Citation Nr: 21012597 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 16-13 240 DATE: March 4, 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 1968 to July 1971, with verified service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board denied this claim in an August 2019 decision. The Veteran appealed the denial to the United States Court of Appeals for Veterans Claims (Court). Pursuant to an October 2020 Joint Motion for Partial Remand (JMPR), the Court vacated the Board’s decision, and remanded this matter for further action consistent with the terms of the JMPR. Entitlement to service connection for a skin disability, to include as due to herbicide agent exposure, is remanded. The Veteran contends that he developed a chronic skin disability as a result of service, to include as a result of herbicide agent exposure. His DD Form 214 reflected service in the Republic of Vietnam, and as such, he is presumed to be exposed to herbicide agents. Briefly, service treatment records dated in June 1969 show complaints of a body rash from the waist-down; the clinical impression was “fungical.” An October 1969 record shows the Veteran reported a history of recurrent bumps in the inguinal area. He was diagnosed with moderately severe folliculitis. An undated record showed that the Veteran was subsequently seen for continual spotty erythematous pustules and was diagnosed with tinea cruris, with secondary infection. In November 1969 he was seen again and initially, the rash was noted to have stopped spreading. Subsequently, he was seen for complaints of a “firey red scrotum;” however, the clinician’s impression was illegible, except for the part that showed it was secondary to long-term use of antibiotics. His April 1971 separation examination did not list any skin conditions. The Veteran asserts that his current skin condition is the same skin condition noticed in service. He has provided conflicting statements regarding the onset of the skin symptoms after discharge, however. In March 2015, a VA examiner noted the Veteran was recently diagnosed with papular eczema. He opined the papular eczema is less likely than not that related to his exposure to herbicide agents during his Vietnam service, in part, because this skin condition is not on the list of conditions presumptively related to herbicide agent exposure. The examiner also explained that since the Veteran stated the rash developed on his torso around 1999, and this was recently diagnosed as papular eczema, it was not related to the rashes in service. In the October 2020 JMPR, the Court found the March 2015 VA medical opinion was inadequate to satisfy the duty to assist due to the examiner’s reliance on the absence of the skin condition from the list of enumerated conditions VA has presumptively associated with herbicide agents exposure. The Court remanded this matter for the Board to ensure a new examination that adequately addresses whether his skin condition is related to service is provided. That same month, the Veteran’s private dermatologist at Dermatology Associates submitted a statement that he has a history of Grover’s disease and nummular dermatitis. These conditions were not discussed by the March 2015 VA examiner. In light of the above, an addendum nexus opinion necessary. Moreover, the record shows that the Veteran identified relevant outstanding private treatment records. Specifically, he stated that his rash was first treated by his primary care physician at Gray Family Health, and more recently with a private dermatologist at Dermatology Associates. This remand will allow VA to obtain authorization to request them, or for the Veteran to provide them. The matter is REMANDED for the following actions: 1. Obtain updated VA treatment records from January 2020 to the present. 2. Ask the Veteran to complete a VA Form 21-4142 for any non-VA health provider, who has treated his skin condition, including from Gray Family Health and Dermatology Associates. Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 3. If feasible, schedule the Veteran for an appropriate VA examination to determine the nature and etiology if his current skin disorder(s). If an in-person/telehealth examination is not feasible, the requested opinions must still be obtained based on record review. A copy of the Remand, and records obtained in connection with this Remand, must be reviewed by the examiner before providing the following opinions. For each identified skin disorder, the examiner should opine whether it is at least as likely as not: 1) had onset in service or 2) related to in-service exposure to herbicide agents? The examiner is advised that a negative opinion cannot be based solely on the fact that the skin disability is not on the list of diseases that are presumptively associated with exposure to herbicide agents. A fully-explained rationale for the opinion is required. In providing the requested opinion and rationale, the examiner is to consider the Veteran’s description (and documented history) of his in-service symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s symptoms and diagnoses in service and thereafter represented the onset of his current skin condition, this should be noted. Stated another way, do the service treatment records and the Veteran’s reports about his in-service and post-service symptoms (which reportedly onset in either 1981 or in 1991) align with how the currently diagnosed skin condition(s) is/are known to develop? D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Tang, 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.