Citation Nr: 1319065 Decision Date: 06/12/13 Archive Date: 06/21/13 DOCKET NO. 10-08 714 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Detroit, Michigan THE ISSUES 1. Entitlement to service connection for chloracne, to include as due to herbicide exposure. 2. Entitlement to service connection for rosacea, basal cell carcinoma, and skin cancer. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARINGS ON APPEAL The Veteran and his spouse (J.M.) ATTORNEY FOR THE BOARD S. Mishalanie, Counsel INTRODUCTION The Veteran served on active duty from August 1966 to June 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision promulgated by the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan. In June 2010, the Veteran testified at a RO hearing before a Decision Review Officer. In July 2012, he and his wife testified at a Board videoconference hearing before the undersigned Acting Veterans Law Judge. Transcripts of both proceedings are of record. In addition to the paper claims file, there is a Virtual VA electronic claims file associated with the Veteran's claims. The Virtual VA file has been reviewed in conjunction with the disposition of the issues on appeal. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND In this case, the Veteran claims entitlement to service connection for skin disabilities as due to herbicide exposure. Alternatively, he asserts that his skin disabilities were caused or aggravated by sun exposure during his service in Vietnam. During the July 2012 Board hearing, he testified that he had acne prior to service and was required to seek treatment for this condition before qualifying for enlistment (Hearing Transcript (Tr.), pg. 3). He said he developed a boil soon after enlistment, which was lanced (Tr., pg. 16). He testified that his current problems began when he was about age 40 and progressively worsened (Tr., pgs. 3-4). Private treatment records dated from March 1995 to March 2009 reflect that the Veteran was treated for a number of skin problems, including seborrheic keratosis, dysplastic nevi, an atypical melanocytic lesion, basal cell carcinoma, sebaceous gland hyperplasia, actinic keratosis, an epidermoid cyst, rosacea, and multiple skin tags. The report of a July 2009 VA examination reflects that the Veteran had been treated for rosacea within the prior 12-month period. A history of basal cell carcinoma, dysplastic nevus, and chloracne was also noted. Physical examination revealed scarring from acne on the arms and torso. There were multiple seborrheic keratoses on the back and multiple nevi. Multiple small surgical scars were noted from biopsies. The diagnoses were status post chloracne, basal cell carcinoma, rosacea, and dysplastic nevus. The examiner, however, did not provide an opinion as to whether any of the Veteran's current skin disabilities were incurred in, aggravated by, or otherwise related to the Veteran's service, to include herbicide and sun exposure therein. Once VA undertakes the effort to provide an examination when developing a service-connection claim, even if not statutorily obligated to do so, VA must provide an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Because the July 2009 VA examiner did not provide an opinion regarding the etiology of the any of the Veteran's skin disabilities, the Board finds that the examination was inadequate and a remand is necessary. In addition, as the Veteran is asserting that one or more of his skin disabilities are related to either herbicide or sun exposure in Vietnam, the RO/AMC should obtain a copy of his military personnel records, to include dates and duty assignments in Vietnam. On remand, the RO should also obtain and associate with the claims file all outstanding VA medical records. During the Board hearing, the Veteran testified that he was receiving ongoing treatment at the VA outpatient clinic in Grand Rapids, Michigan (Tr., pgs. 12, 17); however, none of these records have been associated with the claims file. The Board emphasizes that records generated by VA facilities that may have an impact on the adjudication of a claim are considered constructively in the possession of VA adjudicators during the consideration of a claim, regardless of whether those records are physically on file. See Dunn v. West, 11 Vet. App. 462, 466-67 (1998). Accordingly, the case is REMANDED for the following actions: 1. Obtain a copy of the Veteran's military personnel file, to specifically include dates and duty assignments in Vietnam. All records and/or responses received should be associated with the claims file. If any requested records are not available, the Veteran should be notified of such. 2. Any pertinent VA or other inpatient or outpatient treatment records should be obtained and incorporated in the claims folder. This should specifically include any treatment records from the VA outpatient clinic in Grand Rapids, Michigan. All records and/or responses received should be associated with the claims file. If any requested records are not available, the Veteran should be notified of such. 3. Following receipt of any outstanding treatment records, arrange for the Veteran to undergo VA examination for the purpose of determining the nature and etiology of any current skin disability. Any indicated diagnostic tests and studies must be accomplished. The entire claims file (i.e., both the paper claims file and any electronic medical records) should be made available to and be reviewed by the examiner, and it should be confirmed that such records were available for review. If the examiner does not have access to electronic medical records, any such relevant treatment records must be printed and associated with the paper claims file so they can be available to the examiner for review. The rationale for all opinions expressed must be provided. If an opinion cannot be provided without resort to speculation, it must be noted in the opinion report, and a rationale provided for that conclusion. The examiner is asked to identify all current skin disabilities, including any chloracne, rosacea, basal cell carcinoma, and skin cancer (or any residuals thereof). Then, for each diagnosed disability, the examiner should provide opinions as to: a) Whether it is at least as likely as not (50 percent or greater probability) that the skin disability had its onset during the Veteran's period of military service or is otherwise related to such service, including any herbicide or sun exposure therein? b) Clarify whether the Veteran has had or now has chloracne or other acneform disease consistent with chloracne. If so, is it at least as likely as not (50 percent or greater probability) that the skin disability manifested in service or to a degree of 10 percent within one year of herbicide exposure in service? c) Specific to the pre-existing acne that was noted on the Veteran's pre-induction and enlistment examinations, was there any increase in the disability in service? If the answer to the question is yes, was the increase due to the natural progress of the disease or due to service, to include any herbicide or sun exposure therein? 4. Review the examination report to ensure that it is in complete compliance with the directives of this remand. If the report is deficient in any manner, the RO/AMC must implement corrective procedures. Stegall v. West, 11 Vet. App. 268, 271 (1998). 5. Upon completion of the above requested development and any additional development deemed appropriate, the RO/AMC is to readjudicate the issues on appeal. All applicable laws, regulations, and theories of entitlement should also be considered, as well as any evidence received since the February 2011 supplemental statement of the case. If any benefit sought on appeal remains denied, the appellant and his representative, if any, should be provided with a supplemental statement of the case. An appropriate period of time should be allowed for response. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). These claims 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). _________________________________________________ STEPHANIE L. CAUCUTT 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).