Citation Nr: 21004798 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 14-09 835 DATE: January 28, 2021 REMANDED Entitlement to service connection for a skin disability, including due to Agent Orange exposure, is remanded. REASONS FOR REMAND The Veteran had active duty service from March 1968 to March 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO), which, in relevant part, denied service connection for actinic keratosis. The Veteran and his wife testified before the undersigned Veterans Law Judge (VLJ) at a hearing in August 2014. This matter was before the Board in February 2016, May 2018, and August 2020, and remanded for additional evidentiary development. Entitlement to service connection for a skin disability, including due to Agent Orange exposure, is remanded. Throughout the rating period on appeal, the Veteran has been assessed with basal cell carcinoma of the skin, folliculitis, neoplasm of the skin, actinic keratoses, seborrheic keratoses, and skin erosions. He asserts that his skin disability was incurred in service, including due to his exposure to Agent Orange. He served in Vietnam from September 1968 to September 1969. Thus, exposure to Agent Orange is conceded. The Veteran’s service-treatment records reveal that he had an infection on the left side of his neck in April 1969, which was cleaned, and he was instructed not to shave. He testified at the hearing in August 2014 and indicated that this was a skin rash on his neck, which was red and bumpy, which came back in the same spot. His wife testified and indicated that it later spread to his eyebrows. Pursuant to the Board’s August 2020 remand instructions, a medical opinion was issued in October 2020. The examiner concluded that the Veteran’s actinic keratosis or seborrheic keratosis was not related to service given that there was no diagnosis in service and his symptoms were subjective only. After a review of the evidence, the Board finds that the August 2020 medical opinion is insufficient to determine the present claim. In this regard, the August 2020 examiner, and the previous examiners, failed to provide an opinion as to whether the Veteran’s skin disability was directly related to his conceded exposure to Agent Orange. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994); Stefl v. Nicholson, 21 Vet. App. 120 (2007) (notwithstanding the presumptive provision, a claimant is not precluded from establishing service connection for disability due to Agent Orange exposure with proof of direct causation). Moreover, the examiner failed to discuss the additional skin disabilities of record, i.e., folliculitis, neoplasm of the skin, and skin erosions. Given the procedural history in this matter, the Board finds that a VA examination and/or medical opinion by a dermatologist is warranted on remand. The matter is REMANDED for the following actions: 1. Obtain and associate with the claims file the Veteran’s updated VA treatment records from October 2020 to the present. 2. After completion of #1, schedule the Veteran for a VA examination with a dermatologist to provide an opinion regarding the nature and etiology of the Veteran’s skin disability. If an examination is not able to be performed and/or not necessary, please forward the claims file to a dermatologist to provide an opinion in this matter. The claims file, including a copy of this remand, must be reviewed in its entirety and such review should be noted in the examination report. The examiner should discuss all skin disabilities found on examination and identified during the pendency of this claim, including basal cell carcinoma of the skin, folliculitis, neoplasm of the skin, actinic keratoses, seborrheic keratoses, and skin erosions. For each skin disability, please respond to the following: Is it at least as likely as not (probability of at least 50 percent) that the Veteran’s skin disability was incurred in and/or etiologically related to his period of active service, including his conceded exposure to Agent Orange? The examiner is advised that he or she should discuss whether the Veteran’s skin disability is directly related to his exposure to Agent Orange regardless of whether or not it is on the presumptive list. The examiner must provide a comprehensive rationale for each opinion provided.  The examiner should review and discuss the Veteran’s August 1969 service-treatment record, his hearing testimony, and statements of record, including the May 2012 statement. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports are to be considered in formulating any opinion.    If any opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner does not have the knowledge or training.  As appropriate, the AOJ should conduct additional development or supplement the record.    Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. (Hurley) Merrick 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.