Citation Nr: 21068018 Decision Date: 11/08/21 Archive Date: 11/08/21 DOCKET NO. 19-24 540 DATE: November 8, 2021 REMANDED Entitlement to service connection for right foot dyshidrosis, to include as due to herbicide exposure, is remanded. Entitlement to service connection for left foot dyshidrosis, to include as due to herbicide exposure, is remanded. Entitlement to an acquired psychiatric disorder, including posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1965 to February 1969, to include service in the Republic of Vietnam. These matters come before the Board of Veterans' Appeals (Board) from an August 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In a September 2019 decision, the Board denied the petition to reopen the Veteran's claim for service connection for right and left foot dyshidrosis. Subsequently, the Veteran appealed these issues to the United States Court of Appeals for Veterans Claims (Court/CAVC). In a September 2020 Order, the Court vacated the Board's September 2019 decision denying the reopening of the Veteran's claim for service connection for right and left foot dyshidrosis and remanded the matter to the Board for action consistent with the Joint Motion for Remand (JMR). In a May 2021 decision, the Board reopened the Veteran's claims for service connection for foot conditions and remanded those claims for additional development. These claims are addressed together in the remand section below. The claim for service connection for a psychiatric disability issue was remanded by the Board in September 2019 and was denied in a July 2020 Board decision. Subsequently, the Veteran appealed the denial of his service connection claim to the United States Court of Appeals for Veterans Claims (Court/CAVC). In a July 2021 decision, the Court granted the parties' Joint Motion for Remand (JMR), vacated the Board's July 2020 decision, and remanded the matter to the Board for action consistent with the ruling. That claim is now once again before the Board and is addressed in the remand section below. 1. and 2. Entitlement to service connection for right foot dyshidrosis and left foot dyshidrosis, to include as due to herbicide exposure, are remanded. The Veteran asserts that his right and left conditions arose during or as a result of his active service, including as due to in-service herbicide exposure. In this case, the Veteran's service treatment records (STRs) include an August 1965 entrance Report of Medical History in which the Veteran was noted as positive for foot trouble. His January 1969 pre-separation Report of Medical History notes that the Veteran was positive for athlete's foot in June 1968, but it was successfully treated without complication or sequelae. His STRs, including his medical examinations, are otherwise negative for foot or skin problems. In August 2011, the Veteran filed a claim for service connection for blisters on his feet due to exposure to Agent Orange. During the Veteran's February 2016 VA examination for skin diseases, the VA examiner noted a diagnosis for athlete's foot in June 1968. At the time of the examination, the Veteran reported lesions on his palms and soles consistent with dyshidrosis. The examiner noted that he was treated, and the lesions resolved with no sequelae. Since then, he reported pain and erythema of the bilateral in-step and bilateral palmar surfaces. He reported that there "are little bumps in these spots always." The examiner opined that the claimed conditions were less likely than not related to his active service, as tinea pedis was due to a fungus, while dyshidrosis was not due to fungus or an infectious cause. A March 2016 VA treatment record, a podiatry consult, provided an assessment of "[p]robable onychomycosis bilateral hallux." The VA podiatrist recommended that the Veteran spray Lysol in his shoes to decrease the chance of athlete's foot. During the Veteran's October 2020 Appellate Brief, the Veteran's representative cited a study that indicated that mental health conditions may aggravate common skin conditions. They argued that the Veteran's claimed foot conditions may have been aggravated by his claimed psychiatric disorder. The Board remanded the Veteran's claims in May 2021. However, the Board's remand directives did not include any directions to address the theory of secondary service aggravation. Accordingly, the Board finds that these claims must be remanded for an addendum VA medical opinion to address this theory. 2. Entitlement to an acquired psychiatric disorder, including PTSD, is remanded. In the July 2021 JMR, the parties noted that the Veteran reported in a January 2016 treatment note that he had nightmares of his time in service and had experienced and night sweats since the 1970s. However, neither the Board nor the Veteran's VA examiners addressed these reported symptoms. Based on these facts, the Board finds that the Veteran must be afforded a VA addendum medical opinion to address these facts. Accordingly, this claim is remanded for further development. The matters are REMANDED for the following action: 1. Forward the Veteran's claims file to an appropriate examiner to determine the nature and etiology of any diagnosed bilateral foot disability, to include right and left foot dyshidrosis. The claims file must be reviewed by the examiner in conjunction with the addendum opinion. The report must reflect that the claims file was reviewed. All findings must be reported in detail. Specifically, the examiner must address the following: (a) Identify any diagnosed bilateral foot disability, to include right and left foot dyshidrosis that the Veteran may have been diagnosed with throughout the appeal period; and (b) Provide an opinion as to whether each diagnosed condition is at least as likely as not (a 50 percent or greater probability) caused or aggravated (worsened beyond its natural progression) by any diagnosed psychiatric disorder. The examiner must consider and address the October 2020 Appellate Brief and the study cited in that brief. All opinions must be supported by a detailed rationale, which must address the Veteran's lay contentions provided in the record. 2. Forward the Veteran's claims file to a qualified psychiatrist or psychologist to determine the nature and etiology of any diagnosed psychiatric disorder. The claims file must be reviewed by the examiner in conjunction with the addendum opinion. The report must reflect that the claims file was reviewed. All findings must be reported in detail. Specifically, the examiner must address the following: (a) Identify any psychiatric disorders that the Veteran may have been diagnosed with throughout the appeal period; and (b) Provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any diagnosed psychiatric disorder had its onset during or is otherwise related to any event or injury during active duty. The examiner must consider and address the January 2016 treatment note in which the Veteran reported experiencing nightmares of the war and night sweats since the 1970s. All opinions must be supported by a detailed rationale, which must address the Veteran's lay contentions provided in the record. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Hicks, 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.