Citation Nr: 21065144 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 18-29 186 DATE: October 25, 2021 REMANDED Entitlement to service connection for a skin disability (other than dermatophytosis, tinea pedis and onychomycosis) is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1997 to March 2004. This appeal comes before the Board of Veterans' Appeals (Board) from an August 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2020, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A hearing transcript is associated with the record. In May 2020, February 2021, and August 2021, the Board remanded the claims for further development. During the pendency of this appeal, a November 2020 rating decision granted service connection for posttraumatic stress disorder (PTSD) and dermatophytosis, to include tinea pedis and onychomycosis. In addition, an August 2021 rating decision granted service connection for bilateral metatarsalgia (claimed as bilateral foot condition). This constitutes a full award of the benefits sought on appeal with respect to these issues. As such, there is no case or controversy for the Board to adjudicate with respect to the original claims for entitlement to service connection for PTSD, dermatophytosis, and bilateral metatarsalgia. See Grantham v. Brown,114 F.3d 1156, 1158-59 (Fed. Cir. 1997); see also 38 U.S.C. § 7104; 38 C.F.R. § 20.101. Accordingly, the only matter remaining for appellate consideration is entitlement to service connection for a skin disability, other than dermatophytosis, tinea pedis and onychomycosis. As stated above, the Board remanded the matter to obtain a VA addendum opinion. Although a medical opinion was obtained in August 2021, the Board finds the opinion inadequate for adjudicative purposes. As such, another remand is necessary to obtain an adequate medical opinion that complies with the terms of the prior remand. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20. 800(c). 38 U.S.C. § 7107(b). Entitlement to service connection for a skin disability, other than dermatophytosis, tinea pedis and onychomycosis, is remanded. The Veteran contends that his skin conditions, primarily affecting his feet, are caused by wading through polluted flood water following a monsoon when he was stationed in Korea in 1998. See Hearing Transcript at 19 (February 2020). The Veteran has been diagnosed with bilateral foot hyperkeratosis and bilateral foot xerosis. See C&P Exam (May 2021). The August 2021 VA examiner opined that the Veteran does not have a skin disability (other than dermatophytosis, tinea pedis, and onychomycosis) that at least as likely as not began in service or is otherwise related to an in-service injury, event or disease. In support of that conclusion, the examiner acknowledged the Veteran's contention that his skin disability affecting the feet is related to his in-service exposure to polluted water. The examiner, however, appears to suggest that the Veteran's report of in-service skin symptoms (i.e., cracking and bleeding) are consistent with insufficient moisture or dry skin and inconsistent with clinical findings expected to be found after exposure to water. The Board notes that the opinion is inadequate. First, the opinion does not discuss whether the Veteran's current diagnoses of hyperkeratosis and xerosis of the bilateral feet are related to the Veteran's exposure to polluted water nor does it address the etiology of those conditions. Further, while the rationale for the opinion is largely predicated on the Veteran's reports of cracking and bleeding skin during service, the examiner failed to draw a distinction between the current diagnosis of xerosis, defined as abnormally dry skin, and the Veteran's reports of in-service cracking and bleeding, defined by the examiner as dry skin. As such, the Board finds the August 2021 medical opinion is inadequate because the conclusions reached are not supported with an analysis that is adequate for the Board to consider and weigh against other evidence of record. A medical opinion report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two." Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Where VA provides an examination or obtains an opinion, it must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Therefore, to ensure that VA has met its duty to assist, remand for an addendum opinion is necessary. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's skin disabilities, diagnosed as xerosis and hyperkeratosis of the bilateral feet. The entire claims file, to include a copy of this REMAND, should be made available to and reviewed by the clinician. Based on review of the record, detail the Veteran's reported symptoms, including the nature, onset, progression and severity of any symptom consistent with any of the above disabilities. The opinion should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). NOTE (1): A negative medical opinion may not be predicated solely on the absence of in-service documented complaints, findings, or treatment. NOTE (2): A negative medical opinion may not dismiss the Veteran's competent report of symptoms in service and since without providing an explanation as to why. For example, if the Veteran's reports about his symptoms do not align with how the currently diagnosed disability is known to develop, explain; or if the Veteran's reports are generally inconsistent with medical knowledge or implausible, explain. NOTE (3): If another etiology is the more likely cause of the disability, then identify that etiology and fully explain. The conclusions must be supported with data (e.g. history, findings, etc.) along with a reasoned medical explanation connecting the two. The clinician should provide an opinion, with supporting rationale, as to the following: Whether the Veteran's skin disabilities, diagnosed as xerosis and hyperkeratosis of the bilateral feet, at least as likely as not (1) began in service, or (2) are otherwise related to an in-service injury, event, or disease. Consider and expressly address whether these conditions stem from in-service exposure to contaminated/polluted water. Explain. 2. Ensure that the VA medical opinion obtained include a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Krunic, 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.