Citation Nr: 18155093 Decision Date: 12/03/18 Archive Date: 12/03/18 DOCKET NO. 13-00 230 DATE: December 3, 2018 REMANDED Entitlement to service connection for a skin condition, claimed as bumps on forehead and on back of head and including as due to exposure to herbicide agents, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1966 to January 1970. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a May 2012 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). A Board decision of May 2017 denied the Veteran’s claim for service connection for a skin condition of the forehead and back of head. The Veteran appealed the denial to the Court of Appeals for Veteran’s Claims (Court). In April 2018, the Court granted a Joint Motion for Partial Remand (JMPR) submitted by the Veteran and the Secretary of Veterans Affairs. In the JMPR, the parties agreed the Board erred in finding a May 2012 VA dermatology opinion was adequate and in failing to discuss whether the duty to assist required VA to attempt to obtain 1984 treatment records from the Omaha VA. The claim is now before the Board for additional adjudication. Entitlement to service connection for a skin condition, claimed as bumps on forehead and on back of head and including as due to exposure to herbicide agents, is remanded. Duty to Assist in Obtaining VA Medical Records VA’s duty to assist requires efforts to ensure all available VA treatment records have been obtained and associated with the Veteran's claims file. See 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159(c) (2017); see also Sullivan v. McDonald, 815 F.3d 786 (Fed. Cir. 2016). In this case the Veteran underwent an October 2012 VA dermatology examination to evaluate a separate service connection claim for a skin rash on his chest. The examiner noted a prior diagnosis of tinea corporis at the Omaha VA medical center in 1984. However, no 1984 Omaha VA medical records are associated with the file. If available, these records may be relevant to the Veteran’s current claim for a skin condition on his face and head. Under the duty to assist, VA must attempt to obtain these records. Id. Adequacy of the May 2010 VA Dermatology Examination VA has a duty to ensure any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (overruled on other grounds, Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)). A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board's evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). A VA dermatology examination was provided in May 2012. The examiner noted the Veteran’s history of tinea corporis in service and observed his current condition of bumps on his forehead and behind his right ear. The bumps were not tender and fluctuated in size. They did not appear anywhere else on his body. The examiner described the bumps as “possible lipomas” but did not provide a firm diagnosis. She observed that the Veteran did not have any current tinea corporis infection and opined that lipomas are not caused by tinea corporis. The May 2012 examination report is inadequate to evaluate the claim because it does provide a full diagnosis or etiology opinion. The Veteran had observable bumps on his head, but they are only described as “possible lipomas.: No additional testing or diagnostics were suggested. The examiner’s opinion, that there is no causal relationship between tinea corporis and lipomas, fails to fully describe the etiology of the bumps on the Veteran’s face and head. A new examination is necessary. See Stefl, supra. The Board notes that in August 2012 the Veteran filed a separate claim for service connection for “skin rash chest area.” In a September 2012 statement, the Veteran described the condition as reoccurring itchy skin on his chest which he treats with alcohol rubs and anti-itch creams. An October 2012 rating decision denied service connection, the Veteran did not appeal, and the claim is not now before the Board. However, in evaluating the chest rash claim, the Veteran was provided an October 2012 VA dermatology examination. This examiner diagnosed dermatitis or eczema. Additionally, primary care notes from the Omaha VA medical center in May 2012 note a “rash on the chest for several years,” “chronic dermatitis,” and “may have had eczema in the past.” The Veteran’s history of skin conditions may be relevant to his claim for bumps on his face and head. On remand, the examiner must consider and comment on the evidence of record related to other skin symptoms and diagnoses. Finally, the Veteran raises the possibility that the bumps on his head may be related to herbicide exposure. He served in Vietnam and his exposure to herbicide agents is conceded. In September 2012, he submitted documents from an internet search indicating a link between herbicide exposure and skin rash. A medical opinion on whether the bumps on his head are causally related to herbicide exposure is necessary to fully evaluate the Veteran’s claim. Accordingly, the case is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records from 1984 from the Omaha VA medical center. If these records are unavailable, make a formal determination of their unavailability and notify the Veteran. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any rash or bumps on his head, including on his forehead and the back of his head. The examiner must diagnose his condition or provide an explanation as to why no diagnosis can be made. The examiner should discuss all history of skin conditions, including symptoms of itchiness and any diagnosis of dermatitis, eczema or other skin condition on any part of the Veteran’s body. If other skin conditions are found, the examiner must describe the relationship, if any, between these conditions and the bumps on the Veteran’s head. The examiner must opine whether any skin condition diagnosed on the Veteran’s head is at least as likely as not related to an in-service injury, event, or disease, including rashes noted in the Veteran’s service treatment records. The examiner must also opine whether the skin condition, claimed as bumps on the forehead and back of head, however diagnosed, is at least as likely as not related to conceded in-service herbicide agent exposure. In responding to this question, the examiner is asked to discuss the documents submitted by the Veteran in September 2012. (Continued on the next page)   A complete rationale must be provided for all opinions expressed. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jeanne Celtnieks, Associate Counsel