Citation Nr: 1303840 Decision Date: 02/04/13 Archive Date: 02/08/13 DOCKET NO. 08-09 592 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUE Entitlement to service connection for a skin disorder. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Mary E. Rude, Associate Counsel INTRODUCTION The Veteran had active service from December 1987 to October 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona, that denied service connection for a skin condition (claimed as skin irritations). In August 2010 and November 2011, the Board remanded the claim on appeal to the RO, via the Appeals Management Center (AMC) in Washington, DC, for further development. After completing additional development, the AMC continued the denial of the claim (as reflected in September 2011 and June 2012 supplemental statements of the case), and returned this matter to the Board for further appellate consideration. In August 2012, the Veteran's claim was referred for a medical opinion by an expert of the Veterans Health Administration (VHA). 38 U.S.C.A. § 7109 (West 2002); 38 C.F.R. § 20.901 (2012). In October 2012 the expert medical opinion letter was received and was referred to the Veteran and his representative for review and the submission of any additional evidence or argument. 38 C.F.R. §§ 20.903, 20.1304(c) (2012). A copy of the VHA opinion letter has been associated with the claims file. The Board notes that, in addition to the paper claims file, there is a paperless, electronic claims file associated with the appellant's claim. A review of the documents in such file reveals that it contains VA treatment records relevant to the issue on appeal. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). The appeal is REMANDED to the RO via the AMC in Washington, DC. VA will notify the appellant if further action is required. REMAND Unfortunately, the claims file reflects that further development is warranted, even though such development will, regrettably, further delay an appellate decision. As an initial matter, the Board finds that the RO/AMC should verify the Veteran's current address. VA's internal tracking system, known as the Veterans Appeals Control and Locator System (VACOLS), lists the Veteran's as living at an address on North 17th Street. However, recent correspondence to that address has been returned as undeliverable. Furthermore, there is some indication in his outpatient treatment records that he moved and now resides at an address on West Pasadena Avenue. Therefore, the RO/AMC should verify the Veteran's address, and resend any previous correspondence that was not sent to that address since August 2011, to include the November 2011 Board remand, the June 2012 supplemental statement of the case, and the October 2012 VHA opinion letter. In addition, the Board finds that the medical examinations and opinions of record are inadequate for adjudication purposes and that another medical examination and opinion is needed to fairly resolve the claim. VA will obtain a medical opinion if the evidence indicates the existence of a current disability that may be associated with an event, injury, or disease in service, but the record does not contain sufficient medical evidence to decide the claim. 38 U.S.C.A. § 5103A(d)(2) (West 2002); 38 C.F.R. § 3.159(c)(4)(i) (2012); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Furthermore, once VA undertakes the effort to provide an examination, it must provide one that is adequate for purposes of the determination being made. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). To be considered adequate, the medical opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions." Stefl v. Nicholson, 21 Vet. App. 120, 124; see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). While an examiner's conclusion that a diagnosis or etiology opinion is not possible without resort to speculation is considered to be a valid medical conclusion just as much as a diagnosis or conclusive opinion, the examiner must explain the basis for such an opinion, including which facts cannot be determined and whether all procurable and assembled data has been considered. Jones v. Shinseki, 23 Vet. App. 382, 390 (2010). In this case, the Veteran claims that his current skin rash originated in service and has been a chronic, though intermittent, problem since that time. The Veteran's service treatment records indicate that he was treated for a skin rash over his entire body in September 1989 while stationed in Okinawa, Japan and for a rash on his face in September 1990 while stationed in San Francisco. The Veteran was afforded a VA examination to determine the nature and etiology of his current skin rash in August 2010. Unfortunately, the examiner stated that she was unable to provide an opinion without resorting to speculation. For the reasons discussed in the Board's November 2011 remand, the examiner's opinion was inadequate for adjudication purposes. Therefore, the case was remanded for a new VA examination. The record indicates that the Veteran did not appear for his examination scheduled in February 2012. However, as discussed above, the evidence suggests that the Veteran moved and it is unclear whether he received actual notice of the February 2012 examination. In October 2012, the Board received a VHA opinion letter in which a dermatologist reviewed the claims file and recommended an assessment in a dermatology clinic for a diagnosis and further clarification of the Veteran's lower back dermatitis. The dermatologist indicated that there was currently "a lack of medical support to document any relationship with the patient's previous exposures and his current dermatological complaints." Given the dermatologist's recommendation, the Board finds that another VA examination and opinion is needed to fairly resolve the claim. The Veteran is hereby notified that failure to report to the scheduled examination, without good cause, may result in denial of the claim for service connection (as the original claim will be considered on the basis of the evidence of record). See 38 C.F.R. § 3.655(a) (2012). Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant and death of an immediate family member. Id. If the Veteran fails to report to the scheduled examination, the RO/AMC should obtain and associate with the claims file the notice of the date and time of the examination sent to him by the pertinent VA medical facility. Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). Expedited handling is requested.) 1. Verify the Veteran's current address. Resend any recent correspondence that was not sent to his current address since August 2011, to include the November 2011 Board remand, the June 2012 supplemental statement of the case, and the October 2012 VHA opinion letter. Any changes to the Veteran's contact information should be updated in VACOLS. 2. Thereafter, schedule the Veteran for a VA skin disease examination to evaluate the nature and etiology of any current skin disorder. Any and all indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The claims folder must be made available to and be reviewed by the examiner. Following a thorough evaluation, the examiner should indicate the precise nature and extent of any and all skin disorders. For each skin disorder identified, the examiner is asked to state whether it is at least as likely as not (i.e., a 50 percent probability or greater) that any such diagnosed disorder began during service or is otherwise due to or the result of service or any event or injury in service. The examiner is asked to specifically make note of any service treatment records indicating treatment for a skin condition and to discuss their potential relevance. A complete rationale for each opinion offered must be included in the report, and an explanation of the principles involved would be of considerable assistance to the Board. Specifically, that rationale should explain the extent to which the opinion is based on medical principles and the extent to which it is based on the history provided by the Veteran. If the examiner determines that he/she cannot provide an opinion on the issue at hand without resorting to speculation, the reviewer should explain the inability to provide an opinion, identifying precisely what facts could not be determined. In particular, he/she should comment on whether an opinion could not be rendered because the limits of medical knowledge have been exhausted or whether additional information could be obtained that would lead to a conclusive opinion. The RO/AMC should ensure that any additional evidentiary development suggested by the examiner should be undertaken so that a definitive opinion can be obtained. The RO/AMC should ensure that the examiner's report complies with this remand, especially with respect to the instructions to provide a thorough medical opinion and complete explanation. If the report is insufficient, it should be returned to the examiner for necessary corrective action, as appropriate. 3. After completing the requested action and any additional notification and/or development deemed warranted, readjudicate the claim. If the benefit sought on appeal is not fully granted, issue the Veteran and his representative a supplemental statement of the case before returning the claim to the Board for further appellate consideration. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ SONJA A. MISHALANIE Acting Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).