Citation Nr: 23052154 Decision Date: 09/21/23 Archive Date: 09/21/23 DOCKET NO. 20-07 443 DATE: September 21, 2023 ORDER Entitlement to service connection for eczema is granted. REMANDED Entitlement to service connection for a right ankle disability is remanded. Entitlement to service connection for a left ankle disability is remanded. FINDING OF FACT The evidence of record is in relative equipoise as to whether the Veteran's eczema began during active service. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran's favor, the criteria for service connection for eczema are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1983 to August 1983, from October 1987 to March 1988, from February 2003 to January 2004, from January 2008 to February 2009, and from November 2011 to January 2013, with additional periods of service in the United States Army Reserve. The Veteran testified at a videoconference hearing before the undersigned in October 2022. A transcript is of record. SERVICE CONNECTION 1. Entitlement to service connection for eczema. The Veteran asserts that his eczema began during active duty or is otherwise due to his active service, to include as due to environment exposures in Southwest Asia. See October 2022 Hearing Transcript. The Board concludes that the Veteran has a current disability that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). A November 2018 VA examination shows the Veteran has a current diagnosis of eczema. Two post-deployment health reassessments (PDHRA) indicate the Veteran endorsed concerns regarding skin diseases or rashes following active-duty deployments. See October 2007 PDHRA (completed for the Veteran's May 2003 to December 2003 deployment); December 2008 PDHRA (completed for the Veteran's April 2008 to December 2008 deployment). Thus, the question becomes whether the current disability is related to service. The Veteran underwent a VA Gulf War general medical examination in November 2018. Upon examination, the Veteran reported that he was diagnosed with eczema following deployment in 2003. He reported that his local physician treats the condition with over-the-counter emollients and that the rash occurs on the bottom of his legs, posterior thighs, and bilateral forearms. The examiner noted that the Veteran marked "yes" to skin disease or rash concerns on the December 2008 PDHRA. However, the examiner did not provide an opinion regarding in-service onset and, instead, focused on whether environmental exposures in Southwest Asia could cause eczema. During the December 2018 Board hearing, the Veteran reported that his eczema began during his 2003 deployment to Southwest Asia and had continued to the present. The Board acknowledges that the Veteran is competent to report the symptoms of his disabilities. Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept. 14, 2009). The Board finds that the Veteran's lay assertations of experiencing symptoms of eczema that began in service and have persisted to the present to be both competent and credible. Given the Veteran's October 2007 and December 2008 PDHRAs indicating skin disease and rash concerns, his credible assertions that his eczema symptoms began during active service and continue today, and the lack of the negative nexus opinion addressing in-service onset, the Board finds that the evidence is at least in relative equipoise as to whether the Veteran's eczema arose in active service. Resolving all doubt in favor of the Veteran, service connection for eczema is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to service connection for a right ankle disability is remanded. 2. Entitlement to service connection for a left ankle disability is remanded. The Veteran asserts that bilateral ankle disabilities began during active duty or are otherwise due to his active service. See October 2022 Hearing Transcript. Upon VA examination in November 2018, the Veteran reported current ankle instability with frequent ankle rolling. The examiner indicated historical diagnoses of bilateral achilles enthesophytes, right lateral collateral ligament strain, and left ankle fracture but did not indicate if the Veteran had current ankle disabilities. Further, while the examiner provided a negative nexus opinion regarding environmental exposures in Southwest Asia, the examiner did not provide an opinion regarding direct service connection or in-service onset. Thus, remand is warranted so that clarification can be sought regarding current diagnoses, as well as an etiology opinion regarding in-service onset and/or direct service connection. The matters are REMANDED for the following action: 1. Obtain any of the Veteran's VA treatment records that have not already been associated with the claims file. 2. Schedule the Veteran for an examination to assess the nature and etiology of the Veteran's claimed bilateral ankle disabilities. The examiner should review the record, and take a history from the Veteran as to the progression of the claimed disability. Based on a review of the record, interview and examination of the Veteran, the examiner is asked to respond to the following: (a.) Please clarify all disabilities affecting the Veteran's bilateral ankles that have presented since he filed his claim in March 2018. The Board notes that in Saunders v. Wilkie, the Federal Circuit held that pain alone, even without an underlying pathology or diagnosis, can constitute a disability under VA law where such pain results in functional impairment that affects earning capacity. 886 F.3d 1356, 1361 (Fed. Cir. 2018). (b.) For each diagnosed disability (whether resolved or currently ongoing), is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the disability had onset during active service or is otherwise related to the Veteran's periods of active service? A complete rationale based upon consideration of relevant lay and medical evidence, including the Veteran's October 2022 Board hearing testimony, must be provided for all opinions. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Bristow Williams, 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.