Citation Nr: 22040771 Decision Date: 07/16/22 Archive Date: 07/16/22 DOCKET NO. 18-51 850 DATE: July 16, 2022 ORDER Entitlement to service connection for a skin disability is denied. Entitlement to service connection for a bilateral wrist disability is denied. Entitlement to service connection for a bilateral elbow disability is denied. REMANDED Entitlement to a rating in excess of 60 percent for coronary artery disease is remanded. FINDINGS OF FACT 1. The evidence of record persuasively weighs against finding that the Veteran has a skin disability related to service or any exposure therein. 2. The evidence of record persuasively weighs against finding that the Veteran has had a wrist disability related to service. 3. The evidence of record persuasively weighs against finding that the Veteran has an elbow disability related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for a skin disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for a bilateral wrist disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a bilateral elbow disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1968 to September 1971. The Board thanks him for his service to our country. The Veteran testified before the undersigned Veterans Law Judge during a January 2022 Board hearing. A transcript of the hearing is in the Veteran's e-folder. Service connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (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). Service connection may also be awarded on a presumptive basis for certain chronic diseases, to include skin cancer as a malignant tumor, listed in 38 C.F.R. § 3.309 (a), that manifest to a degree of 10 percent within one year of service separation. 38 C.F.R. §§ 3.303 (b), 3.307. Service connection may be awarded on the basis of continuity of symptomatology for those conditions listed in 38 C.F.R. § 3.309 (a) if a claimant demonstrates (1) that a condition was noted during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007); 38 C.F.R. § 3.303 (b). Subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. The Veteran's service personnel records reflect that he served in the Republic of Vietnam during the Vietnam War. Therefore, he is presumed to have been exposed to herbicide agents. The law provides that, if a veteran was exposed to an herbicide agent during service, certain listed diseases shall be service-connected if the requirements of 38 U.S.C. § 1116; 38 C.F.R. § 3.307 (a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113; 38 C.F.R. § 3.307 (d) are also satisfied. The list of diseases afforded this presumption does not include skin cancer. Consequently, the herbicide agent exposure presumptive provisions of 38 U.S.C. § 1116 do not apply in this claim. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the evidence is persuasively against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 1. Entitlement to service connection for a skin disability. 2. Entitlement to service connection for a bilateral wrist disability. 3. Entitlement to service connection for a bilateral elbow disability. The Veteran contends that he has a bilateral wrist disability and a bilateral elbow disability due to repairing heavy equipment and bulldozers in Vietnam. While in the field, he had to use manual tools. When asked during the hearing if had a current disability, and had a doctor diagnosed him with a wrist or elbow problem, he stated that he "just put different stuff on it and keep going" and that he had not gone to the doctor for these problems. With respect to his elbow, when he was asked if he ever sought treatment in service for his complaints he responded, "No, that came with older age." See January 2022 Board hearing transcript. The Veteran also contends that he has skin cancer due to exposure to Agent Orange in Vietnam, and exposure to diesel fuel, gasoline and heavy equipment during service. The Veteran stated that he did not recall having any skin conditions in service. He also testified that he began experiencing problems with his skin "about three years ago." See January 2022 Board hearing transcript. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current disability involving either wrist, or either elbow or the skin that is related to service. VA CAPRI records show that in September 2016, the Veteran called the tele-nurse line and requested an appointment. He complained of pain in both wrists and elbows that he said was arthritis. He said he took three Aleves in the morning and used Asper cream on his joints. He also complained of a dark brown spot with a scab on the right cheek for eight to nine months that he said would not heal or go away. The report of a September 2016 primary care visit the next day relates that the Veteran had a skin irritation on the right cheek that would not go away. On physical examination, he had actinic keratosis on the right cheek. The pertinent assessment was actinic keratosis vs basal cell carcinoma on the right cheek. The VA physician stated that they suspected actinic keratosis vs basal cell carcinoma on the right cheek. An April 2017 VA treatment report relates that the Veteran stated he had a "? Precancer[o]us lesi[o]n" removed from his right check [by a private provider] and he would submit the corresponding records. Incidentally, the Veteran's VA CAPRI records do not contain such records, or any indication that the Veteran submitted them. On physical examination, he had a small scar on the right cheek. The pertinent assessment was actinic keratosis vs basal cell carcinoma on the right cheek. A May 2018 treatment note