Citation Nr: 21001968 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 16-04 963 DATE: January 12, 2021 ORDER Service connection for chloracne is granted. FINDINGS OF FACT 1. The Veteran was exposed to herbicides, to include Agent Orange during his period of active duty. 2. The Veteran’s chloracne is due to his exposure to herbicides. CONCLUSION OF LAW The criteria for service connection for chloracne have been met. 38 U.S.C. §§ 1110, 1131, 1154, 5103A, 5017; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REMANDED Entitlement to service connection for a skin disability, including eczema, actinic keratosis, and onychomycosis, but excluding chloracne is remanded. REASONS AND BASES FOR FINDINGS AND CONCLUSION As the most recent VA examination confirmed several diagnoses of a skin disability the Board will expand the claim accordingly. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled). Thus, the Board finds that a broader interpretation is appropriate. The issue has been recharacterized accordingly, as noted on the title page. The Veteran testified before the undersigned Veterans Law Judge in a March 2019 video conference hearing. A transcript of that hearing has been associated with the file. The Board remanded the matters in April 2019, for additional development. The Board finds that the remand directives have not been substantially complied with, and an additional remand is required for the skin disabilities, not including the chloracne disability. See Stegall v. West, 11 Vet. App. 268. As will be explained below, although the VA opinion is inadequate, the Board will not remand the service connection claim for chloracne, causing additional delay, when there is sufficient evidence in the record to grant this claim. Service Connection Generally, to establish direct service connection a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.” Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In addition, a veteran who served in the Republic of Vietnam during the Vietnam era is presumed to have been exposed during to an herbicide agent, unless there is affirmative evidence to the contrary. 38 C.F.R. § 3.307 (a)(6)(iii). For veterans presumed to have been exposed to herbicides, certain enumerated diseases shall be service connected even though there is no record of such disease during service, so long as the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § 3.307 (a)(6)(iii) are met, and the rebuttable presumption provisions of 38 U.S.C. § 1113 and 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). The diseases listed at 38 C.F.R. § 3.309(e) shall have become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other acneform disease consistent with chloracne shall have become manifest to a degree of 10 percent or more within a year after the last date on which the Veteran was exposed to an herbicide agent. 38 C.F.R. § 3.307 (a)(6)(ii). The December 2019 VA Skin Diseases Disability Benefits Questionnaire (DBQ) confirms a diagnosis of chloracne. The diagnosis date is listed as 2019. The VA also provided a positive opinion, stating that it is at least as likely as not that the Veteran’s chloracne is related to service, specifically his in-service exposure to herbicide agents. As stated in the April 2019 remand, exposure to herbicide agent has been conceded. Given the diagnosis of chloracne, the positive opinion, and the fact that chloracne is an enumerated disease under 38 C.F.R. § 3.309(e) the Board finds that service connection for chloracne is warranted. The Board notes that the record is silent as to whether the chloracne manifested to a degree of 10 percent within a year of the Veteran’s March 1965 separation of his June 1972 separation. However, resolving all reasonable doubt in favor of the Veteran the Board finds that this element has been met and service connection for chloracne is granted. REASONS FOR REMAND The Board remanded the matter in April 2019 in order to obtain afford the Veteran with and examination in order to confirm all current diagnoses of a skin disability and to obtain an adequate opinion. A VA examination was performed in December 2019 and an opinion provided. The VA examiner confirmed several skin disabilities to include actinic eczema, actinic keratosis, and onychomycosis. The December 2019 opinion is inadequate. It is conclusory and is based solely on whether or not the disabilities are presumed to be caused by herbicide agents. As such, a remand is required to obtain an addendum opinion for the skin disabilities, to exclude chloracne. The matters are REMANDED for the following action: 1. Forward the Veteran’s claims file to an appropriate VA examiner for an addendum opinion regarding the nature and etiology of his skin disabilities, other than his now service-connected chloracne. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. The examiner should identify each skin disorder (except chloracne) found at any time during the appeal period. If an examination is performed and any previously diagnosed skin disorder is not found on examination, the examiner should address the prior diagnoses of record and indicate whether they may have resolved or been misdiagnosed. The examiner should provide an opinion as to whether it is at least as likely as not (i.e., probability of 50 percent) that the Veteran’s skin disorder, to exclude chloracne, manifested during active service; or is otherwise related to an event, injury, or disease incurred during active service, to include his presumed exposure to herbicide agents during his service in Vietnam. The examiner is advised that the Veteran is presumed to have been exposed to herbicide agents during service. The examiner is further advised that when a veteran is found not to be entitled to a regulatory presumption of service connection for a given disability that he/she is still required to provide a medical opinion on a direct basis that includes detailed, adequate rationale. (Continued on the next page)   The examiner is asked to provide a complete a rationale for all opinions offered. 2. The AOJ should ensure that the addendum opinion conforms with the remand directives. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Talamantes 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.