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Citation Nr: 1721981
Decision Date: 06/14/17    Archive Date: 06/23/17

DOCKET NO.  06-13 505	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in San Juan, the Commonwealth of Puerto Rico

THE ISSUES

1.  Entitlement to service connection for an acquired psychiatric disorder.

2.  Entitlement to service connection for the skin disorders of lipomas and seborrheic dermatitis.

REPRESENTATION

Veteran represented by:  Puerto Rico Public Advocate for Veterans Affairs

ATTORNEY FOR THE BOARD

Christopher McEntee, Counsel

INTRODUCTION

The Veteran served on active duty from October 1955 to October 1957 and from August 1969 to August 1972.

This matter is before the Board of Veterans' Appeals (Board) on appeal of December 2005 and March 2011 rating decisions by the San Juan, Puerto Rico, Department of Veterans Affairs (VA) Regional Office (RO).  In August 2008, July 2014, and February 2016, the Board remanded the issues on appeal for additional development.

The record consists of electronic claims files and has been reviewed.  New and relevant evidence has not been added to the record since the most recent Supplemental Statement of the Case (SSOC) dated in November 2016.

This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2016).  38 U.S.C.A. § 7107(a)(2) (West 2014).

FINDINGS OF FACT

1.  A chronic acquired psychiatric disability was not manifest during service or within one year of discharge from service, and is not attributable to service.

2.  Chronic lipomas and/or dermatitis were not manifest during service and are not attributable to service.

CONCLUSIONS OF LAW

1.  A chronic acquired psychiatric disability was not incurred in or aggravated by service, and may not be presumed related to service.  38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2016).

2.  Chronic lipomas and/or dermatitis were not incurred in or aggravated by service.  38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2016).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

I. Veterans Claims Assistance Act of 2000

VA has a duty to notify and to assist the Veteran in the development of his claims.  In correspondence to the Veteran dated from September 2005, VA notified the Veteran of the information and evidence needed to substantiate and complete the claims decided here, to include notice of what part of that evidence is to be provided by the claimant, what part VA will attempt to obtain, and how service connection claims, disability ratings, and effective dates are determined.  See Dingess v. Nicholson, 19 Vet. App. 473 (2006).  With regard to the duty to assist, the Veteran's medical records, to include service treatment records (STRs), VA and private treatment records, and medical evidence from the Social Security Administration (SSA), have been obtained.  Moreover, the Veteran underwent VA examinations during the appeal period.

The Board finds that further action is unnecessary under 38 U.S.C.A. § 5103A and 38 C.F.R. § 3.159.  The Veteran will not be prejudiced as a result of the Board's adjudication of the issues below.

II.  Service Connection

The Veteran claims that he incurred psychiatric and skin disabilities during active duty.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C.A. §§ 1110, 1131 (West 2014); 38 C.F.R. § 3.303 (2016).  To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called "nexus" requirement.  Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).  Under 38 U.S.C.A. § 1154(b), the evidentiary burden for combat veterans with respect to evidence of in-service incurrence or aggravation of an injury or disease is reduced.  See Collette v. Brown, 82 F.3d 389, 392 (Fed.Cir.1996).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant.  38 U.S.C.A. § 5107; 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).  To deny a claim on the merits, the preponderance of the evidence must be against the claim.  Alemany v. Brown, 9 Vet. App. 518, 519 (1996).

Acquired Psychiatric Disability

Since December 1990, the Veteran has claimed service connection for acquired psychiatric disability.  His claim had been denied in prior final Board and rating decisions.  In the claim now addressed on appeal, submitted in August 2005, the Veteran asserted that he incurred posttraumatic stress disorder (PTSD) in the early 1970s due to combat exposure in the Republic of Vietnam.  His claim to reopen service connection was denied in the December 2005 rating decision on appeal.  In August 2008, the Board reopened the claim and subsequently remanded it for additional evidentiary development.

Under 38 C.F.R. § 3.304(f), there are particular requirements for establishing PTSD that are separate from those for establishing service connection generally.  Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010).  Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred.  See 38 C.F.R. § 3.304(f) and 38 C.F.R. § 4.125 (requiring PTSD diagnoses to conform to the DSM-IV-V).

If a stressor claimed by a veteran is related to the veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor.  "Fear of hostile military or terrorist activity" means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device (IED); vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror.  38 C.F.R. § 3.304(f)(3).

Moreover, for veterans who served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities such as psychosis are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service.  38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307(a), 3.309(a).  For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time.  If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim.  38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (the theory of continuity of symptomatology can be used only in cases involving those disabilities specified as chronic under 38 C.F.R. § 3.309(a)).
In assessing this claim, the Board will consider any acquired psychiatric disorder diagnosed during the appeal period.  See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled).  See also Mittleider v. West, 11 Vet. App. 181, 182 (1998) (in the absence of medical evidence that does so, VA is precluded from differentiating between symptomatology attributed to a nonservice-connected disability and symptomatology attributed to a service-connected disability).

The evidence consists of STRs, private and VA treatment records, records from the Social Security Administration (SSA), lay assertions from the Veteran, and VA compensation examination reports.  This evidence documents that the Veteran has acquired psychiatric disability.  Medical evidence dated from the early 1990s notes diagnoses of depressive disorder, anxiety, schizophrenia, PTSD, and alcohol induced psychosis with hallucinations during withdrawal.  The evidence also indicates that the Veteran experienced a combat stressor during service.  The record documents that the Veteran served in Vietnam from January 1970 to June 1971.  In an October 2005 lay statement of record, the Veteran described exposure to combat conditions while serving there as a truck driver.  He described undergoing enemy attacks and witnessing the deaths of fellow service members.  In an April 2012 VA compensation examination report, an examining psychiatrist found that these experiences amounted to in-service stressors.  As such, the evidence shows that the Veteran incurred combat stressors during active duty.  See 38 U.S.C.A. § 1154; 38 C.F.R. § 3.304(f).

The record demonstrates, however, that post-service psychiatric problems are unrelated to the in-service stressors.  The preponderance of the evidence indicates that the Veteran did not have a chronic psychiatric disability during service, and did not manifest within the first year of discharge from service a disorder such as psychosis.  See 38 C.F.R. §§ 3.303, 3.307, 3.309.  The STRs do not indicate psychiatric disability during service.  In fact, the Veteran's psychological state was specifically examined in the months prior to his August 1972 discharge from service.  Medical reports dated between March and May 1972 indicate that the Veteran experienced conflict with medical treating personnel while undergoing treatment for back disability.  Treating personnel suspected possible malingering related to the injury.  In response, the Veteran underwent psychological evaluation.  In a May 1972 report, the evaluating psychologist indicated that no psychiatric disability or symptoms were found.  Further, the April 1972 discharge report of medical examination notes the Veteran's psychiatric state as normal, while a June 1972 medical evaluation board report addressing orthopedic disability is negative for psychiatric disability, as is a June 1972 physical evaluation board (PEB) report.

