DERMATITIS OR ECZEMA

CAROLINE B. FLEMING · 2026 · Case ID: A26036948

MIXED

Summary

The veteran, who served from August 1986 to July 1991, July 2007 to May 2008, and March 2018 to October 2018, with subsequent Reserve and Air National Guard service, appeals the denial of service connection for hypertension, bilateral hip conditions, and neck/cervical spine strain. The veteran also sought to establish these conditions as secondary to a service-connected lumbar spine disability. The Board granted service connection for a skin condition diagnosed as melasma. For the skin condition, the Board found a current diagnosis supported by private dermatology records and resolved reasonable doubt in the veteran's favor, citing competent and credible lay statements from the veteran, his wife, and a superior officer that corroborated the onset and continuity of symptoms since service in Niger. Regarding hypertension, the Board denied service connection, noting the absence of a diagnosis or consistent elevated blood pressure readings in service or post-service records, and assigning no probative value to the veteran's lay assertions due to the medical nature of the condition. For the hip and neck conditions, service connection was denied both directly and secondarily. The Board found no in-service complaints, treatment, or diagnosis for these conditions, and the veteran's lay assertions linking them to service or his lumbar spine disability were assigned no probative value due to the lack of medical expertise. The Board also found no pre-decisional duty to assist error occurred regarding the lack of VA examinations for the denied conditions.

Rationale

Current disability established by private dermatology records and VA examiner acknowledgment of hyperpigmentation.; Evidence in relative balance regarding current diagnosis.; Benefit of the doubt applied to establish current disability.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210513-159439

Full Decision Text

Citation Nr: A26036948
Decision Date: 04/21/26 Archive Date: 04/21/26

DOCKET NO. 210513-159439
DATE: April 21, 2026

ORDER

Service connection for a skin condition diagnosed as melasma is granted.

Service connection for hypertension claimed as high blood pressure is denied.

Service connection for a left hip condition, to include as secondary to service-connected disability, is denied.

Service connection for a right hip condition, to include as secondary to service-connected disability, is denied.

Service connection for neck/cervical spine strain, to include as secondary to service-connected disability, is denied.

FINDINGS OF FACT

1. The Veteran's skin condition, diagnosed as melasma, was incurred in service.

2. The Veteran has not had a diagnosis of hypertension at any time prior to or during the pendency of the claim.

3. The Veteran's bilateral hip disabilities are not related to service or caused or aggravated by his service-connected lumbar spine disability.

4. The Veteran's neck/cervical spine strain is not related to service or caused or aggravated by his service-connected lumbar spine disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for a skin condition, diagnosed as melasma, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for left hip pain are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

4. The criteria for service connection for right hip pain are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

5. The criteria for service connection for neck/cervical strain are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 1986 to July 1991, from July 2007 to May 2008, and from March 2018 to October 2018, with additional periods of service in the Reserve and California Air National Guard.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2021 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) also known as the agency of original jurisdiction (AOJ).

In the May 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket.

However, in November 2024, the Veteran, through his representative, withdrew his hearing request in writing. See Correspondence. As such, the Board finds that the Veteran's request for a hearing is deemed withdrawn. Consequently, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative within 90 days following the November 14, 2024, notice of withdrawal of the hearing. See 38 C.F.R. §20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the request to withdraw the hearing, or (2) more than 90 days following the withdrawal of hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 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.

Service connection

In general, service connection may be established for a disability resulting from a disease or injury incurred in or aggravated by active service. See
. §§ 20.300, 20.302(a), 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.

Service connection

In general, service connection may be established for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 1131; 38 C.F.R. § 3.303. Service connection requires evidence showing: (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a nexus between the current disability and the disease or injury incurred or aggravated in service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 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. See 38 C.F.R. § 3.303(d).

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); see also Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and instead held a "but for" causation or aggravation is enough to show entitlement to secondary service connection).

In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994).

The Board must also fully consider the lay assertions of record. Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed by a lay person, to include observable symptoms. See 38 C.F.R. § 3.159(a)(2); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

VA is responsible for determining whether the evidence supports the claim or is in relative balance, with a claimant prevailing in either event. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claimant is entitled to the benefit of the doubt when there is an "approximate" (meaning nearly equal) balance of positive and negative evidence regarding any material determination. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). If the evidence persuasively weighs against a claim, the claim is denied.

