SCARS DISFIGURING

Summary

The veteran, who served from January 2001 to September 2008, including service in Iraq, appeals the denial of service connection for chest scars. The veteran claimed the scars originated in service from lesions caused by shower water, which healed into persistent, painful, circular scars. The Board found the veteran had an in-service event (neck masses) and a current disability (chest scars). However, the Board denied service connection due to a lack of nexus. A VA examiner opined that the scars were not caused by service, as no medical evidence linked the in-service neck masses to the current chest scars. The Board found this opinion probative, even though it did not directly address the veteran's lay statement on causation or a 2012 shingles diagnosis. The Board determined the veteran's lay statements lacked credibility because they were inconsistent with service treatment records, which showed no chest lesions or scarring during service, only on the back. The Board also noted the 2012 shingles diagnosis was an acute, isolated incident unrelated to service. The Board found no presumptive service connection for chest scars related to Camp Lejeune or toxic exposures, as the service post-dated relevant periods and the scars were not among presumptive conditions. The Board concluded the evidence weighed against service connection, and the benefit-of-the-doubt doctrine was not applicable. Service connection for chest scars was denied.

Rationale

No positive nexus between in-service neck masses and current chest scars.; Veteran's lay statements regarding onset and continuity of chest scarring lack credibility.; No presumptive service connection for chest scars related to Camp Lejeune or toxic exposures.

Full Decision Text

Citation Nr: A26033903
Decision Date: 04/13/26	Archive Date: 04/13/26

DOCKET NO. 220829-272712
DATE: April 13, 2026

ORDER

Entitlement to service connection for chest scars is denied.

FINDING OF FACT

The evidence of record persuasively weighs against finding that the Veteran's chest scars began during active service or are otherwise related to an in-service injury or disease.

CONCLUSION OF LAW

The criteria for service connection for chest scars are not met.  38 U.S.C. § 1110; 38 C.F.R. § 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from January 2001 to 2006 and from October 2007 to September 2008.

By way of history, the agency of original jurisdiction (AOJ) denied service connection for chest scars in a February 2022 rating decision, which was itself a higher-level review (HLR) of a January 2022 rating decision. The Veteran appealed the February 2022 rating decision - recognizing this as the most recent merits-based decision - via an August 2022 notice of disagreement (NOD), in which he selected the Direct Review docket. See Terry v. McDonough, 37 Vet. App. 1, 12-13 (2023). The Veteran's claim was again denied by an October 2024 Board decision, which the Veteran then appealed to the Court of Appeals for Veterans Claims (the Court). The Court vacated the previous Board decision and directed the Board, in granting a Joint Motion for Remand (JMR), to address whether a VA examination was inadequate for failure to address the Veteran's lay statements. This now brings the matter back to the Board. 

Therefore, the Board may only consider the evidence of record at the time of the January 2022 AOJ decision, which was subsequently subject to HLR. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to HLR, 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 with this decision. 

1. Entitlement to service connection for chest scars

The Veteran contended that his chest scars were incurred in service. 

Factual Background

The Veteran's skin was noted to be normal in reports of medical examination and history in December 2000. 

In October 2001, the Veteran's service treatment records reflect that he complained of a mass on the back of his neck, and had noticed no similar masses elsewhere. In November 2001, service treatment records reflect another complaint of a mass on the Veteran's back, in an area where previous lesions had not healed. In January 2003, the Veteran reported that he did not have shingles nor any other skin disease.

In a September 2008 report of medical history, the Veteran reported no then-current nor historical skin diseases. In a post-deployment medical assessment in March 2009, the Veteran reported no skin diseases or rashes. 

In June 2012, the Veteran reported to a VA medical center complaining of a rash on his left chest, ribs, and back. VA medical center staff diagnosed this rash as herpes zoster - or shingles - and noted that the Veteran previously had chickenpox. The Veteran's VA medical center records from that point note a history of shingles, but do not include any more reports of a chest rash or related pain. In fact, from that time, the medical record affirmatively reflects a lack of any rashes or scar, with such absence recorded in January and September 2017, and October 2019. Indeed, in October 2019, the Veteran affirmatively reported no persistent skin rash. 