With regard to the issue of presumptive service connection under 38 C.F.R. § 3.309(a), the record contains no medical evidence dated between August 1972 and August 1973 - within the first year of discharge from service - indicating chronic psychiatric disability.  Psychiatric problems are not noted in VA medical reports and treatment records dated from the early 1970s through the 1980s.  And the Veteran did not mention psychiatric problems in multiple claims he filed following service (for orthopedic disabilities), prior to his original service connection claim for psychiatric disability in 1990.  Indeed, the earliest post-service evidence of an acquired psychiatric disability is found in a September 1990 private psychiatry report, which notes diagnoses of schizophrenia and PTSD.  This report is dated over 18 years after discharge from active duty.  See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of years between discharge from active service and the medical documentation of a claimed disability may be considered in evaluating a claim of service connection).

Thus, no evidence dated between August 1972 and September 1990 indicates that the Veteran then had chronic psychiatric disability.  Notwithstanding his claim to service connection related to combat conditions in Vietnam in the early 1970s, the record does not document the existence of chronic psychiatric disability during service, within the first year of separation from service, or for multiple years following service.  The preponderance of the evidence indicates that, for years following service, the Veteran did not have characteristic manifestations sufficient to identify a chronic disease entity.  See 38 C.F.R. §§ 3.303, 3.307, 3.309; see also Walker, supra.

The medical nexus evidence also indicates that acquired psychiatric disability is not related to service.  In the only medical opinion of record to comment on the issue of medical nexus, the December 2012 VA examiner found the in-service stressors unrelated to current psychiatric problems.  The examiner diagnosed psychosis, with hallucinations due to alcohol abuse.  The examiner found that the Veteran did not have PTSD or any other psychiatric disorder in addition to psychosis.  And the examiner found the psychosis likely unrelated to service.  This examiner indicated a review of the claims file, and noted that an interview of the Veteran and a personal examination of the Veteran were both conducted.  In the report, the examiner also detailed the Veteran's medical history of psychiatric issues.  Further, the examiner reiterated her opinion in an October 2014 addendum opinion, which was requested by the Board in the July 2014 remand.  As the opinion is based on the evidence of record detailed earlier, and is explained, the opinion is of probative value.  See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the value of a physician's statement is dependent, in part, upon the extent to which it reflects clinical data or other rationale to support the opinion).

The record contains multiple VA and private reports and treatment records dated between 1990 and 2014 addressing the issue of psychiatric disability.  These reports and records note acquired psychiatric disability such as depression, anxiety, PTSD, schizophrenia, and alcohol induced psychosis.  None the reports and records, other than the December 2012 VA report and October 2014 addendum report, provides a medical opinion addressing the issue of medical nexus.  Moreover, the PTSD diagnosis is only noted in private reports dated in September 1990 and July 2005.  These reports do not provide a rationale explaining the basis for providing such a diagnosis.  The reports merely note the Veteran's adverse symptoms, his experiences, and the diagnosis without any explanation.  See Bloom, supra.  Importantly, none of the examining or treating VA medical personnel diagnosed the Veteran with PTSD.  In sum, the evidence is not sufficient to find that the Veteran has PTSD related to his experiences in Vietnam.  See 38 C.F.R. § 3.304(f).

In assessing this claim, the Board has considered the Veteran's complaints of psychiatric difficulty.  He is competent to report observable symptoms such as mental anguish and limitation.  See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  However, on the issues of diagnosis and etiology, the medical evidence is more credible.  The development of a psychiatric problem is an internal pathology beyond the Veteran's capacity to observe.  It is a complex question of etiology which requires the determination of a medical professional.  See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007).  Indeed, the lay evidence on this question is medically insignificant when compared with the findings by the neutral and informed December 2012 VA examiner.  In weighing the evidence, the Board finds that the medical evidence of record, and the lack thereof, preponderates against the Veteran's claim regarding diagnosis and etiology.  See Alemany and Gilbert, both supra.

As the preponderance of the evidence is against the claim to service connection for a psychiatric disability, the benefit-of-the-doubt doctrine does not apply, and the claim must be denied.  38 U.S.C.A. § 5107; 38 C.F.R. § 3.102.

Skin Disability

Since April 1990, the Veteran has claimed service connection for skin disorders due to service in Vietnam and exposure to herbicides there.  In August 1994, the RO denied his original claim in an unappealed rating decision, which became final.  In the claim now addressed on appeal, submitted in May 2010, the Veteran attempted to reopen the issue.  The RO denied his claim in the March 2011 rating decision on appeal.  In July 2014, the Board reopened the claim and subsequently remanded it for additional evidentiary development.  In February 2016, the Board found service connection warranted for two skin disorders - actinic keratosis and basal cell carcinoma.  The Board explained in the decision that the evidence of record was in equipoise regarding whether the Veteran's sun exposure during service in Vietnam led to subsequent development of these skin problems.  In that decision the Board also remanded for additional development the issue of whether two other skin disorders - lipomas and seborrheic dermatitis - relate to service in general, or to herbicides exposure in Vietnam in particular.  See Clemons and Mittleider, both supra.

VA regulations provide that a veteran who had active military, naval, or air service in the Republic of Vietnam during the Vietnam Era (beginning on January 9, 1962 and ending on May 7, 1975) shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service.  38 U.S.C.A. § 3.307(a)(6)(iii).  In such circumstances, service connection may be granted on a presumptive basis for any disease listed in 38 C.F.R. § 3.309(e).  The record documents that the Veteran served in Vietnam during the applicable time period and was therefore presumably exposed to herbicides there.  However, the list of multiple chronic disorders noted under 38 C.F.R. § 3.309(e) does not include the two skin disorders at issue here - seborrheic dermatitis and lipomas.  As such, this regulation is inapplicable to the claims on appeal.  The Board further notes that these two skin disorders are not among the listed chronic disorders in 38 C.F.R. § 3.309(a).  Nevertheless, the Board will consider the direct service connection theory of entitlement for the Veteran's claim.  38 C.F.R. § 3.303; Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994); Ramey v. Brown, 9 Vet. App. 40, 44 (1996).

The evidence consists of STRs, private and VA treatment records, records from SSA, lay assertions from the Veteran, and VA compensation examination reports.  This evidence documents that the Veteran has had during the appeal period lipomas and seborrheic dermatitis.  In fact, these skin disorders are diagnosed in the most recent VA compensation examination report addressing the Veteran's skin, dated in October 2016.  The evidence also indicates that the Veteran experienced a skin disorder during service.  A March 1972 STR notes erythematous plaque in the groin area, which was believed to be herpes simplex.

