Citation Nr: 21066503 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 15-14 724A DATE: November 1, 2021 REMANDED Entitlement to service connection for a skin condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Coast Guard from April 1982 to August 1985 This matter comes before the Board of Veterans' Appeals (Board) on appeal of a September 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded the appeal in December 2018 and June 2021, and the matter has been returned for appellate consideration. Entitlement to service connection for a skin disorder is remanded. The Veteran is seeking service connection for a skin disorder. He and his representative contend that his current skin disorder is related to in-service exposure to herbicides or other biological agents, sun, fuel solvents, and/or mosquito bites. The claim was remanded in December 2018 with a directive to schedule a VA examination to determine the nature and etiology of the Veteran's skin disorder. The November 2019 VA examiner found that the Veteran had a diagnosis of intertrigo. The VA examiner, however, found the Veteran's condition unrelated to service because the Veteran's disability was not a condition associated with herbicides. In June 2021, the Board found that examination inadequate because the examiner failed to address the Veteran's contentions that his skin condition was caused by in-service exposure to herbicides, sun, fuel solvents, and mosquito bites. The Board again remanded the claim, this time for an addendum VA examination opinion which addressed the Veteran's contentions. The addendum opinion was issued in July 2021. The July 2021 VA examiner noted a current diagnosis of intertrigo per the November 2019 VA examination report and opined that the Veteran's current diagnosis of intertrigo was less likely than not incurred in or caused by an injury, event, or illness while in service. In the rationale, he noted that the Veteran's other skin complaints during service, sunburn, dermatitis, mosquito bites, were isolated cases since resolved, and that diagnosis and treatment for skin cancer in 1985, 1990, and 1995 occurred decades after discharge, thus was unrelated to service, and that Agent Orange has not been identified as a cause of skin cancer. In an August 2014 letter to Congress and a September 2014 Notice of Disagreement (NOD) and attached appendices, the Veteran claimed that he was sprayed with a toxic substance while standing in a San Francisco bus terminal in January 1966 and 5 days later developed a skin rash, which covered his entire face and chest and required hospitalization for nearly a month to recover. An October 2021 IHP submitted by the Veteran's representative objected to the July 2021 VA examination opinion as inadequate for failing to sufficiently address causation and aggravation independently. In support of this argument, the representative listed two cases that address secondary service connection as set forth in 38 C.F.R. § 3.310. Both Atencio v. O'Rourke, 30 Vet. App. 74 (2018) and El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) address secondary service connection, which is a theory of entitlement not raised in this case. The Veteran's three service-connected disabilities are a low back disability, diabetes mellitus, and coronary artery disease. He has not asserted, and the record does not show, that these disabilities may have caused or aggravated his skin condition. A remand by the Board imposes upon the Secretary of VA a concomitant duty to ensure compliance with the terms of the remand, and that the Board itself commits error as a matter of law in failing to ensure this compliance. Stegall v. West, 11 Vet. App. 268, 270-71 (1998). The Board finds that the July 2021 VA opinion is inadequate and fails to comply with the June 2021 remand directive. Specifically, it failed to address the Veteran's lay statements in his NOD regarding his skin conditions, exposure to a sprayed substance, and symptoms during and after service. While the Board regrets additional delay, it finds that further development is required. The Board cannot proceed with final adjudication of the claim until an additional addendum medical opinion with a detailed supporting rationale is obtained that adequately addresses the nature and etiology of the Veteran's current claimed disability. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matter is therefore REMANDED for the following actions: 1. Obtain an addendum opinion from a qualified clinician, preferably a dermatologist, to determine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's current skin disability is related to, or aggravated by, skin conditions during active duty, to include exposure to herbicides or other toxic substances, excessive sun exposure, fuel solvents, and mosquito bites. Provide a complete copy of the file to the clinician, including a copy of this remand. The addendum opinion must provide a detailed rationale, noting medical treatment records and addressing the Veteran's lay statements noted in the September 2014 NOD and attached appendices. The examiner is advised that a negative opinion may not be based solely on the fact that the Veteran's skin condition is not listed among the diseases and conditions presumptively associated with herbicide exposure. If an opinion cannot be rendered without speculation, the examiner should state so and note the reasons. 2. After the addendum opinion has been completed, the claim should be readjudicated. If the outcome is unfavorable to the Veteran and his representative, a SSOC should be sent to them and reasonable time allowed for a response before the claim is returned to the Board for further appellate consideration. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kathleen M. Fiorillo, 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.