Citation Nr: 21012326 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 13-17 723 DATE: March 4, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, other than service-connected PTSD, to include attention deficit/hyperactivity disorder, (ADHD) is remanded. Entitlement to service connection for a skin condition, to include as due to herbicide exposure and/or secondary to PTSD is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1966 to April 1969. The Veteran testified during a videoconference hearing before the undersigned Veterans Law Judge in June 2016. The Board of Veterans’ Appeals (Board) remanded the matters for further development in October 2016, July 2018, and August 2020 for further development. Unfortunately, an additional remand is necessary before the Board can adjudicate the matters on appeal. 1. Entitlement to service connection for an acquired psychiatric disorder, other than service-connected PTSD, to include ADHD is remanded. Pursuant to the Board’s July 2018 remand, the Veteran was afforded VA examination and addendum opinion regarding his ADHD in March 2020. The examiner was asked, in part, to provide a nexus opinion to determine if the Veteran’s diagnosis of ADHD was related to active duty service. The Veteran provided January 2011 private medical evidence from Dr. L.K. which showed a diagnosis for ADHD combined type under DSM-IV. As this diagnosis was made during the pendency of the appeal, it qualified as a current diagnosis under McClain v. Nicholson, 21 Vet. App. 319 (2007). Although the examiner did not diagnosis the Veteran with ADHD, the July 2018 remand directives clearly required a nexus opinion as to the previously diagnosis of ADHD in the record. Therefore, an addendum opinion is necessary to ensure substantial compliance with the previous remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). 2. Entitlement to service connection for a skin condition, to include as due to herbicide exposure and/or secondary to PTSD is remanded. The remand July 2018 Board remand directed the agency of original jurisdiction (AOJ) to provide the Veteran with an addendum nexus opinion for the Veteran’s skin disorder. Approximately 2 years after the remand, the AOJ had yet to provide the Veteran with an addendum opinion as requested. Therefore, the Board remanded the matter again for an addendum opinion in August 2020. Id. Pursuant to the August 2020 remand, the Veteran was provided with a VA examination and nexus opinion in November 2020. The examiner, in part, was tasked with determining if any of the Veteran’s diagnosed skin disorders were caused by herbicide exposure. The examiner provided negative nexus opinions, and based part of the rationale on the fact that “VA has very specific parameters on what can be considered ratable with regard to Agent Orange herbicide exposure.” However, this basis for a negative nexus opinion is inadequate. The Board is well aware of disabilities for which VA has presumptively associated with herbicide exposure, and no professional medical opinion would be necessary for said disabilities. However, under Combee, the Veteran can still meet the requirements for service connection on a direct basis based upon the specific facts of the Veteran’s claims file. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). Therefore, a professional medical opinion is necessary to determine if the Veteran’s specific disabilities are due to herbicide exposure, and an addendum opinion is required as to the nature and etiology of the Veteran’s skin condition. The matters are REMANDED for the following action: 1. Forward the Veteran’s claim file to a qualified psychiatrist or psychologist in order to obtain an addendum opinion as to the nature and etiology of ADHD. The claims file, to include a copy of this Remand, must be made available to and be reviewed by the examiner. Specifically, the examiner must provide an opinion as to whether the previously diagnosed ADHD (see January 2011 records) is at least as likely as not (a 50 percent or greater possibility) related to service, or caused or aggravated (increased in severity beyond the natural progress of the disorder) by service-connected PTSD. A complete rationale for all opinions expressed should be provided. The examiner must explain the relevance or significance, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching his or her conclusions, by detailing how such medical knowledge applies to the Veteran specifically. 2. Forward the Veteran’s claim file to a qualified medical professional in order to obtain an addendum opinion as to the nature and etiology of the Veteran’s skin disorder. The claims file, to include a copy of this Remand, must be made available to and be reviewed by the examiner. Specifically, the examiner must address the following: (a.) Provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any skin disorder identified is related to service, to include due to exposure to Agent Orange; and (b.) Provide an opinion as to whether it is at least as likely as not that any skin disorder identified is caused or aggravated (increased in severity beyond the natural progress of the disorder) by service-connected PTSD. A complete rationale for all opinions expressed should be provided. The examiner must explain the relevance or significance, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching his or her conclusions, by detailing how such medical knowledge applies to the Veteran specifically. Recitation of VA regulations is not an adequate rationale for Board purposes. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. N. Quarles, 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.