Citation Nr: 20005886 Decision Date: 01/23/20 Archive Date: 01/23/20 DOCKET NO. 10-40 963 DATE: January 23, 2020 REMANDED Entitlement to service connection for skin condition, to include basal cell carcinoma, lichenoid keratosis, and dermatitis, due to exposure to environmental hazards, is remanded. Entitlement to service connection for left foot condition, diagnosed as left foot pes cavus and metatarsalgia, to include as secondary to residuals of fracture right first phalanx, right little toe with cavovarus foot, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Marine from April 1962 to August 1966. This appeal to the Board of Veteran’s Appeals (Board) arose from April 2009 and April 2014 rating decisions by the Department of Veteran Affairs (VA) Regional Office (RO). The Veteran has perfected the appeal. See July 2009 and July 2014 Notices of Disagreement; September 2010 and May 2017 Statements of the Case (SOC); October 2010 and May 2017 Substantive Appeals (VA Form 9). The Veteran requested a hearing before the Board. The requested hearing was conducted in August 2017 by the undersigned Veterans Law Judge. A transcript of the hearing is associated with the file. In February 2018, the Board granted the request to reopen the claim for entitlement to service connection for a skin condition. The Board then remanded the reopened claim of service connection for a skin condition, along with the claim of entitlement to service connection for left foot condition for further evidentiary development. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900 (c) (2018). 38 U.S.C.§ 7107 (a)(2) (2012). Unfortunately, after a thorough review of the Veteran’s claims file, the Board determines that the evidentiary development directed by the Board in February 2018 has not been completed in its entirety. 1. Entitlement to service connection for skin condition to include basal cell carcinoma, lichenoid keratosis, and dermatitis, due to exposure to environmental hazards is remanded. The Veteran contends that he developed a skin condition due to his service, specifically being exposed to certain environmental hazards in service. The medical evidence establishes that the Veteran has been diagnosed with a few conditions related to his skin, such as basal cell carcinoma, lichenoid keratosis, and dermatitis. The Veteran claims that during his active service, he worked as a barber and as a result, hair follicles would fall on his body. Additionally, the Veteran states that during his duties as a mechanic and driver, the Veteran handled fuel and oil, and was exposed to chemicals from the fuel and oil. The Veteran also expressed driving through areas where pesticides and other chemicals may have been sprayed. The Veteran’s military occupational specialty was as an automotive mechanic. The Veteran’s records also indicate he was a driver as well. Thus, the Veteran’s statements regarding exposure to fuel, oil, and other chemicals are consistent with the places, types, and circumstances of the Veteran’s service. The Board remanded this claim in order to obtain a medical opinion addressing whether the Veteran’s skin condition is caused by or related to any exposure to environmental hazards during his service. In April 2019, the VA examiner opined that his condition was less likely than not incurred in or due to any event, exposure, or condition experienced while in service. The rationale provided was that there was no evidence of chronicity and the prolonged period between service and initial skin diagnosis makes any connection unlikely. The opinion did not address the Veteran’s allegations regarding exposure to fuel, motor oil, chemical pesticides, and hair follicles and if the pathology of the Veteran’s skin condition was consistent with the alleged exposures. Additionally, the Veteran asserted having issues with his skin since service. The April 2019 medical opinion is not fully responsive to the directives in the February 2018 Board remand. Stegall v. West, 11 Vet. App. 268 (1998). Based on the above, another remand is necessary in order to obtain an addendum opinion that considers and addresses whether there is any relation between the Veteran’s skin condition and exposure to environmental hazards during his service. 2. Entitlement to service connection for left foot condition, diagnosed as left foot cavus pes and metatarsalgia, to include as secondary to residuals of fracture right first phalanx is remanded. The Veteran asserts that his left foot condition is caused by or aggravated by his right foot disability. In May 2017, the VA examiner opined that it was less likely than not that the Veteran’s left foot metatarsalgia is due to the right foot disability. The examiner explained that his right foot digit fractures healed without complications and that there is no science-based rationale for any aggravation of left foot metatarsalgia beyond expected progression. The examiner opined that the Veteran’s left foot pain is more likely caused by residuals of the healed 2nd, 3rd, and 4th metatarsal fractures from a July 2003 workplace injury. The examiner also opined that the