Citation Nr: 1323675 Decision Date: 07/25/13 Archive Date: 08/06/13 DOCKET NO. 08-26 530 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to service connection for a skin disorder, to include chloracne, as due to herbicide exposure. 2. Entitlement to service connection for skin cancer of the face and right shoulder as due to herbicide exposure. REPRESENTATION Veteran represented by: Disabled American Veterans ATTORNEY FOR THE BOARD E. Pomeranz, Counsel INTRODUCTION The Veteran had active service from December 1963 to June 1968 including service in Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a June 2007 rating action by the Department of Veterans Affairs (VA) Regional Office (RO) located in Houston, Texas, which denied the Veteran's claims for service connection for chloracne, skin cancer of the face and right shoulder, and for peripheral neuropathy of the upper and lower extremities, all as due to herbicide exposure. The Veteran filed a notice of disagreement (NOD) in July 2007 and a statement of the case (SOC) was issued in June 2008. However, in the Veteran's substantive appeal (VA Form 9), dated in July 2008, he indicated that he was only appealing the issues of entitlement to service connection for chloracne and skin cancer of the face and right shoulder, as due to herbicide exposure. Accordingly, the claim for service connection for peripheral neuropathy of the upper and lower extremities as due to herbicide exposure is not before the Board for appellate consideration. The Veteran was scheduled for a Travel Board hearing in May 2013, but did not appear for the hearing. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the Veteran if further action is required. REMAND The case is REMANDED for the following action: 1. Ask the Veteran if he has received any VA, non-VA, or other medical treatment that is not evidenced by the current record. Provide the Veteran with the necessary authorizations for the release of any non-VA treatment records not currently on file. Obtain these records and associate them with the claims folder. If the records are not obtainable (or none exist), the Veteran should be notified and the record clearly documented. 2. After the above has been completed, schedule the Veteran for a skin diseases examination with an appropriate clinician. The purpose of the examination is to determine whether the Veteran has a skin disorder, to include chloracne, and/or skin cancer of the face and right shoulder, that is related to his period of active service, to include in-service exposure to herbicides. The following considerations will govern the examination: a. The claims folder, and a copy of this remand, must be available to the examiner for review in conjunction with the examination. The examiner MUST take a complete history from the Veteran as to the onset, nature, and progression of symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran regarding his skin conditions, the examiner must state this, with a fully reasoned explanation. All appropriate tests and studies should be accomplished. b. The examiner is advised: * The Veteran is presumed by law to have been exposed to herbicides during service in Vietnam; * The Veteran alleges that he developed a skin disorder on his face, including the eye and cheek areas, since Vietnam; that he has been previously treated for "adult acne;" and that his current skin symptoms are the same as those he had in Vietnam; * VA Medical Center (VAMC) outpatient treatment records show that in an August 2008 physical examination, the Veteran was diagnosed with warts to the face. He was referred for a dermatological consultation which he underwent in September 2008. The examiner stated that the Veteran had a history of a basal cell carcinoma on his right shoulder. According to the examiner, the Veteran indicated that he had papules around his left eye and asked if that could be related to herbicide exposure. The Veteran had been using retin-A without improvement. The physical examination showed that the Veteran had well-healed scars on the vertex of his scalp and his right shoulder, with no evidence of recurrence. There was a 5 mm hyperpigmented macule with regular color on the back of the neck. There were hyperkeratotic verrucous papules on the right fourth finger, left second finger, left third finger, and left palm. There were scaly pink papules on the Veteran's scalp and he had flesh-colored nodules in the corner of the left eye with multiple open comedones around his eyes and on bilateral cheeks. The diagnoses were the following: history of non-melanoma skin cancer with well-healed scars; benign-appearing nevus with no current evidence of malignancy; verruca vulgaris; actinic keratosis; and Favre-Racouchot Syndrome. However, the examiner did not address the pertinent question of whether any of the Veteran's current skin disorders were related to his period of service, specifically to his in-service exposure to herbicides. c. After a review of the examination findings and the entire evidence of record, the examiner must answer the following questions: (i) Does the Veteran currently have chloracne? If so, was the Veteran's chloracne manifested within one year after discharge from service? In the alternative, is the Veteran's chloracne related to his period of active service, to include his in-service exposure to herbicides? (The Veteran's exposure to herbicides is presumed by law.) (ii) Does the Veteran currently have a skin disorder other than chloracne? If so, and with respect to the Veteran's currently diagnosed nevus of the neck, verruca vulgaris, actinic keratosis, and Favre-Racouchot Syndrome (see VAMC outpatient treatment record dated September 24, 2008), are the Veteran's currently diagnosed skin disorders, to specifically include nevus of the neck, verruca vulgaris, actinic keratosis, and Favre-Racouchot Syndrome, related to his period of active service, to include his in-service exposure to herbicides? (iii) Is the Veteran's skin cancer, and residuals thereof (see VAMC outpatient treatment record dated September 24, 2008), related to his period of active service, to include his in-service exposure to herbicides? An explanation must be provided for any opinion or conclusion expressed. 3. After completion of the above and any other development deemed necessary, the RO should review and re-adjudicate the issues on appeal. If any such action does not resolve each claim to the Veteran's satisfaction, the RO must provide the Veteran and his representative, if any, a supplemental statement of the case (SSOC) and an appropriate period of time should be allowed for response. Thereafter, the case should be returned to this Board for appellate review. The Veteran 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). This claim must be afforded expeditious treatment. The law requires that all claims that are 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). _________________________________________________ VITO A. CLEMENTI 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).