The preponderance of the evidence indicates, however, that the Veteran did not have a chronic skin disorder during service.  See 38 C.F.R. § 3.303.  The STRs indicate that the Veteran did not have a chronic skin disorder during service.  The STRs dated prior to and following the March 1972 STR noting erythematous plaque are negative for skin problems.  The April 1972 discharge report of medical examination notes the Veteran's skin as normal, with the exception of scar tissue related to orthopedic injuries.  And the June 1972 medical board report and PEB report addressing orthopedic disability are negative for skin disability.  Further, the evidence dated soon after service is negative for skin disability.  A January 1973 VA general medical examination report found the Veteran's skin to be normal.  Skin problems are not noted in VA medical reports and treatment records dated from the early 1970s to the late 1980s.  And the Veteran did not mention skin problems in multiple claims he filed following service, prior to his original service connection claim for skin disability in 1990.  Indeed, the earliest post-service evidence of skin disability is found in a November 1987 VA dermatology treatment record noting complaints of skin rashes, including on the scalp.  This report is dated over 15 years after discharge from active duty.  See Maxson, supra.  Thus, no evidence dated between August 1972 and November 1987 indicates that the Veteran then had chronic skin disability.  The record does not document the existence of chronic skin disability during service or for multiple years following service.  The preponderance of the evidence indicates that, for years following service, the Veteran did not have characteristic manifestations sufficient to identify a chronic disease entity.  See 38 C.F.R. § 3.303.

Further, the medical nexus evidence indicates that lipomas and seborrheic dermatitis are not related to service.  The Veteran has undergone three VA compensation examinations into his skin, in January 2011, October 2014, and October 2016.  In the July 2014 and February 2016 remands, the Board found the January 2011 and October 2014 examination reports inadequate with regard to the two disorders at issue here - lipomas and seborrheic dermatitis.  See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (noting that once VA undertakes an examination, an adequate one must be produced).  Pursuant to the February 2016 remand, an adequate examination report and opinion (dated in October 2016) has been included in the record.  See Colvin v. Derwinski, 1 Vet. App. 171 (1991) (when medical evidence is inadequate, VA must supplement the record with an advisory opinion or with another medical examination report).

In the October 2016 report, the VA examiner noted the Veteran's complaints of "palpable lumps (lipoma) in trunk and extremities for years."  The Veteran also reported "erythematous scaling rash in face and ears" for the past 10 years.  On examination, the examiner noted mild seborrheic dermatitis on the eyebrows, nasal folds, and behind the ears.  The examiner also noted "non-tender subcutaneous nodules (benign tumors) scattered on extremities and trunk[.]"  In the opinion, the examiner found these skin problems likely unrelated to service.  In support, the examiner noted that the STRs and medical evidence did not "show any evidence of signs, symptoms, diagnosis, treatments or a chronic disability pattern consistent with or suggestive of Lipoma or derma during active military service[.]"  The examiner also stated that "[t]he medical literature does not support a direct etiologic relation between past exposure to Agent Orange and further development of" lipomas or dermatitis.  See 38 C.F.R. § 3.303.  The October 2016 VA examiner indicated a review of the claims file, and noted that an interview of the Veteran and a personal examination of the Veteran were both conducted.  In the report, the examiner also detailed the Veteran's medical history of skin problems.  Further, the report and opinion directly respond to the Board's February 2016 remand requests.  As the opinion is based on the evidence of record detailed earlier, and is explained, the opinion is of probative value.  See Bloom, supra.

In assessing this claim, the Board has considered the Veteran's assertions regarding skin disability, particularly that his problems relate to herbicides exposure.  He is competent to report observable symptoms such as rashes.  See Jandreau, supra.  However, on the issue of etiology, the medical evidence is more credible.  The question of whether lipomas or dermatitis relate to service is a medical determination beyond the Veteran's capacity to observe.  It is a complex question necessitating input from a medical professional.  See Woehlaert, supra.  Indeed, the lay evidence on this question is medically insignificant when compared with the findings by the neutral and informed October 2016 VA examiner.  Thus, in weighing the evidence, the Board finds that the medical evidence of record, and the lack thereof, preponderates against the Veteran's claim regarding etiology.  See Alemany and Gilbert, both supra.

As the preponderance of the evidence is against the claim to service connection for lipomas and seborrheic dermatitis, the benefit-of-the-doubt doctrine does not apply, and the claim must be denied.  38 U.S.C.A. § 5107; 38 C.F.R. § 3.102.

ORDER

Entitlement to service connection for an acquired psychiatric disability is denied.

Entitlement to service connection for lipomas and seborrheic dermatitis is denied.

