Citation Nr: 25007705 Decision Date: 06/10/25 Archive Date: 06/10/25 DOCKET NO. 15-07 518 DATE: June 10, 2025 ORDER Service connection for a skin disability is granted. FINDINGS OF FACT 1. The Veteran served in the Republic of Vietnam during the Vietnam Era and was therefore presumptively exposed to herbicide agents. 2. The evidence does not weigh persuasively against finding that the Veteran's skin disability is etiologically related to in-service herbicide exposure. CONCLUSION OF LAW With resolution of reasonable doubt in the Veteran's favor, the criteria for a grant of service connection for a skin disability have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the Army from June 1968 to May 1971, including service in the Vietnam War, for which his decorations included the Combat Infantry Badge. This matter is on appeal from a September 2012 rating decision. The Board remanded this issue in March 2024 to attempt to obtain additional records and to afford the Veteran a VA examination. The Agency of Original Jurisdiction (AOJ) has done so. It was remanded again by the Board in February 2025 to afford the Veteran an additional VA medical opinion. The AOJ has done so. Because the Board is granting the Veteran's claim in full, any question as to the sufficiency of the AOJ's compliance with its remand instructions is moot. 1. Skin Disability The Veteran contends that his skin disability is due to exposure to herbicides during his active duty service. He has also raised other theories of service connection, including on a secondary basis to other service-connected disabilities. But, because the herbicide exposure theory is dispositive, the Board will not address his other contentions. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Regulations also provide that 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). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence. Therefore, the Veteran prevails in a claim when (1) the weight of the evidence supports the claim or (2) when the evidence is in equipoise. It is only when the weight of the evidence is against the claim that the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran's service personnel records note service in the Republic of Vietnam during the Vietnam Era. VA regulations provide that a veteran who had active military, naval, or air service in the Republic of Vietnam during the Vietnam Era shall be presumed to have been exposed to herbicides unless there is affirmative evidence to establish that the veteran was not exposed. 38 C.F.R. § 3.307(a)(6)(iii). In his September 2013 Notice of Disagreement (NOD), the Veteran reported that his skin rash "started in Vietnam and still continues." The Veteran was afforded a VA examination for skin diseases in August 2024. The clinician diagnosed unspecified dermatitis. In its February 2025 remand, the Board found that this clinician's opinions with regard to a nexus to service were inadequate. For this reason, those opinions are of limited probative value and will play no role in the Board's decision. Certain diseases are deemed associated with herbicide exposure under current law. The list of those diseases does not include dermatitis. 38 U.S.C. § 1116(a)(2) (2020). However, a claimant is not precluded from establishing service connection with proof of actual direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In other words, the fact that an appellant does not meet the requirements for service connection on a presumptive basis does not in and of itself preclude the establishment of service connection, as entitlement may alternatively be established on a direct basis. The Veteran was afforded additional VA medical opinions by a different clinician in February 2025. The clinician opined that the Veteran's dermatitis was not incurred in or caused by active duty service, including herbicide exposure, but based this opinion on a lack of continuity of care, which is not an adequate rationale. However, the clinician also opined that evidence regarding an association between dermatitis and herbicide exposure because the evidence was "inconclusive" regarding skin conditions including eczema. In a March 2025 opinion, the same clinician added that it would be uncommon for patients with chronic skin conditions to treat their own symptoms for significant lengths of time. The clinician also clarified that evidence of an increased risk of eczema in veterans exposed to herbicides was "inconclusive" and that eczema is a type of dermatitis. This case has been pending since December 2011, more than thirteen years ago. In that time, the Veteran has not been afforded a VA medical opinion with regard to the etiology of his skin disability that is adequate to decide his claim. The record contains a diagnosis of dermatitis and an opinion that, while ostensibly unfavorable to the Veteran's claim, notes that evidence of increased risk due to herbicide exposure is "inconclusive." Given the insufficient rationales supporting the medical opinions of record, the Board finds that this statement is of the greatest probative value. Further development would result in undue delay to a claim that has already been pending for more than thirteen years. See Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009). If the evidence is "inconclusive," then it does not weigh persuasively against the claim. In light of the totality of the circumstances, and after resolving all reasonable doubt in the Veteran's favor, the evidence does not weigh persuasively against finding that his skin disability is etiologically related to herbicide exposure during his active duty service. Accordingly, the Board finds that granting service connection for a skin disability is the decision that is the most consistent with VA's policy to administer the law under a broad and liberal interpretation consistent with the facts of the case. 38 C.F.R. §§ 3.303(a), 3.307, 3.309. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Frank, 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.