Citation Nr: 21061538 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 17-45 015 DATE: October 4, 2021 REMANDED Entitlement to service connection for a skin disorder, to include as due to in service herbicide exposure, is remanded. REASONS FOR REMAND The Veteran, who is the appellant, had active service from August 1966 to August 1970. This matter came before the Board of Veterans' Appeals (Board) on appeal from a June 2016 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. The instant matter was previously before the Board in May 2019, where the Board remanded the issue for additional development. Unfortunately, for the reasons discussed below, the Board finds the directed development was not adequately completed, and remand for a new VA skin examination and opinion is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection for a Skin Disorder is Remanded. VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. Floyd v. Brown, 9 Vet. App. 88, 93 (1996). VA must afford a veteran a medical examination and/or obtain a medical opinion when it is necessary to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). A remand by the Board confers on the claimant, as a matter of law, the right to compliance with the remand orders. Failure of the Board to ensure compliance with remand instructions constitutes error and warrants the vacating of a subsequent Board decision. See Stegall, 11 Vet. App. at 271. The Veteran first received a VA skin examination in May 2016. At that time, the VA examiner diagnosed dermatitis, and then rendered a negative nexus opinion due to a lack of evidence that skin disability symptoms diagnosed in 2011 were related to the Veteran's multiple in-service skin diagnoses/treatments. In May 2019, the Board remanded for a new VA skin disability opinion on the questions of 1) whether it was at least as likely as not that a currently diagnosed skin disorder was related to the multiple in-service skin diagnoses; and 2) whether it was at least as likely as not that a currently diagnosed skin disorder was related to presumed in service herbicide exposure. Further, the Board directed that, in rendering the first opinion, the VA examiner was to consider the Veteran's "competent and credible report that he has experienced rashes intermittently since returning from Vietnam." A new VA examination and corresponding opinions were obtained in November 2019. As to the first question, the VA examiner appears to render a negative opinion on the basis that the in-service skin symptoms were acute only, there was no post-service chronicity of care until 2011, and the Veteran's dermatitis went into remission in 2017. Such opinion does not recognize the diagnosis of dermatitis during the course of this appeal, and also does not address the Veteran's statements, which the Board has previously found credible, concerning skin disorder symptoms from service separation to the present. As to the question of whether a currently diagnosed skin disorder was related to presumed in service herbicide exposure, in rendering a negative opinion the VA examiner merely stated that, without further evidence regarding the rash, the claimed condition was less likely than not related to the presumed in-service herbicide exposure. As no rationale was provided for this opinion, it is not adequate for VA rating purposes. Finally, in the opinion report the VA examiner explained that, prior to 2017, the Veteran might have had a diagnosis of mycosis fungoides, rather than dermatitis/eczema, which is a skin disease that can be caused by non-Hodgkin's lymphoma; however, the VA examiner stated that, "without more workup [I am] unable to make that diagnosis at this time." As the Veteran is service connected for non-Hodgkin's lymphoma, remand for clarification of diagnosis and a secondary service connection (38 C.F.R. § 3.310) opinion is necessary. The issue of service connection for a skin disorder is REMANDED for the following action: 1. Contact the Veteran and request information as to any outstanding private treatment (medical) records concerning the skin. Upon receipt of the requested information and the appropriate releases, the Agency of Original Jurisdiction (AOJ) should contact all identified health care providers and request that they forward copies of all available treatment records and clinical documentation for the relevant time period on appeal pertaining to the treatment of the skin disorders, not already of record, for incorporation into the record. If identified records are not ultimately obtained, the Veteran should be notified pursuant to 38 C.F.R. § 3.159(e). 2. Associate with the record all VA treatment records pertaining to the treatment of the Veteran's skin, not already of record, for the period from April 2021. 3. Schedule the appropriate VA skin examination. A rationale for all opinions and a discussion of the facts and medical principles involved should be provided. The VA examiner should provide the following opinions: A) The VA examiner should provide a diagnosis for all skin disorders present since on or about January 2016 to the present, to include any skin disorders that may have resolved during the appeal period. In particular, the VA examiner should address whether the Veteran has/had a diagnosis of mycosis fungoides. B) For each skin disorder diagnosed, is it at least as likely as not (50 percent or higher degree of probability) that the diagnosed skin disorder is caused by and/or related to the Veteran's in-service skin treatment. When answering this question, please consider the Veteran's competent and credible report that he has experienced rashes intermittently since returning from Vietnam and separating from the military in 1970. The Board also directs the VA examiner's attention to a February 2016 VA treatment record indicating that the Veteran had a small rash on the right hand, which the Veteran states was similar to prior episodes of ringworm. C) For each skin disorder diagnosed, is it at least as likely as not (50 percent or higher degree of probability) that the diagnosed skin disorder is related to the Veteran's presumed in-service herbicide exposure? D) For each skin disorder diagnosed, in particular mycosis fungoides (if diagnosed), is it at least as likely as not (50 percent or higher degree of probability) that the diagnosed skin disorder was caused by the service connected non-Hodgkin's lymphoma. E) For each skin disorder diagnosed, in particular mycosis fungoides (if diagnosed), is it at least as likely as not (50 percent or higher degree of probability) that the diagnosed skin disorder was aggravated (that is, worsened in severity) by the service connected non Hodgkin's lymphoma. 4. Then, readjudicate the remanded issue. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Blowers, 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.