Citation Nr: 21072666 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 17-28 509A DATE: December 6, 2021 REMANDED Entitlement to service connection for a skin disability, claimed as a leg rash, to include as due to herbicide agent exposure, is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1965 to September 1967, including service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2019, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge. The Board remanded the appeal in November 2019, February 2021, and June 2021 for further development. 1. Entitlement to service connection for a skin disability, claimed as a leg rash, to include as due to herbicide agent exposure, is remanded. The Board regrets further delay but another remand is required. Pursuant to the Board's June 2021 remand directives, an addendum opinion was obtained in August 2021. The examiner indicated that she could not state without resorting to speculation whether the Veteran's diagnosed skin conditions were related to service, but did not adequately explain why. Moreover, the examiner did not opine on whether the Veteran's nexus between his skin disabilities and service was medically consistent with the reported symptomatology. Thus, this opinion is inadequate, and an addendum opinion is needed to ensure substantial compliance with the Board's June 2021 remand directives. Stegall v. West, 11 Vet. App. 268 (1998). 2. Entitlement to service connection for a right knee disability is remanded. 3. Entitlement to service connection for a left knee disability is remanded. The Board regrets further delay but another remand is required. Pursuant to the Board's June 2021 remand directives, a VA examination was obtained in September 2021. The Board asked the examiner to opine on whether it was medically consistent, based on the Veteran's lay statements and symptomatology, that there was a nexus between the Veteran's right knee and/or left knee disabilities and active service. In rendering an opinion, the Board specifically asked the examiner to address and accept as true the Veteran's credible reports of an in-service bilateral knee injury, his military occupational specialty (MOS) of a truck driver, and continuous knee pain during and since the in-service injuries. However, in rendering the negative opinion, the examiner did not do so (critically, just like the previous examiner did not), and instead relied on a lack of documentation of right knee and left knee issues (notwithstanding leg cramps) in the Veteran's STRs and a lack of continuity of care since service in addressing the etiology of his right knee and left knee disability. Nor did the examiner address whether arthritis onset within a year of separation from service as requested by the Board. Thus, this opinion is inadequate, and an addendum opinion is needed to ensure substantial compliance with the Board's June 2021 remand directives. See Stegall, supra. The Board notes the examiner's statement that he may not be an accurate historian, given his dementia, but the Board emphasizes that any credibility findings are squarely within the purview of the Board. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from a dermatologist, other than the August 2021 dermatologist, addressing the nature and etiology of any skin conditions. No additional examination is necessary, unless the examiner determines otherwise. The entire claims file should be made available to the examiner. After a review of the claims file, the examiner is requested to address the following: (a.) For each diagnosed skin disorder present since December 2016, including nummular dermatitis (stemming from dry skin), capillaritis and statis dermatitis (see August 2021 VA examination report), please opine as to whether it is at least as likely as not (50 percent or greater probability) that such disability had its onset in service or is otherwise related to service, to include as a result of conceded herbicide agent exposure therein. In addressing this question, please address each condition separately and please discuss and concede the Veteran's May 2019 Board hearing testimony that: (1) he first noticed a rash during active duty the day after he returned to the United States from Vietnam and the rash has continued to the present; and (2) certain environmental factors will cause the rash to be worse. In addressing this question, the examiner must assume items (a)(1) - (a)(2) as true, even despite the absence of "objective documentation." If the conditions are not related to herbicide agent exposure, please thoroughly explain this finding. (b.) Please state whether the Veteran's nexus between the Veteran's skin disabilities and service is medically consistent with the symptomatology reported by the Veteran in items (a)(1) and (a)(2) above. Please furnish a robust rationale for all opinions and conclusions expressed, and please do not rely solely on the fact that a given disability is not eligible for presumptive service connection, as doing so will render the opinion inadequate. If unable to provide an opinion without resorting to speculation, please indicate whether there is any additional evidence that would enable you to do so, or whether the inability to opine is based on the limits of medical knowledge. Failure to address these inquiries will result in further remand. 2. Obtain an addendum opinion from an examiner other than the February 2020, April 2021, and September 2021 examiners, addressing the nature and etiology of the Veteran's right and left knee disabilities. No additional examination is necessary, unless the examiner determines otherwise. The entire claims file should be made available to the examiner. After a review of the claims file, the examiner is requested to address the following: (a.) For diagnosed bilateral knee arthritis and tendonitis/tendinosis, please opine as to whether it is at least as likely as not (50 percent or greater probability) that each disability had its onset in service or is otherwise related to service. In addressing this question please discuss both conditions separation, and please address the following from the Veteran's May 2019 Board hearing testimony: (1) that his bilateral knee pain had its onset during active service and has continued to the present; (2) his military occupational specialty (MOS) of truck driver and its cumulative impact of continuously having to jump out of the truck to reach the ground; (3) his conceded but undocumented in-service bilateral knee injury sustained when he hit both knees on a truck bumper from which he took approximately one month to recover; (4) his brother and sisters' reports that the Veteran returned from Vietnam limping from a knee injury. In addressing this question, the examiner must assume items (a)(1) - (a)(4) as true, even despite the absence of "objective documentation." (b.) Please state whether a nexus between the Veteran's right or left knee disabilities and service is medically consistent with the symptomatology reported by the Veteran in items (a)(1) and (a)(4) above. (c.) For any diagnosed arthritis, is it at least as likely as not that this condition manifested within a year of a qualifying period of active service, or by September 1968? Please note, the Veteran's statements may not be discounted solely on the lack of confirmation in the medical records. Please be advised any negative opinion premised solely on an absence of treatment will be returned as inadequate. If the Veteran's reported history is discounted, the examiner must provide a reason for doing so. A robust rationale is requested for any opinion furnished. If unable to provide an opinion, please indicate whether there is any additional evidence that would enable you to do so, or whether the inability to opine is based on the limits of medical knowledge S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. J. Rogers, 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.