Citation Nr: 20004853 Decision Date: 01/22/20 Archive Date: 01/21/20 DOCKET NO. 19-01 653 DATE: January 22, 2020 REMANDED Entitlement to service connection for a skin disability other than basal cell carcinoma, to include urticarial-type lesions and seborrheic keratosis, to include as due to herbicide agent exposure is remanded. Entitlement to service connection for basal cell carcinoma, to include as due to herbicide agent exposure is remanded. REASONS FOR REMAND The Veteran had active duty service in the United States Navy from April 1968 to March 1970, to include service in Vietnam. For his meritorious service, the Veteran was awarded the Vietnam Campaign Medal, the National Defense Service Medal, and the Vietnam Service Medal. This appeal comes to the Board of Veterans’ Appeals (Board) from April 2016 and March 2017 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for urticarial type lesions, to include as due to herbicide agent exposure is remanded. 2. Entitlement to service connection for basal cell carcinoma, to include as due to herbicide agent exposure is remanded. The Veteran is seeking service connection for urticarial type lesions and basal cell carcinoma, to include as due to herbicide agent exposure. The Veteran asserts that since his service in Vietnam, he has had skin problems. He contends that he first began experiencing skin lesions while he was in Vietnam. He never had problems before he entered into service. Further, he asserts that his skin conditions are caused by herbicide agent exposure. His military occupational specialty was construction mechanic, and he was exposed to Agent Orange, gas and diesel fumes, chemicals, such as TCE (trichloroethylene), and other harmful chemicals used to clean construction equipment. See November 2016 Correspondence and March 2017 Statement in Support of Claim. The Veteran’s DD-214 shows that he served in Vietnam for a period of 16 months. The Veteran was awarded the Vietnam Service Medal with Fleet Marine Force Combat Operations Insignia for Service Aboard U.S. Naval Mobile Construction Battalion One during October 1968 through January 1969. Therefore, the Board presumes that the Veteran was exposed to herbicide agents during his service in Vietnam. See 38 C.F.R. § 3.307(a)(6)(iii). Service treatment records show that the Veteran was diagnosed with pilonidal sinus on his April 1968 Report of Medical Examination for enlistment. A January 1970 health record revealed that, at the time, the Veteran had a rash of unknown origin with an abrupt onset with small patches of reddened areas covering his shoulders, stomach, and back. The physician suspected that the Veteran had an allergic or nervous reaction. The Veteran was prescribed Benadryl. He returned to the clinic the next day, and the physician noted that the Veteran had an allergic reaction to Penicillin. Post service treatment records show that the Veteran was diagnosed with urticaria and basal cell carcinoma. Also, a May 2016 VA dermatology note shows that the Veteran was assessed with irritated seborrheic keratosis. In February 2017, the Veteran was afforded a VA examination for skin diseases. The VA examiner diagnosed the Veteran with urticaria. The VA examiner opined that the Veteran’s urticarial type lesions on his back were less likely than not caused by, or a result of, or aggravated by pilonidal sinus on his back that occurred while on active duty. The Veteran’s enlistment examination noted a dry pilonidal cyst. The Veteran’s service treatment records documented one episode of wet pilonidal cyst, treated with packing and dressing, which was resolved. There were not any medical notes documenting an urticarial type lesion on the Veteran’s back in his service treatment records. The Veteran’s separation examination noted dry pilonidal cyst. The Veteran’s service treatment records documented an allergic rash to ampicillin, reaction to insect bites, and a body rash on both his leg and back; he was diagnosed and treated for heat rash. The Veteran’s service treatment records did not document an urticarial type lesion on his back. Medical records after his separation, noted an allergic reaction with urticarial lesions over the upper extremity and torso on April 2016. A dermatology consultation on October 2015 noted a lesion on the Veteran’s back for months; he was diagnosed with seborrheic keratosis. The Veteran’s available medical records were silent for urticarial lesion on his back. In addition, according to a widely-utilized, literature-based medical reference source, pilonidal cyst did not have a causal effect in the development of urticarial type lesions on the back. The February 2017 VA examination does not adequately address whether the Veteran’s currently diagnosed skin disorders are related to his military service, particularly his exposure to herbicide agents and other chemicals while he served in Vietnam. The VA examination does not consider the other diagnosed skin disabilities notated in the Veterans post service treatment records. A remand is necessary for a more adequate VA examination and opinion that thoroughly addresses these matters. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment or private treatment records and associate with the claims file. 2. After the above development has been completed, schedule the Veteran for a VA examination to determine the nature and etiology of any skin disorder present at any time during the relevant appeal period, to include basal cell carcinoma, seborrheic keratosis, and urticarial-type lesions. The record and a copy of this remand must be made available and reviewed by the examiner in conjunction with the examination. All necessary tests should be completed. The VA examiner should address the following: (a.) Identify a diagnosis for any skin disorder, to include basal cell carcinoma, seborrheic keratosis, and urticarial-type lesions, present at any time during the appeal period from July 2015 to present. (b.) For any disorder identified in response to the above, the examiner should state whether it is at least as likely as not that the skin disorder is related to his military service, to include conceded exposure to herbicide agents, gas and diesel fumes, chemicals such as TCE, and other harmful chemicals used to clean construction equipment? See November 2016 Correspondence. In responding to the above, the examiner’s attention is directed to a November 2016 correspondence from the Veteran, to which he attached medical articles discussing a report published in the February 2014 issue of Plastic and Reconstructive Surgery medical journal concerning a pilot study indicating that “there may be an association between Agent Orange and development of nonmelanotic skin cancer…” (continued on next page)   A rationale for all opinions must be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she should provide a complete explanation stating why this is so. A. SOLOMON Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Crawford, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.