Citation Nr: 21007410 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 17-00 419 DATE: February 9, 2021 REMANDED Entitlement to service connection for a skin disability, to include as due to herbicide agent exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1970 to January 1971. In November 2019, the Board remanded this case for additional development. The Board finds that there has been substantial compliance with the remand requests. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for a skin disability, to include as due to herbicide agent exposure is remanded. The Board requested a medical opinion which addressed the etiology of a skin disability. A December 2019 VA examination diagnosed porphyria cutanea tarda. The examiner opined that the diagnosed skin disability was “related to sequela of Hepatitis C in which his diagnosis of porphyria cutanea tarda is commonly associated.” The examiner explained that porphyria cutanea tarda occurred because the liver could not properly remove toxins from the blood because of chronic hepatitis C. The Board finds the VA examiner’s rationale for the opinion incomplete. The Board notes that porphyria cutanea tarda was not diagnosed within one year of service. However, the examiner did not explain the rationale for concluding that porphyria cutanea tarda was more likely related to hepatitis C rather than herbicide agent exposure while in service. The Board notes that during the June 2019 Board hearing, the Veteran testified that he no longer had hepatitis C. In addition to a diagnosis of hepatitis while in service and chronic hepatitis C years after separation from service; medical records show that hepatitis C had been treated and was undetectable since August 2017. The examiner noted a history of treatment of hepatitis C. The examiner did not discuss whether the hepatitis during service could have led to the porphyria cutanea tarda or the current porphyria cutanea tarda is related to the skin icterus found during service in 1971. When VA provides an examination or obtains an opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). As the Board finds the examiner's opinion incomplete, a remand is necessary to obtain an addendum opinion. The matter is REMANDED for the following action: 1. After obtaining any necessary releases, obtain all relevant VA and private treatment records not already associated with the claims file. All attempts to locate records must be documented in the claims file. 2. Schedule the Veteran for a VA examination with a medical doctor examiner who has not previously examined the Veteran. The examiner must review the claims file and should note that review in the report. The examiner should provide the following opinions: (a.) The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that porphyria cutanea tarda is related to service or any event, disease, or injury during service. (b.) The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that porphyria cutanea tarda is related to presumed exposure to herbicide agents during service. The examiner should reconcile that finding with the December 2019 VA examination opinion. (c.) The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that porphyria cutanea tarda is related to the finding of skin icterus and hepatitis during the Veteran’s service in 1971. The examiner should reconcile that finding with the December 2019 VA examination opinion. (d.) The examiner should discuss the significance, if any, of the fact that hepatitis C was treated and found to be undetectable since 2017, and whether that bears any significance to the December 2019 VA examination finding that hepatitis C was the cause of porphyria cutanea tarda. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E.O., 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.