____________________________________________
KRISTI L. GUNN
Veterans Law Judge, Board of Veterans' Appeals

Department of Veterans Affairs

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text: C

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text: R

text: To

text: establish

text: a

text: right

text: to

text: compensation

text: for

text: a

text: present

text: disability

text: a

text: Veteran

text: must

text: show

text: the

text: existence

text: of

text: a

text: present

text: disability

text: in

text: service

text: incurrence

text: or

text: aggravation

text: of

text: a

text: disease

text: or

text: injury

text: and

text: a

text: causal

text: relationship

text: between

text: the

text: present

text: disability

text: and

text: the

text: disease

text: or

text: injury

text: incurred

text: or

text: aggravated

text: during

text: service

text: the

text: so

text: called

text: nexus

text: requirement

text: Holton

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: quoting

text: Shedden

text: v

text: Principi

text: F

text: d

text: Fed

text: Cir

text: Under

text: U

text: S

text: C

text: A

text: b

text: the

text: evidentiary

text: burden

text: for

text: combat

text: veterans

text: with

text: respect

text: to

text: evidence

text: of

text: in

text: service

text: incurrence

text: or

text: aggravation

text: of

text: an

text: injury

text: or

text: disease

text: is

text: reduced

text: See

text: Collette

text: v

text: Brown

text: F

text: d

text: Fed

text: Cir

text: When

text: there

text: is

text: an

text: approximate

text: balance

text: of

text: positive

text: and

text: negative

text: evidence

text: regarding

text: any

text: issue

text: material

text: to

text: the

text: determination

text: of

text: a

text: matter

text: the

text: benefit

text: of

text: the

text: doubt

text: will

text: be

text: granted

text: to

text: the

text: claimant

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: Gilbert

text: v

text: Derwinski

text: Vet

text: App

text: To

text: deny

text: a

text: claim

text: on

text: the

text: merits

text: the

text: preponderance

text: of

text: the

text: evidence

text: must

text: be

text: against

text: the

text: claim

text: Alemany

text: v

text: Brown

text: Vet

text: App

text: Acquired

text: Psychiatric

text: Disability

text: Since

text: December

text: the

text: Veteran

text: has

text: claimed

text: service

text: connection

text: for

text: acquired

text: psychiatric

text: disability

text: His

text: claim

text: had

text: been

text: denied

text: in

text: prior

text: final

text: Board

text: and

text: rating

text: decisions

text: In

text: the

text: claim

text: now

text: addressed

text: on

text: appeal

text: submitted

text: in

text: August

text: the

text: Veteran

text: asserted

text: that

text: he

text: incurred

text: posttraumatic

text: stress

text: disorder

text: PTSD

text: in

text: the

text: early

text: s

text: due

text: to

text: combat

text: exposure

text: in

text: the

text: Republic

text: of

text: Vietnam

text: His

text: claim

text: to

text: reopen

text: service

text: connection

text: was

text: denied

text: in

text: the

text: December

text: rating

text: decision

text: on

text: appeal

text: In

text: August

text: the

text: Board

text: reopened

text: the

text: claim

text: and

text: subsequently

text: remanded

text: it

text: for

text: additional

text: evidentiary

text: development

text: Under

text: C

text: F

text: R

text: f

text: there

text: are

text: particular

text: requirements

text: for

text: establishing

text: PTSD

text: that

text: are

text: separate

text: from

text: those

text: for

text: establishing

text: service

text: connection

text: generally

text: Arzio

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: Service

text: connection

text: for

text: PTSD

text: requires

text: medical

text: evidence

text: diagnosing

text: the

text: condition

text: in

text: accordance

text: with

text: C

text: F

text: R

text: a

text: a

text: link

text: established

text: by

text: medical

text: evidence

text: between

text: current

text: symptoms

text: and

text: an

text: in

text: service

text: stressor

text: and

text: credible

text: supporting

text: evidence

text: that

text: the

text: claimed

text: in

text: service

text: stressor

text: occurred

text: See

text: C

text: F

text: R

text: f

text: and

text: C

text: F

text: R

text: requiring

text: PTSD

text: diagnoses

text: to

text: conform

text: to

text: the

text: DSM

text: IV

text: V

text: If

text: a

text: stressor

text: claimed

text: by

text: a

text: veteran

text: is

text: related

text: to

text: the

text: veteran

text: s

text: fear

text: of

text: hostile

text: military

text: or

text: terrorist

text: activity

text: and

text: a

text: VA

text: psychiatrist

text: or

text: psychologist

text: confirms

text: that

text: the

text: claimed

text: stressor

text: is

text: adequate

text: to

text: support

text: a

text: diagnosis

text: of

text: PTSD

text: and

text: that

text: the

text: veteran

text: s

text: symptoms

text: are

text: related

text: to

text: the

text: claimed

text: stressor

text: in

text: the

text: absence

text: of

text: clear

text: and

text: convincing

text: evidence

text: to

text: the

text: contrary

text: and

text: provided

text: the

text: claimed

text: stressor

text: is

text: consistent

text: with

text: the

text: places

text: types

text: and

text: circumstances

text: of

text: the

text: veteran

text: s

text: service

text: the

text: veteran

text: s

text: lay

text: testimony

text: alone

text: may

text: establish

text: the

text: occurrence

text: of

text: the

text: claimed

text: in

text: service

text: stressor

text: Fear

text: of

text: hostile

text: military

text: or

text: terrorist

text: activity

text: means

text: that

text: a

text: veteran

text: experienced

text: witnessed

text: or

text: was

text: confronted

text: with

text: an

text: event

text: or

text: circumstance

text: that

text: involved

text: actual

text: or

text: threatened

text: death

text: or

text: serious

text: injury

text: or

text: a

text: threat

text: to

text: the

text: physical

text: integrity

text: of

text: the

text: veteran

text: or

text: others

text: such

text: as

text: from

text: an

text: actual

text: or

text: potential

text: improvised

text: explosive

text: device

text: IED

text: vehicle

text: imbedded

text: explosive

text: device

text: incoming

text: artillery

text: rocket

text: or

text: mortar

text: fire

text: grenade

text: small

text: arms

text: fire

text: including

text: suspected

text: sniper

text: fire

text: or

text: attack

text: upon

text: friendly

text: military

text: aircraft

text: and

text: the

text: veteran

text: s

text: response

text: to

text: the

text: event

text: or

text: circumstance

text: involved

text: a

text: psychological

text: or

text: psycho

text: physiological

text: state

text: of

text: fear

text: helplessness

text: or

text: horror

text: C

text: F

text: R

text: f

text: Moreover

text: for

text: veterans

text: who

text: served

text: days

text: or

text: more

text: of

text: active

text: service

text: during

text: a

text: war

text: period

text: or

text: after

text: December

text: certain

text: chronic

text: disabilities

text: such

text: as

text: psychosis

text: are

text: presumed

text: to

text: have

text: been

text: incurred

text: in

text: service

text: if

text: they

text: manifested

text: to

text: a

text: compensable

text: degree

text: within

text: one

text: year

text: of

text: separation

text: from

text: service

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: a

text: a

text: For

text: the

text: showing

text: of

text: chronic

text: disease

text: in

text: service

text: there

text: is

text: required

text: a

text: combination

text: of

text: manifestations

text: sufficient

text: to

text: identify

text: the

text: disease

text: entity

text: and

text: sufficient

text: observation

text: to

text: establish

text: chronicity

text: at

text: the

text: time

text: If

text: chronicity

text: in

text: service

text: is

text: not

text: established

text: a

