CHLORACNE

Summary

The Veteran, an Army service member who served from November 1965 to September 1967, including service in Vietnam, appeals the denial of service connection for chloracne. The Board reviewed the case based on the direct review docket, considering evidence of record up to the December 2025 rating decision. The Veteran claims his chloracne is related to herbicide exposure during service. The Board noted favorable findings from the December 2025 rating decision, including toxic exposure risk activity (TERA), Vietnam service, and a current chloracne diagnosis. The VA examiner provided a negative nexus opinion, stating chloracne typically manifests shortly after exposure and the long delay until diagnosis was inconsistent with its clinical course. However, the Board found this opinion inadequate as it failed to address the Veteran's statement that his chloracne first manifested shortly after returning from Vietnam in 1967. The Veteran's wife also treated him for the condition at that time. Despite the lack of a formal diagnosis until 2025, the Board found the evidence indicated an onset in 1967, within one year of his last presumed exposure to herbicides in April 1967. The Board also deferred to the examiner's description of the current condition as deep acne, despite some descriptive inconsistencies, and resolved doubt in the Veteran's favor to find that the symptoms met the 10% threshold for presumptive service connection. The Board found the evidence in approximate balance and resolved doubt in the Veteran's favor, granting service connection for chloracne.

Rationale

Presumptive service connection under 38 C.F.R. § 3.309(e); Chloracne manifested within one year of last exposure; Resolved doubt in Veteran's favor due to approximate balance of evidence

Full Decision Text

Citation Nr: A26032767
Decision Date: 04/09/26	Archive Date: 04/09/26

DOCKET NO. 260121-627938
DATE: April 9, 2026

ORDER

Entitlement to service connection for chloracne is granted.

FINDING OF FACT

The Veteran's chloracne is presumed to be caused by his exposure to herbicide agents during service.

CONCLUSION OF LAW

The criteria for service connection for chloracne are met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from November 1965 to September 1967.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2025 rating decision (January 2026 notification letter) by a Department of Veterans Affairs (VA) Regional Office, which is the Agency of Original Jurisdiction (AOJ).

The Veteran elected the Board's direct review docket in his January 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement). This restricts the Board's review to the evidence of record at the time of the December 2025 rating decision. If evidence was submitted after the AOJ issued the December 2025 decision, the Board did not consider it in its decision. 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 claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included in this decision. 

The Board notes the Veteran has the right to select a different Board review option by submitting a new VA Form 10182 within one year from the date the AOJ mailed the decision on appeal, or within 60 days of the date the Board received the VA Form 10182, whichever date is later. 38 C.F.R. § 20.202(c)(2); see Williams v. McDonough, 37 Vet. App. 305 (2024). Although the period to change dockets per 38 C.F.R. § 20.202(c)(2) has not elapsed, the issue is being granted in full, and therefore, there is no prejudice to the Veteran in proceeding to adjudicate the appeal. 

This appeal has been advanced on the Board's docket. 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.900(c).

Entitlement to service connection for chloracne

The Veteran believes that his chloracne is related to his exposure to herbicide agents during service in the Republic of Vietnam.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

Service connection may be established on a presumptive basis for certain disabilities, including chloracne, if the Veteran was exposed to herbicide agents during his military service. 38 C.F.R. § 3.309(e). Chloracne must become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent during active service in order to be presumed to have been caused by service. 38 C.F.R. § 3.307.

The December 2025 rating decision made favorable findings that the Veteran had toxic exposure risk activity (TERA), that he served in Vietnam, and that he has a current diagnosis of chloracne. In general, the Board is bound by favorable findings in the Rating Decision on appeal. 38 C.F.R. § 20.801(a).

The December 2025 VA examination provided a negative nexus opinion with the rationale that large-scale human exposures consistently demonstrate that
 must become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent during active service in order to be presumed to have been caused by service. 38 C.F.R. § 3.307.

The December 2025 rating decision made favorable findings that the Veteran had toxic exposure risk activity (TERA), that he served in Vietnam, and that he has a current diagnosis of chloracne. In general, the Board is bound by favorable findings in the Rating Decision on appeal. 38 C.F.R. § 20.801(a).

