Citation Nr: 21067766 Decision Date: 11/05/21 Archive Date: 11/05/21 DOCKET NO. 16-15 761 DATE: November 5, 2021 REMANDED Entitlement to service connection for a skin condition is remanded. REASONS FOR REMAND The Veteran had active duty service from August 1967 to July 1970, with combat service in Vietnam from January 1968 to January 1969. This matter comes before the Board of Veterans' Appeals (Board) from a March 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran's claim was remanded in April 2021 for a VA examination in accordance with a July 2020 Joint Motion for Remand (JMR), issued by the Court of Appeals for Veterans Claims (Court), of which vacated and remanded the Board's June 2019 denial of the claim. Upon review of the August 2021 VA medical examiner's opinion, the Board finds that additional development is required prior to its adjudication of the Veteran's claim. 1. Entitlement to service connection for a skin condition is remanded. Upon review of the August 2021 VA examiner's opinion, the Board notes that all theories of entitlement raised by the record/Veteran were not addressed therein, specifically as to whether the Veteran's currently diagnosed skin conditions are directly related to his conceded agent orange exposure. To point, if a veteran served in the Republic of Vietnam during the period from January 9, 1962, to May 7, 1975, he or she will be presumed to have been exposed to herbicide agents. 38 C.F.R. § 3.307(a)(6). Certain diseases, will be presumed service-connected if a veteran was exposed to herbicide agents in service, even if there is no record of the disease during service. 38 C.F.R. §§ 3.307(a)(6), 3.309(e). Additionally, even if a disease is not considered presumed service-connected to exposure to herbicide agents, VA should still address whether there could be a direct link between the Veteran's diagnosis and herbicide exposure. See Combee v. Brown, 34 F.3d 1039, 1042-43 (Fed. Cir. 1994); McCartt v. West, 12 Vet. App. 164, 167 (1999). As the Veteran served in Vietnam during the presumptive period, herbicide exposure is conceded in his case. See DD 214. While the January 2021 VA examiner opined that the Veteran's skin conditions are not directly related to agent orange exposure, the Board cannot rely on the opinion as the VA examiner did not adequately consider the Veteran's lay statements regarding in-service incurrence of jungle rot disease during combat in Vietnam. Moreover, the January 2021 VA examiner's opinion is conclusory in nature without a supporting rationale, and therefore not probative. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Although the Veteran is not competent to diagnose a condition such as "jungle rot," the Board finds his statements concerning the symptoms he experienced at the time to be credible as well as probative. See Layno v. Brown, 6 Vet. App. 465, 471 (1994); Caluza v. Brown,7 Vet. App. 498 (1995). Accordingly, a remand is warranted here to obtain an addendum medical opinion to address the outstanding theory of entitlement, namely as to whether the Veteran's currently diagnosed skin conditions are directly related to conceded agent orange exposure during service. See Szemraj v. Principi, 357 F.3d 1370, 1371 (Fed. Cir. 2004); Roberson v. Principi, 251 F.3d 1378, 1384 (Fed. Cir. 2001). Lastly, the record also reveals conflicting medical literature as to whether acquired psychiatric disorders aggravate skin conditions. In contrast to the Mayo Clinic medical literature relied upon by the August 2021 VA examiner, the Veteran's Appellate Brief points to medical findings made by the Cleveland Clinic indicating that anxiety and stress can cause rosacea symptoms to worsen. See October 6, 2021 Appellate Brief. Accordingly, the Board finds that upon remand, the VA examiner should also provide an addendum medical opinion resolving said conflict. The matter is REMANDED for the following action: Obtain addendum medical opinions from the August 2021 VA medical examiner, or another appropriate clinician if deemed unavailable, for the Veteran's claimed for skin condition(s). Upon review of the record, to include this remand, as well as indicated below, the VA examiner is requested to opine as to all of the following: a. Is it at least as likely as not (50 percent probability or greater) that the Veteran's currently diagnosed skin condition(s) are directly related to his herbicide exposure during service? b. Is it at least as likely as not (50 percent probability or greater) that the Veteran's currently diagnosed skin condition(s) are aggravated beyond their natural progression by his service-connected PTSD disability? Note that aggravation in this context means any incremental increase in the non-service-connected disability (i.e., any additional impairment of earning capacity) caused by the service-connected disability. The VA medical examiner is requested to specifically address the conflicting medical literature of record from the Mayo and Cleveland clinics as to whether psychiatric disorders aggravate skin conditions. See VBMS, document titled Appellate Brief, dated October 6, 2021. The VA examiner is asked to provide the underlying reasons for all opinions expressed, and are reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.R. Fey, 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.