DERMATITIS OR ECZEMA

M. SORISIO · 2026 · Case ID: A26029922

MIXED

Summary

The veteran, who served from October 1984 to November 1992, appeals the denial of service connection for several conditions. The Board granted service connection for pseudofolliculitis barbae, finding the veteran's statements credible and consistent with service, and noting the VA examiner's positive nexus opinion based on military grooming standards. Service connection for hypertrophic scarring as secondary to pseudofolliculitis barbae was also granted, as the Board found the prior favorable findings for both conditions binding. The Board remanded claims for bilateral toenail fungus, a skin condition other than pseudofolliculitis barbae, and genital warts or syphilis. The remand for skin conditions was due to inadequate VA examinations and failure to obtain complete private treatment records. Specifically, the November 2021 VA opinion for skin conditions was found inadequate for failing to address lay evidence and the nexus to service, and the October 2022 VA opinion was inadequate because its premise about silent service treatment records was false, as records did document treatment for a rash and cyst. The October 2022 addendum opinion was also inadequate for relying on absence of documented chronicity while ignoring lay evidence. For toenail fungus, the November 2021 VA opinion was inadequate for failing to address the nexus to service, and the October 2022 opinion was inadequate for relying on silent service treatment records while ignoring lay evidence of continued symptoms. The case was remanded for adequate examinations and to obtain complete private treatment records.

Rationale

Favorable finding of current disability; Credible lay evidence of in-service experience; Positive VA nexus opinion based on military grooming standards

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251209-613142

Full Decision Text

Citation Nr: A26029922
Decision Date: 04/02/26 Archive Date: 04/02/26

DOCKET NO. 251209-613142
DATE: April 2, 2026

ORDER

Service connection for pseudofolliculitis barbae is granted.

Service connection for hypertrophic scarring as secondary to now service-connected pseudofolliculitis barbae is granted.

REMANDED

Entitlement to service connection for bilateral toenail fungus is remanded.

Entitlement to service connection for a skin condition other than pseudofolliculitis barbae is remanded.

Entitlement to service connection for genital warts or syphilis is remanded.

FINDINGS OF FACT

1. The evidence favors a finding that the Veteran's pseudofolliculitis barbae is related to his service.

2. The evidence favors a finding that the Veteran's hypertrophic scarring is caused by the Veteran's now service-connected Veteran's pseudofolliculitis barbae.?

CONCLUSIONS OF LAW

1. The criteria for service connection for pseudofolliculitis barbae are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for hypertrophic scarring as secondary to now service-connected pseudofolliculitis barbae are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from October 1984 to November 1992. The Veteran also had active duty for training from June 1983 to August 1983.

In the December 2025 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, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

For the pseudofolliculitis barbae and scarring claims, 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.

For the remaining claims, because the Board is remanding them, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Lastly, the August 2023 AOJ decision expressly determined that new and relevant evidence was received to warrant readjudicating the claims. The Board is bound by these favorable findings. See 38 U.S.C. § 5104A; 38 C.F.R. § 3.104(c). As such, the Board need not adjudicate whether new and relevant evidence was received to warrant readjudicating the claims and may proceed to the merits of the underlying service connection claims.

Service Connection

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

Entitlement to direct service connection requires evidence of three elements: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Walker v. Shinseki, 708 F.3d 133
U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Secondary service connection may be granted for a disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists, (2) that there is an already service-connected disability, and (3) that there is "but for" causation or aggravation of the disability for which service connection is sought by a service-connected disability. See Spicer v. McDonough, 61 F.4th 1360, 1363 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and holding "but for" causation or aggravation is enough to show entitlement to secondary service connection).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).?

A. Pseudofolliculitis Barbae

The December 2024 rating decision contains favorable findings that the Veteran has been diagnosed with pseudofolliculitis barbae. The Board is bound by this favorable finding. 38 C.F.R. § 3.104. Thus, the first element of service connection is met.

The Veteran has noted that he started to experience small ingrown hairs, pain, and bumps after shaving during service. The Veteran is competent to provide evidence regarding the facts or circumstances of what he experienced in service. The Board finds the Veteran's statements regarding his experience after shaving to be credible, as they are consistent with the circumstances of his service. 38 C.F.R. § 3.159(a)(2). Therefore, the second element of the claim of service connection is met.

What remains to be established is whether there is a relationship between the Veteran's service and his current pseudofolliculitis barbae.

Concerning pseudofolliculitis barbae, the Veteran was afforded a VA examination in October 2022 and the examiner diagnosed pseudofolliculitis barbae. The Veteran noted that his condition began during military service after shaving. The examiner provided a positive nexus opinion. The examiner's rationale was that pseudofolliculitis barbae disproportionately affects active-duty military service members who are held to strict grooming standard. The examiner explained that the military regulations require short, tapered hair, which can require weekly to biweekly haircuts to maintain, and this is a major trigger for the induction and perpetuation of pseudofolliculitis barbae. The examiner added that pseudofolliculitis barbae is a chronic inflammatory condition that is caused by ingrown hairs of the face, scalp, nape of the neck, and other areas. The examiner stated that once the hair is removed in these areas, the new hair emerges and turns back on itself, penetrating into the skin. The examiner elaborated that as the tip of the hair proceeds through the epidermis epithelial, cells incompletely form about the shaft forming a pseudo follicle.

