Citation Nr: 18140557 Decision Date: 10/03/18 Archive Date: 10/03/18 DOCKET NO. 14-19 210 DATE: October 3, 2018 REMANDED Entitlement to service connection for a skin condition, to include as secondary to exposure to herbicides and jet fuel, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1965 through March 1969. The Veteran presented sworn testimony before the undersigned Veterans Law Judge during a September 2015 Travel Board hearing. A transcript has been associated with the claims file. The Board remanded the above-listed issue in December 2015. Pursuant to the remand instructions, the RO obtained a VA examination of the Veteran’s skin conditions and readjudicated the matter. As discussed below, though the requested development was completed, it was not completed adequately. The matter must be remanded for full compliance with the remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998).   The Veteran was afforded a VA examination in February 2016 to determine whether any of his diagnosed skin conditions were etiologically related to his active duty service, to include exposure to jet fuel and herbicide agents. The examiner identified several age-related skin changes, but noted they did not rise to the level of a disabling skin condition for compensation and pension purposes. One of the conditions noted on the skin examination was a lesion on the Veteran’s left thigh, which was too small to characterize as a skin condition. The examiner provided no rationale regarding the lesion identified on his left thigh, which was later diagnosed as folliculitis. The opinion also contained no discussion of the Veteran’s in-service herbicide and jet fuel exposures. It is also unclear what the examiner meant by the conclusion the Veteran had skin issues “not disabling” for compensation purposes. Was the examiner concluding these conditions would not warrant a compensable rating? If so, that is not the correct question at this time, which is whether service connection is warranted. The rationale for the examiner’s opinion was also inadequate. The examiner stated the skin conditions were less likely related to service because none of the conditions is related to service. That is a conclusion, not an explanation. An April 2016 private treatment record reflected the Veteran underwent a punch biopsy to identify the lesion on his leg, and was diagnosed with non-specific folliculitis. The Veteran submitted a nexus statement in March 2017 which noted he had been treated for a rash that “comes and goes and is irritated by the sun.” A biopsy performed revealed perifolliculitis, which the nurse practitioner opined was more likely than not related to his Agent Orange exposure under the Chloracne category. However, the nurse practitioner did not provide any rationale explaining how perifolliculitis, which manifests as inflammation around the hair follicles (see Dorland’s Illustrated Medical Dictionary, 1413 (32nd ed. 2012)), is related to Chloracne, which is characterized as acne caused by exposure to chlorine compounds. See Dorland’s at 344. Accordingly, the March 2017 private nexus statement is inadequate.   The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a skin condition because no VA examiner has opined whether any skin condition, to include perifolliculitis, is etiologically related to his active duty service, to include exposure to herbicides and jet fuel. The matter is REMANDED for the following action: 1. Send a letter to the Veteran and ask him to complete a VA Form 21-4142 for any private treatment he has received for his skin conditions since May 2016. 2. Obtain the Veteran’s VA treatment records for the period from August 2014 to the present. 3. Only after the above development is completed, to the extent possible, request an addendum VA medical opinion from a medical professional to address whether it is at least as likely as not (at least 50 percent probability or greater) that the any current diagnosed skin condition is etiologically related to the Veteran’s active duty service, to include exposure to herbicides and jet fuel. The 2016 VA examiner noted the Veteran had multiple benign appearing age-related skin changes (lentigos, seborrheic keratosis, skin tags, intertrigo, xerosis) that were not “disabling.” Regardless of whether they are disabling, the examiner still must provide nexus opinions for all of the Veteran’s skin conditions. The entire claims folder and a copy of this REMAND should be reviewed by the examiner. All opinions are to be accompanied by a rationale consistent with the evidence of record. A discussion of the pertinent evidence, relevant medical treatises, and generally accepted medical principles is requested. If the examiner cannot provide an opinion without resorting to speculation, he or she shall provide complete explanations stating why this is so. In so doing, the examiner shall explain whether any inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Parsons, Associate Counsel