text: showing

text: of

text: continuity

text: of

text: symptoms

text: after

text: discharge

text: is

text: required

text: to

text: support

text: the

text: claim

text: C

text: F

text: R

text: b

text: Walker

text: v

text: Shinseki

text: F

text: d

text: Fed

text: Cir

text: the

text: theory

text: of

text: continuity

text: of

text: symptomatology

text: can

text: be

text: used

text: only

text: in

text: cases

text: involving

text: those

text: disabilities

text: specified

text: as

text: chronic

text: under

text: C

text: F

text: R

text: a

text: In

text: assessing

text: this

text: claim

text: the

text: Board

text: will

text: consider

text: any

text: acquired

text: psychiatric

text: disorder

text: diagnosed

text: during

text: the

text: appeal

text: period

text: See

text: Clemons

text: v

text: Shinseki

text: Vet

text: App

text: when

text: a

text: claimant

text: makes

text: a

text: claim

text: he

text: is

text: seeking

text: service

text: connection

text: for

text: symptoms

text: regardless

text: of

text: how

text: those

text: symptoms

text: are

text: diagnosed

text: or

text: labeled

text: See

text: also

text: Mittleider

text: v

text: West

text: Vet

text: App

text: in

text: the

text: absence

text: of

text: medical

text: evidence

text: that

text: does

text: so

text: VA

text: is

text: precluded

text: from

text: differentiating

text: between

text: symptomatology

text: attributed

text: to

text: a

text: nonservice

text: connected

text: disability

text: and

text: symptomatology

text: attributed

text: to

text: a

text: service

text: connected

text: disability

text: The

text: evidence

text: consists

text: of

text: STRs

text: private

text: and

text: VA

text: treatment

text: records

text: records

text: from

text: the

text: Social

text: Security

text: Administration

text: SSA

text: lay

text: assertions

text: from

text: the

text: Veteran

text: and

text: VA

text: compensation

text: examination

text: reports

text: This

text: evidence

text: documents

text: that

text: the

text: Veteran

text: has

text: acquired

text: psychiatric

text: disability

text: Medical

text: evidence

text: dated

text: from

text: the

text: early

text: s

text: notes

text: diagnoses

text: of

text: depressive

text: disorder

text: anxiety

text: schizophrenia

text: PTSD

text: and

text: alcohol

text: induced

text: psychosis

text: with

text: hallucinations

text: during

text: withdrawal

text: The

text: evidence

text: also

text: indicates

text: that

text: the

text: Veteran

text: experienced

text: a

text: combat

text: stressor

text: during

text: service

text: The

text: record

text: documents

text: that

text: the

text: Veteran

text: served

text: in

text: Vietnam

text: from

text: January

text: to

text: June

text: In

text: an

text: October

text: lay

text: statement

text: of

text: record

text: the

text: Veteran

text: described

text: exposure

text: to

text: combat

text: conditions

text: while

text: serving

text: there

text: as

text: a

text: truck

text: driver

text: He

text: described

text: undergoing

text: enemy

text: attacks

text: and

text: witnessing

text: the

text: deaths

text: of

text: fellow

text: service

text: members

text: In

text: an

text: April

text: VA

text: compensation

text: examination

text: report

text: an

text: examining

text: psychiatrist

text: found

text: that

text: these

text: experiences

text: amounted

text: to

text: in

text: service

text: stressors

text: As

text: such

text: the

text: evidence

text: shows

text: that

text: the

text: Veteran

text: incurred

text: combat

text: stressors

text: during

text: active

text: duty

text: See

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: f

text: The

text: record

text: demonstrates

text: however

text: that

text: post

text: service

text: psychiatric

text: problems

text: are

text: unrelated

text: to

text: the

text: in

text: service

text: stressors

text: The

text: preponderance

text: of

text: the

text: evidence

text: indicates

text: that

text: the

text: Veteran

text: did

text: not

text: have

text: a

text: chronic

text: psychiatric

text: disability

text: during

text: service

text: and

text: did

text: not

text: manifest

text: within

text: the

text: first

text: year

text: of

text: discharge

text: from

text: service

text: a

text: disorder

text: such

text: as

text: psychosis

text: See

text: C

text: F

text: R

text: The

text: STRs

text: do

text: not

text: indicate

text: psychiatric

text: disability

text: during

text: service

text: In

text: fact

text: the

text: Veteran

text: s

text: psychological

text: state

text: was

text: specifically

text: examined

text: in

text: the

text: months

text: prior

text: to

text: his

text: August

text: discharge

text: from

text: service

text: Medical

text: reports

text: dated

text: between

text: March

text: and

text: May

text: indicate

text: that

text: the

text: Veteran

text: experienced

text: conflict

text: with

text: medical

text: treating

text: personnel

text: while

text: undergoing

text: treatment

text: for

text: back

text: disability

text: Treating

text: personnel

text: suspected

text: possible

text: malingering

text: related

text: to

text: the

text: injury

text: In

text: response

text: the

text: Veteran

text: underwent

text: psychological

text: evaluation

text: In

text: a

text: May

text: report

text: the

text: evaluating

text: psychologist

text: indicated

text: that

text: no

text: psychiatric

text: disability

text: or

text: symptoms

text: were

text: found

text: Further

text: the

text: April

text: discharge

text: report

text: of

text: medical

text: examination

text: notes

text: the

text: Veteran

text: s

text: psychiatric

text: state

text: as

text: normal

text: while

text: a

text: June

text: medical

text: evaluation

text: board

text: report

text: addressing

text: orthopedic

text: disability

text: is

text: negative

text: for

text: psychiatric

text: disability

text: as

text: is

text: a

text: June

text: physical

text: evaluation

text: board

text: PEB

text: report

text: With

text: regard

text: to

text: the

text: issue

text: of

text: presumptive

text: service

text: connection

text: under

text: C

text: F

text: R

text: a

text: the

text: record

text: contains

text: no

text: medical

text: evidence

text: dated

text: between

text: August

text: and

text: August

text: within

text: the

text: first

text: year

text: of

text: discharge

text: from

text: service

text: indicating

text: chronic

text: psychiatric

text: disability

text: Psychiatric

text: problems

text: are

text: not

text: noted

text: in

text: VA

text: medical

text: reports

text: and

text: treatment

text: records

text: dated

text: from

text: the

text: early

text: s

text: through

text: the

text: s

text: And

text: the

text: Veteran

text: did

text: not

text: mention

text: psychiatric

text: problems

text: in

text: multiple

text: claims

text: he

text: filed

text: following

text: service

text: for

text: orthopedic

text: disabilities

text: prior

text: to

text: his

text: original

text: service

text: connection

text: claim

text: for

text: psychiatric

text: disability

text: in

text: Indeed

text: the

text: earliest

text: post

text: service

text: evidence

text: of

text: an

text: acquired

text: psychiatric

text: disability

text: is

text: found

text: in

text: a

text: September

text: private

text: psychiatry

text: report

text: which

text: notes

text: diagnoses

text: of

text: schizophrenia

text: and

text: PTSD

text: This

text: report

text: is

text: dated

text: over

text: years

text: after

text: discharge

text: from

text: active

text: duty

text: See

text: Maxson

text: v

text: Gober

text: F

text: d

text: Fed

text: Cir

text: the

text: passage

text: of

text: years

text: between

text: discharge

text: from

text: active

text: service

text: and

text: the

text: medical

text: documentation

text: of

text: a

text: claimed

text: disability

text: may

text: be

text: considered

text: in

text: evaluating

text: a

text: claim

text: of

text: service

text: connection

text: Thus

text: no

text: evidence

text: dated

text: between

