Citation Nr: 18158170 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 16-59 774 DATE: December 14, 2018 REMANDED Entitlement to service connection for psoriatic arthritis is remanded. Entitlement to service connection for right knee replacement is remanded. Entitlement to service connection for psoriasis is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1971 to August 1971. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that the evidence of record contains a June 2014 RO rating decision adjudicating the issues currently on appeal. Following the June 2014 decision, the Veteran submitted pertinent medical treatment records related to his psoriasis disability. The RO advised in a June 2014 letter that the medical records were untimely, however, the RO had an obligation to assist the Veteran per regulation. Thereafter, the RO evaluated the submitted evidence and issued a March 2015 rating decision consistent with 38 C.F.R. § 3.156(b). The Board finds that the RO’s actions consistently treated the matter as an ongoing appeal. As such, the Board considers the issues as being on appeal throughout the claims period and no final decision was rendered. Gonzalez-Morales v. Principi, 16 Vet. App. 556, 557-58 (2003) (finding that the Board must accept appeals even if the substantive appeal is untimely, when there is no evidence that the RO closed the appeal and it treated the appeal as timely). 1. Entitlement to service connection for psoriatic arthritis is remanded. 2. Entitlement to service connection for right knee replacement is remanded. 3. Entitlement to service connection for psoriasis is remanded. The Veteran contends that his psoriasis was aggravated beyond its natural progression by his active duty service. In June 2014, the Veteran was afforded a VA examination to determine the etiology of his psoriasis skin condition. The examiner opined that the condition, which was clearly and unmistakably in existence prior to service, was not aggravated beyond its natural progression by an in-service event, injury, or illness. The rationale cited the Veteran’s past medical history and his current state of health after service, which showed an expected natural course of the psoriasis according to the weight of available medical literature. The Board finds the examination incomplete as the examiner failed to discuss the Veteran’s lay statements regarding his active military service. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Here, the Veteran’s lay statements are critical to the evaluation of the psoriasis disability based on his alleged exposure to chemical agents while in training to service military helicopters. His DD Form 214, reveals he served as a helicopter repairman for five months prior to his discharge for the psoriasis condition. Moreover, his October 1970 entrance examination noted skin legions on his hands (box #72). He also had a prior history of skin conditions on his hands prior to service from approximately the age of five. However, the Veteran specifically states in a July 2014 letter that during his Military Occupational Specialty (MOS) training he had to stick his hands and arms in caustic and dangerous cleaning solutions. His prior medical history as well as his enlistment examination both only report a skin condition on his hands. The Veteran was able to successfully complete basic training prior to starting his military MOS training without any incidents related to his skin. Only after he began the MOS training did his skin condition begin to deteriorate based on his lay statements. Therefore, remand is warranted for another evaluation to consider the lay testimony. Further, the Board finds that due to the contentions of the Veteran each of the other two issues on appeal are intertwined with the psoriasis issue. See, e.g., August 2015 notice of disagreement. Therefore, all issues are remanded. Additionally, updated VA treatment records should be associated with the record on remand. See Sullivan v. McDonald, 815 F.3d 786, 792 (Fed. Cir. 2016) (finding that because § 3.159(c)(3) expanded the VA’s duty to assist to include obtaining VA medical records without consideration of their relevance.) The matters are REMANDED for the following actions: 1. Update/Obtain VA treatment records from May 2014 to the present. Document all requests for information as well as responses in the claims file. 2. After completion of step #1, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his psoriasis disability. The examiner is to provide an opinion whether is it at least likely as not related to an in-service injury, event, or disease. A comprehensive rationale is to accompany the opinion. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions.   The examiner, when formulating the opinion, is to answer and discuss: (a.) The Veteran’s July 2014 lay statement regarding placing his hands and arms in chemical agents; specifically, whether this action aggravated the psoriasis beyond its natural progression because prior to the MOS training the record indicates he only had psoriasis on his hands. (b.) If aggravation is found identify the baseline level of disability prior to the aggravation. (c.) If the Veteran’s psoriasis was aggravated during his active service, then is it at least likely as not that his psoriatic arthritis is 1) proximately due to OR 2) aggravated by to his service-connected psoriasis. (Continued on the next page)   (d.) If, the Veteran’s psoriasis was aggravated during his active service, then is it at least likely as not that his right knee replacement is 1) proximately due to OR 2) aggravated by his service-connected psoriasis. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. M. Williams, Associate Counsel