Veteran’s condition was not caused by or related to left leg numbness reported in-service. The examiner explained the in-service report included left leg numbness without any trauma that was associated with a vein or muscle. The examiner also specified that the Veteran’s left leg pain was diagnosed as mild bursitis, which has resolved. The Board remanded this claim in order to obtain an opinion regarding the Veteran’s left foot cavus foot deformity, since the opinion only addressed the metatarsalgia. On the April 2019 VA examination, the examiner determined that the Veteran did not have a current diagnosis of a left foot condition. As a result, the examiner did not render an opinion regarding the Veteran’s left foot cavus deformity. As stated in the February 2018 remand directives, the examiner was to identify any left foot disorders “shown by the record.” The record has shown that the Veteran has been diagnosed with metatarsalgia and pes cavus of the left foot. In addition, a July 2019 medical record, after the April 2019 VA examination, indicates foot pain and other diagnoses. The requirement of a current disability is satisfied when the claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Board directed the examiner to provide an opinion for a left foot condition, to include left foot cavus deformity and metatarsalgia, which has been established by the medical evidence. The examination report is not responsive to the questions and directives specified in the remand. Thus, during this remand, an addendum opinion should be obtained that adequately addresses the etiology of the Veteran’s left foot conditions. The matters are REMANDED for the following action: 1. Provide the Veteran an opportunity to identify any pertinent treatment records for his skin and left foot conditions. The Agency of Original Jurisdiction (AOJ) should secure any necessary authorizations. Additionally, all updated VA treatment records should be obtained. If any requested outstanding records cannot be obtained, the Veteran should be notified of such. 2. Once all available, relevant medical records have been received, and associated with the claims file, the AOJ should refer the Veteran's entire claims file to a medical professional of appropriate expertise to provide an addendum opinion (or, if the VA examiner determines that it is necessary, schedule the Veteran for a VA examination) to address the nature and etiology of the Veteran's skin and left foot conditions. The claims file and a copy of this REMAND should be made available to the examiner for review. After record review (and if necessary, examination), the VA examiner should offer his or her opinion with supporting rationale as to the following inquiries: Skin Conditions (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s skin conditions, to include basal cell carcinoma, lichenoid keratosis, and dermatitis, were incurred in, caused by, or etiologically related to the Veteran's service? The examiner must consider and address whether the following in-service exposures caused, or is related to the development of the Veteran’s skin conditions: (1) exposure to hair follicles while working as a barber. (2) exposure to fuel and oil working as an automotive mechanic. (3) exposure to other chemicals and pesticides while working as driver. The examiner must provide an opinion for each skin condition shown by the record. Left Foot Conditions (a) If the Veteran has any left foot disabilities other than left foot cavus deformity (pes cavus) and metatarsalgia, please provide the diagnosis or diagnoses. (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s left foot conditions, to include left foot cavus deformity (pes cavus) and metatarsalgia, are due to, or aggravated (i.e., worsened beyond the natural progress) by his service-connected residuals of fracture right first phalanx (right little toe with cavovarus foot). The examiner must provide an opinion for each left foot diagnosis shown by the record. If the Veteran’s left foot conditions, to include pes cavus and metatarsalgia, are deemed not to be due to, or aggravated by a service-connected right foot disability, then the examiner should, if possible, identify the cause considered more likely and explain why that is so. The basis for each opinion is to be fully explained with a complete discussion of the pertinent lay and medical evidence of record and sound medical principles, including the use of any medical literature or studies, which may reasonably explain the medical analysis in the study of this case. 3. Then, review the record, conduct any additional development deemed necessary, and readjudicate the claims. If any benefit sought remains denied, furnish to the Veteran and his representative an appropriate supplemental statement of the case (SSOC). The Veteran and his representative should be afforded the appropriate time period to respond. Thereafter, if indicated, the case should be returned to the Board for the purpose of appellate disposition. DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Middleton, 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.