With his October 2021 claim application, the Veteran reported that he believed that his claimed chest scars had begun in service as lesions that healed and became circular scars which have been persistent and painful. 

Later in October 2021, the Veteran was provided with a VA examination for his claimed chest scars. He reported to that examiner that his scarring had been incurred in service by lesions which developed on
 any more reports of a chest rash or related pain. In fact, from that time, the medical record affirmatively reflects a lack of any rashes or scar, with such absence recorded in January and September 2017, and October 2019. Indeed, in October 2019, the Veteran affirmatively reported no persistent skin rash. 

With his October 2021 claim application, the Veteran reported that he believed that his claimed chest scars had begun in service as lesions that healed and became circular scars which have been persistent and painful. 

Later in October 2021, the Veteran was provided with a VA examination for his claimed chest scars. He reported to that examiner that his scarring had been incurred in service by lesions which developed on his chest caused by the water in the showers on base. He claimed these lesions healed into circular scars on his chest. The Veteran repeated this contention in February 2022 while meeting for an informal conference for HLR of his denied claim. The VA examiner confirmed the Veteran's current chest scarring, and noted a date of onset in 2004, apparently relying on the Veteran's own reporting. The examiner then opined that the Veteran's current scars were not caused by service because there was no evidence that linked the current chest scars to military service. 

Analysis

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

Here, the AOJ has made the favorable findings that the Veteran had an in-service event - his neck masses reported in service - as well as a current disability - the chest scars noted by the VA examiner. Under general service connection principles, as represented by the Shedden elements described above, this leaves only the question of a nexus. 

Unfortunately, there is no positive nexus here. The VA examiner declined to find a nexus, noting that there was no medical evidence which could link the Veteran's in-service neck masses to his current chest scars. The Board finds that this opinion was probative, although it did not address the Veteran's lay statement as to onset and causation nor the 2012 shingles diagnosis. 

First, the opinion's lack of a direct statement on the Veteran's lay opinion on causation does not render the opinion inadequate. The Veteran claimed that his chest scars began in service and were caused by the water in the showers in a particular base. The Veteran is not competent to provide a nexus opinion on this point. Such a nexus opinion - that masses incurred in service caused the current chest scars - would require medical expertise which the record does not show the Veteran possesses. Nothing in the record demonstrates that the Veteran received any special training or acquired any medical expertise in evaluating disabilities, and so his opinion as to causation is not competent medical evidence and lacks probative value. He is competent only to report his symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007).

Nor is the opinion inadequate for failing to address the Veteran's lay statement as to the reporting of his symptoms in service, separate from the Veteran's lay nexus opinion. Although the Veteran is competent to report that his symptoms began in service and led to scarring over the intervening years, this reporting is not credible. First, the Veteran's service treatment records reflect no chest scarring nor chest lesions during service. The Veteran's post-service lay statements allege that the he developed lesions below his neck, on his chest, that eventually became the scars on his chest. This lay description lacks credibility. The service treatment records do not reflect any lesions nor masses on the Veteran's chest at all during his service. Instead, the only masses or lesions noted in the service records developed on the Veteran's back, not his chest, and the Veteran affirmatively denied that any similar masses had developed elsewhere. Further, after that reporting in October and November 2001, the Veteran repeatedly denied or was noted not to have any skin rash, disease, or other chest scarring both in service and after. Thus, the Veteran's statement as to onset and continuity is not credible and lacks probative value. Although the opinion
 that the he developed lesions below his neck, on his chest, that eventually became the scars on his chest. This lay description lacks credibility. The service treatment records do not reflect any lesions nor masses on the Veteran's chest at all during his service. Instead, the only masses or lesions noted in the service records developed on the Veteran's back, not his chest, and the Veteran affirmatively denied that any similar masses had developed elsewhere. Further, after that reporting in October and November 2001, the Veteran repeatedly denied or was noted not to have any skin rash, disease, or other chest scarring both in service and after. Thus, the Veteran's statement as to onset and continuity is not credible and lacks probative value. Although the opinion omitted any reference to that lay description, this is non-prejudicial to the Veteran because those lay statements lack credibility and probative value. Cf. McKinney v. McDonald, 28 Vet. App. 15, 30 n.14 (2016) (noting that the Board had not made a credibility assessment of a Veteran's lay statement when finding the examiner should have addressed it).  