text: August

text: and

text: September

text: indicates

text: that

text: the

text: Veteran

text: then

text: had

text: chronic

text: psychiatric

text: disability

text: Notwithstanding

text: his

text: claim

text: to

text: service

text: connection

text: related

text: to

text: combat

text: conditions

text: in

text: Vietnam

text: in

text: the

text: early

text: s

text: the

text: record

text: does

text: not

text: document

text: the

text: existence

text: of

text: chronic

text: psychiatric

text: disability

text: during

text: service

text: within

text: the

text: first

text: year

text: of

text: separation

text: from

text: service

text: or

text: for

text: multiple

text: years

text: following

text: service

text: The

text: preponderance

text: of

text: the

text: evidence

text: indicates

text: that

text: for

text: years

text: following

text: service

text: the

text: Veteran

text: did

text: not

text: have

text: characteristic

text: manifestations

text: sufficient

text: to

text: identify

text: a

text: chronic

text: disease

text: entity

text: See

text: C

text: F

text: R

text: see

text: also

text: Walker

text: supra

text: The

text: medical

text: nexus

text: evidence

text: also

text: indicates

text: that

text: acquired

text: psychiatric

text: disability

text: is

text: not

text: related

text: to

text: service

text: In

text: the

text: only

text: medical

text: opinion

text: of

text: record

text: to

text: comment

text: on

text: the

text: issue

text: of

text: medical

text: nexus

text: the

text: December

text: VA

text: examiner

text: found

text: the

text: in

text: service

text: stressors

text: unrelated

text: to

text: current

text: psychiatric

text: problems

text: The

text: examiner

text: diagnosed

text: psychosis

text: with

text: hallucinations

text: due

text: to

text: alcohol

text: abuse

text: The

text: examiner

text: found

text: that

text: the

text: Veteran

text: did

text: not

text: have

text: PTSD

text: or

text: any

text: other

text: psychiatric

text: disorder

text: in

text: addition

text: to

text: psychosis

text: And

text: the

text: examiner

text: found

text: the

text: psychosis

text: likely

text: unrelated

text: to

text: service

text: This

text: examiner

text: indicated

text: a

text: review

text: of

text: the

text: claims

text: file

text: and

text: noted

text: that

text: an

text: interview

text: of

text: the

text: Veteran

text: and

text: a

text: personal

text: examination

text: of

text: the

text: Veteran

text: were

text: both

text: conducted

text: In

text: the

text: report

text: the

text: examiner

text: also

text: detailed

text: the

text: Veteran

text: s

text: medical

text: history

text: of

text: psychiatric

text: issues

text: Further

text: the

text: examiner

text: reiterated

text: her

text: opinion

text: in

text: an

text: October

text: addendum

text: opinion

text: which

text: was

text: requested

text: by

text: the

text: Board

text: in

text: the

text: July

text: remand

text: As

text: the

text: opinion

text: is

text: based

text: on

text: the

text: evidence

text: of

text: record

text: detailed

text: earlier

text: and

text: is

text: explained

text: the

text: opinion

text: is

text: of

text: probative

text: value

text: See

text: Bloom

text: v

text: West

text: Vet

text: App

text: the

text: value

text: of

text: a

text: physician

text: s

text: statement

text: is

text: dependent

text: in

text: part

text: upon

text: the

text: extent

text: to

text: which

text: it

text: reflects

text: clinical

text: data

text: or

text: other

text: rationale

text: to

text: support

text: the

text: opinion

text: The

text: record

text: contains

text: multiple

text: VA

text: and

text: private

text: reports

text: and

text: treatment

text: records

text: dated

text: between

text: and

text: addressing

text: the

text: issue

text: of

text: psychiatric

text: disability

text: These

text: reports

text: and

text: records

text: note

text: acquired

text: psychiatric

text: disability

text: such

text: as

text: depression

text: anxiety

text: PTSD

text: schizophrenia

text: and

text: alcohol

text: induced

text: psychosis

text: the

text: reports

text: and

text: records

text: other

text: than

text: the

text: December

text: VA

text: report

text: and

text: October

text: addendum

text: report

text: provides

text: a

text: medical

text: opinion

text: addressing

text: the

text: issue

text: of

text: medical

text: nexus

text: Moreover

text: the

text: PTSD

text: diagnosis

text: is

text: only

text: noted

text: in

text: private

text: reports

text: dated

text: in

text: September

text: and

text: July

text: These

text: reports

text: do

text: not

text: provide

text: a

text: rationale

text: explaining

text: the

text: basis

text: for

text: providing

text: such

text: a

text: diagnosis

text: The

text: reports

text: merely

text: note

text: the

text: Veteran

text: s

text: adverse

text: symptoms

text: his

text: experiences

text: and

text: the

text: diagnosis

text: without

text: any

text: explanation

text: See

text: Bloom

text: supra

text: Importantly

text: of

text: the

text: examining

text: or

text: treating

text: VA

text: medical

text: personnel

text: diagnosed

text: the

text: Veteran

text: with

text: PTSD

text: In

text: sum

text: the

text: evidence

text: is

text: not

text: sufficient

text: to

text: find

text: that

text: the

text: Veteran

text: has

text: PTSD

text: related

text: to

text: his

text: experiences

text: in

text: Vietnam

text: See

text: C

text: F

text: R

text: f

text: In

text: assessing

text: this

text: claim

text: the

text: Board

text: has

text: considered

text: the

text: Veteran

text: s

text: complaints

text: of

text: psychiatric

text: difficulty

text: He

text: is

text: competent

text: to

text: report

text: observable

text: symptoms

text: such

text: as

text: mental

text: anguish

text: and

text: limitation

text: See

text: Jandreau

text: v

text: Nicholson

text: F

text: d

text: Fed

text: Cir

text: However

text: on

text: the

text: issues

text: of

text: diagnosis

text: and

text: etiology

text: the

text: medical

text: evidence

text: is

text: more

text: credible

text: The

text: development

text: of

text: a

text: psychiatric

text: problem

text: is

text: an

text: internal

text: pathology

text: beyond

text: the

text: Veteran

text: s

text: capacity

text: to

text: observe

text: It

text: is

text: a

text: complex

text: question

text: of

text: etiology

text: which

text: requires

text: the

text: determination

text: of

text: a

text: medical

text: professional

text: See

text: Woehlaert

text: v

text: Nicholson

text: Vet

text: App

text: Indeed

text: the

text: lay

text: evidence

text: on

text: this

text: question

text: is

text: medically

text: insignificant

text: when

text: compared

text: with

text: the

text: findings

text: by

text: the

text: neutral

text: and

text: informed

text: December

text: VA

text: examiner

text: In

text: weighing

text: the

text: evidence

text: the

text: Board

text: finds

text: that

text: the

text: medical

text: evidence

text: of

text: record

text: and

text: the

text: lack

text: thereof

text: preponderates

text: against

text: the

text: Veteran

text: s

text: claim

text: regarding

text: diagnosis

text: and

text: etiology

text: See

text: Alemany

text: and

text: Gilbert

text: both

text: supra

text: As

text: the

text: preponderance

text: of

text: the

text: evidence

text: is

text: against

text: the

text: claim

text: to

text: service

text: connection

text: for

text: a

text: psychiatric

text: disability

text: the

text: benefit

text: of

text: the

text: doubt

text: doctrine

text: does

text: not

text: apply

text: and

text: the

text: claim

text: must

text: be

text: denied

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: Skin

text: Disability

text: Since

text: April

text: the

text: Veteran

text: has

text: claimed

text: service

text: connection

text: for

text: skin

text: disorders

text: due

text: to

text: service

text: in

text: Vietnam

text: and

text: exposure

text: to

text: herbicides

text: there

text: In

text: August

text: the

