Citation Nr: 21068312 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 16-43 232 DATE: November 10, 2021 REMANDED Entitlement to service connection for a skin condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Coast Guard from July 2002 to July 2006 and in the United States Army from January 2008 to June 2009. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The appeal was remanded in June 2021 for further development. It has since been returned to the Board for further appellate consideration. 1. Entitlement to service connection for a skin condition is remanded. The Board regrets the delay, however additional development is required prior to adjudicating the claim for a skin condition. The Veteran contends his skin conditions are related to active service. In his August 2016 substantive appeal (VA Form 9) he wrote that his skin condition occurred immediately after he was exposed to gas during service. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Pursuant to the Board's June 2021 Board remand, the Veteran was afforded a VA examination in June 2021. The examiner noted the following diagnoses: dyshidrotic eczema, dermatophytosis (onychomycosis), and psoriasis. The examiner opined that it was less likely than not that the Veteran's skin condition was related to his service. The examiner considered all skin diagnoses present and addressed the Veteran's lay statements. However, the Board finds that the VA examination is inadequate, as the examiner does not provide a supporting rationale for the opinion rendered, instead she merely lists medical articles and a history of the Veteran's conditions while in-service and post-service. For example, citing to medical literature the examiner reasoned that there is "a remote chance that the dyshidrotic eczema to his hands is actually an irritant dermatitis with varying prognoses." The examiner failed however to elaborate regarding if the Veteran's dyshidrotic eczema is due to exposure to an irritant and/or what if any prognoses his condition met. Also, the examiner did not provide a medical explanation or rationale for the other diagnoses of record, dermatophytosis (onychomycosis) and psoriasis. Moreover, the examiner indicated that "the Veteran's skin condition is a long-term occupational hand eczema, (i.e., caused by any of the irritants the Veteran has been exposed to in service), definitive diagnosis requires him to undergo histopathology with a dermatologist. This will ensure diagnosis for the claimed condition or lack thereof." Additionally, the examiner opined that no baseline level of severity could be determined. The examiner explained "that in order to establish whether or not his skin condition was aggravated beyond its natural progression, histopathology will need to be done to determine if the skin condition to his hands is a dyshidrotic eczema (diagnosis made upon his presentation of signs and symptoms), part of his psoriasis, related to his onychomycosis (skin condition to hands could be bullous tinea), or a long term/chronic irritant dermatitis (which determines if the skin condition was as likely than not caused by an irritant while in service." The Board notes that the examiner was a Nurse Practitioner General Practice and given the fact it was noted that the Veteran needs to undergo histopathology with a dermatologist for a definitive diagnosis, the Board finds that an opinion by a dermatologist on this matter is required by the terms of the June 2021 VA Medical Opinion in order to render an examination adequate for this Veteran. Accordingly, remand is necessary. The matters are REMANDED for the following action: 1. Obtain all updated records (i.e., those not already of record) of VA and adequately identified private treatment the Veteran has received for the disability on appeal. 2. Following the receipt of any outstanding records, schedule the Veteran for an examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) with a DERMATOLOGIST to determine the nature and likely cause of his skin disorder. The Veteran's entire claims file, to include a copy of this remand, should be provided to the examiner. Any indicated tests and studies must be accomplished, and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. The examiner must provide and opinion whether it is at least as likely as not (50 percent or greater probability) that any diagnosed skin disorder had onset, is caused by, aggravated by, or is otherwise related to active military service. In providing this opinion, the examiner must address all relevant evidence of record, including but not limited to in-service treatment for skin complaints, the Veteran's contention that his skin condition is a result of his exposure to gas during a gas chamber exercise, and the June 2021 VA examination. The examiner is advised that the Veteran is competent to report his symptoms and history and that such reports must be considered. If the examiner rejects the Veteran's reports, the examiner must provide a reason for doing so. All opinions must include a detailed rationale. Providing an opinion or conclusion without enough explanation will delay processing of the claim and require further clarification. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Braxton, 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.