Citation Nr: 21063903 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 16-01 299 DATE: October 18, 2021 ORDER Entitlement to service connection for a skin condition is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army from September 1963 to September 1967. This case comes before the Board of Veterans Appeals (Board) from a June 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The matter has previously been considered by the Board in August 2019 and December 2020. 1. Entitlement to service connection for a skin condition At the outset, the Board recognizes that there have been previous remands for additional development. While the Board regrets the delay involved in remanding this case again, it is also of the opinion that further development is required to comply with VA's duty to assist the Veteran in the development of the facts pertinent to his claim. See 38 C.F.R. § 3.159. The Veteran seeks service connection for a skin condition which he contends began during his active duty service, to include as a result of his exposure to Agent Orange while serving in the Republic of Vietnam. As noted in the August 2019 remand, although the Veteran's claimed skin condition is not one of those enumerated diseases which have associated with herbicide agent exposure under 38 C.F.R. § 3.309(e), a claimant is not precluded from establishing service connection for such disability as due to herbicide agent exposure with proof of direct causation. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). As a result, the claim was remanded, in part, for a VA medical opinion to address the question of whether the Veteran's claimed skin condition was due to his conceded exposure to herbicide agents in service. In June 2021, the Veteran was afforded a VA examination wherein chronic pruritis was diagnosed. The examiner opined that this condition was less likely than not incurred in or caused by the exposure to Agent Orange during service. However, the sole rationale for that opinion was that pruritis was not listed as one of the presumptive service connected disabilities for herbicide agents exposure. As noted, for any disability that is not presumed to be related to herbicide agent exposure, service connection may still be established with proof of direct causation. Accordingly, the June 2021 VA examiner's rationale is inadequate and remand for a new VA medical opinion is necessary to independently answer whether the condition is one which could be the result of Agent Orange. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's claimed skin condition, including chronic pruritis, is at least as likely as not related to in-service exposure to herbicide agents. The examiner is advised that a negative opinion cannot be based solely on the fact that the claimed skin condition is not on the list of diseases that are presumptively associated with exposure to herbicide agents. (Continued on the next page) If the examiner determines that a physical examination of the Veteran is necessary to provide the requested opinion, such should be arranged. The examiner should provide a complete rationale for all opinions rendered. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Stuedemann, Angela L. 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.