SCARS OTHER OF HEAD FACE OR NECK

Summary

The veteran served from October 1968 to December 1970. This case involves appeals for service connection for a skin disorder on the right shoulder and gout. The Board of Veterans' Appeals (Board) granted both claims. For the skin disorder, the Board found credible the veteran's report of a skin growth on his right shoulder during service, supported by later medical records and a VA examiner's finding of credibility regarding the veteran's report, despite the examiner's ultimate opinion that it was unlikely related to service. The Board found the evidence indicated service connection was warranted, applying the benefit of the doubt. For gout, the veteran claimed it was secondary to toxic exposure in Vietnam and service-connected diabetes. While a recent VA examiner found gout unlikely related to service or diabetes, the Board noted prior inadequate opinions and favorable findings in earlier VA reports, including that diabetes is a risk factor for gout. The Board applied the benefit of the doubt, finding the evidence did not demonstrate the gout was not due to diabetes. Service connection for both the right shoulder skin disorder and gout was granted.

Rationale

Credible lay report of skin growth during service; Supported by later medical records; Benefit of the doubt applied

Full Decision Text

Citation Nr: 26004529
Decision Date: 04/14/26	Archive Date: 04/14/26

DOCKET NO. 17-44 526
DATE: April 14, 2026

ORDER

Entitlement to service connection for a skin disorder on the right shoulder is granted.  

Entitlement to service connection for gout is granted.  

FINDINGS OF FACT

1. There is an approximate balance of positive and negative evidence indicating that residuals of a skin disorder on the right shoulder were incurred in service.  

2. There is an approximate balance of positive and negative evidence indicating that gout is secondary to service-connected disability.  

CONCLUSIONS OF LAW

1. The criteria for service connection for residuals of a skin disorder on the right shoulder are met.  38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for gout are met.  38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from October 1968 until December 1970.    

This matter came to the Board of Veterans' Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO).

Service Connection

On February 20, 2014, the Veteran claimed entitlement to service connection for several disabilities.  Many of the claims were ultimately granted.  A 100 percent rating has been assigned since February 20, 2014, with the exception of the period between May 2023 and August 2024, during which time a 90 percent rating had been assigned.  

Among his claims in February 2014 were service connection claims for gout and a skin disorder on the right shoulder.  In the rating decision on appeal the RO denied the claims.  Between August 2020 and October 2025, the Board remanded these claims several times, seeking adequate medical commentary regarding whether the disorders were incurred in service.  

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.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant.  38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.  To deny a claim, the evidence must clearly weigh against the claim.  See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

The evidence in this matter consists of lay assertions, service treatment records (STRs), service personnel records (SPRs), private and VA treatment records, and multiple VA examination reports dated from November 2014 to February 2026.  

	Right Shoulder Skin Disorder 

A finding of direct service connection under 38 C.F.R. § 3.303 is warranted where the evidence indicates: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during active service.  See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009).

Based on the evidence, a service connection finding is warranted for residuals of a skin disorder on the right shoulder.  See 38 C.F.R. § 3.303.

The Board has previously found credible the Veteran's report of having a right shoulder skin growth during service in 1969.  A right shoulder skin lipoma was noted in September 2001 as a current problem and a right shoulder skin lipoma is noted in a January 2022 VA examination report.  Further, a December 2025 VA examiner found credible the Veteran's report of having a skin problem on his right shoulder.  The examiner stated that examination did not identify a lipoma on his skin, and that the Veteran was not competent to diagnose himself with a lipoma.  The examiner found the Veteran's report of the problem credible, however.  See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (laypersons are competent to describe observable matters).     

In December 2025 and January 2026 opinions, the VA examiner went on to find it unlikely that the skin disorder related to service, to include
 a January 2022 VA examination report.  Further, a December 2025 VA examiner found credible the Veteran's report of having a skin problem on his right shoulder.  The examiner stated that examination did not identify a lipoma on his skin, and that the Veteran was not competent to diagnose himself with a lipoma.  The examiner found the Veteran's report of the problem credible, however.  See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (laypersons are competent to describe observable matters).     

In December 2025 and January 2026 opinions, the VA examiner went on to find it unlikely that the skin disorder related to service, to include service in the Republic of Vietnam and exposure to herbicides there.  See 38 C.F.R. § 3.307.  Nevertheless, as with other opinions previously found to be inadequate by the Board, this opinion is limited in probative value because it is contradicted by the Veteran's lay assertions, which the examiner found credible.  See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007).  

Based on the foregoing, the Board cannot find that the evidence demonstrates that the Veteran does not have residuals of a skin disorder on his right shoulder related to service.  See Lynch, supra.  

	Gout

The Veteran asserts that he developed gout as the result of toxic exposure during service to include herbicide exposure in Vietnam.  He also asserts that he developed the disorder as the result of service-connected disability to include diabetes mellitus type 2 (diabetes).  See 38 C.F.R. §§ 3.303, 3.310. 

Service connection may be established on a secondary basis for a disability which is caused by service-connected disease or injury.  38 C.F.R. § 3.310 (a).  Establishing service connection on a secondary basis requires evidence showing (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by service-connected disability.  38 C.F.R. § 3.310 (a).

Prior Board remands have detailed the ways in which VA medical opinions countering the claim regarding gout were inadequate.  See Barr, supra.  

The Veteran underwent a new VA examination in November 2025.  In the opinion, the examiner diagnosed gout but found it likely unrelated to service, to service-connected disability, and to toxic exposures during service.  The examiner reiterated his findings in a February 2026 addendum report.  

However, the examiner's opinions did not persuasively counter favorable findings already in the record, which are noted in earlier VA reports.  See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the value of a physician's statement is dependent, in part, upon the extent to which it reflects clinical data or other rationale to support the opinion).  A January 2022 VA opinion describes service-connected diabetes as a risk factor for gout while January and March 2025 VA opinions state that gout is a metabolic condition commonly associated with hyperuricemia and influenced by factors such as diet, genetics, renal function, and comorbid conditions like diabetes.  See 38 C.F.R. § 3.310.  

Based on the foregoing, the Board cannot find that the Veteran's gout is not due to diabetes.  See Lynch, supra.  

Accordingly, this is an appropriate case in which to invoke VA's doctrine of reasonable doubt, grant the Veteran the benefit of the doubt, and grant the claims.  38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.

 

 

G. A. WASIK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Christopher McEntee

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.