Citation Nr: 21077303 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 14-08 870 DATE: December 29, 2021 REMANDED Entitlement to service connection for a skin condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from February 1968 to September 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In May 2019, the Board issued a decision denying service connection for a skin condition. The Veteran appealed the matter to the Court of Appeals for Veterans Claims (Court), which vacated the May 2019 Board decision, pursuant to an April 2020 Joint Motion for Remand (JMR). The Court remanded the matter for action consistent with the terms of the JMR. Since the JMR, the Board has remanded the matter in both October 2020 and May 2021. In August 2014 and October 2018, the Veteran testified at Board hearings by different Veterans Law Judges (VLJs), as the VLJ who held the September 2014 hearing was no longer with the Board. Unfortunately, the VLJ who held the October 2018 hearing is also no longer with the Board. In November 2021, the Board informed the Veteran that the prior VLJ was no longer with the Board and requested that he respond within thirty days of the letter if he desired another hearing. To date, the Veteran has not responded to the letter. Accordingly, the Board will proceed with adjudication. Unfortunately, the Board finds that another remand is warranted for further development. The Board sincerely regrets the additional delay and is aware that the matter has been remanded twice since the April 2020 JMR. The Board wishes to assure the Veteran that this remand is necessary in order to obtain an adequate opinion that addresses all relevant evidence of record in support of his claim. Entitlement to service connection for a skin condition is remanded. In May 2021, the Board remanded the matter for further development, to include obtaining an addendum medical opinion. The Board directed the examiner to discuss the Veteran's statements regarding his in-service symptoms and reoccurring skin symptoms since service and to document such conditions in the examination report. The Veteran has made several statements regarding the onset and symptomatology of his skin condition. In a December 2007 VA treatment note, the provider indicated that the Veteran had a rash over the entire trunk and arms with itching. The Veteran stated that he had the condition since 1968 when he was in Vietnam and that it began as a small patch and was extending. The examiner noted that the condition showed dark discoloration over the Veteran's upper back and shoulder and red annular rigged patches over his abdomen and forearms. In a December 2011 VA treatment note, the Veteran reported a long-standing back rash since he served in Vietnam. In February 2012, the Veteran stated that he developed a rash on his back that itched continuously and was very irritating during service. He further stated that his back became discolored upon discovering the itch. He also noted that his back was examined while in service and that he was told that "it was nothing and that everybody gets those marks and rashes on their back." At a March 2013 VA examination, the Veteran reported that he began to experience a scaly, itchy rash on his back, chest, and upper arms in 1968 while in Vietnam. In November 2013, the Veteran's spouse submitted a statement discussing the onset and symptoms of the Veteran's skin condition. She stated that she became involved with the Veteran in 1969 and that they were married in 1971. She noticed his skin condition and noted that it worsened over the years. She stated that the condition showed very dark discoloration, rash, sores, and bleeding. At a September 2014 VA examination, the Veteran was diagnosed with post-inflammatory hyperpigmentation. The Veteran stated that a history of tinea versicolor onset in 1968 with scaly, itchy, and discolored patches on chis chest, upper arms, and back. He also endorsed small and dry itchy patches on his hands, feet, and back since 1968. He indicated that symptoms have been constant and that he scratches often. At the September 2014 Board hearing, the Veteran testified that he developed a skin rash in service and that it had been with him ever since service. See Sept. 2014 Hearing Transcript, pp. 8-9. At an October 2015 VA examination, the examiner diagnosed the Veteran with post-inflammatory hyperpigmentation. The examiner described the history again with an onset in 1968 with scaly, itchy, and discolored patches on the chest, upper arms, and back. The examiner noted small and dry itchy patches on the hands, feet, and back since 1968. The examiner noted that there was evidence of multiple macules and patches consistent with post-inflammatory pigmentation of the back. At the October 2018 Board hearing, the Veteran testified that while serving in Vietnam, he developed white spots on the top of his back and noticed itching. At a January 2021 VA examination, the