Citation Nr: 21077383 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 12-21 365A DATE: December 29, 2021 REMANDED The issue of entitlement to service connection for a skin disability, other than skin cancer, to include skin neoplasms (also claimed as skin rash), is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from March 1968 to January 1970, to include service in the Republic of Vietnam. He died in April 2018. The appellant is his surviving spouse and has been substituted as the claimant in this case. See 38 U.S.C. § 5121A. This case comes before the Board of Veterans' Appeals (Board) on appeal from a December 2009 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. In April 2018, March 2021, and August 2021, the Board remanded the Veteran's claim for service connection for a skin disability for additional development. Regrettably, the Board finds that another remand is necessary prior to readjudication of the claim. In this case, it is contended that the Veteran had a skin disability that was directly related to his exposures to herbicides agents and/or excessive sun. As an initial matter, the Board notes that the VA has conceded to the Veteran's in-service exposures to herbicide agents and excessive sun while serving on active duty in Vietnam. Additionally, in an August 2021 decision, the Board granted service connection for skin cancer, which grant was implemented by the agency of original jurisdiction (AOJ) via rating decision dated in September 2021. As such, the Board has excluded skin cancer from the claim on appeal. In October 2021, the AOJ obtained a medical opinion to assess the nature and etiology of the Veteran's claimed skin disability, other than skin cancer, as directed by the Board in its August 2021 remand. Specifically, in that action, the Board noted that although VA opinions were provided in April, May, and June 2021, none of those opinions addressed any skin disability other than skin cancer. Thus, the Board directed the AOJ to obtain an opinion regarding the likelihood that the Veteran had a skin disability other than skin cancer that was attributable to the Veteran's service, to include his presumed in-service exposure to herbicide agents. Upon review of the record, a VA clinician provided an unfavorable opinion as to the Veteran's diagnosed skin conditions (actinic keratosis and dermatitis) being directly related to his active duty service, to include his conceded exposures to herbicides and excessive sun. Reviewing the October 2021 medical opinion the Board finds this opinion to be inadequate, as the examiner partially relied on the lack of in-service medical evidence showing a diagnosis of the noted skin conditions, and the fact that the diagnosed conditions are not listed as presumptively related to Agent Orange. Additionally, the examiner rationalized that the diagnosed skin conditions can occur due to accumulated sun exposure, but the Veteran's less than 2 years of active duty would not be considered enough sun exposure to influence his skin conditions, noting that the first indication of a skin lesion on the Veteran was in 2002, 50 years of sun exposure after service, which is more likely the accumulated sun exposure that caused the diagnosed conditions. Notably, the examiner failed to discuss and/or consider the Veteran's competent and credible lay statements of first experiencing skin rashes in the early 1970s, in which he started seeing a dermatologist who informed him that his skin conditions are normally seen in patients who have been exposed to harsh chemicals or extreme sun exposures, with the Veteran specifically adding that he was only exposed to extreme sun during his active duty in Vietnam. See NOD, November 2013. Therefore, the Board finds that the claim of service connection for a skin disability, other than skin cancer, must be remanded for the AOJ to obtain an addendum VA medical opinion that adequately addresses the Veteran's claim. The matters are REMANDED for the following action: 1. Arrange to obtain an addendum medical opinion form the VA clinician who provided the October 2021 VA medical opinion. If the October 2021 VA examiner is not available, please forward the claims file to another appropriate clinician. The entire claims file, including a copy of this remand, must be made available to the examiner, and note review of the record in the examination report. Any indicated tests or studies should be performed. Following complete review of the record, the clinician must opine whether it at least as likely as not (50 percent or greater probability) that the Veteran's diagnosed skin conditions (actinic keratosis and dermatitis) had their onset during active duty or are otherwise etiologically related to his active duty service, to include the conceded exposures to herbicides and excessive sun. Please note: in the requested opinion, the clinician must not rely on the lack of in-service treatment, complaints, or diagnosis of the skin conditions, and/or on the fact that they are not listed conditions presumptively related to Agent Orange. Any opinion should include a detailed rationale. The examiner should consider the entire claims file, and discuss the Veteran's lay statements regarding the nature, onset, and chronicity of symptoms. The examiner is advised that the appellant and Veteran are competent to report symptoms, and that his/her reports must be considered in formulating the requested opinion. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rational for the conclusion that an opinion could not be provided without resorting to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTIN E. NEILSON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Carter, 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.