The December 2025 VA examination provided a negative nexus opinion with the rationale that large-scale human exposures consistently demonstrate that chloracne is an early effect of exposure rather than a delayed condition appearing decades later, and that chloracne is expected to manifest shortly after exposure, with lesions either resolving or persisting over time, not first appearing many decades later. The examiner explained that the extremely long interval between service and the 2025 diagnosis is inconsistent with the known clinical course and timing of dioxin-induced chloracne. This opinion is inadequate because it does not discuss the evidence of record that the Veteran's chloracne first manifested shortly after his return from Vietnam. Dalton v. Nicholson, 21 Vet. App. 23, 40 (2007).

Although the Veteran was not formally diagnosed until he attended a November 2025 VA examination, that examination report notes that the onset date of his chloracne was 1967. A September 2025 statement from the Veteran reports that the Veteran's skin disability developed as soon as he got back from Vietnam, and that his wife used to treat him. The Veteran explained that he did not have insurance at that time. A December 2025 VA treatment note indicates that the Veteran reported that he has had blackheads on his back since returning from Vietnam. This evidence is not contradicted by the Veteran's service treatment records (STRs) because, although the Veteran denied skin disease in the August 1967 report of medical history and was found to have normal skin in the August 1967 separation examination, the Veteran's report that his wife treated his chloracne indicates that it became manifest in the four months of 1967 after he was discharged from service. 

The Board recognizes that in order to be presumed to have been caused by exposure to herbicide agents, the Veteran's chloracne must have manifested to a degree of 10 percent or more within a year after he was last exposed. 38 C.F.R. § 3.307. The Veteran's personnel records indicate that he left Vietnam, and thus was last presumed to have been exposed to herbicide agents, in April 1967, which is within one year of the reported onset of his chloracne. A 10 percent rating for chloracne is assigned for deep acne (deep inflamed nodules and pus-filled cysts) affecting less than 40 percent of the face and neck; or deep acne affecting non-intertriginous areas of the body (other than the face and neck). 38 C.F.R. § 4.118, Diagnostic Code (DC) 7829. 

The November 2025 VA examination indicates that the Veteran's chloracne is currently manifest by deep acne affecting less than 40 percent of his face and neck as well as intertriginous areas (axilla of the arm, anogenital region, skin folds of the breasts, or between digits). The examiner described the history of the chloracne in 1967 as manifested by noticeable skin pustules and noted that the Veteran continues with multiple pustules on his back as well as blackheads. The Board recognizes that DC 7829 refers to pustules as noncompensable superficial acne and describes deep acne as deep inflamed nodules and pus-filled cysts. However, the Board will defer to the medical expertise of the examiner in finding that, in this case, the Veteran's symptoms meet the criteria of deep acne even though they are described as pustules in the medical history section. Because the medical history taken by the examiner indicates that the Veteran's pustules "continued" rather than worsened, the Board resolves doubt in the Veteran's favor to find that the symptoms that appeared on his back in 1967 were of similar severity to those that were present when he was examined in November 2025 and thus were deep acne. Deep acne affecting non-intertriginous areas of the body, like the back, is consistent with the assignment of a 10 percent rating. Therefore, the Board finds that the Veteran's chloracne manifested to a degree of 10 percent or more within a year of his last exposure to herbicide agents and thus is presumed to be caused by his military service.

Upon review of the record, the
 medical history taken by the examiner indicates that the Veteran's pustules "continued" rather than worsened, the Board resolves doubt in the Veteran's favor to find that the symptoms that appeared on his back in 1967 were of similar severity to those that were present when he was examined in November 2025 and thus were deep acne. Deep acne affecting non-intertriginous areas of the body, like the back, is consistent with the assignment of a 10 percent rating. Therefore, the Board finds that the Veteran's chloracne manifested to a degree of 10 percent or more within a year of his last exposure to herbicide agents and thus is presumed to be caused by his military service.

Upon review of the record, the Board finds the evidence to be at least in approximate balance as to whether the Veteran's chloracne is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for chloracne is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, 782 (Fed. Cir. 2021) (en banc).

 

 

JENNIFER HWA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Budd, 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.