Citation Nr: 21071821 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 18-22 941 DATE: December 1, 2021 ORDER Entitlement to service connection for a skin condition is remanded. REASONS AND BASES FOR REMAND The Veteran served on active duty in the United States Army from October 1966 to June 1969 with service in the Republic of Vietnam; from June 1974 to March 1980 with service in Panama; and with service in the National Guard through 2002. This matter comes before the Board of Veterans' Appeals (Board) from an August 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). A hearing before the undersigned Veterans' Law Judge (VLJ) was provided in April 2021. A copy of the transcript is of record. In June 2021 the Board issued a remand order for a VA examination and nexus opinion. There has not been substantial compliance with Board remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for a skin condition The Veteran contends that he has a skin disorder due to herbicide exposure, due to working under vehicles on the ground in Vietnam. The Veteran's service treatment records (STRs) do not show complaint, treatment or diagnosis for a skin condition. In the Veteran's physical examinations on reenlistment in May 1974, and in Reserve or National Guard examinations in October 1981 and November 1987 Reports of Medical History, the Veteran denied any "skin disease." STR-Medical. The Veteran's post-service medical record shows that his skin was found to be normal in August 2008. December 2012 CAPRI, pp. 6. However, in the same month the Veteran reported that he had a rash that "comes, breaks open, itches and then goes away" and expressed his view that it was from Vietnam. August 2019 CAPRI, p. 31. The Veteran later denied rashes and lesions in September 2009 and 2010. He was found to be without rashes in September 2011. December 2012 CAPRI, pp. 6, 12, 18, 28. The Veteran was first diagnosed with eczema in November 2016. January 2017 CAPRI, p. 109. In August 2017, the Veteran wrote that he returned from Vietnam in June 1969 and his sores began in early 1970, with the Veteran putting a bandage on to self-medicate. He wrote that he had treatment beginning in 2007. The Veteran's wife also wrote that she had been married to the Veteran since May 1985 and has witnessed his re-occurring rash. She also wrote that the Veteran was not given a diagnosis of chloracne, but rather it was self-diagnosed by the Veteran and his wife after reading the VA website. The articles read by the Veteran and his wife were included. In a June 2021 remand, the Board found that a new VA examination and medical opinion was warranted, as the May 2017 VA examination did not take into consideration physical examinations during service, and the VA examiner provide a nexus opinion. See June 2021 BVA Decision. A VA examination was provided in July 2021. The Veteran stated that he worked as a mechanic in Vietnam, with work that included lying on the ground without a shirt. The Veteran reported that in March 1970 he had an onset of rashes in the lower back, which extended up to the midback, with small pustular lesions that would last for 2-3 weeks. The Veteran said that he would cover these lesions with a bandage to prevent irritation. He reported that over the past 50 years he has had recurrent eruptions in the same area every couple of months, without a pattern of obvious aggravating entities. At the time of examination the Veteran did not have any lesions, but he presented the examiner with pictures of prior eruptions. Upon examination the VA examiner found that the Veteran had "some residual mild lichenification of the skin with mild hyperpigmentation" that was not characteristic of scarring that would be seen with chloracne. No treatment was noted, and the Veteran was diagnosed with "irritant contact dermatitis." The VA examiner provided a negative nexus opinion, stating that three examinations in service, dated 5/17/74, 10/28/81 and 11/7/87 all were negative for skin disease. The examiner further stated that he reviewed the Veteran's sick call records and did not find any instances of the Veteran reporting a skin condition. Furthermore, the examiner, based upon photographs shown to him by the Veteran of the condition and from the Veteran's description, found that: "it is obvious that the Veteran's rash is not consistent with the distribution, timeline or appearance of chloracne. In short, he doesn't have a diagnosis of chloracne. It is more likely that the Veteran has a chronic irritant dermatitis that is the source of his recurrent lesions. The findings on exam today are consistent with mild post inflammatory hyperpigmentation as a result of his contact dermatitis. His recurrent skin condition is not proximately due to the result of or aggravated by any inservice condition, event or exposure. The Veteran does not have a diagnosis of chloracne. Therefore his contention that he should be service connected for chloracne cannot be supported." See July 2021 C&P Exam. The Board finds this nexus opinion to be insufficient for the purpose of adjudication. The Board's remand directives were for the VA examiner to determine the etiology of the Veteran's skin condition and to provide an opinion as to whether it is at least as likely as not caused by the Veteran's military service. The VA examiner determined that the Veteran has contact dermatitis rather than chloracne but did not address the cause. While the Veteran claimed his skin condition to be chloracne, it is not required that the Veteran claim entitlement to service connection for a disability with an absolute certainty of its classification, but instead a claim is based on what a reasonable individual would believe considering the group of symptoms being claimed. See Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009). As such, an addendum opinion is required so that there is compliance with prior Board remand directives. Accordingly, the case is REMANDED for the following actions: 1. Afford the Veteran a VA addendum opinion from the July 2021 VA examiner, if possible, and from a qualified examiner otherwise. The examiner should review the claims folder and acknowledge such review in the examination report or in an addendum, and any indicated studies should be performed. Attention is called to the statements by the Veteran and his spouse on the onset and observations of the reported rash and the VA articles about chloracne and Mayo clinic article about dermatitis, posted in the file on April 23, 2021. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that any currently diagnosed skin condition (other than chloracne) including contact dermatitis onset during or is caused by the Veteran's military service, to include presumed herbicide exposure but also the Veteran's description of his work repairing vehicles in Vietnam lying on the ground without a shirt or his service in Panama 2. The examiner must consider the Veteran's service treatment records, medical records, his lay statements, this remand and previous examination. 3. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and whether there is additional evidence that would permit the opinion to be provided. J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Abels, 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.