Citation Nr: 21069099 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 19-27 037 DATE: November 17, 2021 ORDER Entitlement to service connection for a low back disability is granted. REMANDED Entitlement to service connection for a skin condition, to include as secondary to herbicide agent exposure, is remanded. FINDING OF FACT The Veteran's low back disability is at least as likely as not related to his service. CONCLUSION OF LAW The criteria for entitlement to service connection for a low back disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from May 1967 to January 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office. In July 2021, the Veteran and Dr. R., his chiropractor, testified before the undersigned at a hearing via videoconference. A transcript of the Veteran's testimony has been associated with the claims file. The Board has reviewed the Veteran's VA treatment records, which document complaints of skin rashes and lesions on his bilateral lower extremities. However, it is unclear whether he has a current diagnosis of chloracne. As such, the Board has broadened the characterization of his claim into a claim for service connection for a skin condition, however diagnosed, to recognize this fact. See Clemons v. Shinseki, 23 Vet. App. 1 (2009); Brokowski v. Shinseki, 23 Vet. App. 79 (2009). This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.800(c). Service Connection The Veteran asserts that he is entitled to service connection for a low back disability due to lifting heavy equipment and wearing boots that were too small during service. Service connection may be granted if there is a disability resulting from personal injury or disease incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish service connection, the evidence must show (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Importantly, where there is an approximate balance of positive and negative evidence regarding a material issue, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b). If the Board determines that the preponderance of the evidence is against the claim, it has necessarily found that the evidence is not in approximate balance, and the benefit-of-the-doubt principle is not applicable. Here, the record indicates that the Veteran has a current diagnosis of a low back disability. Additionally, the Veteran testified that he volunteered to work in a motor pool while he was stationed in Korea, which required him to lift heavy equipment, such as Jeep engine blocks. His service treatment and personnel records confirm that he was stationed in Korea with the 122nd Signal Battalion between January 1968 and January 1969 and that he complained that his boots were too small. As such, the first and second elements of the service connection framework have been satisfied. The chief question for the Board is thus whether the evidence suggests that there is a nexus between the Veteran's service and his current disability. To that end, the Veteran's chiropractor, Dr. R., testified during the July 2021 hearing that the Veteran's current low back disability is etiologically related to his service. Dr. R. explained that when the bones in the feet are altered, it affects the mechanics of the knees, hips, and pelvis. He indicated the Veteran had likely strained his muscles and joints while trying to compensate for this. He opined that the Veteran's low back disability was directly related to trauma to the torso caused by lifting heavy engine parts and compensating for the altered, impaired mechanics of his lower limbs due to his small boots. Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. 38 C.F.R. § 3.159(a)(1). Dr. R., a chiropractor, is competent to offer an opinion with respect to the etiology of a spinal condition. Moreover, the Board has no reason to doubt his credibility. His opinion is supported by a thorough rationale and is not directly contradicted by the record. As such, this opinion is entitled to significant probative weight. Affording him the benefit of the doubt, the Board finds that the evidence indicates that the Veteran's current low back disability is at least as likely as not related to his service. As such, service connection is granted. REASONS FOR REMAND The Veteran also argues that he has a skin condition, which he has stated is chloracne, which had its onset in 1968 while he was stationed in Korea. More specifically, he contends that he developed chloracne after being exposed to herbicide agents, such as Agent Orange, when he was responsible for converting water trucks into trucks that would spray herbicide agents. If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases shall be service connected if the requirements of section 3.307(a)(6) are met even though there is no record of such disease during service, provided that other regulatory provisions are satisfied. 38 C.F.R. § 3.309(e). For instance, chloracne is among the diseases presumed to be associated with herbicide agent exposure. Id. For VA purposes, the term "herbicide agent" means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975. 38 C.F.R. § 3.307(a)(6)(i). A veteran, who, during active military service, served in the Republic of Vietnam during the period beginning in January 1962 and ending in May 1975, is presumed to have been exposed to herbicide agents. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). Service "in the Republic of Vietnam" includes service both on the landmass of Vietnam and the waters that are no more than 12 miles offshore of Vietnam. 38 U.S.C. § 1116A. VA regulations further provide for a presumption of herbicide agent exposure where a veteran served on or near the demilitarized zone (DMZ) during certain time periods. 38 C.F.R. § 3.307(a)(6)(iv). Specifically, a veteran who during active service served between April 1, 1968, and August 31, 1971, in a unit that, as determined by the Department of Defense, operated in or near the DMZ within an area that herbicides are known to have been applied during that period shall be presumed to have been exposed during such service to an herbicide agent, barring affirmative evidence to establish that the Veteran was not exposed to any such agent. Id. In a case where a veteran is alleging herbicide agent exposure outside of those locations, the presumptive provisions do not apply, and exposure must be determined on a case-by-case basis. See 38 C.F.R. § 3.309(e). Here, the Veteran is not alleging that he served in the Republic of Vietnam, but rather that he was exposed to herbicide agents during his service in Korea. To that end, the claims file contains a formal finding that the VA Regional Office did not have sufficient information to corroborate the Veteran's exposure or to perform additional research through appropriate bodies, such as the National Archives and Records Administration. In this formal finding, the VA Regional Office indicated that it had reviewed the Veteran's military and personnel records, as well as statements and correspondence he submitted. The Board notes, however, that the VA Regional Office did not sufficiently exhaust efforts to obtain information necessary to corroborate herbicide agent exposure. For instance, the VA Regional Office did not attempt to verify herbicide agent exposure by requesting additional information, such as unit histories or chronologies for the 122nd Signal Battalion. Additional development is warranted on remand to attempt to verify the Veteran's purported herbicide agent exposure. Additionally, the Veteran's current VA treatment records reflect complaints of chronic redness, rash, blistering, itching, numbness, and tingling pain, as well as slow-healing ulcers, on his bilateral lower extremities, which he stated he had experienced since 1968. At this juncture, however, the VA Regional Office has not provided the Veteran with a VA examination regarding the nature and etiology of his skin condition. In the interest of assembling clear and reliable findings, remand is necessary to accomplish this. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Accordingly, this matter is REMANDED for the following action: (This matter has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.800(c). Expedited handling is requested.) 1. Undertake any necessary development to independently verify the Veteran's alleged exposure to herbicide agents in Korea in 1968 and 1969, to include contacting appropriate sources for records. The record search should encompass the period from January 1968 to January 1969 and should include appropriate sources such as daily journals, operational reports and lessons learned, unit histories, and command chronologies, from the 122nd Signal Battalion stationed in Korea. Any additional action necessary for independent verification, to include follow-up action requested by the contacted entity, should be accomplished. If the search for corroborating information leads to negative results, this should be documented in a formal finding in the claims file. 2. Thereafter, arrange for the Veteran to undergo a VA examination with an appropriate examiner to determine the nature and etiology of his skin condition. The entire claims file, including a copy of this remand, must be made available to and reviewed by the examiner. After reviewing the claims file in its entirety and examining the Veteran, the examiner is asked to do the following: (a.) Identify all skin conditions that have been present at any point during the period on appeal, including skin conditions that have since resolved. In doing so, the examiner is asked to clarify whether the Veteran has a current diagnosis of chloracne. (b.) For any identified skin condition, opine as to whether it at least as likely as not (approximately 50 percent or greater probability) is related to or had its onset during his service. The examiner is reminded to consider the Veteran's lay statements regarding the onset of his disability in 1968. The examiner must provide a complete rationale for any opinions offered, which is supported by citations to pertinent evidence of record and/or medical authority. All relevant evidence, including the Veteran's lay statements, must be addressed. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Rademacher, 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.