Neither is the exam inadequate for not addressing the Veteran's 2012 shingles diagnosis. First, nowhere does the record nor the Veteran raise this as a basis for entitlement to service connection, nor as evidence of continuity or of any relation to the Veteran's scars allegedly incurred in service. Herpes zoster, or shingles, is defined as an "acute infectious, usually self-limited, disease believed to represent activation of latent human herpes virus 3 in those who have been rendered partially immune after a previous attack of chickenpox." See DORLAND's ILLUSTRATED MEDICAL DICTIONARY 845 (30th ed. 2003). Accordingly, absent evidence showing a chronic disability related to herpes zoster, the Board finds, by definition, that the reported infection was acute. Thus, the Board views the shingles diagnosis as a freestanding incident of infection, not related to any previous medical history other than chickenpox. This is further supported by the Veteran's reporting, in January 2003 - after the incident of a neck mass - that he did not then have shingles. That the examiner did not address this, then, does not render the exam inadequate, as the record does not provide evidence of a connection to the Veteran's service and instead the 2012 rash stands out as an acute, isolated incident separate from service, and so not relevant to the claim. Even without a discussion of the 2012 rash, the Board believes that the exam, read as a whole, provides a complete rationale of the Veteran's medical history sufficient to render a decision as to the chest scars because, as the examiner stated, there is no evidence connecting the current scars to anything in service and is based on proper medical principles applied to the credible and competent facts. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007); see also Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008).

Without a nexus, the claim cannot satisfy the Shedden elements described above, and so must be denied on a direct basis. Shedden, supra.

Nor are there any relevant presumptive bases to grant service connection here. Although the Veteran's personnel record shows service at Camp Lejeune, his service post-dated the period - August 1953 through December 1987 - relevant to presumptive service connection associated with that base. Nor are the Veteran's claimed scars among the presumptive disabilities associated with service there. This basis, then, cannot show entitlement to service connection here and is inapplicable. See 38 C.F.R. § 3.307(a)(7)(i).

Finally, the Board notes that the Veteran's military record reflects service in Iraq, but the Veteran was not provided with an opinion as to whether presumed toxic exposures were related to his claimed scars standing alone or as part of a medically unexplained chronic multisymptom illness (MUCMI), and there is insufficient medical evidence to find this is the case without such an opinion. Even were the Board to presume that the chest scarring ought to qualify as potentially presumptively arising from toxic exposures, it had not manifested to an extent warranting a 10 percent disability rating during the period on review as the affected area was only five square centimeters, while the rating criteria requires an affected area of 929 square centimeters, and so was not entitled to presumptive service connection. 38 C.F.R. § 4.118, Diagnostic Code 7802. Further, the duty to provide an opinion as to toxic exposure and MUCMI did not arise until the August 2022 effective date of the PACT Act, which post-dated the rating decision on appeal. Thus, it was
 such an opinion. Even were the Board to presume that the chest scarring ought to qualify as potentially presumptively arising from toxic exposures, it had not manifested to an extent warranting a 10 percent disability rating during the period on review as the affected area was only five square centimeters, while the rating criteria requires an affected area of 929 square centimeters, and so was not entitled to presumptive service connection. 38 C.F.R. § 4.118, Diagnostic Code 7802. Further, the duty to provide an opinion as to toxic exposure and MUCMI did not arise until the August 2022 effective date of the PACT Act, which post-dated the rating decision on appeal. Thus, it was thus not a pre-decisional duty to assist error not to provide an opinion on toxic exposure, and so is not a proper basis for remand. See 38 U.S.C. § 5103A(f)(2)(A); 38 C.F.R. § 20.802(a). 

Therefore, the evidence does not establish that it is at least as likely as not that the Veteran is entitled to service connection for his chest scars. The evidence of record persuasively weighs against the claim for service connection, and the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). The claim is denied.

 

 

Thomas H. O'Shay

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. Kronick

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.