examiner again noted an onset of tinea versicolor in 1968 with scaly, itchy, discolored patched on the chest, upper arms, and back. In July 2021, a VA examiner provided addendum opinions, as requested in the May 2021 remand. The examiner stated that "while the Veteran's statements about onset were reviewed and considered, these statements are directly contraindicated by documented medical evidence." The examiner then described the characteristics of tinea versicolor. She stated that it is typically asymptomatic but does often get bigger. Further, patches may be "yellow or brownish, or sometimes red or pink." Additionally, they are usually lighter or darker than the surrounding healthy skin and affected areas may be somewhat scaly. They also may itch "a little." The examiner concluded that it would be unlikely that the Veteran would have had a symptomatic skin condition for greater than thirty years without seeking treatment, especially since he reported experiencing symptoms of the condition. In a separate July 2021 opinion, the same examiner stated that "the Veteran had no evidence of tinea versicolor or other rash during [active duty]" and that a condition of the suggested severity would have required medical attention over a period of thirty years. The Board finds the July 2021 opinions to be inadequate for adjudication purposes. First, it is unclear whether the Veteran has one or multiple current skin condition diagnoses. The July 2021 examiner only discussed the Veteran's tinea versicolor, however, prior VA examinations indicate a diagnosis of post-inflammatory hyperpigmentation. An opinion is necessary to determine whether these are two distinct diagnoses and, if so, whether post-inflammatory hyperpigmentation is related to the Veteran's service. Additionally, the Board finds that the July 2021 examiner failed to address the significant lay evidence of record as to the onset and symptomatology of the Veteran's skin condition. In both opinions, the examiner simply stated that the Veteran's statements were reviewed and considered but that such statements were contradicted by medical evidence. In the second document, the examiner stated that the Veteran had no evidence of tinea versicolor or other rash during active duty. This lack of consideration of the significant lay evidence of record further renders the examination inadequate. See Dalton v. Peake, 21 Vet. App. 23 (2007) (noting that a medical opinion is inadequate if it does not take into account the Veteran's reports of symptoms and history even if recorded in the course of the examination). The Board also notes that the Veteran has stated that his skin was discolored, scaly, and itched. The July 2021 examiner indicated that such symptoms may be associated with tinea versicolor. The Board also notes that the prior remand directed the examiner to discuss the Veteran's statements regarding his in-service symptoms and reoccurring skin symptoms since service and to document such conditions in the examination report. However, the examiner did not adequately comply with this directive in the examination, further warranting remand. See Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand confers on the claimant, as a matter of law, the right to compliance with the remand order). The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination with a dermatologist to determine the nature and etiology of any skin condition. Any indicated evaluations, studies, or tests deemed necessary by the examiner should be accomplished. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion and the examination report should include a discussion of the Veteran's documented medical history and assertions. The examiner must address the following: (a.) Determine all current diagnoses of skin conditions, including but not limited to tinea versicolor and of post-inflammatory hyperpigmentation. (b.) For each condition diagnosed, determine whether it is at least likely as not (a 50 percent probability or greater) that the condition is related to the Veteran's active duty service. In responding to the above, the examiner must address the several lay statements of record regarding onset and symptomatology of the Veteran's skin condition. See Feb. 2012 Medical Treatment Record Government Facility, p. 1; Apr. 2013 CAPRI, p. 109; Feb. 2012 Statement in Support of Claim; Mar. 2013 VA Examination; Nov. 2013 Correspondence from Spouse; Sept. 2014 C&P Examination, Sept. 2014 Hearing Transcript, pp. 8-9; Oct. 2015 C&P Examination; Oct. 2018 Hearing Transcript, p. 3; Jan. 2021 C&P Examination. The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries and that his reports must be taken into account in formulating the requested opinions. The examiner must provide rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. Roya Bahrami Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Watkins, 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.