Citation Nr: 18150603 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 16-33 543 DATE: November 15, 2018 ORDER Whether new and material evidence has been received to reopen a claim for service connection for a skin disorder, to include as due to herbicide exposure, is granted. REMANDED Entitlement to service connection for a skin disorder, to include as due to herbicide exposure, is remanded. FINDINGS OF FACT 1. An unappealed October 2013 rating decision denied service connection for a skin disorder. 2. The evidence received since the October 2013 rating decision is new and relates to an unestablished fact necessary to substantiate the claim. CONCLUSION OF LAW The evidence received since the October 2013 rating decision is new and material, and the claim for service connection for a skin disorder is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active duty service from July 1968 to July 1971, including service in the Republic of Vietnam from June 1969 to June 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Huntington, West Virginia. The RO previously considered and denied a claim for service connection for a skin disorder to include as due to herbicide exposure in an October 2013 rating decision. The RO found that while exposure to herbicides was conceded and post-service medical records documented diagnoses of psoriasis and basal cell carcinoma, neither of those conditions is currently recognized as due to herbicide exposure. The RO also denied service connection on a direct basis as there was no evidence of a skin disorder while in service. The Veteran did not appeal that decision. The evidence received since the October 2013 rating decision includes the May 2015 VA examination report, VA treatment records, and lay assertions. The Board finds that the additional evidence added to the record is new and material. In this regard, the evidence was not previously considered by VA and it raises a reasonable possibility of substantiating the claim of entitlement to service connection for a skin disorder. Specifically, the June 2016 VA Form 9 contains the Veteran’s statement with respect to continuity of symptomatology. As such, reopening the claim of entitlement to service connection for a skin disorder is warranted. To that extent only, the appeal is granted. REASONS FOR REMAND The Veteran was afforded a VA examination in May 2015. The examiner noted a history of sebaceous cysts and basal cell carcinoma. In May 2010, the Veteran had a biopsy-proven basal cell carcinoma removed from his forehead. He also has a history of psoriasis. See January 2006 private treatment records. At the time of the May 2015 VA examination, the Veteran had multiple cysts on his right shoulder, left temple area, chest, and low back. He was prescribed hydrocortisone, 2 percent twice daily. The examiner opined that it was less likely than not that his sebaceous cysts were due to herbicide exposure. The examiner noted that the only skin conditions with an established link to Agent Orange are chloracne and porphyria cutanea tarda. See May 2015 VA examination report. However, the examiner did not address the Veteran’s other skin conditions, i.e., psoriasis and basal cell carcinoma. Therefore, the Board concludes that the May 2015 VA examination was incomplete and inadequate. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (if VA provides an examination that examination must be adequate). In addition, it appears that the Veteran’s claim was denied on the basis that his diagnosed skin conditions are not presumptive disabilities to herbicide exposure. See April 2016 Statement of the Case. Although sebaceous cysts, psoriasis and basal cell carcinoma are not on the list of diseases that VA has associated with herbicide exposure, the regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. §§ 3.303(d), 3.309(e); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In other words, a presumption of service connection provided by law is not the sole method for showing causation in establishing a claim for service connection for disability due to herbicide exposure. See Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that the availability of presumptive service connection for some conditions based on exposure to Agent Orange does not preclude direct service connection for other conditions based on exposure to Agent Orange). As the Board lacks sufficient medical evidence to render a decision on the issue, a VA examination is needed. See McClendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006). The matter is REMANDED for the following action: 1. Schedule a VA examination by a qualified examiner to determine the nature and etiology of any currently diagnosed skin disorder. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The claims file must be made available to, and reviewed by the examiner. It should be noted that the Veteran is presumed to have been exposed to certain herbicide agents, including Agent Orange, during his military service. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently diagnosed skin disorder is causally or etiologically related to the Veteran’s active service, to include herbicide exposure therein (regardless of the fact that such an association may not be presumed). The examiner should address the Veteran’s lay statement. See May 2016 VA Form 9. (Continued on the next page)   A complete rationale must be provided for any opinion offered. 2. Then, readjudicate the claim on appeal. If the decision is adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board. REBECCA N. POULSON Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D.S. Chilcote, Associate Counsel