The Board concludes that the evidence persuasively favors a finding that the Veteran's pseudofolliculitis barbae is at least as likely as not related to his service. In reaching this conclusion, the Board assigns substantial weight of probative value to the October 2022 VA opinion, since the examiner's opinion is based on a thorough review of the medical evidence, is well-reasoned, and supported by medical evidence. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App.
hair proceeds through the epidermis epithelial, cells incompletely form about the shaft forming a pseudo follicle.

The Board concludes that the evidence persuasively favors a finding that the Veteran's pseudofolliculitis barbae is at least as likely as not related to his service. In reaching this conclusion, the Board assigns substantial weight of probative value to the October 2022 VA opinion, since the examiner's opinion is based on a thorough review of the medical evidence, is well-reasoned, and supported by medical evidence. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The examiner explained that pseudofolliculitis barbae disproportionately affects active-duty military service members because of the strict hygiene standards which can require weekly to biweekly haircuts to maintain, and this is a major trigger for pseudofolliculitis barbae.

In sum, the Board is satisfied that the requirements for service connection for pseudofolliculitis barbae are met and service connection is granted.

B. Scarring

The December 2024 rating decision made a favorable finding that the Veteran has a current disability of hypertrophic scarring based on a September 2022 VA examination report. The rating decision also made a favorable finding based on a September 2022 VA opinion that the hypertrophic scarring is caused by pseudofolliculitis barbae. The Board is bound by these favorable findings. See 38 U.S.C. § 5104A; 38 C.F.R. § 3.104(c). As the decision above awards service connection for pseudofolliculitis barbae, all three elements of the claim seeking secondary service connection for hypertrophic scarring are met. Therefore, the requirements of service connection for hypertrophic scarring are met, and the claim is granted. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

REASONS FOR REMAND

Service connection for a skin condition (other than pseudofolliculitis barbae), bilateral toenail fungus, and genital warts/syphilis are remanded.

1. Private Treatment Records

In October 2021, the Veteran submitted individual treatment records from Blackburn Woolfolk Dermatology, Kelsey Seybold Clinic, and Tanglewood Dermatology. However, the records indicate the Veteran may have received other treatment from these providers that was not included with the submitted records. The Veteran's VA treatment records also document that the Veteran receives treatment from an outside dermatologist. In a June 2022 statement, the Veteran indicated that he has visited many outside specialists for his skin condition. It does not appear from the available evidence that any efforts have been made to obtain complete records of treatment from these providers. Because these records were identified prior to the decision on appeal and since they might contain information bearing on the Veteran's appeal, efforts should have been made to procure them. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). As such, remand is necessary to cure this pre-decisional duty to assist error.

2. VA Examination

Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007) ("An opinion is adequate where it is based upon consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's 'evaluation of the claimed disability will be a fully informed one.'"); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) ("Neither a VA medical examination report nor a private medical opinion is entitled to any weight in a service-connection or rating context if it contains only data and conclusions...It is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes probative value to a medical opinion.").

A. Skin

The Veteran was afforded a VA examination in November 2021 and the examiner diagnosed folliculitis. The examiner offered a negative nexus opinion. The examiner's rationale was that the Veteran was diagnosed with syphilis during service and there was no evidence of post-service treatment
fully informed one.'"); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) ("Neither a VA medical examination report nor a private medical opinion is entitled to any weight in a service-connection or rating context if it contains only data and conclusions...It is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes probative value to a medical opinion.").

A. Skin

The Board finds the November 2021 VA opinion to be inadequate. The examiner's rationale is limited to a conclusory statement outlining that the Veteran suffered from syphilis during service while ignoring the Veteran's competent lay evidence that his rash began in service and has continued with cysts on his buttocks area and red, painful bumps on his upper front and rear torso. Miller v. Wilkie, 32 Vet. App. 249, 258-60 (2020) (holding that an examination that does not address credible and relevant lay evidence does not include enough detail to inform the Board's decision and, thus, is inadequate). Moreover, the examiner stated that the diagnosed condition of folliculitis is different than syphilis, but this fails to answer the question of whether the diagnosed condition is related to the Veteran's service. As such, the Board finds the November 2021 VA opinion to be inadequate.

In October 2022 a VA examiner offered a negative nexus opinion concerning the Veteran's skin condition. The examiner's rationale was that the Veteran's STRs were silent for any treatment for a skin condition.

