Citation Nr: 21065546 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 16-02 814 DATE: October 26, 2021 ISSUE Entitlement to service connection for nodules under the skin, diagnosed as dermatofibromas and lipomas (hereinafter referred to as skin disabilities), including as due to exposure to Gulf War environmental hazards. REMANDED Entitlement to service connection for skin disabilities, including as due to exposure to Gulf War environmental hazards, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1984 to September 1994, including service in Southwest Asia. This matter comes before the Board of Veterans' Appeals (Board) from an April 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board videoconference hearing in February 2019. The Veteran was previously informed that the judge who held that hearing is no longer at the Board. The hearing transcript has been associated with the record. This matter was most recently before the Board in July 2021 when it was remanded for additional evidentiary development. It has since been returned to the Board for further appellate action. The Veteran contends that his skin disabilities are due to his military service, including exposure to a toxic cloud, oily shower, and due to the anthrax vaccination. In response to the Board's remand, an addendum VA-contracted opinion was obtained in August 2021 in which the examiner stated in pertinent part that medical records showed that the Veteran was seen in August 1992 for a rash to the upper thighs with itching which he had previously before. The examiner stated that dermatofibroma was a commonly occurring cutaneous entity usually centered within the skin's dermis. The examiner stated that there were two theories of the genesis of dermatofibromas: (1) reactive process vs. a clonal, and (2) neoplastic proliferation. The examiner stated that evidence existed for both of these theories. The examiner stated that often, patients who presented with a dermatofibroma related a history of possibly inciting local trauma at the site, such as from an insect bite or superficial puncture wound from thorns or wood. The examiner stated that thus, it was reasonable to state that the Veteran's dermatofibromas did not result from his anthrax vaccine in service reaction. In this case, the Board finds that clarification is required from the August 2021 examiner as to whether it is at least as likely as not (50 percent or better probability) that the Veteran's nodules under the skin, diagnosed as dermatofibromas and lipomas, had onset in service or are otherwise related to service; to include the aforenoted 1992 complaints of itching on the thigh. The matter is REMANDED for the following action: 1. Provide access to the electronic claims file to the August 2021 examiner, or appropriate substitute if this examiner is not available, to provide an addendum opinion. The electronic claims file must be made available to and reviewed by the examiner. An examination should be performed if deemed necessary by the examiner providing the requested opinion. Based on review of the files, the examiner should state a medical opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran's nodules under the skin, diagnosed as dermatofibromas and lipomas, had onset in service or are otherwise related to service; to include the aforenoted in-service 1992 complaints of itching on the thigh. 2. After completing the requested actions, and any additional notification and/or development deemed warranted, the RO should readjudicate the claim on appeal. If any benefit sought on appeal remains denied, the RO must furnish the Veteran and his representative with an appropriate supplemental statement of the case and afford a reasonable opportunity for response. MICHAEL A. PAPPAS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R.M.K., 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.