text: RO

text: denied

text: his

text: original

text: claim

text: in

text: an

text: unappealed

text: rating

text: decision

text: which

text: became

text: final

text: In

text: the

text: claim

text: now

text: addressed

text: on

text: appeal

text: submitted

text: in

text: May

text: the

text: Veteran

text: attempted

text: to

text: reopen

text: the

text: issue

text: The

text: RO

text: denied

text: his

text: claim

text: in

text: the

text: March

text: rating

text: decision

text: on

text: appeal

text: In

text: July

text: the

text: Board

text: reopened

text: the

text: claim

text: and

text: subsequently

text: remanded

text: it

text: for

text: additional

text: evidentiary

text: development

text: In

text: February

text: the

text: Board

text: found

text: service

text: connection

text: warranted

text: for

text: two

text: skin

text: disorders

text: actinic

text: keratosis

text: and

text: basal

text: cell

text: carcinoma

text: The

text: Board

text: explained

text: in

text: the

text: decision

text: that

text: the

text: evidence

text: of

text: record

text: was

text: in

text: equipoise

text: regarding

text: whether

text: the

text: Veteran

text: s

text: sun

text: exposure

text: during

text: service

text: in

text: Vietnam

text: led

text: to

text: subsequent

text: development

text: of

text: these

text: skin

text: problems

text: In

text: that

text: decision

text: the

text: Board

text: also

text: remanded

text: for

text: additional

text: development

text: the

text: issue

text: of

text: whether

text: two

text: other

text: skin

text: disorders

text: lipomas

text: and

text: seborrheic

text: dermatitis

text: relate

text: to

text: service

text: in

text: general

text: or

text: to

text: herbicides

text: exposure

text: in

text: Vietnam

text: in

text: particular

text: See

text: Clemons

text: and

text: Mittleider

text: both

text: supra

text: VA

text: regulations

text: provide

text: that

text: a

text: veteran

text: who

text: had

text: active

text: military

text: naval

text: or

text: air

text: service

text: in

text: the

text: Republic

text: of

text: Vietnam

text: during

text: the

text: Vietnam

text: Era

text: beginning

text: on

text: January

text: and

text: ending

text: on

text: May

text: shall

text: be

text: presumed

text: to

text: have

text: been

text: exposed

text: during

text: such

text: service

text: to

text: an

text: herbicide

text: agent

text: unless

text: there

text: is

text: affirmative

text: evidence

text: to

text: establish

text: that

text: the

text: veteran

text: was

text: not

text: exposed

text: to

text: any

text: such

text: agent

text: during

text: that

text: service

text: U

text: S

text: C

text: A

text: a

text: iii

text: In

text: such

text: circumstances

text: service

text: connection

text: may

text: be

text: granted

text: on

text: a

text: presumptive

text: basis

text: for

text: any

text: disease

text: listed

text: in

text: C

text: F

text: R

text: e

text: The

text: record

text: documents

text: that

text: the

text: Veteran

text: served

text: in

text: Vietnam

text: during

text: the

text: applicable

text: time

text: period

text: and

text: was

text: therefore

text: presumably

text: exposed

text: to

text: herbicides

text: there

text: However

text: the

text: list

text: of

text: multiple

text: chronic

text: disorders

text: noted

text: under

text: C

text: F

text: R

text: e

text: does

text: not

text: include

text: the

text: two

text: skin

text: disorders

text: at

text: issue

text: here

text: seborrheic

text: dermatitis

text: and

text: lipomas

text: As

text: such

text: this

text: regulation

text: is

text: inapplicable

text: to

text: the

text: claims

text: on

text: appeal

text: The

text: Board

text: further

text: notes

text: that

text: these

text: two

text: skin

text: disorders

text: are

text: not

text: among

text: the

text: listed

text: chronic

text: disorders

text: in

text: C

text: F

text: R

text: a

text: Nevertheless

text: the

text: Board

text: will

text: consider

text: the

text: direct

text: service

text: connection

text: theory

text: of

text: entitlement

text: for

text: the

text: Veteran

text: s

text: claim

text: C

text: F

text: R

text: Combee

text: v

text: Brown

text: F

text: d

text: Fed

text: Cir

text: Ramey

text: v

text: Brown

text: Vet

text: App

text: The

text: evidence

text: consists

text: of

text: STRs

text: private

text: and

text: VA

text: treatment

text: records

text: records

text: from

text: SSA

text: lay

text: assertions

text: from

text: the

text: Veteran

text: and

text: VA

text: compensation

text: examination

text: reports

text: This

text: evidence

text: documents

text: that

text: the

text: Veteran

text: has

text: had

text: during

text: the

text: appeal

text: period

text: lipomas

text: and

text: seborrheic

text: dermatitis

text: In

text: fact

text: these

text: skin

text: disorders

text: are

text: diagnosed

text: in

text: the

text: most

text: recent

text: VA

text: compensation

text: examination

text: report

text: addressing

text: the

text: Veteran

text: s

text: skin

text: dated

text: in

text: October

text: The

text: evidence

text: also

text: indicates

text: that

text: the

text: Veteran

text: experienced

text: a

text: skin

text: disorder

text: during

text: service

text: A

text: March

text: STR

text: notes

text: erythematous

text: plaque

text: in

text: the

text: groin

text: area

text: which

text: was

text: believed

text: to

text: be

text: herpes

text: simplex

text: The

text: preponderance

text: of

text: the

text: evidence

text: indicates

text: however

text: that

text: the

text: Veteran

text: did

text: not

text: have

text: a

text: chronic

text: skin

text: disorder

text: during

text: service

text: See

text: C

text: F

text: R

text: The

text: STRs

text: indicate

text: that

text: the

text: Veteran

text: did

text: not

text: have

text: a

text: chronic

text: skin

text: disorder

text: during

text: service

text: The

text: STRs

text: dated

text: prior

text: to

text: and

text: following

text: the

text: March

text: STR

text: noting

text: erythematous

text: plaque

text: are

text: negative

text: for

text: skin

text: problems

text: The

text: April

text: discharge

text: report

text: of

text: medical

text: examination

text: notes

text: the

text: Veteran

text: s

text: skin

text: as

text: normal

text: with

text: the

text: exception

text: of

text: scar

text: tissue

text: related

text: to

text: orthopedic

text: injuries

text: And

text: the

text: June

text: medical

text: board

text: report

text: and

text: PEB

text: report

text: addressing

text: orthopedic

text: disability

text: are

text: negative

text: for

text: skin

text: disability

text: Further

text: the

text: evidence

text: dated

text: soon

text: after

text: service

text: is

text: negative

text: for

text: skin

text: disability

text: A

text: January

text: VA

text: general

text: medical

text: examination

text: report

text: found

text: the

text: Veteran

text: s

text: skin

text: to

text: be

text: normal

text: Skin

text: problems

text: are

text: not

text: noted

text: in

text: VA

text: medical

text: reports

text: and

text: treatment

text: records

text: dated

text: from

text: the

text: early

text: s

text: to

text: the

text: late

text: s

text: And

text: the

text: Veteran

text: did

text: not

text: mention

text: skin

text: problems

text: in

text: multiple

text: claims

text: he

text: filed

text: following

text: service

text: prior

text: to

text: his

text: original

text: service

text: connection

text: claim

text: for

text: skin

text: disability

text: in

text: Indeed

text: the

text: earliest

text: post

text: service

text: evidence

text: of

text: skin

text: disability

text: is

text: found

text: in

text: a

text: November

text: VA

text: dermatology

text: treatment

text: record

text: noting

text: complaints

text: of

text: skin

text: rashes

text: including

text: on

text: the

text: scalp

text: This

text: report

text: is

text: dated

text: over

text: years

text: after

text: discharge

text: from

text: active

text: duty

text: See

