Citation Nr: 21074738 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 17-51 431 DATE: December 16, 2021 REMANDED Entitlement to service connection for a skin disorder, other than tinea unguium and tinea pedis, to include as due to herbicide exposure, is remanded. Entitlement to service connection for a prostate disorder, to include as due to herbicide exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1967 to March 1971, March 1971 to February 1974, March 1974 to December 1975, and from January 1977 to March 1992, with additional Reserve and National Guard service, including service in the Republic of Vietnam. This case comes before the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO). These issues were previously before the Board in March 2016 and May 2019, each time remanded for further development. That development was completed, and the case has since been returned to the Board for appellate review. 1. Entitlement to service connection for a skin disorder is remanded. Remand is required for an addendum VA medical opinion. Where VA provides the Veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The Veteran underwent a VA examination in August 2021 where the examiner provided a negative nexus opinion. The examiner noted a 1974 diagnosis of impetigo resolved, a 2003 diagnosis of keratosis, and 2013 diagnoses of urticaria and seborrheic dermatitis. The examiner explained that the only two skin conditions presumed to be service-connected due to Agent Orange are chloracne and porphyria cutanea tarda, which the Veteran does not have. The examiner supported their rationale by providing the URL for a VA publication regarding skin conditions qualifying for presumptive service connection. The Board notes that the May 2019 Board remand instructed the examiner to address whether any skin disorders during the appeal period are causally or etiologically related to the Veteran's active-duty service, to include as due to herbicide exposure. The examiner was not asked to address whether they are diseases considered for presumptive service connection, which is a matter of law, and not medical opinion. The examiner otherwise provided no etiological opinion for any skin disorder. Accordingly, remand is required. 2. Entitlement to service connection for a prostate disorder is remanded. Remand is required for an addendum VA medical opinion. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr, 21 Vet. App. at 311. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez, 22 Vet. App. at 301. A medical opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). The Veteran underwent a VA examination in August 2021 where the examiner provided a negative nexus opinion. The examiner noted diagnoses of benign prostatic hyperplasia (BPH) and erectile dysfunction in 2010, 18 years following discharge from active-duty service. The examiner opined that there was no evidence of symptoms while on active duty relating to either condition, to include as due to herbicide exposure. The Board notes that the Veteran reported at the examination that they began to have prostate issues in service in the 1990s, including pain, burning with urination, and slow start to urinate. On the examination report, the examiner noted that the current symptoms included incompetent urination with coughing or laughing, and slow stream. However, at the Veteran's September 1991 retirement examination, the Veteran endorsed frequent painful urination on the report of medical history, and the examiner noted recurrent dysuria and recommended followup with urology on the report of medical examination. The examiner did not address these service treatment records (STRs), or otherwise provide any other supporting rationale. Accordingly, remand is required for an addendum VA medical opinion. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding the etiology of any prostate disorder, to include BPH and erectile dysfunction, from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. (a) For each diagnosed prostate disorder during the appeal period, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the prostate disorder had onset in, or is otherwise related to, active service, to include as due to conceded herbicide exposure. (b) The examiner should consider the following: 1) the September 1991 STRs noting frequent painful urination, recurrent dysuria, and a referral to urology; 2) the October 2013 statement where the Veteran asserted that their prostate issues are due to herbicide exposure; 3) the October 2013 statement where the Veteran asserted that they began having prostate issues at 40 while in service; and 4) the August 2021 VA examination where the Veteran reported prostate issues in the 1990s, including pain, burning with urination, and slow start to urinate. 2. Obtain an addendum opinion regarding the etiology of any skin disorder other than tinea pedis and tinea unguium from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. (a) For each diagnosed skin disorder during the appeal period, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the skin disorder had onset in, or is otherwise related to, active service, to include as due to conceded herbicide exposure. The examiner is reminded that service connection still is possible, including due to herbicide exposure, even if the disorder is not presumptively linked to herbicides. (b) The examiner should consider the following: 1) the STRs noting skin lesions, skin disease, impetigo, and rashes; 2) the July 2006 statement asserting the removal of growths during service; 3) the May 2008 statement asserting that the recent removal of a keratosis growth on the forehead is the same as in service; and 4) the October 2013 statement asserting that the skin disorders are related to herbicide exposure. Nykeia Miller Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Rogos 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.