Citation Nr: 18145365 Decision Date: 10/26/18 Archive Date: 10/26/18 DOCKET NO. 09-42 227A DATE: October 26, 2018 REMANDED Entitlement to service connection for a skin disorder, also claimed as chloracne and stasis dermatitis, to include as secondary to herbicide agent exposure, is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active military service in the Army from July 1970 to February 1972, to include service in Vietnam from January 1971 to January 1972. This appeal comes to the Board of Veterans’ Appeals (Board) from a September 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The issue of entitlement to service connection for ulcers was also denied by the RO in September 2008 and was timely appealed in the January 2009 Notice of Disagreement (NOD). Subsequently, the Statement of the Case (SOC), issued in September 2009, denied the issue. According to the Veteran’s Substantive Appeal, dated November 2009, he stated that he did not wish to pursue this claim. Therefore, the claim of entitlement to service connection for ulcers is not on appeal and will not be addressed in this decision. Also, on his November 2009, VA Form 9, substantive appeal, the Veteran requested a hearing before the Board. However, in April 2012, the Veteran submitted a written statement withdrawing his hearing request. In April 2015, the Board remanded the claims for further development. 1. Entitlement to service connection for a skin disorder, also claimed as chloracne and stasis dermatitis, to include as secondary to herbicide agent exposure, is remanded. Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran’s claims so that he is afforded every possible consideration. See 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2018). The Veteran served on active duty in Vietnam from January 1971 to January 1972. The Veteran is therefore presumed to have been exposed during such service to an herbicide agent and may be presumed to have been exposed during such service to any other chemical compound in an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 U.S.C. § 1116 (2012); 38 C.F.R. § 3.307 (a)(6)(iii) (2018). Diseases entitled to the presumptive service connection based on such exposure are listed under 38 C.F.R. § 3.309(e). The Board notes that a presumption of service connection based on exposure to herbicides used in the Republic of Vietnam during the Vietnam era is not warranted for any condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. See Health Outcomes Not Associated With Exposure to Certain Herbicide Agents, 72 Fed. Reg. 32,395 (June 12, 2007). However, the Veteran has the opportunity to show that his presumed exposure is directly responsible for his disabilities. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In April 2017, the Veteran was afforded a VA examination for skin disease. In October 2017, an addendum medical opinion was obtained for the Veteran’s skin disease. In the April 2017 VA examination report, it was noted that the Veteran was diagnosed with stasis dermatitis, onychomycosis, and tinea pedis. With regard to the Veteran’s diagnoses of onychomycosis and tinea pedis, there is no adequate opinion regarding whether these conditions are related to his military service or presumed herbicide exposure. The April 2017 VA examiner opined that these conditions were less likely than not incurred in or caused by his military service, to include herbicide agent exposure. He opined that the diagnosed onychomycosis and tinea pedis were not among the diseases presumed to be associated with herbicide agent exposure. This opinion is inadequate because it did not consider whether the Veteran’s diagnosed onychomycosis and tinea pedis were directly due to his presumed herbicide agent exposure. The October 2017 addendum opinion discussed stasis dermatitis only and not tinea pedis and onychomycosis. 2. Entitlement to a TDIU is remanded. Additionally, the Veteran’s claim for a TDIU should be remanded as well. The Veteran’s claim for a TDIU is inextricably intertwined with his claim for service connection for a skin disorder. These claims should be considered together. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that where a claim is inextricably intertwined with another claim, the claims must be adjudicated together in order to enter a final decision on the matter). The matters are REMANDED for the following action: 1. Obtain any outstanding pertinent VA treatment or private treatment records and associate them with the claims file. 2. Following completion of the above, send the claims file to an examiner of appropriate knowledge and expertise to render an opinion as to the nature and etiology of the Veteran’s skin disorders (other than stasis dermatitis), to include tinea pedis and onychomycosis, claimed as chloracne. The claims file and a copy of this remand must be reviewed by the examiner. It is up to the discretion of the examiner whether a new VA examination is necessary. (a.) With respect to the Veteran’s skin disorders (other than stasis dermatitis), to include tinea pedis and onychomycosis, claimed as chloracne, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any of the Veteran’s currently diagnosed skin disorders are caused by or otherwise related to his active military service, to include his presumed exposure to herbicides. The Veteran’s assertion of a rash and itching skin since service should be specifically considered and discussed. (b.) A rationale for all requested opinions should be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he/she should provide a complete explanation stating why this is so. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he/ she has (CONTINUED ON NEXT PAGE) exhausted the limits of current medical knowledge in providing an answer to that particular question. BARBARA B. COPELAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Crawford, Associate Counsel