Citation Nr: 0721166 Decision Date: 07/13/07 Archive Date: 07/25/07 DOCKET NO. 03-24 836 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Reno, Nevada THE ISSUE Entitlement to service connection for pseudofolliculitis barbae. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C.A. Skow, Counsel INTRODUCTION The appellant served on active duty for training in the U.S. Marine Corp Reserves (USMCR) from December 1975 to April 1976. This matter came before the Board of Veterans' Appeals (the Board) on appeal from an August 2002 rating decision of the Reno, Nevada, Department of Veterans Affairs (VA) Regional Office (RO). FINDINGS OF FACT Chronic pseudofolliculitis barbae is currently shown and had its onset in service. CONCLUSION OF LAW Pseudofolliculitis barbae was incurred in service. 38 U.S.C.A. § 1131 (West 2002 & Supp. 2006); 38 C.F.R. §§ 3.303, 3.304 (2006). REASONS AND BASES FOR FINDING AND CONCLUSION The appellant entered on active duty for training in the USMCR in December 1975. Service entrance examination shows no complaints or findings for skin rash or pseudofolliculitis barbae. About two weeks after entering service, the appellant reported a shaving rash. A reduced shaving schedule and use of hot towels prior shaving and cream after shaving were prescribed. No improvement in the rash problem was observed as of one month later. There is no service separation examination. The appellant was administratively discharged because of an inability "to maintain a clean shaven face" due to skin irritation of the face caused by pseudofolliculitis barbae. See Service Personnel Record, April 1976. On VA examination in August 1976, the appellant reported that he had had problems with his beard areas, particularly his neck, since he joined the service. By history, after he first started to shave, he had the onset of a rash. Examination was positive for some inflammatory papules and pustules. The diagnosis was pseudofolliculitis barbae. The examiner attributed the condition to improperly shaving and noted that it was commonly found in "black people when they begin to shave, regardless of their environment or other conditions." Post service medical records dated from April 2001 continue to show that the appellant had problems with pseudofolliculitis barbae. On an initial evaluation dated April 2001, pseudofolliculitis barbae was assessed based on clinical findings for numerous hyperpigmented papules around the beard area, and post inflammation hyperpigmentation. One percent hydrocortisone was prescribed. The appellant was seen again in March 2002; it was noted that his condition was treatable but not curable. At his March 2004 hearing, the appellant testified that he had not shaved prior to entering service. He further testified that he had not had any skin problems prior to service and that he has had skin problems since service. He reported using creams on his face and taking antibiotics for his flare-ups. On dermatological evaluation in January 2006, the appellant reported a history of bumps on his face beginning in service. He further reported that he treats his skin problems with hydrocortisone cream. Pseudofolliculitis barbae was diagnosed. Based on a review of the claims folder, the examiner commented that the current diagnosis for pseudofolliculitis barbae was related to the in-service shaving rash, and "is a continuation of that same eruption." In a June 2006 addendum, the examiner noted that this condition did not pre-exist the appellant's service and that it was common in African-Americans and other population groups. A VA medical opinion dated December 2006 reflects that pseudofolliculitis barbae is a chronic skin condition, that it is and is not a reaction to shaving technique, and that it is common in certain groups of people with curly and kinky hair that may grow back into the hair follicle and set up an inflammatory reaction termed pseudofolliculitis barbae. The physician enclosed several reprint articles from the internet describing this condition. The physician commented that pseudofolliculitis barbae was not caused by service and would have developed independent of military service if he shaved his beard area. Analysis Initially, the Board notes that the appellant did not engaged in combat and he does not assert that his claimed skin disability is a result of combat. Therefore, the provisions of 38 U.S.C.A. § 1154(b) (West 2002) are not for application in this matter. Compensation may be awarded for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 2002). Service connection basically means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303 (2006). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. See Caluza v. Brown, 7 Vet.App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed.Cir.1996) (table); see also Hickson v. West, 12 Vet.App. 247, 253 (1999); 38 C.F.R. § 3.303. Under § 3.303(b), an alternative method of establishing the second and/or third Caluza element is through a demonstration of continuity of symptomatology. See Savage, 10 Vet.App. at 495-97; see also Clyburn v. West, 12 Vet.App. 296, 302 (1999). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Savage, 10 Vet.App. at 495-96; see Hickson, 12 Vet.App. at 253 (lay evidence of in-service incurrence sufficient in some circumstances for purposes of establishing service connection); 38 C.F.R. § 3.303(b). Significant in case law is that lay persons are not competent to opine as to medical etiology or render medical opinions. See Grover v. West, 12 Vet.App. 109, 112 (1999); Espiritu v. Derwinski, 2 Vet.App. 492, 494 (1992). Lay testimony is competent, however, to establish the presence of observable symptomatology and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet.App. 465, 469 (1994); see also Falzone v. Brown, 8 Vet.App. 398, 405 (1995) (lay person competent to testify to pain and visible flatness of his feet); Espiritu, 2 Vet.App. at 494-95 (lay person may provide eyewitness account of medical symptoms). The Court has emphasized that "symptoms, not treatment, are the essence of any evidence of continuity of symptomatology." Savage, 10 Vet.App. at 496 (citing Wilson v. Derwinski, 2 Vet.App. 16, 19 (1991)). Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, supra (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted")). Barr v. Nicholson, No. 04-0534 (U.S. Vet. App. June 15, 2007). In this case, service medical records and discharge documents show that the appellant had pseudofolliculitis barbae in service, and there is considerable medical evidence that the appellant currently has pseudofolliculitis barbae. A medical opinion shows that pseudofolliculitis barbae is a chronic condition. See VA Medical Opinion dated December 2006. Additionally, the appellant has provided sworn testimony, which is credible, that he has had symptoms of pseudofolliculitis barbae since service. As indicated above, the appellant is wholly competent to report symptoms within his ken, observable symptoms such as those associated with pseudofolliculitis barbae. Lastly, a medical opinion reflects that "pseudofolliculitis barbae was related to the in-service shaving rash" and that his current symptoms were a continuation of that condition. Weighing the evidence of record, the Board finds that the preponderance of the evidence supports entitlement to service connection for pseudofolliculitis barbae. We note that pseudofolliculitis barbae is a chronic condition that began in service. This fact is uncontroverted in the record. While there is evidence of record showing that the appellant would have developed this condition because of his race regardless of whether he was in the service has no probative value in this matter. Pseudofolliculitis barbae is not identified by law or regulation as a congenital disorder or developmental defect, which would preclude entitlement to compensation under the service connection provisions. Accordingly, the claim is granted. As this claim has been granted, any discussion of the provisions of the Veterans Claims Assistance Act of 2000 (VCAA), (codified at 38 U.S.C.A. §§ 5100, 5102-5103A, 5106, 5107, 5126 (West 2002), (imposes obligations on VA in terms of its duty to notify and assist claimants)), is rendered moot. ORDER Service connection for pseudofolliculitis barbae is granted. ____________________________________________ H. N. SCHWARTZ Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs