Citation Nr: 18157884 Decision Date: 12/13/18 Archive Date: 12/13/18 DOCKET NO. 16-33 522 DATE: December 13, 2018 REMANDED Entitlement to service connection for confluent and reticulated papillomatosis (CRP) due to exposure to Gulf War environmental hazards, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1982 to August 1985 and from December 1986 to March 1991, including service in Southwest Asia. Entitlement to CRP due to exposure to Gulf War environmental hazards The Veteran contends that she has a skin condition that is due to her exposure to Gulf War environmental hazards. She contends that she noticed her skin condition only after returning from service and it has been progressing since then. The Veteran’s service treatment records show that she was treated for a rash on her chest and back in May 1985, during her first period of active duty. Upon separation from her first period of active duty, her August 1985 separation examination showed “normal” results for “skin, lymphatics.” Upon entry into her second period of active duty, the Veteran’s November 1986 enlistment examination showed “abnormal” results for “skin, lymphatics,” with a note describing acne on the “face, chest, ant v. post.” Her self-report of medical history at this time noted that she was using a cream to treat acne. No other skin disabilities or disorders were identified by the Veteran or noted on entry. The Veteran was provided with a VA skin diseases examination in December 2013 where she reported a history of a rash on her back and chest with onset in service. The VA examiner found a diagnosis for CRP and noted that there was no objective evidence of a chronic skin disorder during service. The examiner noted that aside from the one complaint of a rash on the Veteran’s chest and back, there is no further medical documentation regarding complaint, evaluation, or treatment during the remainder of her active duty service despite the fact that she was seen multiple times in sick call for other medical problems. The examiner added that a rash on the upper body can be due to a number of conditions. The examiner also noted that there was no evidence of a skin problem during the separation examination or within one year of service. In January 2014, the Veteran submitted a statement from her mother noting that it was not until after her deployment to the Gulf War from 1990 through 1991 that her skin started to change. The Veteran’s mother stated that the changes in her skin appearance were first noticed in April 1991 while she was being treated during her pregnancy. The Board notes that the Veteran is claiming exposure to Gulf War environmental hazards, which happened during her second period of active duty from December 1986 through March 1991. The RO has found that the Veteran was exposed to environmental contaminants during this period of service. However, the December 2013 VA examiner did not comment on whether the Veteran’s current disability is a result of this exposure, or the statement from the Veteran’s mother that she developed the skin disabilities after her deployment. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and likely etiology of her diagnosed skin disability. The Veteran’s claims file must be made available to the examiner. All diagnostic testing deemed to be necessary by the examiner should be accomplished. The examiner should indicate whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s diagnosed skin disability had causal origins in service or is otherwise related to the Veteran’s active duty service, to include her exposure to Gulf War environmental hazards. The examiner should accept the history of symptoms provided by the Veteran as true unless the examiner provides a rationale as to why the Veteran’s recollection is affirmatively contradicted by the medical evidence. The examiner should also consider and discuss the following: (i) a May 1985 service treatment record noting a rash on the chest and back, and a post-service March 1999 private treatment record noting pigmented patches on the chest, back, and neck. (ii) a lay statement from the Veteran’s mother from January 2014 noting that the changes in the Veteran’s skin appearance were first noticed in April 1991, while she was being treated for her pregnancy. A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 2. After undertaking any additional development deemed appropriate, and giving the Veteran full opportunity to supplement the record, adjudicate the Veteran’s pending claim in light of any additional evidence added to the record. If any benefit sought on appeal remains denied, the Veteran and her representative should be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. M. Donohue Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Morrad, Associate Counsel