Citation Nr: 22018359 Decision Date: 03/29/22 Archive Date: 03/29/22 DOCKET NO. 17-53 489 DATE: March 29, 2022 ORDER Entitlement to service connection for actinic keratosis is denied. FINDING OF FACT The most probative evidence is against finding that the Veteran's actinic keratosis began during service or is otherwise related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for actinic keratosis have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 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 October 1971 to January 1976. This matter comes before the Board of Veterans' Appeals (Board) from a June 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for actinic keratosis The Veteran seeks service connection for actinic keratosis, which he asserts began during service. Alternatively, he has alleged he was exposed to Agent Orange during service in the Philippines and was exposed to contaminated water at Camp Lejeune. In a January 2019 statement, the Veteran asserted that he was first treated for actinic keratosis in 1975. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Generally, to prove service connection there must be: (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). As an initial matter, the medical evidence shows the Veteran has a current diagnosis of actinic keratosis. The question becomes whether this condition is related to service. However, upon review of the record, the weight of the evidence is against the claim. Service treatment records are silent for complaints of or treatment for actinic keratosis or any skin condition. Separation examination revealed normal skin, other than a scar on the right forehead that was also noted on the Veteran's entrance examination. Thereafter, the first medical evidence of a skin disorder is a September 2016 private treatment record which reveals the Veteran was treated for skin lesions that began six months prior. He was diagnosed with actinic keratosis. While the Veteran alleges he had actinic keratosis on the right cheek during service, the Board finds the separation examination showing normal skin and the treatment record showing a 6 month history of the lesion to be more probative than the Veteran's assertion. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (VA cannot ignore a veteran's testimony simply because the veteran is an interested party; personal interest may, however, affect the credibility of the evidence). Moreover, while the Veteran believes that his current actinic keratosis began in or is related to service, as a lay person, he has not shown that he has specialized training sufficient to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis or etiology). In this regard, the diagnosis and etiology of skin disorders are matters not capable of lay observation and require medical expertise to determine. Thus, the opinion of the Veteran regarding the etiology of his actinic keratosis is not competent medical evidence. The Board acknowledges that the Veteran has also alleged his actinic keratosis is due to exposure to Agent Orange in the Philippines and or due to exposure to contaminated water at Camp Lejeune. The record does not establish such exposures. Regardless, actinic keratosis is not a disability that has been associated with herbicide agents or contaminated water at Camp Lejeune, and the medical evidence of record does not suggest such alleged exposures as a causal factor for the skin disability. 38 C.F.R. §§ 3.307, 3.309(e), (f). The Board acknowledges that the Veteran has not been afforded a VA examination on this issue. However, there is no competent evidence of the condition in service and no competent evidence suggesting a link between the current disability and service. Accordingly, a VA examination is not required. See 38 C.F.R. § 3.159(c); see also McLendon v. Nicholson, 20 Vet. App. 79, 84 (2006); Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010) (noting that a conclusory lay statement that a current condition is related to service is insufficient to warrant a medical examination because it would "eliminate the carefully drafted statutory standards governing the provision of medical examinations and require the Secretary to provide such examinations in virtually every veteran's disability case"). In sum, the weight of the competent and probative evidence is against the claim, and service connection for actinic keratosis is denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the competing evidence is not in approximate balance, the doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. K. A. BANFIELD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Lance, Associate 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.