Citation Nr: 21065877 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 17-40 618 DATE: October 27, 2021 ORDER Entitlement to revision of a July 1969 rating decision denying entitlement to service connection for bilateral hearing loss based on clear and unmistakable error (CUE) is denied. REMANDED Entitlement to an increased disability evaluation for chloracne is remanded. FINDINGS OF FACT 1. The Veteran's claim for service connection for bilateral hearing loss was denied in a July 1969 rating decision, which became final because he did not submit a notice of disagreement or new and material evidence within the appeal period. 2. The correct facts, as known at the tie, were before the adjudicators in July 1969 and the statutory and regulatory provisions extant at the time were correctly applied. CONCLUSION OF LAW The criteria for entitlement to revision of a July 1969 rating decision denying entitlement to service connection for bilateral hearing loss based on CUE have not been met. 38 U.S.C. § 5109A; 38 C.F.R. §§ 3.104, 3.105(a). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the United States Navy from September 1967 to February 1969, with additional service in the United States Naval Reserve. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2020, the Veteran testified at a hearing before the undersigned. A transcript of his testimony has been associated with the claims file. At the outset, the Board notes that at his September 2020 hearing, the Veteran and his representative argued that there was clear and unmistakable error in a July 1969 rating decision to the extent that service connection was not granted for tinnitus. Nonetheless, because the RO has not yet adjudicated this claim, it is not currently on appeal and the Board therefore lacks jurisdiction over it. As such, the Board will refer the matter to the RO for adjudication in the first instance. Clear and Unmistakable Error By way of procedural background, the Veteran originally applied for service connection for bilateral hearing loss in April 1969. This application was denied in a July 1969 rating decision. Subsequently, the Veteran filed a motion to revise the July 1969 rating decision. In a March 2012 rating decision, the RO denied this motion. In a May 2012 notice of disagreement, he indicated that he disagreed with the outcome of the March 2012 rating decision because he did not have hearing loss prior to service. Additionally, he submitted various lay statements regarding the onset of his hearing loss. Thereafter, the RO reopened his claim for service connection in an August 2015 rating decision, which also granted service connection for bilateral hearing loss from April 26, 2010. The Veteran asserts that he is entitled to an earlier effective date for service connection for bilateral hearing loss because the July 1969 rating decision denying service connection contains clear and unmistakable error, or CUE. More specifically, the Veteran's representative has argued that the RO erred in its July 1969 rating decision because the Veteran did not actually have preexisting hearing loss in his right ear and because his hearing was in fact aggravated by service. To that end, the Veteran and his representative have challenged the findings of a Navy medical board report and contend that his hearing loss progressed during service. But for these errors, they allege, service connection for hearing loss would have been granted. A previous RO determination that is final and binding will be accepted as correct in the absence of CUE. Where evidence establishes such error, the prior decision will be reversed or amended. 38 C.F.R. § 3.105(a). Here, the Veteran did not file a timely Notice of Disagreement challenging the July 1969 rating decision, nor did he submit new evidence and material evidence within one year of its promulgation. Thus, the July 1969 rating decision became final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104(a), 3.160(d), 3.156(b), 20.302, 20.1103. Once a decision becomes final, it may only be revised by a showing of CUE. 38 C.F.R. §§ 3.104, 3.105. CUE is a very specific and rare kind of "error." It is the kind of error, of fact or of law, that when called to the attention of later reviewers compels the conclusion, to which reasonable minds could not differ, that the result would have been manifestly different but for the error. Simply to claim CUE on the basis that previous adjudications had improperly weighed and evaluated the evidence can never rise to the stringent definition of CUE. Similarly, neither can broad-brush allegations of "failure to follow the regulations" or "failure to give due process," or any other general, nonspecific claim of "error." Fugo v. Brown, 6 Vet. App. 40, 43-44 (1993). In addition, failure to address a specific regulatory provision involves harmless error unless the outcome would have been manifestly different. Id. at 44. Where evidence establishes CUE, the prior decision will be reversed or amended. 