Citation Nr: 21068822 Decision Date: 11/15/21 Archive Date: 11/15/21 DOCKET NO. 16-04 190 DATE: November 15, 2021 REMANDED Entitlement to service connection for a skin disability is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from November 1968 to November 1970 with additional service in the California Army National Guard. These matters are before the Board of Veterans' Appeals (Board) on appeal from May 2013, April 2016, and May 2016 rating decisions. In September 2018, the Board denied service connection for GERD, skin disability, and an increased rating for left lower extremity radiculopathy, and remanded the issues of service connection for a cervical spine disability, right and left upper extremity radiculopathy, hypertension, right and left knee disabilities, and increased rating for diabetes mellitus with erectile dysfunction (ED) [to obtain new medical examinations and medical opinions.] The Veteran appealed the September 2018 Board decision to the United States Court of Appeals for Veterans Claims (CAVC). In an Order issued in August 2019, CAVC granted a Joint Motion to Remand (JMR) of the parties and remanded all issues for further development [to provide the Veteran with a medical examination/opinion for his skin disability, an adequate medical opinion for his GERD disability, and provide adequate reasons and bases for increased rating for left lower extremity radiculopathy.] In March 2020, the Board remanded the issues in compliance with the JMR. [A July 2020 rating decision granted service connection for GERD, resolving that matter.] In September 2020, the Board granted service connection for a cervical spine disability, right and left upper extremity radiculopathy, and an increased rating of 20 percent for a left lower extremity radiculopathy. The September 2020 Board decision denied all other issues on appeal and remanded service connection for a skin disability [to obtain a new medical examination and medical opinion.] In April 2020 correspondence, the Veteran's representative requested to withdraw his representation. The originating agency (AOJ) acknowledged the withdrawal in July 2020 correspondence. Entitlement to service connection for a skin disability is remanded. The September 2020 Board remand ordered development for a VA examination to ascertain the nature and etiology of the Veteran's skin disability. The examiner was to identify each skin diagnosis found (or shown by the record within the appeal period) and opine regarding each skin disability diagnosed, whether it was related to the Veteran's service (to include on the basis of onset on active duty.) On September 2021 VA examination, the provider diagnosed dermatitis and seborrheic keratosis. The examiner addressed direct service connection and opined that the skin disability was less likely than not caused by a claimed in-service injury, event, or illness. The examiner did not address whether the Veteran's acknowledged exposure to herbicide agents caused his skin disabilities (as has been alleged), or his lay reports of continuity of symptoms since service. Accordingly, development for a fully adequate medical opinion in this matter is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: Arrange for the Veteran's claims file to be forwarded to an appropriate clinician (in dermatology) for review and a medical advisory opinion regarding the likely etiology of his diagnosed skin disabilities. [If further examination of the Veteran is deemed necessary for an opinion sought, such should be arranged.] The examiner should provide opinions that respond to the following: (a.) Identify (by diagnosis) each skin disability shown during the pendency of this claim. If dermatitis and seborrheic keratosis are not diagnosed, reconcile that finding with the notations in the record suggesting otherwise. (b.) Identify the likely etiology for each skin disability entity (specifically including dermatitis and seborrheic keratosis) diagnosed. Is it at least as likely as not (a 50% or better probability) that it had its onset/was incurred during the Veteran's active service? The rationale provided must address the Veteran's acknowledged exposure to herbicide agents (and not merely recite that the skin disabilities are not listed as a presumptive condition), and his lay statements alleging he has had continuity of symptoms since service. All opinions must include rationale that cites to supporting factual data and/or medical literature, as deemed appropriate. If an opinion sought cannot be provided without resort to mere speculation, there must be explanation why that is so. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lederman, Michael 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.