1. Service connection for skin condition diagnosed as melasma.

The Veteran contends that his skin disability is related to service. See October 2020 Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ); May 2021 VA Form 10182; February 2025 Appellate Brief. Specifically, he asserts that he developed a skin condition around his neck during deployment in Niger and symptoms of this condition has continued since then. Id.
.4th 776 (Fed. Cir. 2021); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). If the evidence persuasively weighs against a claim, the claim is denied.

1. Service connection for skin condition diagnosed as melasma.

Resolving reasonable doubt in the Veteran's favor, the Board finds that he has a current skin condition, diagnosed as melasma, that began in service and has continued after service. 38 C.F.R. §§ 3.102, 3.303; Lynch, 21 F.4th 776; Ortiz, 274 F.3d 1361.

Regarding the first element of service connection, a current disability, the Board finds this element has been met. October 2020 private dermatology records from Dr. J.F.D. show a diagnosis of melasma. Notably, a December 2020 VA examiner acknowledged hyperpigmentation (discoloration) around the Veteran's neck that began during service but found that he did not have a skin condition. Here, the record contains evidence in favor and against finding a current diagnosis exists. Therefore, the evidence is in relative balance. Consequently, the Board resolves reasonable doubt in the Veteran's favor and finds that he had a current skin condition, which has been diagnosed as melasma. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, 21 F.4th 776; Ortiz, 274 F.3d 1361.

Accordingly, the question before the Board is whether the Veteran's disability was incurred in service or is otherwise related to some event or injury in service.

In this case, the record contains competent and credible lay statements that the Veteran's symptoms began in service and were ongoing between onset and separation from service.

The Veteran submitted a September 2020 statement from his superior, J.M.P., Lt Col, USAF. The Lieutenant Colonel asserted that while deployed in Niger, he noticed the Veteran had a brownish ring around his neck and advised him to seek treatment.

The Veteran also submitted an October 2020 statement in which he asserted that during deployment, he was approached by a commander who pointed out an abnormal dark ring around his neck and recommended that he consult the medic team, which sent him to a local hospital in Niger where the doctor attributed his condition to sudden sun exposure and extreme heat. After deployment, he sought treatment, and a private dermatologist diagnosed melasma due to sun exposure.

In an October 2020 statement, the Veteran's wife asserted that after the Veteran's deployment to Niger from March 2018 to October 2018, she noticed a dark ring around his neck, which was not present prior to his deployment. She reported that the Veteran told her that a doctor in his unit said the discoloration is due to extreme sun exposure during deployment.

The Veteran also submitted October 2020 private treatment records from Dr. J.F.D., his private dermatologist, in which he reported discoloration around his neck present since 2018 and the clinician diagnosed melasma.

During the December 2020 VA Examination, the Veteran reported he was deployed to Africa and about six months into deployment he developed discoloration on his neck.

The Board assigns great probative weight to the statements of the Veteran, his wife and his colleague about his injury. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed by a lay person, to include observable symptoms. See 38 C.F.R. § 3.159(a)(2); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Here, the Veteran, his wife, and his colleague are all competent to report observing signs of a skin condition both in service and post-service. Their reports are credible and probative as they are internally consistent. There is, further, no evidence to contradict these probative statements and observations.

In sum, the Board finds that the probative evidence of record indicates that the Veteran developed a skin condition in service, which was later diagnosed as melasma, and that he has experienced continuous symptoms since service. Therefore, the Board finds that the Veteran's disability was incurred in service. 38 C.F.R. § 3.303(d). Accordingly, service
, 492 F.3d 1372 (Fed. Cir. 2007). Here, the Veteran, his wife, and his colleague are all competent to report observing signs of a skin condition both in service and post-service. Their reports are credible and probative as they are internally consistent. There is, further, no evidence to contradict these probative statements and observations.

2. Service connection for hypertension.

The Veteran contends that he has a hypertension disability that is related to service. See March 2021 Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ); May 2021 VA Form 10182; February 2025 Appellate Brief.

The Board is cognizant that the Veteran has not received a formal VA examination for his claimed hypertension disability; however, the Board finds that a pre-decisional duty to assist error did not occur based on the evidence of record at the time of the March 2021 AOJ rating decision on appeal. See 38 C.F.R. § 20.802.

In McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006), the United States Court of Appeals for Veterans Claims (Court) held that an examination is required when there is (1) evidence of a current disability, (2) evidence establishing an "in-service event, injury or disease," or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation, (3) an indication that the current disability may be related to the in-service event, and (4) insufficient evidence to decide the case. The Court noted that the first element only requires consideration of whether there is evidence of a current disability or persistent or recurrent symptoms thereof and an assessment that the evidence is competent. McLendon, 20 Vet. App at 81; Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (finding that lay testimony is competent to establish the presence of observable symptomatology).

Here, the Veteran's service treatment records show normal blood pressure readings and do not contain evidence of high blood pressure during service. See May 2008 JB San Antonio Military Treatment Facility notes. Post-service treatment records also show normal blood pressure readings. See January 2009 ER treatment notes. In his March 2021 claim, the Veteran first asserted that during a recent visit to a VA clinic, he registered high blood pressure. March 2021 Martinsburg VAMC Primary care notes show one blood pressure reading of 124/91, which the clinician noted as increased blood pressure "without a diagnosis of hypertension." At that time, the Veteran was provided a blood pressure cuff and recommended a blood pressure check within a month. In this case, with the exception of the single incident in March 2021 of increased blood pressure without hypertension, the record does not contain a diagnosis of hypertension or elevated blood pressure readings prior to March 2021 suggesting hypertension. Given the above, the Board finds that the threshold for providing a VA examination and opinion were not met and no pre-decisional duty to assist error occurred prior to the March 2021 rating decision. See 38 C.F.R. § 20.802; McLendon, 20 Vet. App. at 81. Consequently, the Board will proceed with adjudication of the claim based on the evidence in the record at the time of the March 2021 rating decision.

The Board concludes that the Veteran does not have and has not had a hypertension disability that is related to service at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

As noted above, service treatment records do not contain documentation of elevated blood pressure readings, a diagnosis, or treatment for hypertension at any time during service. Post-service treatment records do not contain a diagnosis of hypertension and only contain one March 2021 elevated reading with a notation by the clinician that no diagnosis of hypertension exists and no high blood pressure or elevated blood pressure readings subsequent to suggesting hypertension.

The Board acknowledges the Veteran's contention that he has a hypertension disability
of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

The Board acknowledges the Veteran's contention that he has a hypertension disability that is related to service. However, although lay persons are competent to report symptoms experienced at any time, as well as provide opinions on some medical issues, the specific disability in this case, hypertension, falls outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau, 492 F.3d 1372. Specifically, the Veteran is not shown to have the required medical knowledge or training to offer an opinion as to whether he has a diagnosis of hypertension that is related to service. Thus, the Veteran's statements regarding a diagnosis of hypertension and a link to service are assigned no probative value.

After a thorough review of the record, the Board finds that the probative evidence of record supports a finding that the Veteran has not been diagnosed with hypertension. Consequently, as the probative evidence shows that the Veteran does not have clinically diagnosed hypertension disability, the claim must be denied.

3. Service connection for a left hip condition, to include as secondary to service-connected disability.

4. Service connection for a right hip condition, to include as secondary to service-connected disability.

5. Service connection for neck/cervical spine strain, to include as secondary to service-connected disability.

The Veteran contends that he has bilateral hip and neck/cervical spine strain disabilities that are related to service. See September 2020 Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ); May 2021 VA Form 10182; February 2025 Appellate Brief. Alternatively, he asserts that his disabilities are secondary to his service-connected lower back disability. See February 2025 Appellate Brief; July 2021 Statement.

The Board is cognizant that the Veteran has not received a formal VA examination for his claimed hip and neck disabilities; however, the Board finds that a pre-decisional duty to assist error did not occur based on the evidence of record at the time of the March 2021 rating decision on appeal. See 38 C.F.R. § 20.802.

In McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006), the United States Court of Appeals for Veterans Claims (Court) held that an examination is required when (1) there is evidence of a current disability, (2) evidence establishing an "in-service event, injury or disease," or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation, (3) an indication that the current disability may be related to the in-service event, and (4) insufficient evidence to decide the case. The Court noted that the first element only requires consideration of whether there is evidence of a current disability or persistent or recurrent symptoms thereof and an assessment that the evidence is competent. McLendon, 20 Vet. App at 81; Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (finding that lay testimony is competent to establish the presence of observable symptomatology).