38 C.F.R. § 3.105(a). For the purpose of authorizing benefits, the rating or other adjudicatory decision which constitutes a reversal of a prior decision on the grounds of CUE has the same effect as if the corrected decision had been made on the date of the reversed decision. Id. CUE is established when the following conditions are met: (1) either (a) the correct facts in the record were not before the adjudicator, or (b) the statutory or regulatory provisions in existence at the time were incorrectly applied; (2) the alleged error must be "undebatable," not merely "a disagreement as to how the facts were weighed or evaluated"; and (3) the commission of the alleged error must have "manifestly changed the outcome" of the decision being attacked on the basis of CUE at the time that decision was rendered. Evans v. McDonald, 27 Vet. App. 180, 185 (2014), aff'd, 642 F. App'x 982 (Fed. Cir. 2016); Damrel v. Brown, 6 Vet. App. 242, 245 (1994); Russell v. Principi, 3 Vet. App. 310, 313-14 (1992). The error must be of a type that is outcome-determinative, and subsequently developed evidence may not be considered in determining whether an error existed in the prior decision. See Porter v. Brown, 5 Vet. App. 233, 235-36 (1993); Glover v. West, 185 F.3d 1328 (Fed. Cir. 1999). A manifest change in the outcome of an adjudication means that, absent the alleged CUE, the benefit sought would have been granted at the outset. King v. Shinseki, 26 Vet. App. 433, 441 (2014). The standard is not whether it is reasonable to conclude that the outcome would have been different. Id. at 442. The benefit-of-the-doubt doctrine is not for application in claims of CUE. Andrews v. Principi, 18 Vet. App. 177, 186 (2004) (citing Russell, 3 Vet. App. at 313) (it is well established that the benefit-of-the-doubt doctrine can never be applicable in assessing a CUE motion because the nature of such a motion is that it involves more than a disagreement as to how the facts were weighed or evaluated). As a threshold matter, the Board finds that the arguments advanced by the Veteran allege CUE with the requisite specificity. See Simmons v. Principi, 17 Vet. App. 104 (2003). The Board will therefore adjudicate the merits of his claims. First, the Board will review the evidence before the RO at the time of the July 1969 rating decision, which includes the Veteran's service records. Before commencing his active duty service in the Navy, the Veteran joined the United States Naval Reserve in September 1966. However, no audiological testing was performed at the time of his September 1966 Reserve induction examination. Service records indicate that he was an inactive member of the Reserve until November 6, 1966, when he attended active duty for training (ACDUTRA) in New London, Connecticut, for the purpose of going to submarine school. On November 7, 1966, he underwent a physical examination for submarine school, which included audiological testing. Based on audiogram results, the Veteran's hearing was classified as defective. The examination report indicates that pure tone thresholds, in decibels, were as follows at the following frequencies: Ear 500 Hertz 1000 Hertz 2000 Hertz 3000 Hertz 4000 Hertz 6000 Hertz 8000 Hertz Right 20 25 5 10 25 40 35 Left 10 10 45 50 45 60 55 A November 1966 record indicates that the Veteran was screened for submarine training and found not qualified by reason of auditory failure. He was not recommended for further submarine testing. Active duty for training ended on November 19, 1966. In September 1967, the Veteran entered active duty in the Navy. It does not appear that he underwent a physical examination upon entry to active duty. In July 1968 service treatment records, however, an audiogram was requested based on bilateral hearing loss. Audiogram data revealed the following pure tone thresholds: Ear 250 Hertz 500 Hertz 1000 Hertz 2000 Hertz 3000 Hertz 4000 Hertz 6000 Hertz 8000 Hertz Right 5 15 20 20 40 40 50 40 Left 10 20 25 50 40 55 50 40 The audiogram report explicitly stated that the data was measured using American Standards Association (ASA) units. A note in the Veteran's service treatment records from July 1968 indicates that he had experienced progressive bilateral hearing loss over the past 18 months and that his hearing did not meet Navy standards. The note asked whether he should be recommended for a physical evaluation board. Subsequently, the Veteran underwent further evaluation for hearing loss. Audiograms performed at the Medical College of South Carolina in August 1968 revealed that there was slight bilateral sensorineural hearing impairment. Pure tone thresholds included the following: Ear 250 Hertz 500 Hertz 1000 Hertz 2000 Hertz 4000 Hertz 8000 Hertz Right 10 20 40 30 35 35 Left 15 25 40 35 60 N.H. The audiogram report indicated that this data was measured in International Standard units. He was ultimately diagnosed with bilateral sensorineural hearing loss with no apparent change since October 1967. Recommendations included noise avoidance and ear plugs. In a subsequent service treatment record from August 1968, his hearing was noted to be below minimum standards. Then-current procedures required for him to be admitted to the "sick list" and referred to a medical board. He was then admitted to the Naval Hospital in Charleston, South Carolina, in September 1968, where he underwent a review by a Navy medical board. The September 1968 Navy Medical Board Report indicated a diagnosis of sensorineural hearing