DERMATITIS OR ECZEMA

Summary

The Veteran, an Army veteran who served from December 1967 to December 1969, including service in Vietnam, appeals the denial of service connection for a skin rash. The case has a complex procedural history with multiple remands due to inadequate medical opinions. The Veteran's pre-induction and separation physicals noted normal skin, and his service treatment records (STRs) are silent regarding skin issues, though a telegram mentioned a leg wound treatment. Post-service records show intermittent complaints of rashes, diagnosed variously as atopic dermatitis, xerotic eczema, and tinea corporis. Multiple VA examinations and opinions were found inadequate by the Board for failing to address the Veteran's reports of in-service symptoms or all diagnosed skin conditions. The Veteran testified credibly about experiencing a rash during service, initially thought to be sunburn, which has persisted intermittently. The Board found the Veteran credible regarding his lay observations of the rash. Despite the lack of in-service treatment records for the skin condition, the Board found the evidence in approximate balance, resolving doubt in the Veteran's favor due to the credible lay testimony and intermittent post-service medical evidence, granting service connection for the skin rash.

Rationale

Veteran's STRs silent for skin condition, but telegram mentioned leg wound.; Post-service records show intermittent rash complaints with various diagnoses (eczema, dermatitis, tinea).; Multiple VA opinions found inadequate for failing to address in-service symptoms or all diagnosed conditions.; Veteran provided credible lay testimony of rash starting during service.; Evidence found in approximate balance, resolving doubt in Veteran's favor.

Full Decision Text

Citation Nr: 26005023
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 14-32 112A
DATE: April 29, 2026

ORDER

Entitlement to service connection for a skin rash, variously described as eczema, dermatitis, or tinea versicolor, is granted.

FINDING OF FACT

After resolving all reasonable doubts in favor of the Veteran, the Board finds that the evidence of record is at least in approximate balance as to whether he experiences a current skin condition that arose during or as a result of his active service.

CONCLUSION OF LAW

The criteria for entitlement to service connection for a skin rash, variously diagnosed as eczema, dermatitis, or tinea versicolor, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from December 1967

to December 1969, to include service in the Republic of Vietnam. He received the Purple Heart Medal and a Bronze Star with "V" device among other medals and awards.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

The Veteran and his spouse both testified before the undersigned Veterans Law Judge in a May 2019 video conference hearing.

This case has a lengthy and complicated procedural history with multiple Board remands to VBA for additional development or clarification of provided medical opinions. Without reporting all the procedural history in this decision, the Board notes that this matter was most recently before the Board in February 2025, when it was remanded once again for additional development.

1. Entitlement to service connection for a skin disability.

Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated during active military service.  38 U.S.C. § 1101; 38 C.F.R. § 3.303(a).  In general, service connection requires: (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of an in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability.  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may be granted for any disease diagnosed after discharge when all evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).

Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant.  38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776, 780-81 (Fed. Cir. 2021). Although all the evidence must be reviewed, only the most relevant evidence must be discussed. Gonzales v. West, 218 F.3d 1378, 1380-1381 (Fed. Cir. 2000).

The Veteran asserts that he experiences a skin condition that arose during or as a result of his active service.

The appeals file includes an August 1967 pre-induction Report of Medical Examination (RME) and a December 1969 RME for separation wherein the Veteran's skin was noted normal. The Veteran's service treatment records (STRs) are silent regarding any treatment. The Board finds this curious as the Veteran's personnel records include a November 1968 Western Union Telegram to the Veteran's parents reporting that the Veteran suffered and was treated for a right leg fragment wound.

Post service treatment records include an October 2012 primary care record noting that the Veteran has reported chronic rash in different areas of his side and arms, wherein the treatment provider diagnosed atopic dermatitis; a subsequent November 2012 primary care record was negative for skin issues. A February 2013 private psychologist report reflects complaints of and a diagnosis of chronic skin rashes. A February 2014 treatment record noted that the Veteran complained about a skin rash as he was checking out after the appointment that was described as red and itchy rash that comes and goes on the torso and bilateral arms. The treatment provider diagnosed xerotic ec
 Western Union Telegram to the Veteran's parents reporting that the Veteran suffered and was treated for a right leg fragment wound.

Post service treatment records include an October 2012 primary care record noting that the Veteran has reported chronic rash in different areas of his side and arms, wherein the treatment provider diagnosed atopic dermatitis; a subsequent November 2012 primary care record was negative for skin issues. A February 2013 private psychologist report reflects complaints of and a diagnosis of chronic skin rashes. A February 2014 treatment record noted that the Veteran complained about a skin rash as he was checking out after the appointment that was described as red and itchy rash that comes and goes on the torso and bilateral arms. The treatment provider diagnosed xerotic eczema. A July 2016 dermatology treatment record noted a diagnosis of actinic keratosis on the right temple and hand. In a separate July 2016 treatment record, the Veteran reported scaley red and itchy rashes on his hands that sometimes bleed. A December 2019 treatment record noted a diagnosis of tinea corporis, and the Veteran was prescribed topical medication to treat.

