Citation Nr: 21063696 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 14-25 407 DATE: October 15, 2021 ORDER Entitlement to service connection for hypothyroidism, to include a skin disorder (ichthyosis), is granted. FINDINGS OF FACT 1. The Veteran's hypothyroidism is presumed to be associated with in-service exposure to herbicide agents. 2. The Veteran's diagnosed ichthyosis is caused by hypothyroidism. CONCLUSION OF LAW The criteria for have been met for service connection for hypothyroidism to include a skin disorder (ichthyosis). 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from August 1967 to August 1969. This case comes before the Board of Veterans' Appeals (Board) on appeal from a June 2011 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO). This issue was previously before the Board in August 2017, March 2019, January 2021, and April 2021, when it was remanded for further development. That development was completed, and the case has since been returned to the Board for appellate review. Duties to Notify and Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.326(a). Considering the Board's favorable decision, however, any deficiencies in VA's duties to notify and assist the Veteran with his claim decided herein are moot. Service connection Legal Criteria Certain chronic diseases may be presumed to be service connected as due to exposure to herbicide agents if manifested in Vietnam during the Vietnam Era. See 38 U.S.C. § 1116; 38 C.F.R. § § 3.307, 3.309(e). The presumptive provisions of 38 U.S.C. § 1116 have been extended to encompass Veterans shown to have been otherwise exposed to tactical herbicides in service on the Demilitarized Zone (DMZ) in Korea. See 38 C.F.R. § 3.307(a)(6)(iv). The National Defense Authorization Act (NDAA) for Fiscal Year 2021, Pub. L. No. 116-283 § 9109, added three disorders to the list of diseases presumptively associated with exposure to herbicide agents. Specifically, it amended 38 U.S.C. § 1116(a)(2) to include parkinsonism, bladder cancer, and hypothyroidism. The Board is required to consider all issues raised either by the claimant or the evidence of record. Robinson v. Mansfield, 21 Vet. App. 545, 552 (2008). This duty includes broadly construing a claim "based on the reasonable expectations of the non-expert, self-represented claimant and the evidence developed in processing that claim," including the claimant's description of the claim and symptoms, as well as medical information submitted or obtained by VA. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). When a claimant makes a claim, he or she is seeking service connection for symptoms, regardless of how those symptoms are diagnosed or labeled. Id. Therefore, where a claimant identifies a particular mental health diagnosis, such as PTSD or anxiety disorder, in a claim form, the scope of the claim should not be limited only to that diagnosis; rather, it must be considered a claim for any mental disability that may be reasonably encompassed by the evidence of record. Id. at 6. The scope of a claim can remain an issue when granting service connection for a specific mental disorder, such as PTSD, as opposed to service connection for a general psychiatric disorder. In those situations, the Board should address and properly adjudicate any other mental disorders reasonably raised by the record and within the scope of the filed claim, or adequately explain why the other diagnosed mental disorders do not warrant consideration for service connection. See Clemons, 23 Vet. App. at 6; see also 38 U.S.C. § 7104(d). This rule also applies to non-mental health conditions. See Brokowski v. Shinseki, 23 Vet. App. 79 (2009) (regarding a neurological disorder). A claimant may "identify the benefit sought" for their claim "by referring to a body part or system that is disabled or by describing symptoms of the disability." Id. at 86-87 (citing to Clemons and 38 C.F.R. § 3.159(c)(3)). Factual Background The Veteran filed a July 2010 claim to reopen a claim of service connection for skin rashes. The Veteran stated he was exposed to herbicide agents while serving in the DMZ in Korea. A June 2011 rating decision denied reopening based on no new and material evidence. The Veteran filed a September 2011 notice of disagreement (NOD). The Veteran submitted a September 2011 article that stated ichthyosis is usually associated with general systemic disease including underactive thyroid. The Veteran submitted a September 2011 supplemental claim for a thyroid condition. An October 2007 VA memorandum confirmed the Veteran's unit served in Korea and was stationed at the DMZ from January 1968 to January 1969. Analysis First, the Board finds the claim for a skin disorder should be broadened to include hypothyroidism due to herbicide agent exposure. The Veteran is not required to know his skin rash may be due to an underlying cause. The Veteran is only required to describe his symptoms. See Brokowski v. Shinseki, 23 Vet. App. 79 (2009). In the initial claim to reopen the Veteran described skin rashes. Second, hypothyroidism is presumed to be associated with in-service exposure to herbicide agents. A March 2011 VA treatment record showed a diagnosis of hypothyroidism. The October 2007 VA memorandum confirmed the Veteran's unit served at the DMZ in Korea. Accordingly, herbicide agent exposure is confirmed and service connection for the Veteran's hypothyroidism is warranted. Lastly, the Veteran's current skin disorder is associated with hypothyroidism. A September 2011 VA dermatology treatment record diagnosed ichthyosis acquired type associated with hypothyroidism. Additionally, the VA dermatologist noted herbicide agent exposure and referred the Veteran to endocrinology for treatment of the skin disorder. An August 2017 VA examination confirmed a diagnosis for ichthyosis. An October 2019 VA examiner opined it was at least as likely as not the Veteran's skin disorder was related to herbicide agent exposure in-service. The VA examiner specifically referenced the September 2011 VA treatment record. The examiner explained the VA dermatologist noted herbicide agent exposure which implied the exposure initiated the condition's onset. A January 2021 VA examiner provided a negative opinion for direct service connection. However, the examiner explained acquired ichthyosis is usually associated with other diseases, such as thyroid disease. The examiner cited to medical literature in the rationale. The Board notes there are negative direct service connection opinions of record. However, the opinions do not consider that the Veteran's skin disorder is associated with his hypothyroidism. The most probative evidence of record makes it clear the skin symptoms are associated with the Veteran's hypothyroidism. Notably, the Veteran's VA dermatologist sent the Veteran to an endocrinologist for treatment of the skin disorder. Accordingly, service connection is granted for hypothyroidism to include the Veteran's ichthyosis. David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Bruton, C 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.