loss, DNEPTE (i.e., did not exist prior to enlistment). The report cross-referenced his November 1966 audiogram results, as well as the results of the Medical College of South Carolina audiogram. The report explained that upon his admission to the hospital, he stated that his hearing had worsened over the past 18 months. The medical board opined that he had neurosensory hearing loss, which appeared to have been first noted on physical examination while at submarine school and was noted on or about the date of his commencement of active duty. There had not been any significant progression of hearing loss in the interim, so he was fit for active duty. The Veteran was released from the hospital back to full duty. However, a November 1968 endorsement from the Chief Bureau of Medicine and Surgery modified the medical board's disposition and recommended that the Veteran be transferred to the Naval Hospital in Philadelphia, Pennsylvania, for further evaluation of his hearing, treatment, and appearance before a medical board. The Veteran was admitted to the Naval Hospital in Philadelphia on November 28, 1968. A December 1968 report from the medical board's otolaryngology service notes that the Veteran's hearing loss existed prior to entry and was not aggravated by service, that he was fit for duty, and that he should be returned to full duty. The report indicated that a representative group of audiometric studies performed at the hospital showed the following results: Ear 125 Hertz 250 Hertz 500 Hertz 1000 Hertz 2000 Hertz 3000 Hertz 4000 Hertz 6000 Hertz 8000 Hertz Right (Air) -5 -5 0 15 15 35 35 45 25 Right (Bone) X -5 0 10 10 25 30 X X Left (Air) 0 -5 0 25 45 50 50 50 40 Left (Bone) X -5 10 15 40 45 40 X X All measurements were done using ASA units. The final Medical Board Report from December 1968 indicates that the Veteran was invited to a previous medical board that had been convened in Charleston in September 1968, which recommended that he be returned to duty, and the third endorsement from that board from November 1968, which directed his transfer to the hospital for reevaluation and appearance before another medical board. The history taken at admission to Philadelphia hospital revealed that he enlisted in the Naval Reserve in September 1966, but no audiogram was done at that time. He did not recall having hearing loss at that time. However, two months later at submarine school, a screening audiogram indicated that he had bilateral hearing loss that was considered disqualifying for submarine service. He continued to drill in the inactive reserve and was ultimately entered active duty. He reported that he had sustained a brief period of unconsciousness after being struck in the head by a baseball when he was 16 and was struck on the head by a shell casing in 1967. Although he denied any significant history of acoustic trauma prior to enlistment, he was exposed to gunfire on active duty. After referencing the representative group of audiometric studies done at that hospital, the medical board concluded that he had perceptive type hearing loss of a lesser degree than that recorded on his initial service audiogram in November 1966. The medical board opined that his disability existed prior to enlistment, had not been aggravated by duty, that he was fit for duty, and that he should be returned to full duty. As a result of the December 1968 report, the Veteran's diagnosis was ultimately revised to deafness, perceptive type, EPTE (existed prior to enlistment). At his February 1969 examination prior to his release from active duty, no audiogram was performed. However, the examiner noted that deafness, perceptive type, had been evaluated at the Naval Hospital. In his April 1969 application for compensation, the Veteran stated that hearing loss was first observed at submarine school in November 1966, and that he was subsequently treated for it at the Naval Hospitals in Charles and Philadelphia. The July 1969 rating decision stated that the Veteran's service records showed that he had no audiogram at the time of his enlistment in the Naval Reserve in September 1966, but that on activation for training, an audiogram was performed in connection with a submarine physical examination. This audiogram revealed bilateral hearing loss, which was considered disqualifying for submarine duty. The RO referenced his November 1966 audiogram results and the audiological evaluation from the December 1968 medical board proceedings. More specifically, the RO noted that the medical board found that he had hearing loss of a lesser degree than initially recorded in November 1966. The RO then stated that the medical board found that his disability pre-existed enlistment and that it was not aggravated by service. Ultimately, service connection was denied, because disability was not incurred in the line of duty or aggravated by service. The Board now turns to the then-applicable law regarding entitlement to service connection. Then, as now, 38 U.S.C. § 1110 generally provided that service connection was warranted for disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, in the active military, naval, or air service. The then-extant version of 38 U.S.C. § 101(24) provided that the term "active military, naval, or air service" included active duty, any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty, and any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from an injury incurred or aggravated during duty. 38 U.S.C. § 101(24) (1969). Additionally, for VA purposes, the term "veteran" applied only to individuals who served in the active military, naval, or air service. 