Citation Nr: 20021541 Decision Date: 03/26/20 Archive Date: 03/26/20 DOCKET NO. 14-26 920 DATE: March 26, 2020 REMANDED Entitlement to service connection for a skin condition, claimed as shingles and hives, to include as secondary to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran had active duty service from February 1992 to December 1994, including service in Southwest Asia from April 1994 to December 1994. The Veteran testified at a video conference hearing before a Veterans Law Judge in November 2017. A transcript of the hearing is associated with the claims file. The Veterans Law Judge who conducted the hearing is no longer employed by the Board of Veterans Appeals (Board). The Veteran was informed of this in a February 2018 letter. In response to that letter, she elected not to testify at another hearing before the Board. See U.S.C. § 7107(c); 38 C.F.R. § 20.707. In April 2018, the Board remanded the Veteran’s claims for entitlement to service connection for a skin condition, claimed as shingles and hives as well as for an acquired psychiatric condition, claimed as a panic disorder for further development. See April 2018 Board Remand. Following the Board’s remand, the Regional Office (RO) granted service connection for panic disorder and assigned a 50 percent disability rating, effective December 22, 2011. See September 2019 Rating Decision. Because the RO’s decision represents a full grant of benefits sought on appeal for the acquired psychiatric condition, there remains no case or controversy as to this issue and the Board will not address it further. Entitlement to service connection for a skin condition, claimed as shingles and hives, to include as due to service-connected disabilities is remanded. As discussed previously in the Board’s April 2018 remand, the Veteran contends she has multiple skin conditions, including recurring shingles and hives, which she argues is associated with a compromised immune system. She further argues she has a compromised immune system as a result of her service-connected fibromyalgia, migraines and chronic fatigue syndrome. In the March 2020 Appellate Brief, the Veteran’s representative further asserted that shingles have been medically associated with both fibromyalgia and migraines, providing a medical resource in support of that contention. See March 2020 Appellate Brief. Alternatively, as previously noted in the Board’s April 2018 remand, the Veteran's VA treatment records suggest an association between her hives and psychiatric symptoms, including stress. Notably, the Veteran is now service-connected for a psychiatric disorder (panic disorder). In satisfaction of the April 2018 Board remand, a VA examination was performed in July 2019. At the examination, the Veteran was diagnosed with urticaria (resolved) and recurrent zoster, which is also known as shingles. See July 2019 VA examination. The VA examiner provided the opinion that given the objective evidence, it was less likely than not that the Veteran’s recurrent shingles was incurred in or caused by her military service, an acquired psychiatric condition or chronically worsened beyond its natural progression (aggravated) by Gulf War Illness or an acquired psychiatric condition. In support of that opinion, the examiner explained that recurrent shingles was a disease with a clear and specific etiology and diagnosis. In the examiner’s opinion, there was no medical evidence that the Veteran’s condition was related to a specific exposure event experienced by the Veteran during her service in Southwest Asia. See July 2019 VA Medical Opinion. However, the examiner’s rationale for the opinion rendered, particularly regarding the secondary causation claims, is merely conclusory and incomplete. Notably, the examiner does not address the Veteran’s contentions that her service-connected disabilities, including chronic fatigue syndrome, fibromyalgia and migraines may weaken her immune system which in turn, may cause her to be more prone to the recurrent shingles. Moreover, the examiner does not address the Veteran’s contention that the stress from her service-connected psychiatric disorder causes or aggravates her recurrent shingles. Because the Board finds the July 2019 VA medical opinion is incomplete, a remand is needed to obtain a medical addendum opinion prior to adjudicating this claim. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s recurrent shingles is proximately due to her service-connected chronic fatigue syndrome, fibromyalgia, migraines and/or psychiatric disorder or aggravated beyond its natural progression by these service-connected disabilities. In rendering an opinion, the examiner is asked to thoroughly address the Veteran’s contentions regarding the impact of stress as well as a compromised immune system resulting from her service-connected disabilities on her recurrent shingles. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Churchwell, 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.