Citation Nr: 25001074 Decision Date: 01/27/25 Archive Date: 01/27/25 DOCKET NO. 18-29 745 DATE: January 27, 2025 ORDER Entitlement to service connection for a skin condition, claimed as chloracne, is denied. INTRODUCTION The Veteran had active service in the U.S. Army from May 1970 to November 1971, with service in the Republic of Vietnam. When this case was previously before the Board in August 2022, January and October 2023, and June 2024 the above-noted issue was remanded for additional development. The case has since been returned for further appellate review. FINDING OF FACT The Veteran's skin disorders, claimed as chloracne but diagnosed as venous stasis ulcerations and a compound dysplastic nevus, were not present in service or until many years thereafter and the most probative evidence indicates his skin disorders are not otherwise etiologically related to service, to include his exposure to herbicides therein. CONCLUSION OF LAW The criteria for service connection for a skin disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1116; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION Duty to Assist The Veterans Claims Assistance Act of 2000 (VCAA), codified in pertinent part at 38 U.S.C. §§ 5103, 5103A, and the pertinent implementing regulation, codified at 38 C.F.R. § 3.159, provide that VA will assist a claimant in obtaining evidence necessary to substantiate a claim but is not required to provide assistance to a claimant if there is no reasonable possibility that such assistance would aid in substantiating the claim. The Board finds VA has complied with its duty to assist the Veteran in the development of his claim. In this respect, all available service treatment records (STRs) and post-service medical evidence identified by the Veteran have been obtained. The Veteran was scheduled for a videoconference hearing before the Board in December 2021, but failed to attend and has not since asked for his hearing to be rescheduled. As such, his prior request for a hearing is deemed withdrawn. Additionally, several VA examinations and medical opinions addressing the Veteran's claimed skin disability have been obtained. Neither the Veteran nor his representative have identified any outstanding, existing evidence that could be obtained to substantiate the claim; the Board is also unaware of any such evidence. Therefore, the Board is satisfied that VA has complied with its duty to assist the Veteran in the development of the claim decided herein. Accordingly, the Board will address the merits of the Veteran's claim. Burden of Proof Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the weight of the evidence must persuasively stand against a finding that the evidence is in "approximate balance" or "nearly equal" to the evidence that supports the claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Legal Criteria Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d). Factual Background and Analysis The Veteran asserts service connection is warranted for a skin disability. As noted above, a review of the record shows he has been diagnosed with venous stasis ulcerations and a compound dysplastic nevus. The Veteran's service treatment records (STRs) are devoid of complaints, treatment, or diagnosis of a skin condition. At the time of his October 1971 separation examination, the examiner found the Veteran's skin to be normal. However, the Veteran contends his skin disability is consequentially related to his exposure to herbicide agents in service. His DD-214 confirms his service in the Republic of Vietnam, and as such, his exposure to herbicides is conceded. Initially, the Board acknowledges that if a veteran was exposed to an herbicide agent during active military, naval, or air service, chloracne shall be service-connected if the requirements of 38 C.F.R. § 3.307 (a)(6)(ii) are met, even though there is no record of such disease during service. 38 C.F.R. § 3.309(e). However, a review of the record does not indicate the Veteran has been diagnosed with chloracne or other acneform disease consistent with chloracne at any time throughout the period of appeal. Nonetheless, as noted above, the Veteran's records indicate he has been diagnosed with both venous stasis ulcerations and a compound dysplastic nevus during this appeal period. As such, the question for the Board is whether the Veteran's current skin disabilities began during service or are at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has currently diagnosed skin disorders, the vast probative evidence is against finding the conditions began during active service, or are otherwise related to an in-service injury, event, or disease. 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), (d). The Veteran was afforded a VA examination in October 2022. Additionally, the Regional Office (RO) obtained medical opinions addressing the Veteran's skin conditions in October 2022, January 2023, June 2023, November 2023, and July 2024. In those reports the examiners universally found the Veteran's current skin disorders were less likely than not incurred in service. Most recently, in July 2024, the RO obtained a comprehensive medical opinion from a Board-Certified Dermatologist, which the Board finds most probative. In his opinion, the examiner acknowledged the Veteran's reports of Agent Orange being the causative factor for the development of his skin disorders. The examiner also considered and discussed the Veteran's post-service diagnoses of venous stasis ulcerations and a compound dysplastic nevus. The examiner did explain that the Veteran's current skin disorders do not have a fully understood etiology. However, the examiner found that based on the onset of the Veteran's disabilities many years after service, his post-service hazardous skin exposures such as sun exposure, and the lack of any medical science linking the Veteran's current disabilities to herbicides, the most likely etiology is a post-service event. To date, the Veteran has not provided a single medical opinion to support his theory of entitlement. After a thorough review of the entire record, the Board finds the vast probative evidence weighs against the Veteran's claim. In sum, the evidence shows that no skin condition was treated or diagnosed until many years after the Veteran's discharge. The Board acknowledges the Veteran's contentions that his skin condition nevertheless originated during service as a result of his herbicide exposure. However, numerous competent medical clinicians-to include a Board-Certified Dermatologist-have concluded the Veteran's current skin disabilities are not consequentially related to his military service, to include his herbicide exposure therein. These clinicians have supported their opinions with particular facts in this case, medical treatises, and objective medical findings. Although the Veteran may sincerely believe his disability is consequentially related to his military service, his lay opinion concerning these matters requiring medical expertise is of less probative value than the medical opinions against the claim. A layperson is competent to testify in regard to the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Caldwell v. Derwinski, 1 Vet. App. 466 (1991). The Board has accepted the Veteran's accounts; however, a layperson is not considered capable of opining, however sincerely, in regard to the diagnosis or causation of a complex disability. King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). Rather, it is the province of trained health care professionals to enter conclusions that require medical expertise, such as opinions as to diagnosis and causation. Jones v. Brown, 7 Vet. App. 134, 137 (1994). For example, a veteran is competent to state that he experiences symptoms that are commonly associated with a skin disability; however, he is not competent to state the etiology of a complex medical condition such as venous stasis ulcerations or compound dysplastic nevi. As discussed above, the medical evidence fails to show the Veteran's claimed disability was either incurred in service or was caused by his exposure to herbicide agents therein. Based on the foregoing, service connection for a skin disability must be denied. In reaching this decision the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable to this claim because the evidence is significantly against the claim. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Fraser, Gordon 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.