38 U.S.C. § 101(2) (1969). At the time of the July 1969 rating decision being challenged, the law also provided that every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of examination, acceptance, and enrollment. 38 U.S.C. § 311 (1969). The applicable statute, 38 U.S.C. § 311 (1969), now 38 U.S.C.§ 1111, was implemented by 38 C.F.R. § 3.304(b) (1969), which provided that: [The veteran] will be considered to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious and manifest) evidence demonstrates that an injury or disease existed prior thereto. Only such conditions as are recorded in examination reports are to be considered as noted. In other words, then then-extant version of 38 C.F.R. § 3.304(b) provided that the presumption of soundness could be rebutted by clear and unmistakable evidence that a disorder existed prior to service. The Board also observes that, prior to January 1, 1967, service department audiometric tests were conducted using ASA units. Service department audiograms conducted after December 31, 1970, are presumed to measure using units set by the International Standards Organization-American National Standards Institute (ISO-ANSI). However, between January 1, 1967, and December 31, 1970, service departments conducted audiograms using both ASA and ISO-ANSI units, oftentimes without affirmatively specifying which audiometric standards were being used during testing. It is possible to convert data from ASA units to ISO-ANSI units when necessary. However, pertinent VA regulations did not require for audiological reports to use ISO-ANSI units for purposes of evaluating hearing loss until September 9, 1975. As such, VA adjudicators would not necessarily have been required by law to convert audiogram data for purposes of evaluating hearing loss at the time of the July 1969 rating decision. Additionally, although modern VA regulations now include a definition of impaired hearing for disability purposes in 38 C.F.R. § 3.385, this formal definition was not in effect prior to May 3, 1990, and would not have existed at the time of the decision being challenged herein. Having set forth the applicable facts and law, the Board will now consider whether revision of the July 1969 rating decision is warranted due to CUE. At the outset, the Board notes that there are two relevant periods of service for purposes of the July 1969 rating decision: his period of ACDUTRA in November 1966, as well as his period of active duty between September 1967 and February 1969. Regarding the period of ACDUTRA service, he had not established service connection for any other disability based on the period of ACDUTRA at the time of the July 1969 rating decision being challenged. As such, he would not have been considered a "veteran" for purposes of the period of ACDUTRA service. Rather, as set forth above, a person would have been considered a "veteran" during a period of ACDUTRA if that person suffered from a disease or injury incurred or aggravated in the line of duty. Accordingly, because he had not established "veteran" status for the period of ACDUTRA service, the presumption of soundness would not apply. Indeed, the plain text of then-extant 38 U.S.C. § 311 limited the application of the presumption of sound condition to veterans. As such, the presumption of soundness does not apply with respect to the period of ACDUTRA service in November 1966. In order to establish service connection for this period of service, he would thus have had to show a permanent increase in his disability during the period of ACDUTRA beyond the natural progress of that disability. With respect to the Veteran's period of active duty service, his status as a veteran is not in question. As such, the presumption of soundness would not be automatically inapplicable. Nonetheless, the presumption of soundness would not have applied to this period of service either, as veterans are taken to be in sound condition when "examined, accepted, and enrolled" into service (emphasis added). Here, however, the Veteran's service treatment records do not contain a physical examination upon entering active duty. In the absence of such an examination, there can be no basis from which to determine whether the Veteran was in sound condition upon entry into this period of service. As such, the presumption of soundness is not applicable to the period of active duty service, and the Veteran would have needed to establish that his disability increased during service. See 38 U.S.C. § 353 (1969) ("A preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease.") Having carefully reviewed the record, the Board finds that there is no clear and unmistakable error of fact or law in the July 1969 rating decision that manifestly changed the outcome of the decision. Ultimately, there is no indication that the RO had the incorrect facts before it at the time