Citation Nr: 21073386 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 17-02 849 DATE: December 8, 2021 REMANDED Entitlement to service connection for anemia is remanded. Entitlement to service connection for hair loss is remanded. Entitlement to service connection for a skin disability is remanded. Entitlement to service connection for an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran had active service from November 1990 to June 1991. These matters are on appeal from a January 2014 rating decision by a Department of Veterans Affairs (VA) regional office (RO). In her Form 9, the Veteran requested a video hearing. However, in a subsequent correspondence, the Veteran withdrew her request for a hearing. The Board regrets the delay but finds a remand is required in all of the Veteran's claims. The Veteran has been diagnosed with all of her claimed conditions. The Veteran has also stated on multiple occasions that her conditions could be due to her exposure to radiation in addition to her service in Southwest Asia. (See e.g. December 2014 Notice of Disagreement.) However, a radiation exposure memo is not associated with the Veteran's file. Additionally, while the Veteran has been afforded examinations for her conditions, this theory of entitlement has not been addressed by any examiner. Barr v. Nicholson, 21 Vet. App. 303 (2007). Anemia Claim Pertaining specifically to the Veteran's claim to service connection for anemia, the Veteran had an examination for her anemia in December 2013. The examiner noted the Veteran did have anemia but it had resolved and noted she was borderline anemic. The examiner reviewed the Veteran's file and opined it was at least as likely than not the Veteran's anemia was incurred in or due to her time in service. The examiner noted the Veteran's anemia resolved. The examiner noted the Veteran's record showed she was borderline anemic prior to service with no etiology and that she was also pregnant during this time. The examiner noted that medical literature reported pregnancy state and associated increases in blood volumes can cause blood volume dilution effect anemias and therefore, the Veteran's service period anemia resolved post-pregnancies. The examiner also noted the Veteran could have had unrelated anemic states both during and post service without any continuity and both have resolved. The Veteran had an examination for nutritional deficiencies in October 2016. The examiner noted the Veteran had been diagnosed in 2015 with a Vitamin D deficiency with secondary symptoms of fatigue and non-specific joint pain. Based on the review of the Veteran's file and medical literature, the examiner found the Veteran's pain and fatigue were due to a Vitamin D deficiency. The examiner opined the Veteran's Vitamin D deficiency with secondary symptoms of fatigue and non-specific joint pain was less likely than not related to a specific exposure event during her time in Southwest Asia. The examiner stated that medical literature did not support Southwest Asia exposure causing a Vitamin D deficiency with fatigue and non-specific joint pain. The examiner stated that based on the majority of literature, the Veteran's Vitamin D deficiency was rather caused by diet deficiency along with inadequate sun exposure. However, in a September 2015 treatment record, the Veteran was noted to be iron deficient. The December 2013 and October 2016 examinations did not account for this. Therefore, the Board finds these examinations to be inadequate. Skin and Hair Loss Claims The Veteran had an examination for her skin in October 2016. The examiner saw the Veteran in person and reviewed her file and noted that she had been diagnosed with alopecia with seborrheic dermatitis and xerosis cutis. The date of diagnosis was listed as unknown. The examiner noted the Veteran's contentions that her hair loss and skin problems were due to her time in service and that she was currently using medication to treat her conditions. The examiner opined the Veteran's Xerosis was a disease with a clear and specific etiology and diagnosis and that it was less likely than not due to the Veteran's time in Southwest Asia. The examiner stated that literature did not support this condition being caused by Southwest Asia exposure and that it is common amongst patients with type II diabetes, which the Veteran had. The examiner also opined alopecia was a diagnosable chronic multi symptom illness with a partially explained etiology. The examiner opined it was less likely than not the Veteran's hair loss was due to her time in service in Southwest Asia. The examiner stated the literature did not support such an association and that it is an autoimmune disease in which the body attacks its own hair follicles. The examiner noted Seborrheic dermatitis is a skin condition which can also involve temporary hair loss if located on the scalp. However, this examiner did not consider the Veteran's contention that her conditions were due to exposure to radiation. There is also a question as to whether the Veteran's skin condition is related to or caused by her diabetes, which is not service-connected. Therefore, the Board finds this examination to be inadequate. While the examiner reported it was due to her diabetes, the Veteran said she had been diagnosed with her skin condition many years prior to her diabetes diagnosis. This point must be clarified on remand. Psychiatric Claim A claim for service connection for a mental disability may encompass claims for service connection of any mental disability that may reasonably be encompassed by several factors, including the veteran's description of the claim, the symptoms the veteran describes and the information the veteran submits or that the Secretary obtains in support of the claim. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Accordingly, the Board has taken an expansive view of the claims for service connection for a mental disorder pursuant to Clemons and re-characterized them as shown on the cover page of this decision. The Veteran's record indicates she has been diagnosed with many mental health disabilities, to include PTSD and depression. While some records indicate depression and PTSD screenings were negative (see e.g. October 2013 treatment record), December 2019 and August 2021 records indicate treatment provider noted the Veteran was first seen by her in December 2019 with a diagnosis of combat related PTSD, panic disorder with agoraphobia, and had been treated with medication. The examiner noted the Veteran's condition had worsened, with flashbacks to her time in service. The examiner noted she couldn't be part of the process to get service connected for his condition, but that she could mention the previously overlooked diagnosis. There is evidence in the Veteran's file that seems to suggest the Veteran has at least one mental health condition that is related to her time in service. The Veteran has not had an examination to determine the etiology of her mental health conditions. The Board finds the evidence in the Veteran's record is sufficient to warrant an examination. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. The AOJ should obtain any of the Veteran's outstanding medical records and associate them with the claims file. If possible, the Veteran should submit any pertinent new evidence regarding the condition at issue in order to expedite the claim. 2. Provide the Veteran with a radiation exposure opinion/memo. 3. Schedule the Veteran for an appropriate examination to determine the nature and etiology of the Veteran's 1) anemia, 2) skin disability, 3) hair disability, and 4) mental health disability. 4. For each disability, the examiner should opine as to the following: (a) Does the Veteran have a currently have a diagnosis of her claimed disability? If not, the examiner must explain the medical treatment records showing the Veteran is treated for this condition. (b) Whether the Veteran's disability was at least as likely as not incurred in and due to her time in service. (c) Whether the Veteran's disability is at least as likely as not proximately due to any of her service connected disabilities. (d) Whether the Veteran's disability is at least as likely as not aggravated by any of her service connected disabilities. NOTE: "Aggravation" does not mean a permanent worsening. Any temporary or incremental worsening is sufficient for a finding of "aggravation." (e) Whether the Veteran's disability is at least as likely as not due to her exposure to radiation. (f) Whether the Veteran's disability is at least as likely as not due to her service in Southwest Asia. The examiner should account for the Veteran's statements about his disabilities and provide a complete rationale for any opinion provided. 5. After undertaking any other appropriate development deemed necessary, readjudicate the issues on appeal based on the additional evidence of record. If the determinations remain adverse to the Veteran, he must be provided with a supplemental statement of the case. An appropriate period of time must then be allowed for a response before the record is returned to the Board for further review. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Snoparsky 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.