Citation Nr: 21068034 Decision Date: 11/08/21 Archive Date: 11/08/21 DOCKET NO. 06-17 850A DATE: November 8, 2021 REMANDED Entitlement to service connection for a skin disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1980 to September 1984 and from May 1996 to February 1997. He had additional periods of inactive duty for training (INACDUTRA) and active duty for training (ACDUTRA) in the Army Reserves from February 1997 to 2005. The Board has remanded the claim in June 2009, June 2016, November 2020, and June 2021 for additional development. While the Board regrets the additional delay, it finds that there was not substantial compliance with the June 2021 remand directives for the issue on appeal as discussed below. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for a skin disorder is remanded. The Board notes that the Veteran's service treatment records (STRs) reflect that he was treated for folliculitis/pseudofolliculitis barbae (PFB) in August 1983. A 1996 service treatment record reflects that the Veteran was diagnosed with dermatitis on his hands. A January 2004 service treatment record reflects that the Veteran reported that he had moles. An August 2004 treatment record reflects that the Veteran was diagnosed with mild dermatoheliosis and benign seborrheic keratosis (SK), and he had various benign skin lesions on his head and back. Post-service VA treatment records indicate that the Veteran has been diagnosed with various skin conditions during the appeal period, including dermatitis, eczematous dermatitis, dermatitis with cellulitis, allergic dermatitis, and seborrheic keratosis. See June 2012 VA Nursing Telephone Encounter; July 2012 VA Primary Care Physician Note; July 2012 Dermatology Consultation; May 2013 Emergency Department Note; April 2019 VA Skin Conditions DBQ. The Veteran also reported being diagnosed with rosacea by a private dermatologist in Germany. See June 2013 VA Primary Care Telephone Encounter. Pursuant to the June 2021 Board remand, the Veteran was afforded a new VA examination in August 2021 whereby the examiner opined that the Veteran's current skin disorder is not related to service. The examiner made a diagnosis of "warts" and stated that the lesions that the Veteran referred to as "moles" were in fact warts. She noted "N/A" under any resolved skin conditions. In response to the Board's instruction to identify all skin disorders diagnosed since the date of the claim, the examiner responded "[n]one of them" and noted only a diagnosis of warts. She stated that eczematous dermatitis, dermatitis with cellulitis dermatitis, allergic dermatitis, seborrheic keratosis and rosacea are acute conditions, which may have appeared in those years during military service and may have resolved but were not present during the examination and there is no known progression of these types of conditions developing into warts years later. The Board notes that the examiner acknowledged the various diagnoses of skin disorders made during the appeal period; however, she did not actually provide an etiology opinion as to those disorders as instructed in the prior Board remand. The examiner seemingly focused only on whether the warts noted at the time of the examination were related to service. Therefore, the Board finds that there was not substantial compliance with the June 2021 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The examiner further stated that the warts appeared for the first time one to two years ago and therefore could not be connected to the service. She then stated there is evidence in his records that a first "mole" appeared in 2002, five years after discharge, and she was not sure that was the same condition she observed on the date of the examination. In additional to the examiner's noncompliance as required by Stegall, the Board finds that the contradictory and confusing statements contained within the August 2021 examiner's medical opinion regarding the nature and etiology of the Veteran's skin disorders make it inadequate for claims purposes. See 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.310; Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The Board further notes that the Veteran had Reserve service from 1997 to 2005 during which time he first reported the skin lesions noted as moles. Therefore, the examiner must also address whether the Veteran's skin disorders diagnosed during the appeal period had their onset in, or are otherwise related to, any period of active duty for training (ACDUTRA). The matters are REMANDED for the following action: 1. Request the Veteran's service personnel records (SPRs), to include all periods of ACDUTRA or INACDUTRA. Also, obtain a complete points statement for the Veteran's military service. Currently, the file contains a points statement last generated in November 2003; VA documents show the Veteran had training days until at least 2005. If the requested records are unobtainable, provide him notice of this in accordance with 38 C.F.R. § 3.159(e) regarding the unavailability of his SPRs. 2. Thereafter, obtain an addendum opinion from a different VA examiner which assesses the etiology of all skin disorders that have been diagnosed since the date of claim. The claims file should be made available to, and reviewed by, the examiner. Another examination should not be scheduled unless deemed necessary by the examiner. Based on a review of the evidence, the examiner is asked to provide an opinion as to: (a) Identify all skin disorders, to include eczematous dermatitis, dermatitis with cellulitis dermatitis, allergic dermatitis, seborrheic keratosis, rosacea, and warts, which were diagnosed since the date of claim. (b) For each skin disorder diagnosed since the date of claim, provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the disorder had its onset during or is otherwise related to active-duty service or to a period of active duty for training (ACDUTRA), to include service in Bosnia and working as a construction engineering supervisor. The examiner must specifically address the Veteran's diagnoses of various skin disorders in service within his STRs, including folliculitis in August 1983, pseudofolliculitis barbae in September 1983, dermatitis in August 1996, and the Veteran's November 2002 report of medical history where he reported developing moles. (Continued on the next page) A complete rationale for all proffered opinions must be provided. If the examiner cannot render any of the requested opinions without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the needed knowledge or training). Emily Tamlyn Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Sneeringer, 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.