or that it misapplied the law. To that end, the presumption of soundness did not apply to either his period of ACDUTRA service in November 1966 or his period of active duty from September 1967 to February 1969. Because the presumption of soundness did not apply, the RO did not need to consider whether his hearing loss clearly and unmistakably preexisted his active service before determining that it pre-existed his service. Given the audiogram results obtained on the second day of his period of ACDUTRA service, however, a reasonable adjudicator could have concluded that he had hearing loss that pre-dated his enlistment in the Reserve. Moreover, a reasonable adjudicator could have concluded that his hearing loss had not been aggravated by his service, particularly when comparing the data from the November 1966 audiogram to the data cited in the medical board's December 1968 report. This data, all measured in ASA units, can be summarized as follows: Ear 500 Hertz 1000 Hertz 2000 Hertz 3000 Hertz 4000 Hertz 6000 Hertz 8000 Hertz Right (Nov. 1966) 20 25 5 10 25 40 35 Right (air) (Dec. 1968) 0 15 15 35 35 45 25 Right (bone) (Dec. 1968) 0 10 10 25 30 X X Left (Nov. 1966) 10 10 45 50 45 60 55 Left (air) (Dec. 1968) 0 25 45 50 50 50 40 Left (bone) (Dec. 1968) 10 15 40 45 40 X X When comparing the pure tone thresholds measured on his physical examination in November 1966 with the pure tone thresholds from the December 1968 report, the data indicates that his hearing improved at certain frequencies in both ears. For instance, pure tone thresholds reflected improved hearing at both the 500 and 1000 Hertz frequencies on both air and bone conduction in the right ear, as well as at the 8000 Hertz frequency on air conduction. Similarly, in the left ear, pure tone thresholds were improved in the 2000, 3000, and 4000 Hertz frequencies in bone and air conduction, while pure tone thresholds were improved at the 6000 and 8000 Hertz frequencies during air conduction. The Board acknowledges that some audiometric data from the December 1968 report showed higher pure tone thresholds at certain frequencies than when compared to the data from the November 1966 audiogram. Nevertheless, it cannot be said that it was obvious and manifest that his hearing loss had permanently worsened during service based on this data. Ultimately, the adjudicators would have been presented with mixed evidence regarding whether the combined audiometric results showed that his hearing loss had worsened during his service. A reasonable adjudicator could have concluded that it had not; indeed, this is the reason that the December 1968 medical board members and the July 1969 rating board concluded that his hearing had not been incurred in or aggravated by service. Because there was a legitimate question as to whether his hearing had in fact been aggravated by service, it cannot be said that reasonable minds would all agree that his hearing had permanently worsened. In reaching this decision, the Board has considered the Veteran's argument that he did not in fact have hearing loss in his right ear in November 1966. This argument, however, is not persuasive. As set forth above, there was no uniform regulatory definition of impaired hearing for VA purposes at the time of the July 1969 rating decision. As such, it was within the province of the adjudicator to review the audiometric data from November 1966 and conclude that he had hearing loss in both his right and left ears at that time. The Board has also considered whether the July 1969 rating decision contains CUE to the extent that the adjudicator did not convert ASA units to ISO-ANSI units. The Board notes, however, that it would have been unnecessary for the RO to do this, as the data was not required to be in ISO-ANSI units for purposes of evaluating hearing loss until several years after the rating decision was issued. Moreover, although the service treatment records did not affirmatively state whether the Veteran's November 1966 audiogram data was measured using ASA units, this audiogram data was gathered prior to January 1, 1967. As such, it would likely have been in ASA units. Moreover, various other audiograms in the record, including the audiogram records discussed by the medical board in December 1968, affirmatively indicate that the data was measured in ASA units. The only data that appear to be in ISO-ANSI units stem from the audiograms performed at the Medical College of South Carolina in August 1968. Even if this data showed that his hearing had worsened, the record contained other audiometric data measured in ASA units from December 1968 that suggested that his hearing had not worsened when compared to the November 1966 audiometric data in ASA units. As such, even if it were an error for the RO to not discuss whether ASA units had been properly converted into ISO-ANSI units, such an error would have been harmless. Moreover, at the time of the July 1969 rating action, the rating board was permitted to rely on its own medical judgment to support its conclusions. Hime v. McDonald, 28 Vet. App. 1, 7 (2016) (finding that a rating panel was not prohibited from relying upon its own medical judgement to support its conclusion where the rating panel included a