text: Maxson

text: supra

text: Thus

text: no

text: evidence

text: dated

text: between

text: August

text: and

text: November

text: indicates

text: that

text: the

text: Veteran

text: then

text: had

text: chronic

text: skin

text: disability

text: The

text: record

text: does

text: not

text: document

text: the

text: existence

text: of

text: chronic

text: skin

text: disability

text: during

text: service

text: or

text: for

text: multiple

text: years

text: following

text: service

text: The

text: preponderance

text: of

text: the

text: evidence

text: indicates

text: that

text: for

text: years

text: following

text: service

text: the

text: Veteran

text: did

text: not

text: have

text: characteristic

text: manifestations

text: sufficient

text: to

text: identify

text: a

text: chronic

text: disease

text: entity

text: See

text: C

text: F

text: R

text: Further

text: the

text: medical

text: nexus

text: evidence

text: indicates

text: that

text: lipomas

text: and

text: seborrheic

text: dermatitis

text: are

text: not

text: related

text: to

text: service

text: The

text: Veteran

text: has

text: undergone

text: three

text: VA

text: compensation

text: examinations

text: into

text: his

text: skin

text: in

text: January

text: October

text: and

text: October

text: In

text: the

text: July

text: and

text: February

text: remands

text: the

text: Board

text: found

text: the

text: January

text: and

text: October

text: examination

text: reports

text: inadequate

text: with

text: regard

text: to

text: the

text: two

text: disorders

text: at

text: issue

text: here

text: lipomas

text: and

text: seborrheic

text: dermatitis

text: See

text: Barr

text: v

text: Nicholson

text: Vet

text: App

text: noting

text: that

text: once

text: VA

text: undertakes

text: an

text: examination

text: an

text: adequate

text: one

text: must

text: be

text: produced

text: Pursuant

text: to

text: the

text: February

text: remand

text: an

text: adequate

text: examination

text: report

text: and

text: opinion

text: dated

text: in

text: October

text: has

text: been

text: included

text: in

text: the

text: record

text: See

text: Colvin

text: v

text: Derwinski

text: Vet

text: App

text: when

text: medical

text: evidence

text: is

text: inadequate

text: VA

text: must

text: supplement

text: the

text: record

text: with

text: an

text: advisory

text: opinion

text: or

text: with

text: another

text: medical

text: examination

text: report

text: In

text: the

text: October

text: report

text: the

text: VA

text: examiner

text: noted

text: the

text: Veteran

text: s

text: complaints

text: of

text: palpable

text: lumps

text: lipoma

text: in

text: trunk

text: and

text: extremities

text: for

text: years

text: The

text: Veteran

text: also

text: reported

text: erythematous

text: scaling

text: rash

text: in

text: face

text: and

text: ears

text: for

text: the

text: past

text: years

text: On

text: examination

text: the

text: examiner

text: noted

text: mild

text: seborrheic

text: dermatitis

text: on

text: the

text: eyebrows

text: nasal

text: folds

text: and

text: behind

text: the

text: ears

text: The

text: examiner

text: also

text: noted

text: non

text: tender

text: subcutaneous

text: nodules

text: benign

text: tumors

text: scattered

text: on

text: extremities

text: and

text: trunk

text: In

text: the

text: opinion

text: the

text: examiner

text: found

text: these

text: skin

text: problems

text: likely

text: unrelated

text: to

text: service

text: In

text: support

text: the

text: examiner

text: noted

text: that

text: the

text: STRs

text: and

text: medical

text: evidence

text: did

text: not

text: show

text: any

text: evidence

text: of

text: signs

text: symptoms

text: diagnosis

text: treatments

text: or

text: a

text: chronic

text: disability

text: pattern

text: consistent

text: with

text: or

text: suggestive

text: of

text: Lipoma

text: or

text: derma

text: during

text: active

text: military

text: service

text: The

text: examiner

text: also

text: stated

text: that

text: t

text: he

text: medical

text: literature

text: does

text: not

text: support

text: a

text: direct

text: etiologic

text: relation

text: between

text: past

text: exposure

text: to

text: Agent

text: Orange

text: and

text: further

text: development

text: of

text: lipomas

text: or

text: dermatitis

text: See

text: C

text: F

text: R

text: The

text: October

text: VA

text: examiner

text: indicated

text: a

text: review

text: of

text: the

text: claims

text: file

text: and

text: noted

text: that

text: an

text: interview

text: of

text: the

text: Veteran

text: and

text: a

text: personal

text: examination

text: of

text: the

text: Veteran

text: were

text: both

text: conducted

text: In

text: the

text: report

text: the

text: examiner

text: also

text: detailed

text: the

text: Veteran

text: s

text: medical

text: history

text: of

text: skin

text: problems

text: Further

text: the

text: report

text: and

text: opinion

text: directly

text: respond

text: to

text: the

text: Board

text: s

text: February

text: remand

text: requests

text: As

text: the

text: opinion

text: is

text: based

text: on

text: the

text: evidence

text: of

text: record

text: detailed

text: earlier

text: and

text: is

text: explained

text: the

text: opinion

text: is

text: of

text: probative

text: value

text: See

text: Bloom

text: supra

text: In

text: assessing

text: this

text: claim

text: the

text: Board

text: has

text: considered

text: the

text: Veteran

text: s

text: assertions

text: regarding

text: skin

text: disability

text: particularly

text: that

text: his

text: problems

text: relate

text: to

text: herbicides

text: exposure

text: He

text: is

text: competent

text: to

text: report

text: observable

text: symptoms

text: such

text: as

text: rashes

text: See

text: Jandreau

text: supra

text: However

text: on

text: the

text: issue

text: of

text: etiology

text: the

text: medical

text: evidence

text: is

text: more

text: credible

text: The

text: question

text: of

text: whether

text: lipomas

text: or

text: dermatitis

text: relate

text: to

text: service

text: is

text: a

text: medical

text: determination

text: beyond

text: the

text: Veteran

text: s

text: capacity

text: to

text: observe

text: It

text: is

text: a

text: complex

text: question

text: necessitating

text: input

text: from

text: a

text: medical

text: professional

text: See

text: Woehlaert

text: supra

text: Indeed

text: the

text: lay

text: evidence

text: on

text: this

text: question

text: is

text: medically

text: insignificant

text: when

text: compared

text: with

text: the

text: findings

text: by

text: the

text: neutral

text: and

text: informed

text: October

text: VA

text: examiner

text: Thus

text: in

text: weighing

text: the

text: evidence

text: the

text: Board

text: finds

text: that

text: the

text: medical

text: evidence

text: of

text: record

text: and

text: the

text: lack

text: thereof

text: preponderates

text: against

text: the

text: Veteran

text: s

text: claim

text: regarding

text: etiology

text: See

text: Alemany

text: and

text: Gilbert

text: both

text: supra

text: As

text: the

text: preponderance

text: of

text: the

text: evidence

text: is

text: against

text: the

text: claim

text: to

text: service

text: connection

text: for

text: lipomas

text: and

text: seborrheic

text: dermatitis

text: the

text: benefit

text: of

text: the

text: doubt

text: doctrine

text: does

text: not

text: apply

text: and

text: the

text: claim

text: must

text: be

text: denied

text: U

text: S

text: C

text: A

text: C

text: F

text: R

text: ORDER

text: Entitlement

text: to

text: service

text: connection

text: for

text: an

text: acquired

text: psychiatric

text: disability

text: is

text: denied

text: Entitlement

text: to

text: service

text: connection

text: for

text: lipomas

text: and

text: seborrheic

text: dermatitis

text: is

text: denied

text: KRISTI

text: L

text: GUNN

text: Veterans

text: Law

text: Judge

text: Board

text: of

text: Veterans

text: Appeals

text: Department

text: of

text: Veterans

text: Affairs