Citation Nr: 21065740 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 15-02 378 DATE: October 27, 2021 REMANDED Entitlement to service connection for a skin condition, to include folliculitis, rosacea, and actinic keratoses, as due to herbicide exposure is remanded. Entitlement to service connection for a heart condition, to include left bundle branch block, as secondary to herbicide exposure is remanded. REASONS FOR REMAND The Veteran had active service from May 1968 to February 1972. These matters are before the Board of Veterans' Appeals (Board) on appeal from the September 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, VA conceded herbicide exposure. See VA Memo, August 2019. These issues were previously before the Board in October 2018 and May 2021, with the latter remanding for new examinations and addendum opinions regarding whether the claimed conditions are related or attributable to the Veteran's conceded herbicide exposure. In Stegall v. West, 11 Vet. App. 268, 271 (1998), the United States Court of Appeals for Veterans Claims (Court) held that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the Board's remand order. Moreover, the Court held that the Board itself errs when it fails to ensure compliance with the terms of its remand. Id. The Board finds that the agency of original jurisdiction did not substantially comply with the remand directives because the opinions did not adequately address whether the claimed conditions are related or attributable to the Veteran's conceded herbicide exposure. See Stegall, 11 Vet. App. at 271. While additional delay is regrettable, the Board finds that another remand is required to fairly decide the Veteran's claims. 1. Entitlement to service connection for a skin condition, to include folliculitis, rosacea, and actinic keratoses, as due to herbicide exposure is remanded. The May 2021 Board remand directed the examiner to provide an opinion as to whether it was at least as likely as not that the Veteran's skin condition is etiologically related to or the result of the Veteran's conceded herbicide exposure. Additionally, the examiner was advised that an unfavorable opinion cannot be based solely on the fact that service treatment records (STRs) do no mention the identified skin condition. In response to the May 2021 remand, a VA examination and opinion were obtained in July 2021. The Veteran was diagnosed with actinic keratoses, folliculitis, and rosacea. The examiner opined that the Veteran's skin conditions are less likely than not related to exposure to herbicides during military service because there was no diagnosis of a skin condition during active duty. The rationale provided was that there would be a record showing complaints of skin changes or a letter stating the Veteran was exposed to herbicides due to a job duty and since there are no records of either, it cannot be connected to service. The Board finds that the medical opinion is inadequate because it contains only data and conclusions, and does not provide an etiological opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). As, the examiner did not adequately address herbicide exposure as directed by the May 2021 Board remand, nor did she acknowledge that the herbicide exposure was conceded, an opinion addressing this theory of entitlement is still needed. Stegall, 11 Vet. App. at 268. As such, the issue is remanded. 2. Entitlement to service connection for a heart condition, to include left bundle branch block, as secondary to herbicide exposure is remanded. The May 2021 Board remand directed the examiner to list all of the Veteran's current heart conditions other than atrial fibrillation, and provide an opinion as to whether it was at least as likely as not that the Veteran's heart condition is etiologically related to or the result of the Veteran's conceded herbicide exposure. In response to the May 2021 remand, a VA examination and opinion were obtained in July 2021. The Veteran was diagnosed with atrial fibrillation and left bundle branch block. However, contrary to the May 2021 directives, the examiner only provided an opinion regarding atrial fibrillation. Id. Therefore, an opinion is still needed for the Veteran's left bundle branch block. As such, the issue must be remanded. The matters are REMANDED for the following action: 1. Forward the Veteran's claims file and a copy of this REMAND to an appropriate VA clinician. The clinician must review the claims file, including a complete copy of this remand. If an examination is deemed necessary, please schedule one. The examiner must opine as to whether the Veteran's currently diagnosed skin conditions are at least as likely as not related to or the result of the Veteran's conceded herbicide exposure. The examiner is advised that an unfavorable opinion cannot be based solely on the fact that the skin condition identified is not on the list of diseases presumptively associated with exposure to herbicide agents or just because the service treatment records (STRs) do not mention the condition. Complete rationales must be provided for all opinions expressed. If the examiner is unable to provide an opinion, he or she must state why, addressing whether this is due to limited medical knowledge and stating (if possible) what information is necessary to give a more conclusive opinion. 2. Forward the Veteran's claims file and a copy of this REMAND to the appropriate VA examiner. The examiner must review the claims file, including a complete copy of this remand. If an examination is deemed necessary, please schedule one. The examiner must opine as to whether the Veteran's currently diagnosed heart condition, other than atrial fibrillation, is at least as likely as not related to or the result of the Veteran's conceded herbicide exposure. Specifically, address the Veteran's diagnosed left bundle branch block. The examiner is advised that an unfavorable opinion cannot be based solely on the fact that the skin condition identified is not on the list of diseases presumptively associated with exposure to herbicide agents or just because the STRs do not mention the condition. (Continued on the next page) Complete rationales must be provided for all opinions expressed. If the examiner is unable to provide an opinion, he or she must state why, addressing whether this is due to limited medical knowledge and stating (if possible) what information is necessary to give a more conclusive opinion. A. J. Spector Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Camille NeSmith, Associate 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.