Citation Nr: 21063120 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 14-29 333 DATE: October 13, 2021 REMANDED Entitlement to service connection for a skin disorder is remanded. Entitlement to service connection for hypertension (HTN) is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1963 to May 1967 with service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned at a hearing in October 2017. The Board remanded this matter in April 2018, April 2020, October 2020, and August 2021 for additional development. The matter is now returned to the Board for further appellate review. This appeal is advanced on the Board's docket pursuant to 38 C.F.R. § 20.902(c) (2019); 38 U.S.C. § 7107 (a)(2) (2012). 1. Entitlement to service connection for a skin disorder is remanded. The Board remanded this matter in August 2021 to obtain a medical opinion for the Veteran's skin disorder, finding the previous opinion of record to be inadequate. VA obtained a new nexus opinion in September 2021. Unfortunately, it is inadequate to adjudicate the Veteran's claim. In the August 2021 Board remand, the Board requested the selected clinician opine whether any currently identified skin disorder is at least as likely as not related to an in-service injury, event, or disease, including skin conditions noted in the Veteran's service treatment records (calluses, plantar warts, cellulitis, and sebaceous cyst). The examiner concluded the Veteran's current skin conditions, including dermatographism, pressure urticaria, xerosis, and eczematous are not related to the skin conditions noted in his service treatment records (STRs). The examiner did not provide any further discussion or rationale to support the negative nexus opinion. The examiner also opined whether the skin conditions noted in the Veteran's STRs are related to his service. As noted above, the Board requested the selected clinician address the etiology of the Veteran's current skin disorder and whether any are related to an in-service injury, event, or disease, to include the skin conditions noted in his STRs. The Board did not request the selected clinician address the etiology of the skin conditions noted in the Veteran's STRs. Accordingly, the September 2021 medical nexus opinion is inadequate. See Barr v. Nicholson, 21 Vet. App. 303, 311; see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (probative value of a medical opinion is derived from it being factually accurate, fully articulated, and soundly reasoned). 2. Entitlement to service connection for HTN is remanded. The Board remanded this matter in August 2021 to obtain an etiology opinion for the Veteran's HTN, finding the previous opinion of record to be inadequate. VA obtained a new nexus opinion in September 2021. Unfortunately, it is inadequate to adjudicate the Veteran's claim. The examiner provided a negative nexus opinion, in part, because the Veteran has risk factors for hypertension, including obesity, sedentary lifestyle, family history, long history of smoking, and race. The examiner did not explain why these risk factors weigh against service connection and are more likely responsible for the Veteran's hypertension. This is particularly relevant because of the Veteran's conceded herbicide agent exposure and studies conducted by the National Academy of Sciences Institute of Medicine (NAS) related to hypertension and herbicide agent exposure, including "Veterans and Agent Orange: Update 11 (2018)," which shows a positive association between herbicide agent exposure and hypertension. Further, in the August 2021 remand, the Board requested the selected clinician specifically discuss the 2018 NAS update. Although the examiner referenced the 2018 NAS update, the examiner did not provide a meaningful discussion. Barr, 21 Vet. App. at 311; Stegall v. West, 11 Vet. App. 268, 271 (1998) (remand by Board confers upon claimant, as a matter of law, the right to compliance with remand order). The matters are REMANDED for the following action: 1. Obtain a medical opinion regarding the nature and etiology of any current skin disorder, to include: dermatographism, pressure urticaria, xerosis, and eczematous. The entire claims file must be made available to and be reviewed by the selected clinician. The Veteran should only be scheduled for a new examination if deemed necessary by the selected clinician. The examiner must opine whether any identified skin disorder is at least as likely as not (50 percent or greater probability) related to an in-service injury, event, or disease, including skin conditions noted in the Veteran's service treatment records (calluses, plantar warts, cellulitis, and sebaceous cyst). The provided opinion must be supported by a rationale based on the facts of the Veteran's case. If the clinician determines that the Veteran has not had eczematous at any point during the appeal, the examiner must explain why he or she concluded that the diagnosis of eczematous reflected in the record was made in error. The examiner must also discuss the Veteran's October 2017 testimony that he experienced in-service rashes and these rashes recurred after his separation from service. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide a reason for doing so. The examiner may not dismiss the Veteran's report of in-service and post-service rashes solely because they are not documented in contemporaneous medical records. 2. Obtain a medical opinion regarding the nature and etiology of the Veteran's hypertension. The entire claims file must be made available to and be reviewed by the selected clinician. The Veteran should only be scheduled for a new examination if deemed necessary by the selected clinician. The examiner must opine whether the Veteran's hypertension is at least as likely as not (50 percent or greater probability) related to an in-service injury, event, or disease, including his conceded herbicide agent exposure. The clinician must also opine whether hypertension at least as likely as not (1) began during active service, or (2) manifested within one year after discharge from service. In responding to these inquiries, the examiner must fully review the relevant evidence of record. The examiner must specifically address the following evidence: a) the Veteran's contention that he was diagnosed with hypertension shortly after his separation from active service. b) the Veteran's testimony that he was initially told that he had hypertension in the 1970s or 1980s at the Allen Park VA. c) the 2018 update to the NAS study which concluded that there is "sufficient" evidence of an association between herbicide agent exposure and hypertension. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Zachery S.C. Luce, 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.