relates that the Veteran had a skin lesion on the right thigh. He had been seen by an outside dermatologist for liquid nitrogen treatment of actinic keratosis on the cheek. No pertinent assessment was provided. Regarding the Veteran's September 2016 report of arthritis during the call to the VA tele-nurse line, the Board observes that the record contains no medical diagnosis or X-ray evidence of elbow or wrist arthritis. To the extent that the Veteran testified at his January 2022 Board hearing that he would submit private medical evidence to support his claims, he has not done so. He affirmatively testified that he had not sought treatment for wrist or elbow problems. He was advised during the hearing that medical evidence was needed, if it existed, regarding his current diagnoses for his claimed disorders and that medical opinions relating his claimed disabilities to service were needed. However, no medical evidence with respect to these claims has been received by VA, even though the Board held the record open for an additional 60 days after the hearing. The duty to assist is not a one-way street; if a claimant wishes help in developing his or her claim, he cannot passively wait for it in those circumstances where his own actions are essential in obtaining the putative evidence. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Here, the Veteran did not provide the private treatment evidence as he testified; moreover, has not provided VA with authorization to seek such private medical records on his behalf. Therefore, the Board finds that all necessary development has been accomplished, no further notice or assistance is required for a fair adjudication of the Veteran's claims and appellate review may proceed without prejudice to the Veteran. Even assuming, arguendo, that the Veteran currently has skin, elbow, and wrist disorders, the evidence is persuasively against the claims. The Veteran's service treatment records are negative for relevant complaints, symptoms, findings or diagnoses and the Veteran testified that he did not seek treatment for these disorders in service but that they developed many years after service. Therefore, even assuming, arguendo, a diagnosis of skin cancer, the evidence is persuasively against a finding that it manifested to a compensable degree within a year of service as the Veteran testified that he first experienced skin problems about three years ago. For this reason, service connection for skin cancer, assuming it exists, on a presumptive basis as a chronic disease is not warranted. The evidence is persuasively against a finding that the Veteran's current skin, elbow, and wrist complaints are related to service, to include presumed herbicide exposure or other exposures in service. The evidence, including the Veteran's statements, indicates all the claimed disabilities first were experienced by the Veteran many years after service. There is no evidence indicating the Veteran's current skin, wrist, and/or elbow problems are related to service, to include herbicides or other exposures, so further development for a VA examination and/or medical opinion is required with respect to these claims. McLendon v. Nicholson, 20 Vet. App. 70 (2006). Generalized lay allegations are not sufficient to meet the McLendon standard, even though medical evidence is not necessarily required. Waters v. Shinseki, 601 F.3d 1274, 1276 (2010). While the Veteran believes that he has bilateral wrist and elbow disabilities and a skin disability related to service, as a layperson he is not competent to opine as to this complex medical matter. Specialized medical training and expertise are required. See Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board can assign no probative weight to the Veteran's assertions that he has an elbow disability, wrist disability or skin cancer that is of service origin or is related to military service. In light of the above, the Board finds that service connection for a bilateral wrist disorder; a bilateral elbow disorder; and a skin disability is not warranted and must be denied. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND Entitlement to a rating in excess of 60 percent for coronary artery disease is remanded. During the January 2022 Board hearing, the Veteran testified that his heart disability had increased in severity since his last VA examination. That examination took place about five years earlier and at that time his doctors told him he would need a new valve in five years. In light of his hearing testimony, the Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of his service-connected coronary artery disease. Regarding current symptoms, the Veteran testified that he has not been breathing as well as he used to and as a result, he had undergone a test three months earlier at his private cardiologist. While he stated during the hearing that he would provide those treatment records, this remand for a VA examination affords him another opportunity to submit the medical records. The matter is REMANDED for the following action: 1. Please associate any relevant updated VA treatment records with the virtual benefits file. 2. Please advise the Veteran to submit any private medical evidence that he wants considered in his appeal directly to the AOJ and provide him with necessary authorizations if he requires VA assistance. 3. Then, please schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected coronary artery disease. M. C. GRAHAM Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Davitian, 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.