The Board finds the October 2022 VA opinion to be inadequate. The examiner's premise that the Veteran's STRs are silent for any treatment for a skin condition is false. A September 1985 STR documents that the Veteran was treated for a rash all over his body. Additionally, April 1988 STRs indicate that the Veteran was treated for a cyst on the upper left leg that the Veteran reported "comes and goes" and that when it first comes back it "is really painful." These records also reflect that staphylococcus aureus was identified in the wound. Thus, the examiner's premise that the Veteran's STRs are silent for any treatment for a skin condition is false. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that an opinion based upon an inaccurate factual premise has no probative value). As such, The Board finds the October 2022 VA opinion to be inadequate.

In October 2022, a VA examiner provided an addendum opinion. The examiner stated that the rash condition was less likely than not related to the Veteran's service. The examiner's rationale was that there was no documented evidence of chronicity of care.

The Board finds the October 2022 addendum opinion to be inadequate. The examiner's rationale is limited to a conclusory statement that relies on the absence of documented medical evidence while ignoring the Veteran's competent lay evidence that he has continued to have rash related symptoms since service. Miller v. Wilkie, 32 Vet. App. 249, 258-60 (2020) (holding that an examination that does not address credible and relevant lay evidence does not include enough detail to inform the Board's decision and, thus, is inadequate). Additionally, the opinion does not discuss the impact of treatment for a staph infection during service.

As an adequate opinion was not obtained prior to the decision on appeal, there was a pre-decisional duty to assist error. Remand is necessary to correct this error.

B. Toes

The Veteran was afforded a VA examination in November 2021 and the examiner diagnosed right foot onychomycosis. The examiner offered a negative nexus opinion. The examiner indicated that the rash in service was given a presumptive diagnosis of syphilis, which is an acute infection if treated properly. The examiner indicated there had been no mention of syphilis since service and explained that the diagnosed condition of onychomycosis is different than syphilis, and thus not due to the body rash during service.

The Board finds the November 2021 VA opinion to be inadequate. The examiner's rationale is limited to conclusory statement outlining that the Veteran had syphilis during service while ignoring the Veteran's competent lay evidence that his toe fungus began and continued after service. Miller v. Wilkie, 32 Vet. App. 249,
offered a negative nexus opinion. The examiner indicated that the rash in service was given a presumptive diagnosis of syphilis, which is an acute infection if treated properly. The examiner indicated there had been no mention of syphilis since service and explained that the diagnosed condition of onychomycosis is different than syphilis, and thus not due to the body rash during service.

The Board finds the November 2021 VA opinion to be inadequate. The examiner's rationale is limited to conclusory statement outlining that the Veteran had syphilis during service while ignoring the Veteran's competent lay evidence that his toe fungus began and continued after service. Miller v. Wilkie, 32 Vet. App. 249, 258-60 (2020) (holding that an examination that does not address credible and relevant lay evidence does not include enough detail to inform the Board's decision and, thus, is inadequate). Moreover, the examiner stated that the diagnosed condition of onychomycosis is different than syphilis, but this fails to answer the question of whether the diagnosed condition is related to the Veteran's service. As such, the Board finds the November 2021 VA opinion to be inadequate.

In October 2022 a VA examiner offered a negative nexus opinion concerning the Veteran's toe fungus. The examiner's rationale was that the Veteran's STRs were silent for any treatment or complaints for a toenail fungus condition.

The Board finds the October 2022 VA opinion to be inadequate. The examiner's rationale is limited to a conclusory statement that relies on the absence of documented medical evidence while ignoring the Veteran's competent lay evidence that his toe fungus began and continued after service. Miller v. Wilkie, 32 Vet. App. 249, 258-60 (2020) (holding that an examination that does not address credible and relevant lay evidence does not include enough detail to inform the Board's decision and, thus, is inadequate). As such, the Board finds the October 2022 VA opinion to be inadequate.

As an adequate opinion was not obtained prior to the decision on appeal, there was a pre-decisional duty to assist error. Remand is necessary to correct this error.

The matters are REMANDED for the following actions:

1. Ask the Veteran to complete a VA Form 21-4142, Authorization and Consent to Release Information to VA, for private treatment he has received from Blackburn Woolfolk Dermatology, Kelsey Seybold Clinic, and Tanglewood Dermatology, and any other identified treatment for a skin condition. Make two requests for any authorized records, unless it is clear after the first request that a second request would be futile.

2. After completing the development above, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his skin disability (other than pseudofolliculitis barbae).

The examiner must opine whether any diagnosed skin disability, including folliculitis, is at least as likely as not related to an in-service injury, event, or disease, including treatment for a staph infection, using the same washing machines and restrooms as servicemembers who were in the Middle East as part of Desert Storm, in-service treatment for syphilis condyloma, warts, and an in-service rash.

A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner.

3. After completing the development in item 1, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his bilateral toenail fungus.

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The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including wearing the same socks for an extended period of time or treatment for a staph infection during service.

M. SORISIO

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