-treated a Listerine mixture spray. Diagnosis after service was chronic dermatitis. See March 2008, January 2016, November 2018 VA treatment records. The Veteran has provided credible lay statements of chronic symptoms of redness and itching on the lower legs in the areas where his boots were tied during service and since service separation, which are the same areas that his blisters were present during service. The VA examiner in December 2016 opined that it is less likely than not that the Veteran's bilateral lower extremity dermatitis was incurred in or caused by service. The VA examiner reasoned that the service treatment records reflect treatment for blisters on top of the feet due to irritation from the military boots in March 1974 during service, but the service separation examination was silent for any skin or foot disorder at service discharge, and there was no evidence of blisters or residual scaring from blisters during the service separation examination. The VA examiner did not consider the history of symptoms of residual redness and itching in the lower extremities once the blisters resolved, that the same areas were affected, and that the symptoms have remained continuous after service separation, notwithstanding an absence of documented medical treatment. The VA examiner's factual assumption that no symptoms existed unless there was documentation in a medical treatment record is a factual assumption that is inconsistent with the lay and medical evidence in this case and with the facts as found by the Board; therefore, the VA examiner's opinion is of no probative value. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis but cannot reject the opinion solely because the history was from the veteran). Additionally, the VA examiner's assumption that there were no symptoms because such symptoms were not documented in a treatment record is a form of legal error by the VA examiner, which the Board cannot adopt by uncritically accepting the VA examiner's flawed factual assumptions, because such a medical treatment record requirement to "corroborate" the lay evidence by medical treatment records is legal error. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (2006) (holding that lay evidence presented by a veteran concerning continuity of symptoms after service may not be deemed to lack credibility solely because of a lack of contemporaneous medical evidence); Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (holding the Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms in service). While dermatitis is not a chronic disease listed under 38 C.F.R. § 3.309(a), as indicated above, the Board has found the evidence at least in equipoise on the question of whether the Veteran had bilateral lower extremity skin disorder symptoms that began during service and continued since service separation, which symptoms were later diagnosed as chronic dermatitis of the lower extremities, thus tending to show direct service onset or incurrence. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a), (d). The Board is granting the service connection claim based on evidence, including that pertinent to service, that establishes that symptoms of a skin disability of the lower extremities (later diagnosed as chronic dermatitis) began in service, so was "incurred in" service. The grant of direct service connection renders moot all other theories of service connection. 3. Service Connection for Bilateral Onychomycosis 4. Service Connection for Bilateral Tinea Pedis In the November 2015 NOD, the Veteran indicated that he was claiming service connection for a skin disorder of the legs and feet due to irritation from boots worn during service. During the November 2021 Board virtual hearing, the Veteran testified that he did not have problems with skin irritation on the feet during service. The Veteran claimed that the skin disorder now affected the lower leg, particularly the areas where the boots had been tied. The Veteran testified that he did not have problems with athlete's foot or infection of the toenails during service. See November 2021 Board Hearing Transcript. Initially, the Board finds that the evidence shows current diagnoses of onychomycosis (toenail fungal infection) and tinea pedis (athlete's foot) on both feet. See November 2017 VA examination report. After a review of all the evidence, both lay and medical, the Board finds that the weight of the evidence is against a finding that the current bilateral onychomycosis tinea pedis were incurred in or otherwise causally related to active service. The service treatment records are silent for symptoms, complaints, findings, diagnosis, or treatment of toenail infections or tinea pedis during service. While a March 1974 service treatment records reflects treatment for blisters and irritation on top of the feet during service, the Veteran clarified that the blisters and residual skin irritation was located on the lower leg along the area where he boots were tied. The January 1975 service separation examination report indicates that the feet and skin were within normal limits on clinical evaluation. Post-service treatment records are silent for any signs or symptoms of onychomycosis and tinea pedis for many years after service. The first report of problems with infections on the toenails is not evidenced until July 2013, 38 years after service separation. At that time the Veteran provided a lay history, for the purpose of treatment, that symptoms of his toenail infection had been present for about three days. Post-service medical records are also silent for signs, symptoms, diagnosis, or treatment of tinea pedis until November 2017, 42 years after service separation, when there was mild to moderate tinea pedis in the interdigital spaces and bottoms of both feet. See July 2013, November 2017 VA examination report. The VA examiner in November 2017 opined there was no nexus between the current bilateral onychomycosis or tinea pedis and active service. This opinion is consistent with the other lay and medical evidence of record, including the Veteran's own testimony that he had no problems with the feet during service, to include athlete's foot and infections of the toenails. See November 2021 Board Hearing Transcript. The weight of the competent and credible evidence demonstrates no relevant injury or disease during service, and no relationship between the current bilateral onychomycosis or tinea pedis that began years after service and active service. For these reasons, the Board finds that a weight of the evidence is persuasive against the claims for service connection for bilateral onychomycosis and tinea pedis on all theories of service connection; therefore, these claims must be denied. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Moore, S. 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.