Citation Nr: 18149447 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 15-05 227 DATE: November 9, 2018 REMANDED Entitlement to service connection for a back disorder is remanded. Entitlement to service connection for alcoholism and depression, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for a skin disorder is remanded. REASONS FOR REMAND The Veteran served from June 1968 to June 1971, including service in Vietnam. As an initial matter, the Board notes that in October 2018 written argument, the Veteran’s representative addressed the issue of entitlement to service connection for mitral valve prolapse. However, a review of the record shows that although the Veteran initiated an appeal as to that issue along with the three issues currently on appeal (see March 2014 notice of disagreement), after the Regional Office (RO) issued a January 2015 statement of the case addressing all issues, the Veteran limited his appeal to only those three issues identified directly above. Therefore, the Veteran has not perfected an appeal as to his service connection claim for mitral valve prolapse (heart condition), and it will not be addressed further herein. 1. Entitlement to service connection for a back disorder and a skin disorder is remanded. The Veteran seeks service connection for a back disorder and skin disorder. His service treatment records (STRs) are comprised mainly of only his enlistment and separation examinations, and these do not record a back problem or a skin problem. The Veteran argues, however, that he experienced back pain from repeated heavy lifting while stationed in Vietnam, and that he relied on pain medication obtained from a company aid station that required servicemembers to sign in when receiving treatment. He also argues that he had skin problems in service, that after separation from service he received treatment from VA, and that he currently experiences flare-ups. The Veteran has not yet been afforded a VA examination for either of the claimed disabilities. With respect to his back claim, the record reflects that the Veteran has a current diagnosis of degenerative disc disease in his lumbar spine and his military occupation as a supply specialist is consistent with the working conditions he described of repeated heavy lifting. Therefore, the Board finds that a VA examination for a medical opinion is warranted. With respect to his skin claim, the Veteran’s postservice VA treatment records are silent for any formal diagnosis of a chronic skin disorder. However, they do show that he received treatment for a fungal infection in June 2013. Moreover, the Veteran is competent to provide lay evidence of his symptomatology, to the extent his symptoms are directly observable by him and do not require specialized medical or other training to describe. Although he is not competent to diagnose his symptoms or render an opinion as to their etiology, his statements are sufficient to trigger VA’s duty to assist to provide him with a VA examination to determine if he has a skin disorder and, if so, whether it is related to his service. Accordingly, these claims are being remanded for the scheduling of a VA examination and any necessary records development. 2. Entitlement to service connection for alcoholism and depression, to include as secondary to service-connected PTSD, is remanded. The Veteran’s claim for service connection for alcoholism and depression has been denied based primarily on a finding that there was no evidence of a psychological disorder in his STRs. However, since the RO’s adjudication of that claim, the Veteran has been granted service connection for PTSD. The Veteran’s representative now argues that the Veteran is entitled to a VA examination addressing his alcohol abuse and depression as secondary to his PTSD. When determining service connection, the Board must consider all theories of entitlement, direct and secondary, if raised by the evidence of record, applying all relevant laws and regulations. Szemraj v. Principi, 357 F.3d 1370, 1371 (Fed. Cir. 2004). Consequently, the Board finds that on remand the Veteran should be provided a VA examination to determine whether his diagnosed alcoholism and other depressive symptoms are a result of his service-connected PTSD. The matters are REMANDED for the following actions: 1. Undertake appropriate efforts to obtain any relevant and outstanding VA and private medical records, to include from Vines Hospital (as successor to Charter Springs) and the VA Outpatient Clinic in Sunrise, Florida, as identified in the Veteran’s June 25, 2015 statement in support of claim. All records obtained must be associated with the claims file. If any identified record is unavailable, the RO should specifically so state, and the documentation used in making that determination should be set forth in the claims file. 3. After all available records have been associated with the record, provide the Veteran with appropriate VA examinations to determine the nature and etiology of any diagnosed back disorder, skin disorder, and psychiatric disorder other than PTSD, to specifically include alcohol abuse disorder and depression. The Veteran’s claims file must be provided to the examiners, who must also obtain a detailed clinical history from the Veteran. All pertinent pathology found on examination must be noted in the reports of the evaluations, and any testing deemed necessary must be performed. The examiners should offer comments and an opinion addressing the following: (a) Whether it is at least as likely as not that the Veteran’s current back disorder, to include degenerative disc disease of the lumbar spine, is related to an in-service injury, event, or disease, including the Veteran’s report of repeated heavy lifting and experiences with back pain therein. (b) Whether it at least as likely as not that the Veteran’s current back disorder, to include degenerative disc disease of the lumbar spine, (1) began during active service, (2) manifested within one year after separation from service, or (3) was noted during service with continuity of the same symptomatology since service. (c) Whether it is at least as likely as not that the Veteran has a current skin disorder that is related to an in-service injury, event, or disease. (d) Whether it is at least as likely as not that the Veteran has a psychiatric disorder other than PTSD, to specifically include alcohol abuse and depression, that is (1) proximately due to his service-connected PTSD, or (2) aggravated beyond its natural progression by his service-connected PTSD. The examiners are advised that the Veteran is competent to report history and symptoms and that those reports must be considered in formulating any requested opinion. If any examiner rejects the Veteran’s reports, the examiner must provide a rationale for doing so. A complete rationale must be given for all opinions and conclusions expressed. If it is not possible to provide a requested opinion without resorting to speculation, the examiner should state why speculation would be required (e.g., if the requested determination is beyond the scope of current medical knowledge, actual causation cannot be selected from multiple potential causes, etc.). If there are insufficient facts or data within the claims file, the examiner should identify the relevant testing, specialist’s opinion or other information needed to provide the requested opinion. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD David S. Katz, Associate Counsel