SCARS OTHER SUPERFICIAL UNSTABLE

Summary

The Veteran, a Veteran who served from September 1968 to June 1971, appeals the denial of service connection for unspecified dermatitis of the hands and seborrheic dermatitis of the scalp. The Board found that the Veteran's service treatment records from November 1970 supported his claim of experiencing hand and scalp issues since active duty, and afforded high probative value to his credible testimony regarding continuity of symptoms. The Board also noted that the VA examiner's opinions were inadequate because they failed to address the potential secondary service connection of these conditions to the Veteran's service-connected residuals of prostate cancer, despite the Veteran reporting a flare-up of hand dermatitis after radiation treatment. The Board found the evidence persuasive, resolving reasonable doubt in the Veteran's favor, and granted service connection for both unspecified dermatitis of the hands and seborrheic dermatitis of the scalp.

Rationale

Favorable finding of current disability by RO; Favorable finding of TERA conceded by RO; Credible testimony of continuity of symptoms since active duty; VA examiner's opinion found inadequate; failed to address secondary basis

Full Decision Text

Citation Nr: A25003651
Decision Date: 01/15/25	Archive Date: 01/15/25

DOCKET NO. 231102-390706
DATE: January 15, 2025

ORDER

Entitlement to service connection for unspecified dermatitis of the hands (claimed as hand rashes) is granted.

Entitlement to service connection for seborrheic dermatitis of the scalp (claimed as dry scalp condition) is granted.

FINDINGS OF FACT

1. The probative evidence of record is at least in relative balance as to whether the Veteran's unspecified dermatitis of the hands is etiologically related to his active duty service. 

2. The probative evidence of record is at least in relative balance as to whether the Veteran's seborrheic dermatitis of the scalp is etiologically related to his active duty service. 

CONCLUSIONS OF LAW

1. With resolution of reasonable doubt in the Veteran's favor, the criteria for a grant of service connection for unspecified dermatitis of the hands have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304  

2. With resolution of reasonable doubt in the Veteran's favor, the criteria for a grant of service connection for seborrheic dermatitis of the scalp have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304  

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in active service from September 1968 to June 1971.  This matter is before the Board of Veterans Appeals (Board) on appeal from the rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) in August 2023. 

In the November 2023 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.  Therefore, the Board may only consider the evidence of record at the time of the August 2023 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

This appeal has been advanced on the?Board's docket pursuant to 38?U.S.C. §?7107; 38?C.F.R. §?20.800.

Service Connection

Service connection may be established for a disability resulting from a disease or injury incurred in or aggravated by service.  38 U.S.C. § 1131; 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 approximate balance.  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). 

1. Service connection for unspecified dermatitis of the hands is
. 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 approximate balance.  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). 

1. Service connection for unspecified dermatitis of the hands is granted.

2. Service connection for seborrheic dermatitis of the scalp is granted.

The Veteran is of the position that he has unspecified dermatitis of the hands and seborrheic dermatitis of the scalp due to his active-duty service.

In the August 2023 rating decision, the RO found that the Veteran was diagnosed with seborrheic dermatitis and unspecified dermatitis of the hands.  These are favorable findings and favorable findings made by the AOJ are binding on all AOJ adjudicators as well as on the Board, therefore the first element of service connection for each claim has been met.  38 U.S.C. §5104A; 38?C.F.R. §?20.801.

The RO also found that participation in a toxic exposure risk activity (TERA) is conceded.  This is also a favorable finding that is binding on the Board and the second element of service connection for each claim has been met.  Id. 

The Veteran was afforded a VA examination for Skin Conditions in August 2023.  He stated that his dry scalp (seborrheic dermatitis of the scalp) and hand rashes (seborrheic dermatitis of the scalp) began in approximately 1970.  He began to notice issues with a dry and flaky scalp once he returned from war. He addressed the issues with over-the-counter products.  He currently uses a shampoo and cream for his hands that help to some extent.  His symptoms are itchy skin on his scalp and hands.  The Veteran stated that his condition has stayed the same since onset.  

The VA examiner referenced the Veteran's May 2021 records wherein he told the clinician that his unspecified dermatitis of the hands started as a rough, itchy rash on his bilateral hands that had been present for approximately 1 year prior to his medical visit.  The Veteran reported that the condition started shortly after the Covid-19 pandemic began due to his increased hand-washing and sanitizing.  The Veteran also noted that in October 2020, he began radiation treatment for his prostate cancer.  He underwent a total of 44 radiation treatments. The treatments led to a flare up of his hand dermatitis.  The examiner then noted the May 2021 clinician's assessment that the Veteran appeared to have hand dermatitis that was likely secondary to frequent washing and sanitizing. 

The August 2023 VA examiner opined that the Veteran's seborrheic dermatitis and unspecified dermatitis of the hands were not related to his active service.  The rationale provided was that seborrheic dermatitis is an inflammatory condition that causes dry flaky skin.  On the scalp it is called dandruff, and it is a very common condition.  The Veteran noted that it has no relationship to herbicide exposure.

The VA examiner opined that the Veteran's unspecified dermatitis of the hands was not related to his active service because it is not associated with herbicide exposure nor is it listed as a presumptive condition of herbicide exposure.  The VA examiner also noted that the Veteran's dermatologist "felt" that his condition was caused by frequent hand washing.

The Board affords low probative value to the August 2023 VA examination and finds the opinions to be inadequate.  The rationale for each condition is speculative.  Additionally, the Veteran noted that the Veteran reported a flare up of his unspecified dermatitis of the hand after undergoing treatment for his prostate cancer.  The Veteran is currently service connected for residuals of prostate cancer; therefore the VA examiner should have also provided an opinion for each claim on a secondary basis.  Specifically, the VA examiner should have provided an opinion as to whether the Veteran's unspecified dermatitis of the hands and seborrheic dermatitis were caused or aggravated by his service-connected residuals of prostate cancer.  

The evidence shows that the Veteran was treated for dermatitis in November 1970 during active service.  The Board finds that this supports the Veteran's statement during his VA examination that he has been experiencing the symptoms associated with his unspecified dermatitis of the hand and seborr
 a flare up of his unspecified dermatitis of the hand after undergoing treatment for his prostate cancer.  The Veteran is currently service connected for residuals of prostate cancer; therefore the VA examiner should have also provided an opinion for each claim on a secondary basis.  Specifically, the VA examiner should have provided an opinion as to whether the Veteran's unspecified dermatitis of the hands and seborrheic dermatitis were caused or aggravated by his service-connected residuals of prostate cancer.  

The evidence shows that the Veteran was treated for dermatitis in November 1970 during active service.  The Board finds that this supports the Veteran's statement during his VA examination that he has been experiencing the symptoms associated with his unspecified dermatitis of the hand and seborrheic dermatitis since active service.  The Veteran is therefore credible and the Board affords high probative value to his statement that his condition has stayed the same since active service.  

The Veteran is competent to provide evidence of that which he experiences, including his symptomatology and medical history.  Layno v. Brown, 6?Vet. App.?465, 469?(1994).  The Veteran has competently related experiencing dry, itchy and flaky skin since active duty.  His accounts are corroborated by his service treatment records and medical records.  

In light of the totality of the circumstances, and after resolving all reasonable doubt in the Veteran's favor, the most persuasive evidence weighs in favor of finding that the Veteran's unspecified dermatitis of the hand and seborrheic dermatitis are etiologically related to his active-duty service. 

Entitlement to service connection for unspecified dermatitis of the hands and service connection for seborrheic dermatitis are granted. 

 

 

D. Martz Ames

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Sanders, Danielle A.

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.