medical member); cf. Colvin v. Derwinski, 1 Vet. App. 171 (1991) (holding that the rating board cannot substitute its own medical judgment for that of medical professionals). The Board notes that it was regular practice of the VA in July 1969 to have three-member rating panels, and that on the rating board, one of the members "will be a medical doctor" (i.e. the medical member). See VA Adjudication Procedure Manual, M21-1, para. 45.01(b) (October 16, 1970). As can be seen on the face of the July 1969 rating decision, a medical member of the rating board participated in making the determination and, as a signatory to the determination, affirmed his agreement with the finding that the Veteran's hearing loss had not been incurred in or aggravated during service. See MacKlem v. Shinseki, 24 Vet. App. 63, 70 (2010) (affirmed No. 2011-7034 (Fed. Cir. Jan. 11, 2012)); Bowyer v. Brown, 7 Vet. App. 549, 552-53 (1995) (holding that the VA's position was substantially justified in a pre-Colvin decision relying on its own medical judgment). "[T]he presence of the medical member on the [rating board], pre-Colvin, allowed the [b]oard to assess the probative value of medical opinions in a way that it now cannot, through the exercise of its own medical expertise and judgment." Hime, 28 Vet. App. at 8. Thus, to the extent the July 1969 determination is alleged to be contrary to the medical evidence of record, the Board finds that the rating board apparently relied upon the medical judgment of the medical member, among other things, in deciding the claim. While the Veteran may not agree with the rating board's determination, this is not a basis for finding CUE. The Veteran's arguments essentially amount to a disagreement as to how the facts were weighed or evaluated by the adjudicator. However, "[i]t is the prerogative of the factfinder. . .to interpret the evidence and draw reasonable inferences from it." Evans, 27 Vet. App. at 187 (citing Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Gilbert v. Derwinski, 1 Vet. App. 49, 52 (1990)). A disagreement as to how the facts were weighed does not support a finding of CUE. Fugo, 6 Vet. App. at 43-44. Ultimately, at the time of the July 1969 rating decision, the adjudicator was presented with conflicting evidence regarding whether the Veteran's hearing loss had permanently worsened during service. It was within the province of the adjudicator to evaluate the competence, credibility, and probative weight of the various conflicting evidence and to conclude that it had not. In sum, the Board finds that the July 1969 rating decision that denied service connection for hearing loss was consistent with, and reasonably supported by, the evidence then of record, and the adjudicators correctly applied existing legal authority. There is no undebatable error that is shown that would have manifestly changed the outcome of the rating decision. The Board is sympathetic to the Veteran's contentions but is bound by the relevant statutory and regulatory provisions. As such, the motion to revise the July 1969 rating decision must be denied. REASONS FOR REMAND The Veteran asserts that he is entitled to a higher disability evaluation for chloracne. At his September 2020 hearing, he indicated that his most recent VA examination was inadequate, as the VA examiner failed to examine areas of his body that exhibited chloracne, including his thighs, genitals, and lower abdomen. Moreover, the Board notes that the most recent VA examination with respect to the severity of his chloracne was conducted in June 2016, over five years ago. When VA undertakes to provide an examination or obtain a medical opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). If an examination report is inadequate or does not contain sufficient detail, the Board is required to return the report in a remand. See Bowling v. Principi, 15 Vet. App. 1, 12 (2001). Moreover, a new medical examination is required when a veteran asserts or provides evidence that a disability has worsened, and the available evidence is too old for an adequate evaluation of the current condition. Weggenmann v. Brown, 5 Vet. App. 281, 284 (1993); see also Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994). Here, in light of the Veteran's contentions regarding the adequacy of the June 2016 VA examination, as well as the age of the examination, the Board finds that remand is warranted to obtain a contemporaneous VA examination regarding the severity of his skin condition. Accordingly, this matter is REMANDED for the following action: 1. After obtaining appropriate authorization, obtain and associate with the claims file any outstanding VA treatment records and any relevant, outstanding private treatment records. (Continued on the next page) 2. Thereafter, schedule the Veteran for a new VA examination with an appropriate examiner regarding the nature and severity of his chloracne. Provide a copy of the entire claims file, including this remand, to the examiner, who must affirmatively acknowledge such review in the examination report. All necessary tests and studies must be performed. Cynthia M. Bruce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Rademacher, 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.