Citation Nr: 21066744 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 13-33 464 DATE: November 2, 2021 REMANDED Entitlement to service connection for a skin disorder, other than squamous cell carcinoma, including as due to herbicide exposure, is remanded. REASONS FOR REMAND The Veteran, who is the appellant, had active service from November 1965 to February 1967. This matter came before the Board of Veterans' Appeals (Board) on appeal from an April 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. As explained in a prior May 2021 Board decision, during the course of this appeal, in an August 2020 rating decision, the RO granted service connection for squamous cell carcinoma; however, as the evidence of record reflects that during the course of this appeal the Veteran has been diagnosed with multiple skin disorders, the Board reframed the issue on appeal as entitlement to service connection for a skin disorder, other than squamous cell carcinoma, including as due to herbicide exposure. The instant matter has been before the Board on multiple occasions. Unfortunately, for the reasons discussed below, remand to obtain an addendum medical opinion is necessary at this time. As such, no further discussion of remand compliance is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran testified from Columbia, South Carolina, at a July 2015 Board videoconference hearing before the undersigned Veterans Law Judge, who was seated in Washington, DC. The hearing transcript has been associated with the record. The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326(a). As the instant decision remands the issue of service connection for a skin disorder, no further discussion of the duties to notify and assist is necessary. Service Connection for a Skin Disorder Other Than Squamous Cell Carcinoma is Remanded. At the time of the May 2021 Board decision, the Board found a January 2020 VA skin examination and opinion was inadequate to the extent it did not address whether various previously diagnosed skin disabilities were related to service, to include presumed in-service herbicide exposure. Specifically, the Board found that, at the time of an October 2017 VA skin examination, the Veteran had been diagnosed with squamous cell carcinoma, basal cell carcinoma, actinic keratosis, and blue nevus. Further, the Board found that other private dermatologic treatment records had diagnosed sebaceous gland hyperplasia, seborrheic keratosis, and intertrigo. As such, the Board remanded for a new VA opinion in which the VA examiner was to 1) identify all of the Veteran's currently diagnosed skin disorders, and explain whether any of the aforementioned previously diagnosed skin disorders were misdiagnosed; and 2) for each diagnosed skin disorder the VA examiner was to opine as to whether the skin disorders were related to service, to include presumed in service herbicide exposure and/or in service sun exposure. The Veteran received a new VA skin examination in July 2021. At that time, the VA examiner diagnosed basal cell carcinoma, squamous cell carcinoma, and actinic keratosis, and provided an adequate VA opinion as to those skin disorders; however, the VA examiner made no mention of the previously diagnosed blue nevus, sebaceous gland hyperplasia, seborrheic keratosis, and/or intertrigo. As the VA examiner did not make a finding that these previously diagnosed skin disorders were misdiagnosed, the Board finds remand for an addendum opinion addressing these previously diagnosed skin disorders to be warranted. Blue nevus is "a benign, usually solitary type of melanocytic nevus, representing a localized proliferation of melanocytes in the dermis. It is a dark blue to black, moderately firm, rounded, sharply defined nodule containing spindle-shaped melanocytes with slender cytoplasmic processes, and is generally seen in association with melanin-laden macrophages in a sclerotic dermis." See DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1273 (32nd ed. 2012). A melanocytic nevus is one of "any numerous acquired or inherited skin lesions composed of nests of nevus cells (altered melanocytes), usually presenting as tan to brown macules or papules with well-defined, rounded borders." Id. at 1274. This skin disorder may be age-related. Sebaceous gland hyperplasia is defined as "single or multiple pale, round lesions, consisting of enlarged, malformed sebaceous glands; the most common location is on the face of an older adult." Id. at 895. Seborrheic keratosis is defined as "a common, usually benign type of skin lesion composed of basaloid cells; it usually first appears after age 30 and presents as a soft, friable plaque with variable pigmentation." Id. at 982. Intertrigo is defined as "a superficial dermatitis occurring on opposed skin surfaces, such as in the axillae or groin, beneath pendulous breasts, or in skin furrows. It is caused by moisture, friction, warmth, and sweat retention, and obesity is a predisposing factor." Id. at 951. The issue is REMANDED for the following action: Return the July 2021 VA skin examination and opinion reports to the VA examiner who rendered the examination and opinion for an addendum opinion. If the original VA examiner is unavailable, a new examiner may be assigned to address the requested opinion. As to the previously diagnosed skin disorders of blue nevus, sebaceous gland hyperplasia, seborrheic keratosis, and intertrigo, the VA examiner should an opinion on the following question: Is at least as likely as not (50 percent or higher degree of probability) that the aforementioned skin disorders were caused by the presumed in service herbicide exposure, and/or in service sun exposure, or are otherwise related to service? For each skin disorder that the VA examiner opines is not related to service, the VA examiner should opine as to the most likely causes for the skin disorders. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Blowers, 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.