Citation Nr: 21075120 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 14-06 965 DATE: December 17, 2021 REMANDED Entitlement to service connection for a skin disability, including basal cell carcinoma, but excluding chloracne is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from September 1965 to July 1969. This matter is before the Board of Veterans' Appeals (Board) on appeal from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In May 2017, a Board hearing was held before the undersigned. A transcript of the hearing is associated with the Veteran's claims file. In October 2020, the Board denied service connection for a skin disability, including basal cell carcinoma, but excluding chloracne. The Veteran appealed the Board's October 2020 decision to the United States Court of Appeals for Veterans Claims (Court). Pursuant to a July 2021 Order by the Court in accordance with a Joint Motion for Partial Remand (Joint Motion), the issue was remanded to the Board for additional development and adjudication. The record indicates various skin disabilities, to include an in-service diagnosis of telangiectasia. At the September 2019 examination, it was noted the Veteran had a history of basal cell carcinoma with residual scarring, with the date of onset being August 2007. He had a history of superficial squamous cell carcinoma in 2008 that was resolved with excision. The Veteran did not have a current known benign or malignant neoplasm. He was noted to have a history of hemangiomas, seborrheic keratosis, telangiectasia, and solar lentigines. The examiner did not provide an opinion regarding the etiology of the Veteran's skin disabilities. In February 2020, the Veteran underwent another examination. In December 2019, the Veteran had a wide excision of superficial melanoma. He was diagnosed with malignant melanoma and pigmented seborrheic keratosis. The examiner noted the Veteran's STRs confirm treatment for ringworm, subcutaneous mass of the neck, and multiple telangiectasias of the face and chest in May 1977. In May 1977, clinicians noted the Veteran had solar damage and had been advised to use sunscreen. On separation from service there was no mention of a skin problem. Dermatology records note a history of extensive intentional sun exposure, with a record from Dermatology Cosmetic Surgery of Dublin from 2008 noting an onset of lesions about 6 - 7 years prior. Post-service records note the Veteran had Bowen's disease, solar lentigines, hemangiomas, and seborrheic keratoses. Although the Veteran had telangiectasias in service, which were attributed to solar damage, the examiner opined he had no evidence of other skin conditions during service. The Veteran had post-service skin conditions related to sun exposure to include skin cancer and solar lentigines. The Veteran had a longer period post-discharge with intentional sun exposure; and therefore, his sun-related conditions are less likely due to sun exposure in service. Further, his various skin disabilities, with the exception of chloracne, are not related to Agent Orange exposure. The February 2020 examiner did not opine whether "each diagnosed skin disability" is related to service. Further, the examiner should address the Veteran's lay statements regarding the rash on his chest that he "has suffered with a rash on my chest since being in Vietnam. I still have this rash on my chest." (May 4, 2017 Board hearing transcript). The September 2010 VA examiner noted the Veteran's skin cancer is due to chloracne. An opinion is needed clarifying whether the Veteran's skin cancer is secondary to his chloracne. April 2011 VA examination report reflects people living in states closer to the equator or with a history of sunburns during childhood see basal cell carcinoma lesions form in the 20s. An examiner's opinion addressing this statement and how it pertains to the Veteran is needed. As such, a remand is required to obtain an addendum opinion. The matter is REMANDED for the following action: 1. Forward the Veteran's claims file to an appropriate VA examiner for an addendum opinion regarding the nature and etiology of his skin disability/skin cancer, other than his already service-connected chloracne. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. (a) The examiner should identify each skin disability (except chloracne) found at any time during the appeal period. If any previously diagnosed skin disability is not found on examination, the examiner should address the prior diagnoses of record and indicate whether they may have resolved or been misdiagnosed. (b) The examiner should provide an opinion regarding whether it is at least as likely as not (i.e., probability of 50 percent) that each currently diagnosed skin disability, including skin cancer, is related to any disease or injury in service, including exposure to Agent Orange and in-service sun exposure. (c) The examiner should provide an opinion regarding whether it is at least as likely as not that basal cell carcinoma was caused or aggravated by his service-connected chloracne? If aggravation is found, please identify to the extent possible the baseline level of disorder prior to the aggravation and determine what degree of additional impairment is attributable to aggravation of basal cell carcinoma by chloracne. 2. Considerations for the Examiner: (a) The examiner is advised that the file, indicates the following diagnoses: basal cell carcinoma, squamous cell carcinoma, Bowen's disease, solar lentigines, DeMorgan hemangiomas, seborrheic keratosis, and telangiectasia. (b) The examiner is asked to address the Veteran's contentions, specifically of experiencing a rash on his chest since service. (c) The examiner is asked to address the in-service dermatology consult for multiple telangiectasis due to solar damage. (d) The examiner is asked to address the April 2011 VA examination report reflecting that people living in states closer to the equator or with a history of sunburns during childhood see basal cell carcinoma lesions form in their 20s. The examiner is asked to provide a complete a rationale for all opinions offered. H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Skiouris, 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.