Citation Nr: 21009508 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 15-26 348 DATE: February 22, 2021 REMANDED Entitlement to service connection for lichen simplex chronicus is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from January 1982 to September 1985. During his period of service, he earned the Air Force Training Ribbon and Air Force Good Conduct Medal. The issue of entitlement to service connection for lichen simplex chronicus was previously before the Board in February 2020. In that decision, the Board denied entitlement to service connection for lichen simplex chronicus and remanded the issues of entitlement to service connection for hypertension and cardiovascular disease, to include as secondary to hypertension. In a September 2020 Joint Motion for Partial Remand (Joint Motion), the United States Court of Appeals for Veterans Claims (Court) indicated that the Board erred when it did not provide an adequate statement of reasons or bases for its determinations. The Court found that the Board did not adequately support its determination that the Veteran, “a trained registered nurse [who was] competent to describe his symptoms,” was not competent to establish that there was a worsening of his lichen simplex chronicus during service. The parties agreed that the Board’s decision did not adequately explain why a VA nurse practitioner had the requisite subject matter expertise to provide a competent opinion, while the Veteran did not have a comparable level of subject matter expertise, frustrating judicial review and requiring vacatur and remand. The Board has determined that additional evidentiary development is necessary prior to the adjudication of the Veteran’s claim of entitlement to service connection for lichen simplex chronicus. Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran’s claim so that he is afforded every possible consideration. See 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2020). [The September 2020 Joint Motion noted that it lacked jurisdiction over the portion of the Board’s decision that remanded the issues of entitlement to service connection for hypertension and cardiovascular disease, to include as secondary to hypertension.] Entitlement to service connection for lichen simplex chronicus The Veteran most recently appeared for a VA skin diseases examination in December 2018. The examiner opined that the condition, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by service. In support of the opinion, the VA examiner indicated that temporary aggravation was plausible, but there was no evidence of permanent aggravation, as the current medical literature did not support such a finding. Thus, a nexus could not be established. At the time of examination, the Veteran reported that he had been diagnosed with lichen simplex chronicus since childhood and had received numerous steroid injections during flare-ups prior to service. He further reported that he had initially been denied entrance to service because he was experiencing a flare-up. He subsequently returned for another examination after being treated by an outside physician. The VA examiner explained that the Veteran’s August 1981 entrance exam revealed the presence of eczema to right ankle and patella. A clinical note in August 1985 noted severe lichen simplex chronic to the right lateral tibial area, to which injection intralesional steroid was administered. In spite of the biopsy confirming the presence of lichen simplex chronicus and eczema at the time of the December 2018 examination, the VA examiner determined there was no evidence of permanent aggravation that was caused by military service. Thus, to avoid mere speculation, the examiner opined that it was not at least as likely as not that the Veteran’s lichen simplex chronicus was increased in severity during service. Unfortunately, the Board finds that the December 2018 VA opinion to be inadequate for adjudication purposes. Specifically, although the VA examiner cited an August 1985 notation of severe lichen simplex chronicus to the right lateral tibial area, it was still determined that the Veteran’s lichen simplex chronicus was not aggravated beyond its normal progression by service. However, the VA examiner failed to discuss the normal progression of the Veteran’s lichen simplex chronicus and did not provide sufficient rationale to support the finding that the Veteran’s lichen simplex chronicus was not permanently aggravated by service. Further, although the examiner noted the August 1985 treatment, the examiner failed to consider or discuss relevant service treatment records which indicating treatment for lichen simplex chronicus in January 1982, June 1983, September 1983, February 1984, and December 1984. The Board acknowledges that once VA undertakes the effort to provide an examination or opinion when developing a service connection claim, an adequate examination or opinion must be provided. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Accordingly, the Board finds that a remand is warranted in order to obtain a new VA examination and opinion. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination with an appropriate examiner with medical expertise in dermatology to address the etiology of lichen simplex chronicus. The examiner must review pertinent documents in the Veteran’s claims file in conjunction with the examination. This must be noted in the examination report. All tests and studies deemed necessary by the examiner should be performed. The examiner should state whether the Veteran’s preexisting lichen simplex chronicus was clearly and unmistakably not aggravated beyond its normal progression by his service. In so doing, the examiner is asked to specifically comment on (a.) the Veteran’s credible reports of worsening symptoms experienced during service and (b.) relevant service treatment records indicating treatment for lichen simplex chronicus in January 1982, June 1983, September 1983, February 1984, and December 1984. Clear and unmistakable evidence is evidence that is obvious, manifest, and undebatable. The term “aggravated” in this context refers to a permanent worsening of the underlying condition beyond the natural progress of the disease, as contrasted to temporary or intermittent flare-ups of symptoms that resolve with a return to the baseline level of disability. In providing the opinion, the examiner must discuss the normal progression of the lichen simplex chronicus. Rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Joseph, 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.