Citation Nr: 21000204 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 17-56 193 DATE: January 4, 2021 REMANDED Entitlement to service connection for a right hand disability, to include Dupuytren’s contracture, right medial mononeuropathy, and Raynaud’s Syndrome (also claimed as neurological condition and decreased circulation in right hand/fingers with functional loss of strength/dexterity), to include as secondary to service-connected residuals, gunshot wound, right shoulder, muscle group III is remanded. Entitlement to service connection for chronic urticaria, to include as due to exposure to herbicide agents in Vietnam and/or due to exposure to contaminated water at Camp Lejeune is remanded. REASONS FOR REMAND The Veteran had active service in the United States Marine Corps from November 1962 to November 1966, to include service in Vietnam. For his meritorious service, the Veteran was awarded (among other awards) the Purple Heart Medal and the Vietnam Service Medal. This appeal comes to the Board of Veterans’ Appeals (Board) from February 2017 and March 2018 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Huntington, West Virginia. In October 2019, the Veteran had a travel board hearing held by the undersigned Veterans Law Judge. A transcript of the hearing is of record. In November 2019, the Board remanded the issues for further development. 1. Entitlement to service connection for a right hand disability, to include Dupuytren’s contracture, right medial mononeuropathy, and Raynaud’s Syndrome (also claimed as neurological condition and decreased circulation in right hand/fingers with functional loss of strength/dexterity), to include as secondary to service-connected residuals, gunshot wound, right shoulder, muscle group II is remanded. In June 2020, a VA examination along with a medical opinion was obtained regarding the Veteran’s right hand disability. However, the medical opinion only addressed the Veteran’s diagnoses of Raynaud’s Syndrome and right medial mononeuropathy. There was no adequate opinion of whether the Veteran had a current diagnosis of Dupuytren’s contracture or whether it was related to his service-connected right shoulder disability. An addendum opinion clarifying the nature and etiology of this disability is needed. 2. Entitlement to service connection for chronic urticaria, to include as due to exposure to herbicide agents in Vietnam and/or due to exposure to contaminated water at Camp Lejeune is remanded. Medical opinions were obtained for the Veteran’s chronic urticaria in March 2020 and April 2020. However, these opinions did not obtain an adequate discussion on whether the Veteran’s urticaria was related to his exposure to herbicide agents while he was stationed in Vietnam. A remand is warranted to obtain a VA addendum opinion addressing this matter. The matters are REMANDED for the following action: 1. Obtain any outstanding private medical treatment records regarding the Veteran’s skin disorder by having the Veteran complete and return a VA Form 21-4142, Authorization and Consent to Release Information. Specifically, the RO should ask the Veteran to provide the contact information of his private treating dermatologist and Tri-State Allergy from his earliest date of first treatment that can be ascertained. If these records cannot be obtained, it should be so noted for the record. 2. Obtain a VA addendum medical opinion regarding the Veteran’s diagnosis of Dupuytren’s contracture of the right hand that the Veteran was diagnosed with on his December 2016 VA examination. If an addendum opinion cannot be obtained without a VA examination, then a VA examination should be scheduled. The VA examiner should review this remand along with the claims file. The examiner should consider the following: (a.) Whether the Veteran has ever had a diagnosis of Dupuytren’s contracture of the right hand during any period on appeal? The examiner should clarify the diagnosis of Dupuytren’s contracture made on the December 2016 VA examination. (b.) If the Veteran has Dupuytren’s contracture of the right hand, whether it is at least as likely as not that the Veteran’s Dupuytren’s contracture of the right hand is proximately due to, the result of, or aggravated by his service-connected residuals of a gunshot wound, right shoulder, muscle group (III)? The VA examiner should discuss all the symptoms of the Veteran’s right hand, including circulation problems. The VA examiner should consider the December 2016 VA medical opinion. All opinions must be supported by a sufficient rationale. The absence of medical evidence cannot be the sole basis for a negative opinion. 3. Pursuant to 38 U.S.C. § 5109(a), obtain an advisory medical opinion from a medical expert, specifically from the medical expert who rendered the March 2020 opinion, if she is available. If the previous medical expert is not available, the RO should find another appropriate clinician to render the medical opinion. This remand and the claims file should be reviewed. The medical expert should address the following: (a.) Whether it is at least as likely as not that that the Veteran’s urticaria is related to his exposure to herbicide agents during his military service? All opinions must be supported by a sufficient rationale. The absence of medical evidence cannot be the sole basis for a negative opinion Evan M. Deichert 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.