Citation Nr: 21015022 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 16-41 044 DATE: March 16, 2021 REMANDED Entitlement to service connection for a left-hand skin disability is remanded. Entitlement to service connection for a bilateral foot skin disability is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1973 to June 1975. The Veteran has a 100 percent schedular VA disability rating, based on posttraumatic stress disorder, from October 8, 2019. This appeal comes before the Board of Veterans’ Appeals (Board) from an October 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California. In August 2019, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A hearing transcript is associated with the record. In November 2019 and August 2020, the Board remanded the claims for further development. Lastly, the Board notes that the Veteran’s representative submitted a waiver, dated in March 2020, to provide an Informal Hearing Presentation (IHP), claiming that they are waiving their right to provide an IHP due to recent personnel changes/staffing issues. See Appellate Brief (March 2020). 1. Entitlement to service connection for a left-hand skin disability is remanded. 2. Entitlement to service connection for a bilateral foot skin disability is remanded. Issues 1-2. The Veteran contends that he started experiencing symptoms of his skin disabilities shortly after a field exercise in which he was exposed to murky water up to his chest. See generally Hearing Transcript (August 2019). The Board finds there has not been substantial compliance with its prior remand, and therefore further remand is required. Stegall v. West, 11 Vet. App. 268 (1998). As an initial matter, the Board notes that, in August 2020, the claims were remanded for a VA examination and medical opinion. VA examination report, dated November 2020, reflects that the Veteran was diagnosed with onychomycosis of the feet and left-hand long finger. No other skin condition was identified by the clinician. Next, although a VA medical opinion was obtained in November 2020, the medical opinion, however, is inadequate as the essential rationale for the opinion is not discernable. Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012). The opinion concluded that the Veteran’s skin disabilities were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In support of the conclusion, the opinion noted review of the Veteran’s service treatment records and found that the records were absent for any skin condition during service. In this instance, the opinion is inadequate because it does not provide the Board a reasoned rationale supporting the conclusion. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“a medical opinion . . . must support its conclusion with analysis that the Board can consider and weigh against contrary opinions”). Moreover, the opinion seems to rely, for the most part, on the absence of documented medical treatment records, during and after service, showing complaints or treatment for any skin condition. Although the Veteran, as a lay person, is not competent to opine on the etiology of his symptoms or diagnosed skin condition, he is, however, competent to report signs and symptoms of his disabilities. See Barr v. Nicholson, 21 Vet. App. 303. In this regard, the Veteran has testified to experiencing symptoms of a skin condition following a field exercise; he has further testified to not being able to go to sick call during the exercise. See Hearing Transcript at 3 (August 2019). The opinion, however, does not reveal a rationale or explanation discounting the Veteran’s competent observations; rather, as evidenced in the opinion, the clinician seems to rely on the absence of documented treatment during service without considering the Veteran’s testimony. See McKinney v. McDonald, 28 Vet. App. 15, 30-31 (2016) (“the VA examiner’s failure to consider [a veteran’s] testimony when formulating her opinion renders that opinion inadequate”). The clinician is not required to accept the Veteran’s theory that his military service caused either of his skin problems, or that he had symptoms associated with any skin disability during or following military service if this is incongruous with the record; however, the clinician is required to fully explain why he or she disagrees with the Veteran’s theory of causation, and provide a discussion of the relevant or significant medical history, clinical findings, medical knowledge or literature, etc., that support the negative medical opinion or conclusions. If another etiology is the more likely cause, the clinician must provide a complete explanation of his or her reasoning. Given the above, the Board may not rely upon the VA medical opinion in its present form and, therefore, finds the medical evidence is inadequate for adjudicative purposes. Where VA provides an examination or obtains an opinion, it must be adequate. Barr, 21 Vet. App. 303. Accordingly, as the Board has a duty to ensure compliance with the terms of its remand, remand is again required. Stegall, 11 Vet. App. 268. In remanding these matters, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran’s assertions. Neither the Veteran’s credibility nor any lack thereof should be presumed in this remand. The matters are REMANDED for the following actions: 1. Obtain all VA treatment records dated from October 2020 to the Present. 2. Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s skin disabilities of the feet and left hand, to include onychomycosis. The entire claims file, to include a copy of this REMAND, should be made available to and reviewed by the clinician. Based on review of the record, detail the Veteran’s reported symptoms, including the nature, onset, progression and severity of any symptom consistent with any skin disability of the feet and left hand. The opinion should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). An adequate medical opinion may not be predicated solely on the absence of an in-service diagnosis or documented complaints. The clinician must opine on: Whether any skin disability of the feet or left hand at least as likely as not (1) began during active service or (2) is related to an in-service injury, event, or disease. Consider and expressly address the Veteran’s theory that his disabilities stem from a field exercise, in which, he was exposed to murky water up to his chest. Explain. NOTE (1): A negative medical opinion may not be predicated solely on the absence of in-service documented complaints, findings, or treatment. NOTE (2): A negative medical opinion may not dismiss the Veteran’s competent report of skin symptoms in service and since without providing an explanation as to why. For example, if the Veteran’s reports about his symptoms do not align with how the currently diagnosed disability is known to develop, explain; or if the Veteran’s reports are generally inconsistent with medical knowledge or implausible, explain). 3. Ensure that the medical opinion obtained includes a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. (Continued on next page) 4. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Griffey, 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.