Citation Nr: 18151393 Decision Date: 11/19/18 Archive Date: 11/16/18 DOCKET NO. 15-38 552 DATE: November 19, 2018 REMANDED Entitlement to service connection for psoriasis is remanded. Entitlement to service connection for psoriatic arthritis is remanded. REASONS FOR REMAND The Veteran had active duty from June 1968 to March 1971, including service in the Republic of Vietnam. A Board hearing was scheduled pursuant to the Veteran’s request on his substantive appeal, however, in correspondence received in July 2018, he withdrew his request for a hearing. 1. Entitlement to service connection for psoriasis is remanded. 2. Entitlement to service connection for psoriatic arthritis is remanded. The Veteran first contends that his psoriasis was caused by exposure to herbicide agents during his service in the Republic of Vietnam. Although the Veteran served in Vietnam during the requisite time period for presumptive service connection, neither psoriasis nor psoriatic arthritis are chronic diseases associated with exposure to certain herbicide agents under 38 C.F.R. § 3.309(e). However, service connection can still be established on a direct basis. The Veteran also contends that his skin condition was caused by ingesting anti-malaria medication required during his service. Service records confirm the Veteran was provided anti-malaria medication, which he completed in December 1969. Treatment records during service do not show any complaints of skin blotches or rashes; however, the Veteran was treated for warts on his right hand in 1969 and 1970. The Veteran submitted a lay statement wherein he described his skin conditions beginning during service and continuing after service. A lay statement from the Veteran’s spouse confirmed that the Veteran experienced additional warts on his skin in addition to rashes and skin blotches since he returned from active service intermittently. The Veteran and his spouse are both competent to report the symptoms of his skin condition, such as a rash or blotches. The Veteran has a current diagnosis of psoriasis and psoriatic arthritis. There is no medical evidence of record addressing the etiology of the Veteran’s psoriasis or psoriatic arthritis. A letter from the Veteran’s primary care provider stated that he had treated the Veteran since 1997 for various skin conditions and has since referred him to a dermatologist. A remand is necessary to obtain a medical examination and opinion to determine the etiology of the Veteran’s psoriasis and psoriatic arthritis. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. Contact the Veteran to determine whether there are any additional relevant private treatment records and obtain any necessary authorizations for such records. 2. After completing (1), forward the Veteran’s claims folder, including a copy of this remand, to a qualified medical provider. A skin diseases examination should be performed at the examiner’s discretion for which all necessary special studies or tests are to be accomplished. Based on a review of the records and, if conducted, an examination, the examiner should address the following: (a.) Identify/diagnose any skin disorder that presently exists or that has existed during the appeal period. (b.) For each identified skin disorder, state whether it is at least as likely as not (50% probability or better) that the Veteran’s skin condition, including psoriasis, had its onset in or was caused by any in-service injury, event, or disease, including exposure to anti-malaria medication or exposure to herbicide agents during his service in Vietnam. (c.) The examiner must opine whether it is at least as likely as not (50% probability or better) that the Veteran’s psoriasis was present or developed during his active service, to include as manifested by warts on his right hand. (d.) The examiner must opine on whether the Veteran has a current diagnosis of psoriatic arthritis and, if so, whether it is caused by or related to the above discussed psoriasis or is in any other way related to the Veteran’s active service. A complete rationale for any opinion expressed must be provided. An examiner’s report that he or she cannot provide an opinion without resort to speculation is inadequate unless the examiner provides a rationale for that statement. As such, if the examiner is unable to offer an opinion, it is essential that the examiner provide a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide the opinion is based on the limits of medical knowledge. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M.E. Lee, Associate Counsel