Citation Nr: 20005449 Decision Date: 01/23/20 Archive Date: 01/22/20 DOCKET NO. 17-01 988 DATE: January 23, 2020 REMANDED Service connection for a skin disability to include as due to herbicide exposure is remanded. REASONS FOR REMAND The Veteran had active service from October 1967 to August 1970, to include service in the Republic of Vietnam. A review of the record reveals that the Veteran has various diagnosed skin disabilities, to include malignant melanoma, seborrheic keratosis, and dermatitis, which he asserts are related to his presumed herbicide exposure in Vietnam. In March 2018, the Board remanded the claim so the Veteran could be afforded an examination. Subsequently, at a February 2019 examination, a VA examiner opined that the Veteran’s skin conditions were less likely than not related to exposure to Agent Orange in Vietnam, with the rationale that without “documentation” that the Veteran was “on the ground in Vietnam at the time that herbicides were sprayed,” it would be hard to state that his diagnosed skin conditions were related to such exposure. He continued to note, however, that dioxin, a byproduct of Agent Orange, was known to contribute to the development of many cancers, and that the Veteran’s skin conditions could be considered as “presumptive diseases” due to any direct exposure to Agent Orange in Vietnam. To the extent that the examiner seemed to suggest that he could not render an opinion because it was not clear to him that the Veteran had confirmed exposure to Agent Orange, the Board notes that veterans who served in the Republic of Vietnam era are presumed to have been exposed to Agent Orange. Indeed, the regional office (RO) has already conceded Agent Orange exposure. In addition, regarding the second part of the examiner’s opinion, wherein he opined that the Veteran’s skin cancer conditions could be considered as “presumptive conditions,” the Board notes that the only skin conditions subject to presumptive service connection due to Agent Orange exposure are chloracne or other acneform diseases consistent with chloracne, and porphyria cutanea tarda; it is not shown by the record that the Veteran has a skin disability that may be presumed to be related to Agent Orange exposure by regulation. However, that stated, a claimant may establish service connection based on exposure to Agent Orange with proof of actual direct causation. See Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that the availability of presumptive service connection for some conditions based on exposure to Agent Orange does not preclude direct service connection for other conditions based on exposure to Agent Orange); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994); Brock v. Brown, 10 Vet. App. 155 (1997). The Board finds that an addendum opinion should be sought and that it must be made clear to the examiner that the Veteran is presumed to have been exposed to Agent Orange. Then, the examiner should address whether the Veteran’s diagnosed skin conditions are at least as likely as not related to the Veteran’s presumed exposure, even if he does not suffer from any of the Agent Orange presumptive conditions listed in 38 C.F.R. § 3.309(e). The matters are REMANDED for the following action: 1. Obtain a medical opinion from a physician other than the February 2019 VA examiner, addressing the etiology of the Veteran’s skin disabilities, from the February 2019 VA examiner. It is left to the discretion of the examiner whether an in-person examination is warranted. The examiner should address the following: Is it at least as likely as not (50 percent or greater probability) that any of the Veteran’s diagnosed skin conditions had onset in, or are otherwise related to his period of active service, to include his conceded exposure to Agent Orange? The examiner must address the Veteran’s specific assertion that the right side of his body was completely saturated with Agent Orange when he was flying a helicopter in Vietnam. A complete rationale must be provided for any opinion offered. 2. Then, readjudicate the issue. If the claim remains denied, send the Veteran and his representative a supplemental statement of the case. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Polly Johnson, 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.