Citation Nr: 21065049 Decision Date: 10/22/21 Archive Date: 10/22/21 DOCKET NO. 14-11 398 DATE: October 22, 2021 REMANDED Entitlement to service connection for a skin disability is remanded. REASONS FOR REMAND The Veteran had active duty service from November 1967 to June 1969. He has confirmed service in the Republic of Vietnam, and among other awards he is in receipt of the Bronze Star with Oak Leaf Cluster. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO), in which the RO, in relevant part, denied service connection for a skin disability. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a videoconference hearing in February 2016. A copy of the hearing transcript has been reviewed and associated with the claims file. This matter was previously before the Board in April 2018, September 2020, and May 2021, and it was remanded each time for further evidentiary development. Entitlement to service connection for a skin disability is remanded. The Board remanded this matter in May 2021 because the Veteran's medical records revealed additional diagnoses of seborrheic dermatitis, erythrotelangiectatic rosacea, and seborrheic keratosis in February 2020 and a markedly atypical compound nevus in September 2020. Pursuant to the Board's remand directives, an addendum medical opinion was obtained in July 2021. The examiner opined that the Veteran's seborrheic dermatitis, seborrheic keratosis, and compound nevus are each less likely than not related to his active duty service, including his conceded exposure to herbicide agents. Regarding the erythrotelangiectatic rosacea, the examiner stated that the Veteran's medical records did not show that he has been diagnosed with such. The Board finds that the examiner's opinions regarding dermatitis, keratosis, and nevus are all adequate. However, her conclusion that the Veteran does not have an erythrotelangiectatic rosacea diagnosis is contrary to the evidence of record. His VA treatment records show a diagnosis of erythrotelangiectatic rosacea on the face and forehead in February 2020. On remand, the examiner should either provide an etiology opinion for the Veteran's rosacea or provide an explanation as to why the diagnosis of record cannot be confirmed. The matter is REMANDED for the following actions: 1. Obtain and associate with the claims file the Veteran's updated VA treatment records. 2. Obtain an addendum opinion from the examiner who provided the July 2021 VA medical opinion or, if she is unavailable then another similarly qualified examiner may respond instead. The entire claims file, including a copy of this remand, must be made available for review by the examiner, and such review should be noted in the examination report. A new VA examination is only necessary if deemed so by the examiner. After reviewing the evidence, the examiner is asked to opine as to whether the Veteran's documented erythrotelangiectatic rosacea is at least as likely as not (a 50 percent or greater probability) related to his active duty service, including his exposure to sunlight and his conceded exposure to herbicide agents. If the diagnosis of erythrotelangiectatic rosacea cannot be validated or confirmed, please explain why this is so. The examiner must provide a comprehensive rationale for the requested opinion. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports are to be considered in formulating any opinion. If any opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner does not have the knowledge or training. As appropriate, the AOJ should conduct additional development or supplement the record. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Pratt 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.