Citation Nr: 18143865 Decision Date: 10/22/18 Archive Date: 10/22/18 DOCKET NO. 16-13 801 DATE: October 22, 2018 REMANDED Entitlement to service connection for a latex allergy is remanded. REASONS FOR REMAND The Veteran served on active service between August 1991 and August 1996 and February 1998 and February 2013. Entitlement to service connection for a latex allergy is remanded. The Veteran seeks service connection for a latex allergy, contending that he developed a severe latex allergy while in service. According to 38 C.F.R. § 3.380 (2018), “Seasonal and other acute allergic manifestations subsiding on the absence or removal of an allergen are generally to be regarded as acute diseases, healing without residuals.” Yet the regulation also provides that some diseases of allergic etiology “may not be disposed of routinely for compensation purposes as constitutional or developmental abnormalities. Service connection must be determined on the evidence as to the existence prior to enlistment and, if so existent, a comparative study must be made of its severity at enlistment and subsequently.” The regulation also states that “determination as to service incurrence or aggravation must be on the whole evidentiary showing.” In this case, the Veteran entered service without a noted latex allergy upon entrance examination in March 1991. A March 1991 Report of Medical History specifically indicates “None” under listed allergies. The Veteran asserts he had no latex allergy prior to entering service. The Veteran’s service treatment records make several subsequent references to a latex allergy from 1992 through discharge. The Veteran was ultimately required to carry an EpiPen during service in case of sudden exposure, as his allergic reaction could result in anaphylactic shock. The Veteran asserts that his latex disability not only had onset during service, but also increased in severity with additional exposures to latex, to include during his own in-service medical examinations, and in performance of his job as a member of the Military Police. The RO denied entitlement to service connection for the Veteran’s claimed latex allergy stating first that the Veteran’s latex allergy is a congenital or developmental defect, and second that the latex allergy amounted to an acute disease, subsiding on the absence of or removal of the allergen, and healing without residuals. However, it is not clear whether the Veteran’s allergies are acute, especially considering the severity of the allergy described by the Veteran, and the current record includes no medical opinion addressing whether the Veteran’s allergy is congenital or developmental. The Veteran should be provided a VA examination to assess the nature and etiology of his allergy. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination with a qualified medical professional to determine the nature and etiology of the Veteran’s latex allergy. The entire claims file should be sent to, and reviewed by the VA examiner. The examiner should take a history from the Veteran as to the progression of the allergy. Upon review of the record, interview of the Veteran and examination, the VA examiner should respond to the following in sequence: a.) Is it at least as likely as not (at least a 50 percent probability) that the Veteran has a latex allergy that is chronic in nature? If the Veteran’s allergy is not a chronic disability, but rather represents an acute disease, healing without residuals, in the absence of or removal of the allergen, this should be made clear with an explanation as to how this conclusion was reached. In answering this question, the examiner is asked to consider and comment upon the Veteran’s descriptions of how often he experiences his latex allergy, the severity of his reactions, the progression of the allergy over time, and the precautions he must take to avoid exposure. b.) If this Veteran’s allergy is indeed chronic, is it best classified as an acquired disease, a congenital disease or a congenital defect? For VA purposes, a defect differs from a disease in that the former is “more or less stationary in nature” whereas the latter is “capable of improving or deteriorating.” Quirin v. Shinseki, 22 Vet. App. 390, 394 (2009); VAOPGCPREC 82-90 (July 18, 1990). If in fact it is determined that the Veteran’s chronic allergy is a congenital defect, the examiner must discuss the Veteran’s assertion that his allergy worsened in severity during his period of service due to multiple exposures. c.) If the Veteran’s chronic allergy is an acquired or congenital disease, is it clear and unmistakable (i.e. undebatable) that the disability had onset prior to entrance into service in 1991? d.) If the answer to (c) is “YES,” is it also clear and unmistakable (i.e. undebatable) that the disability was NOT aggravated beyond its natural progression during the Veteran’s period of active duty service? e.) If the answer to either (c) or (d) is “NO,” assume as true that the Veteran entered service without the disease. With this assumption in mind, is it at least as likely as not (50 percent or greater probability) that the disease had onset in, or is otherwise related to the Veteran’s period of active duty service? The examiner should consider the Veteran’s contentions that the allergy manifested during service and worsened in severity due to the repeated exposure to latex from latex gloves used during dental and other medical examinations, as well as in the Veteran’s duties as a member of the Military Police. A comprehensive medical rationale is requested in response to all opinions and findings entered. (Continued on Next Page) 2. Then, readjudicate the appeal. If the benefit sought is denied, issue the Veteran a Supplemental Statement of the Case, and return the case to the Board, if otherwise in order. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD David M. Sebstead, Associate Counsel