Citation Nr: 21067533 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 20-17 662 DATE: November 4, 2021 REMANDED The claim of entitlement to service connection for a skin disorder is remanded. REASONS FOR REMAND The Veteran had honorable active duty service with the United States Navy from February 1980 to February 1984. In November 2020, the Board remanded the claim for additional development. In Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the United States Court of Appeals for Veterans Claims (Court) held that the scope of a mental health disability claim includes any mental health disability that could reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record. In compliance with this case law, the Board considers the Veteran's claim of entitlement to service connection for discoloration of the face as one that encompasses any skin disorder. The claim of entitlement to service connection for a skin disorder is remanded. A review of the service treatment records showed skin complaints. In December 1982, the Veteran was treated for tinea cruris/jock itch in the groin area. A December 1982 treatment record indicated that the rash was possibly a ring worm or heat rash in the groin area. A week later, the rash had not improved, and he received an assessment of unresolved jock rash. In September 1983, the Veteran was treated for chronic jock itch. In December 1983, he was treated for ingrown hairs of the navel area. His February 1984 separation examination showed that the Veteran's face and skin were marked as clinically normal. July 2010 department of correction records showed that the Veteran presented with an ear infection and spots on his right side that look like a ring worm. In August 2010, the Veteran was treated with selenium sulfide 2%. An April 2018 VA treatment record noted that the Veteran had a recurrent hyperpigmented rash in the face area. In October 2018, the Veteran stated that his skin discoloration was the result of in-service exposure to extreme heat while he served aboard the USS Coronado in the Persian Gulf during the 1980s. In January 2019, he reported that he damaged his skin in 1980-1981 while serving in the Persian Gulf. He stated that the extreme heat damaged his skin. The Veteran was afforded a VA examination in June 2019. The diagnosis was hyperpigmented rash. The Veteran stated that his hyperpigmented rash first appeared in 1981. He reported intermittent exacerbation of dark areas to the cheeks and forehead. The examiner opined that the Veteran's discoloration of the face was less likely than not incurred in or caused by service. The rationale was that the Veteran's February 1984 examination was silent for a face rash and that the service treatment records did not document a rash or skin condition of the face. September 2019 private medical records from Alexander City Dermatology-Montgomery showed treatment for dermatitis and postinflammatory hyperpigmentation. The Veteran was provided another VA examination in July 2021. The examiner confirmed the diagnosis of hyperpigmented rash. The Veteran stated that his hyperpigmented rash started in 1982 and that he received a diagnosis in 2019. He stated that his in-service exposure to extreme heat caused his skin discoloration. The examiner opined that the Veteran's hyperpigmented rash was less likely than not incurred in or caused by his active duty service. The rationale was that the Veteran's service treatment records were silent for a rash to the face or any other skin issue. It was noted that the Veteran separated from service in 1984 and received a diagnosis of a hyperpigmented skin disorder in 2019. An addendum medical opinion was obtained in September 2021. The reviewing examiner opined that the Veteran's hyperpigmented rash was less likely than not incurred in or caused by his active duty service. The following rationale was provided: The VA has conceded that the [V]eteran has recorded incurrence of rash due to ringworm during service, and the ...Veteran has Gulf War service which entailed exposure to extreme heat conditions. However, the [V]eteran's exit exam dated [February 22, 1984] is silent for any such condition(s) and the c-file records are silent for rash to face and any other skin issue until the Veteran was diagnosed with Hyperpigmented skin condition in 2019. The Veteran separated from service in 1984. This is a 35 year gap therefore intercurrent injury/disease cannot be ruled out as an etiology. A Nexus has not been established. The Board finds that a remand is required to obtain another VA medical opinion. The September 2021 VA examiner found that there was no evidence of a face rash or any type of skin issue until 2019. However, the evidence shows that the Veteran was treated for a skin rash that looked like a ringworm in 2010. During service, the Veteran was treated for a rash in the groin area and medical providers found that it was possibly a ringworm. In light of the above, the Board finds that a remand is required to obtain another medical opinion. On remand, the AOJ should attempt to obtain any outstanding treatment records from Alexander City Dermatology-Montgomery and from any correctional facility that treated him for a skin disorder during his 20-year incarceration. a The matters are REMANDED for the following action: 1. The AOJ should undertake appropriate development to obtain any outstanding records pertinent to the Veteran's claim, to include outstanding treatment records from Alexander City Dermatology-Montgomery and any correctional facility that treated him for his skin disorder. If the AOJ deems the records do not exist or that any additional attempts to obtain these records would be futile, the record should be annotated to reflect such and the Veteran should be notified in accordance with 38 C.F.R. § § § 3.159 (e). 2. Thereafter, the AOJ should afford the Veteran a VA examination by a physician with sufficient expertise, to determine the nature and etiology of the Veteran's skin disorder. All pertinent evidence of record must be made available to and reviewed by the examiner. Any indicated tests and studies should be accomplished. The examiner must identify all skin disorders present during the period of the claim. Following an examination of the Veteran, and a thorough review of the record, the appropriate physician is requested to provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the disorder is etiologically related to the Veteran's active service. In so opining, the examiner must consider and discuss the following: (1) the Veteran's reports that his skin discoloration started when he was exposed to extreme heat during service; (2) the in-service treatment for jock itch, tinea cruris, and possible ringworm/heat rash; and (3) the July 2010 and August 2010 correctional facility medical records showing complaints of a ringworm and treatment with selenium sulfide 2%. 3. Then, readjudicate the issue on appeal. If the benefits sought on appeal are not granted to the Veteran's satisfaction, the Veteran and his representative should be furnished an appropriate supplemental statement of the case and be afforded the requisite opportunity to respond. Thereafter, the case should be returned to the Board for further appellate review. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. McKinley, 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.