Citation Nr: 21061904 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 16-21 177 DATE: October 5, 2021 REMANDED Entitlement to service connection to a skin disability to include eczema, lichen simplex chronicus, and scars of the back, head and legs, to include as secondary to service-connected depressive disorder is remanded. Entitlement to service connection for hypertension, to include as secondary to service-connected depressive disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1966 to September 1966. This case initially came to the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In May 2021, the Board remanded the matter for further evidentiary development. Although the Board regrets the delay, additional development is needed to comply with the May 2021 remand instructions. Stegall v. West, 11 Vet. App. 268 (1998). 1. Skin Disability The Veteran contends that a skin disability is related to service. In an alternative theory, he contends that a skin disability is secondary to service-connected depressive disorder. In July 2021, the Veteran was afforded a VA examination. The examiner opined that the Veteran's skin disability was not aggravated by service-connected disability. The examiner provided a detailed rationale as to why skin disability was not aggravated by service-connected depressive disorder, however, the examiner failed to provide a clear opinion with rationale addressing whether the Veteran's skin disability was caused by his service-connected depressive disorder. 38 C.F.R. § 3.310. In light of the above, the Board finds the examiner's opinion is inadequate and another VA medical opinion is required. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide an examination or obtain a medical opinion, it must ensure that the examination or opinion is adequate). 2. Hypertension The Veteran contends that his hypertension is related to service. In an alternative theory, he contends that his hypertension is secondary to service-connected depressive disorder. In July 2021, the Veteran was afforded a VA examination. The examiner opined that the Veteran's hypertension was not aggravated by service-connected disability. The examiner's reasoning was there is not enough evidence to support hypertension as aggravated beyond its natural progression by the Veteran's depressive disorder. The examiner indicated that it was noted in the military records October 10, 1966 that the Veteran had trauma when he was 14 years old resulting in his homosexual impulses during active military duty ending in his depressive disorder. The examiner noted that the Veteran's (claimed condition/diagnosis) was less likely than not aggravated beyond its natural progression by depressive disorder. The examiner also failed to provide a clear opinion with rationale addressing whether the Veteran's hypertension is related to service or caused by service-connected depressive disorder. Moreover, the relevance of the references to childhood trauma and in-service homosexual impulses to the conclusion is unclear. In light of the above, the Board finds the examiner's opinion is inadequate and another VA medical opinion is required. Barr, 21 Vet. App. at 312. The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate specialist physician as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's skin disability was either (a) caused or (b) aggravated by his service-connected depressive disorder. Both causation and aggravation should be specifically addressed. If an examination is deemed necessary, one should be conducted, to include via telehealth if warranted. The claims file should be reviewed by the physician. If aggravation is found, the physician should identify the baseline level of severity prior to the onset of aggravation. The physician must provide a complete rationale for any opinion set forth. In addressing this matter, the physician should address the pertinent evidence in the service treatment records, post service medical records and examinations, as well as the lay evidence provided by the Veteran. 2. Obtain an opinion from an appropriate specialist physician to determine the nature of the Veteran's hypertension. If an examination is deemed necessary, one should be conducted, to include via telehealth if warranted. The physician should review the claims file prior to rendering the opinion. The physician should answer the following questions: Is at least as likely as not (50 percent or greater probability) that the Veteran's current hypertension had its onset during active service, within the one-year presumptive period, or is otherwise related to service? If the physician determines that the Veteran's hypertension is not directly related to service, then he or she should provide an opinion, with supporting rationale, as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's current hypertension is either (i) caused or (ii) aggravated by his service-connected depressive disorder? If aggravation is found, the physician should identify the baseline level of severity prior to the onset of aggravation. (Continued on the next page) The physician must provide a complete rationale for any opinion set forth. In addressing this matter, the specialist physician should address the pertinent evidence in the service treatment records, post service medical records and examinations, as well as the lay evidence provided by the Veteran. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Walker, 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.