Citation Nr: 21067311 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 13-22 544 DATE: November 3, 2021 REMANDED Entitlement to service connection for a skin disability is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from August 2005 to May 2009. This matter is before the Board on appeal from an April 2014 rating decision. In May 2016, a videoconference hearing was held before the undersigned; a transcript is in the Veteran's record. In September 2016, October 2017, June 2018, February 2021, and June 2021 the case was remanded for additional development. [The February 2021 Board decision also denied a rating in excess of 40 percent for a low back disability; consequently, that matter is no longer before the Board.] [The Board notes that a September 2021 Board decision, by a Veterans Law Judge other than the undersigned, remanded the matters of service connection for left shoulder and left elbow disabilities. Those matters are still pending development at the Agency of Original Jurisdiction (AOJ) and are not currently before the Board.] Entitlement to service connection for a skin disability The Board is aware that the claim has been remanded before (and regrets the delay inherent with another remand); but because there was not substantial compliance with previous remand instructions, another remand is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In June 2021, the Board remanded this matter for an addendum advisory medical opinion to ascertain the nature and likely etiology of the Veteran's claimed skin disability. The Board directed the consulting provider to opine whether the Veteran's (head and feet) skin disability is at least as likely as not related to his active-duty service, to include his acknowledged exposure to chromates and polyurethane paints therein. The Board specifically directed that the rationale for the opinion must express agreement or disagreement with a 2017 private opinion from Dr. J.E., and must identify the more likely etiology if the skin disability was determined to be unrelated to service. In July 2021, the Veteran underwent another skin diseases examination (apparently in addition to the addendum opinion requested). The diagnosis was seborrheic dermatitis of the scalp, only; a skin disability of the feet was not noted. The examiner provided a negative nexus (to service) opinion for the scalp condition, based on a finding that, "In review of claims file there's no evidence of a chemical exposure or scalp condition during service." [She later acknowledged exposure to chromates and polyurethane paints.] She explained, "Seborrheic dermatitis does not have a known causative factor however it can be the result of a yeast/fungus called malassezia that is in the oil secretion of the skin or an irregular response of the immune system." The Board finds the opinion inadequate for rating purposes for several reasons. First, the examiner failed to diagnose a skin disability of the feet, despite diagnoses in the record. See May 10, 2012, July 25, 2012, and July 3, 2013 VA treatment records; see also August 2017 opinion by Dr. J.E. Second, the opinion is internally inconsistent, as the examiner appears to have acknowledged in-service exposure to chromates and polyurethane paints, but based her rationale on a finding of "no evidence of a chemical exposure...during service." Finally, she noted that the Veteran's scalp skin disability can be the result of two different causative factors, but did not identify the etiology considered more likely; accordingly, that portion of the opinion is speculative and fails to comply with the remand orders. See Stegall v. West, 11 Vet. App. at 271. Remand for an adequate addendum advisory opinion that resolves the remaining medical questions is necessary. The matter is REMANDED for the following: Arrange for the Veteran's record to be returned to the July 2021 skin diseases examiner for an addendum opinion regarding the likely etiology of his head and feet skin disability. [If that provider is unavailable or unable to offer the addendum opinion sought, arrange for the Veteran's record to be forwarded to another appropriate clinician for review and the opinion sought.] The consulting provider should review the record (including this Remand and the March and July 2021 skin diseases examination reports/opinions) and provide opinions that respond to the following: (a) Is it at least as likely as not (a 50% or greater probability) that the Veteran's head and feet skin disability arose during (was first manifested in, or is otherwise etiologically related to) his active-duty service, to include his acknowledged exposure to chromates and polyurethane paints therein? The opinion must acknowledge the head and feet skin diagnoses of record (noted above). The rationale for the opinion provided must also comment on (express, with rationale, agreement or disagreement with) the August 2017 private opinion from Dr. J.E. (b) If a diagnosed skin disability is determined to be unrelated to the Veteran's service, identify the etiology considered to be more likely (and explain why that is so). The examiner must include rationale with all opinions, citing to supporting factual data and/or medical literature, as deemed appropriate. [If the addendum opinion is sought from a clinician other than the July 2021 skin diseases examiner, and if in such circumstances a further examination of the Veteran is deemed necessary for an opinion sought, such should be arranged.] GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Dupont, 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.