Citation Nr: 21014673 Decision Date: 03/15/21 Archive Date: 03/15/21 DOCKET NO. 14-24 063 DATE: March 15, 2021 REMANDED Entitlement to service connection for skin condition, to include as due to an undiagnosed illness or as secondary to service-connected chronic fatigue syndrome with joint pain, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1985 to December 1987 and from November 1988 to March 1993. In April 2016, the Board granted the issues of service connection for bilateral hearing loss, tinnitus, and headaches, as well as remanded the issues of service connection for joint pain, disability manifested by fatigue, and a skin condition for additional evidentiary development. In a November 2016 VA rating decision, the issue of service connection for chronic fatigue syndrome with joint pain was granted, which represents a full grant of the benefits sought for joint pain and a disability manifested by fatigue so they are no longer on appeal before the Board. In November 2016, March 2019, and September 2020, the Board remanded the remaining issue on appeal for a skin condition for additional evidentiary development. The case has been returned to the Board for appellate review. Entitlement to service connection for skin condition, to include as due to an undiagnosed illness or as secondary to service-connected chronic fatigue syndrome with joint pain Pursuant to the September 2020 Board remand directives, this issue on appeal was remanded for the agency of original jurisdiction (AOJ) to obtain an additional VA examination during the active stage of the disease and medical opinions addressing the existence and etiology of the Veteran’s skin condition(s) on direct and secondary bases to any service-connected disability. It was noted the examiner should specifically address a list of pertinent evidence dated during and since separation from active service. In October 2020, the Veteran underwent VA examinations for scars/disfigurement and for skin diseases, and multiple VA medical opinions were provided. While the VA examiner provided a medical opinion on a direct basis, the examiner did not specifically address the list of pertinent evidence dated during and since separation from active service, as listed in the remand directive. In fact, the examiner only noted the in-service documentation of a cyst on the upper back in 1984. “[A] remand by... the Board confers on the veteran or other claimant, as a matter of law, a right to compliance with the remand orders.” Stegall v. West, 11 Vet. App. 268, 271 (1998). As such, compliance with the terms of the September 2020 remand is necessary prior to appellate review, and if not, “the Board itself errs in failing to ensure compliance.” Id. Additionally, while the VA examiner provided medical opinions on a secondary basis to each of the Veteran’s service-connected disabilities for causation and aggravation, the rationales provided were solely based on the absence of medical evidence to support a link, this is inadequate. When VA undertakes to provide a VA medical opinion, it must ensure that the opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As such, the Board finds that an additional VA medical opinion on a secondary basis is needed to clarify the etiology of the Veteran’s skin condition. The matter is REMANDED for the following actions: 1. Return the Veteran’s claims file to the examiner who provided the October 2020 VA medical opinions so a supplemental opinion may be provided. If that examiner is no longer available, provide the Veteran’s claims file to a similarly qualified clinician. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination (physical or telehealth) is only required if deemed necessary by the examiner. First, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s skin condition (diagnosed as boils, dermatosis, cherry angioma, furuncle, and scars on right armpit and left shoulder, even if since resolved) began during active service or is related to an incident of service, to include the sebaceous cyst excised in service. The rationale provided should include discussion of the following evidence: December 1987 in-service possible cyst October 1991 in-service treatment of rashes Service treatment record for bites in groin and legs November 2012 VA examination finding a diagnosis of boils since 1991 June 2016 VA examination and medical opinion March 2015 VA medical record noted various skin infections January 2017 VA medical record noting skin problems with lesions January 2020 VA medical opinion Second, the examiner must provide the following: (a.) A rationale for why it is less likely than not (50 percent or greater probability) that the Veteran’s skin condition (diagnosed as boils, dermatosis, cherry angioma, furuncle, and scars on right armpit and left shoulder, even if since resolved) is proximately due to or the result of any of his service-connected disabilities. This rationale cannot be based solely on the absence of lay or medical evidence. (b.) A rationale for why it is less likely than not (50 percent or greater probability) that the Veteran’s skin condition (diagnosed as boils, dermatosis, cherry angioma, furuncle, and scars on right armpit and left shoulder, even if since resolved) is not aggravated beyond its natural progression by any of his service-connected disabilities. This rationale cannot be based solely on the absence of lay or medical evidence. Note – the Veteran’s service-connected disabilities include chronic fatigue syndrome with joint pain, traumatic brain injury, migraine headaches, left lower extremity radiculopathy, lumbar spine disability, tinnitus, hearing loss, irritable bowel syndrome, cyst on back, plantar scar on left foot, scar on forehead The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 2. Then, review all examination reports and medical opinions provided to ensure that the requested information was provided. If any report or opinion is deficient in any manner, the AOJ must implement corrective procedures. 3. Then, readjudicate the claim. If the decision is adverse to the Veteran, issue a Supplemental Statement of the Case and allow the applicable time for response. Then, return the case to the Board. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. 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.