Here, the Veteran's service treatment records do not contain any evidence of complaints of, treatment for, or a diagnosis of hip or neck/cervical strain disabilities. He first reported neck/cervical strain and bilateral hip disabilities in his September 2020 claim. More recently, March 2021 VAMC Primary Care notes show reports of on and off pain, but neither the Veteran nor his treatment provider described any functional impairment of earning capacity prior to the March 2021 rating decision on appeal. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The Veteran also did not assert his secondary service connection theory of entitlement regarding the lower back prior to the March 2021 rating decision at issue here. Given the above, the Board finds that the threshold for providing a VA examination and opinion were not met and no pre-decisional duty to assist error occurred prior to the March 202
bilateral hip disabilities in his September 2020 claim. More recently, March 2021 VAMC Primary Care notes show reports of on and off pain, but neither the Veteran nor his treatment provider described any functional impairment of earning capacity prior to the March 2021 rating decision on appeal. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The Veteran also did not assert his secondary service connection theory of entitlement regarding the lower back prior to the March 2021 rating decision at issue here. Given the above, the Board finds that the threshold for providing a VA examination and opinion were not met and no pre-decisional duty to assist error occurred prior to the March 2021 rating decision. See 38 C.F.R. § 20.802; McLendon, 20 Vet. App. at 81. Consequently, the Board will proceed with adjudication of the claims based on the evidence in the record at the time of the March 2021 rating decision.

Regarding the first element of service connection, post-service treatment notes, as well as a statement from the Veteran's spouse, show complaints of on and off neck/cervical or bilateral hip pain. Further, the AOJ has made favorable findings that the Veteran has a diagnosis of bilateral hip pain and neck pain. See March 2021 rating decision. Therefore, the Board finds that this element has been met.

The issue before the Board is whether the Veteran's neck/cervical and bilateral hip pain disabilities are related to service or caused or aggravated by his service-connected lumbar spine disability.

With respect to direct service connection, the Veteran's service treatment records are negative for complaints, diagnosis or treatment for neck/cervical or bilateral hip pain while in service. The Veteran has not alleged that he incurred any injury or experienced any event in service that led directly to his hip and neck disorders. Thus, the second element of service connection on a direct basis-that of an in-service incurrence-has not been met.

Further, and regarding the third element of service connection, while post-service treatment notes, as well as a statement from the Veteran's spouse, show complaints of on and off neck/cervical or bilateral hip pain after service, the Veteran's record is negative for any competent evidence of a link between neck/cervical or bilateral hip pain disabilities and his time in service.

The Board acknowledges the Veteran's contentions that his neck and hip disabilities are related to service on a direct basis. However, although lay persons are competent to report symptoms experienced at any time, as well as to provide opinions on some medical issues, the specific issue in this case-a nexus between service and the Veteran's claimed neck/cervical and bilateral hip disabilities-falls outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau, 492 F.3d 1372. Specifically, the Veteran is not shown to have the required medical knowledge or training to offer an opinion as to whether his neck/cervical or bilateral hip pain is related to service. As a result, the Veteran's statements purporting to link his current neck and hip disabilities to service are assigned no probative value. Therefore, the Board finds that service connection for a bilateral hip disability and neck/cervical strain on a direct basis is not warranted.

With respect to secondary service connection, the Board acknowledges that the Veteran contends that his neck and bilateral hip disabilities are secondary to his service-connected lumbar spine disability. The Board also acknowledges that the Veteran's wife has asserted that the Veteran's back pain caused by his service-connected lumbar spine disability has "been radiating over the years to include his hips and neck." See February 2025 Appellate Brief. However, as discussed above, the Board finds that the Veteran and his wife are not shown to have the required medical knowledge or training to offer an opinion as to whether the Veteran's neck/cervical or bilateral hip pain is related to or aggravated by his service-connected lumbar spine disability. Kahana, 24 Vet. App. 428; Jandreau, 492 F.3d 1372. Therefore, the Board also finds that service connection for a bilateral hip disability and neck/cervical strain on a secondary basis is not warranted.

After a thorough review of the record, the Board finds that the probative evidence of record supports a finding that the Veteran's neck/cervical strain and bilateral hip disabilities are not related to service connection or to a service-connected disability. Consequently, the claims must be denied.

Caroline B. Fleming

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Michel-Rossi, Mayerline

The Board's decision in this case is binding only with respect to the instant matter
428; Jandreau, 492 F.3d 1372. Therefore, the Board also finds that service connection for a bilateral hip disability and neck/cervical strain on a secondary basis is not warranted.

Caroline B. Fleming

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Michel-Rossi, Mayerline

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.

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