The appeals file includes a May 2020 VA skin diseases examination and medical opinion. The examiner described the Veterans skin condition as a rash that breaks out from time to time, noticed more lately in the last 4 or 5 years, occurring mainly on his chest and arms, with burning and itching. The examiner confirmed a diagnosis of tinea versicolor on the chest and arms from January 2020. The examiner also provided a negative etiology opinion. However, the Board found in a September 2022 Remand Order that this etiology opinion was inadequate and not probative since it ignored the Veteran's lay statements about skin issues starting during his active service.

The Veteran was given a new VA skin diseases examination in October 2022 wherein the examiner confirmed a diagnosis of lipoma from October 2022. The Veteran reported that the cysts will itch and bother him from time to time but do not require medication. No other skin issues were noted. The examiner provided a negative etiology opinion for the Veteran's lipoma and active service. VA sought clarification in December 2022 as this medical etiology opinion did not address the Veteran's skin rash. The December 2022 addendum etiology opinion also failed to address the Veteran's skin rash. The Board found in a June 2023 Remand Order that the October 2022 and December 2022 medical opinions were inadequate to fairly resolve the Veteran's service connection claim, primarily because the examiner did not provide an etiology opinion addressing all skin conditions diagnosed during the pendency of the appeal, as was specifically requested by the Board in its prior remand directives.

The VA subsequently obtained a September 2023 etiology opinion wherein the provider indicated the Veteran had been diagnosed with xerotic eczema, atopic dermatitis, acrochordon, lipoma, actinic keratosis, basal cell carcinoma, tinea corporis, tinea versicolor, and neurofibroma, and noted that many of these appear to be redundant diagnoses assigned to the same condition, making it difficult to determine which are the accurate diagnoses. The examiner provided a negative etiology opinion, indicating that the Veteran's STRs are not silent, but specifically negative for concurrent or historical skin disease at the time of separation from active duty, and the conditions noted in the differential diagnosis for his rash in the treatment records are not found to result from remote herbicide or heat exposure. The Board found this etiology opinion was inadequate in a May 2024 Remand Order as it again failed to address the Veteran's reports of in-service symptoms, and instead, impermissibly based the negative nexus opinion on a lack of documented complaints at separation.

VA obtained a new etiology opinion in July 2024. The examiner provided a negative etiology opinion based entirely on exposure to herbicide agents during active service. VA sought an addendum to clarify this etiology opinion because the examiner failed to address direct service connection for any skin conditions. The Veteran was afforded a new VA skin diseases examination and etiology opinion in July 2024. The examiner noted that the Veteran was only complaining about chronic skin rash and Basal Cell carcinomas and declined other skin conditions for this claim. The Board found in a February 2025 Remand Order that the etiology opinion was inadequate as the examiner's rationale only addressed whether the Veteran's skin disabilities were related to his presumed herbicide agent exposure and failed to address the claim that his skin disabilities are related to heat exposure. 

VA obtained another etiology opinion in March 2025 that provided negative etiology opinions for the Veteran's skin conditions based on both heat and toxic exposure. However, VA sought clarification of the etiology opinion as the rationale appeared to incorrectly indicate that the Veteran had no non-deployment exposures when fact, a
2024. The examiner noted that the Veteran was only complaining about chronic skin rash and Basal Cell carcinomas and declined other skin conditions for this claim. The Board found in a February 2025 Remand Order that the etiology opinion was inadequate as the examiner's rationale only addressed whether the Veteran's skin disabilities were related to his presumed herbicide agent exposure and failed to address the claim that his skin disabilities are related to heat exposure. 

VA obtained another etiology opinion in March 2025 that provided negative etiology opinions for the Veteran's skin conditions based on both heat and toxic exposure. However, VA sought clarification of the etiology opinion as the rationale appeared to incorrectly indicate that the Veteran had no non-deployment exposures when fact, a second toxic exposure memo indicated non-deployment exposures of asbestos, industrial solvents, lead, fuels, CARC paint. 

The appeals file also contains an April 2025 etiology opinion. The examiner noted a negative etiology because of heat exposure. However, the examiner's rationale noted the Veteran reported his skin rash developed in the 1970's and has presented with red, dry, and scaly skin with severe itchiness and persisted intermittently to the present day. The examiner noted that heat exposure is not typically identified as a direct cause of chronic xerotic eczema, which is more commonly associated with dry environments and is often seen in elderly patients during winter months. 

As noted above, the Veteran testified in the May 2019 video conference hearing that his rash first started during active service which he thought was only a sunburn but has continued since leaving Vietnam. The Board finds that the Veteran is credible and competent to report symptoms capable of lay observation, such as a visible skin rash and symptoms such as itching or burning sensations. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).

After resolving all reasonable doubts in favor of the Veteran, the Board finds the evidence of record is at least in approximate balance as to whether he experiences a current skin condition that began during service. While the Veteran's STRs are silent for any treatment in-service treatment for a skin condition, the Board notes that there are medical records and the hearing testimony that reflect he has reported experiencing intermittent skin problems since service. Although the VA medical opinions of record do not support his claim, they do not fully consider his reports of intermittent skin condition symptoms, which he is competent to report. Although there are periods in which the medical evidence of record is negative for evidence of an active skin condition, the Board finds that this evidence does not outweigh the evidence of a chronic, intermittent skin condition. Based on these facts, the Board finds the evidence of record is at least in approximate balance; therefore, the criteria for service connection have been met.

Accordingly, entitlement to service connection for a skin rash is granted.

 

 

ROBERT C. SCHARNBERGER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Banks, Bryan

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.