Citation Nr: 21015438 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 17-05 656 DATE: March 17, 2021 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to dermatitis, is remanded. Entitlement to a compensable disability rating for dermatitis is remanded. Entitlement to service connection for Morgellons disease, to include as secondary to dermatitis, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from August 1983 to December 1991. These matters come before the Board of Veterans’ Appeals (Board) on appeal from April 2013 and October 2014 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Honolulu, Hawaii. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a November 2020 virtual Board hearing. A transcript of that hearing has been associated with the claims file. 1. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to dermatitis, is remanded. The Veteran was afforded a VA mental disorders examination in October 2014. A diagnosis of major depressive disorder was noted. The examiner opined that the Veteran's major depression did not begin while he was on active duty, noting that DSM-5 stipulates on Criteria B that for a depressive mood caused by another medical condition there has to be evidence from history, physical examination or laboratory findings that the disturbance is the direct pathophysiological consequence of the medical condition. The examiner then stated that "[t]here absolutely no psychiatric way to rationalize that his major depressive condition is the result of [eczema]", calling it a "stretch of the imagination not based on medical facts." The examiner also stated that Morgellons disease is "quite controversial in the field of dermatology and at this time is not an accepted medical diagnosis." The examiner then noted that the Veteran is not service connected for Morgellons disease. When VA undertakes to provide a Veteran with an examination, that examination must be adequate for VA purposes. Barr v. Nicholson, 21 Vet. App. 303 (2007). Here, the examiner did not discuss the numerous diagnoses in the VA and private treatment records other than major depressive disorder, nor was aggravation of depression by service-connected dermatitis discussed. Furthermore, the record indicates that the Veteran has been in receipt of social security administration (SSA) disability income sinc 2010, but no medical records from this have been associated with the claims file. Finally, the Veteran testified at the November 2020 Board hearing that he sees two private physicians who treat him for his psychological condition. Based on the above, the Board remands this matter to obtain the Veteran’s SSA medical records and private treatment records to ensure that there is a complete record upon which to decide the Veteran's claims of entitlement to service connection. The Board also remands this matter for a new VA examination. 2. Entitlement to a compensable disability rating for dermatitis is remanded. The Board notes that the Veteran was last afforded a VA examination in April 2013. As such, the need for a thorough and contemporaneous evaluation, as well as the age of the last examination, weigh in favor of remand for a new examination. Weggenmann v. Brown, 5 Vet. App. 281, 284 (1993); see also, Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991) (observing that where the record does not adequately reveal the current state of the claimant's disability, a VA examination must be conducted); see also 38 C.F.R. § 3.326 (a). As such, this matter is remanded for a new VA examination to determine the current manifestations and severity of the Veteran's dermatitis. 3. Entitlement to service connection for Morgellons disease, to include as secondary to dermatitis, is remanded. The Veteran was afforded a VA skin diseases examination in April 2013. Diagnoses of dermatitis and Morgellons disease were noted. The VA examiner opined that the Veteran's Morgellons disease is less likely than not proximately due to or the result of his service, noting that the Centers for Disease Control (CDC) has concluded that Morgellons is an "unexplained dermopathy" and is not caused by an infection or parasites. The Veteran testified at the November 2020 VA examination that he is being treated by an infectious disease specialist Dr. F. Pien, for his Morgellons disease. The Board notes that no records from Dr. Pien have been associated with the claims file. Here, as the VA examiner did not have the benefit of reviewing the private treatment records, as well as the above-mentioned SSA medical records, the Board finds that a remand to obtain the private treatment records and afford the Veteran a new VA examination is required. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for Dr. Francis Pien. Make two requests for the authorized records from Dr. Francis Pien, unless it is clear after the first request that a second request would be futile. 2. Ask the Veteran to complete a VA Form 21-4142 for Dr. Rios. Make two requests for the authorized records from Dr. Rios, unless it is clear after the first request that a second request would be futile. 3. Ask the Veteran to complete a VA Form 21-4142 for Dr. Minalidad. Make two requests for the authorized records from Dr. Minalidad, unless it is clear after the first request that a second request would be futile. 4. Obtain the Veteran’s federal records, to include medical records, from Social Security Administration. Document all requests for information as well as all responses in the claims file. 5. Obtain the Veteran’s VA treatment records for the period from February 2018 to the Present. Acquired Psych 6. After, and only after, completion of steps one through five, schedule the Veteran for a VA examination for his acquired psychiatric disorder. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is the Veteran’s acquired psychiatric disorder at least as likely as not related to service? Provide a rationale to support the opinion(s). In providing the requested opinion, consider the Veteran’s description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of his/her current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? Is the Veteran’s acquired psychiatric disorder at least as likely as not proximately due to service-connected dermatitis? Is the Veteran’s acquired psychiatric disorder at least as likely as not aggravated, i.e., worsened beyond its natural progression, by service-connected dermatitis? The examiner’s attention is invited to the January 13, 2011 VA treatment record which notes that the Veteran's an evaluation from an infectious disease specialist "put [the Veteran's] mind at ease about [his] diagnosis as he [has] struggled with the same rash for [the] past 20 years". Dermatitis 7. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected dermatitis. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. Morgellons 8. Schedule the Veteran for a VA examination for his Morgellons disease. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is Morgellons disease at least as likely as not related to service, including? Provide a rationale to support the opinion(s). In providing the requested opinion, consider the Veteran’s description of his/her in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of his/her current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? Is Morgellons disease at least as likely as not proximately due to service-connected dermatitis? Is Morgellons disease at least as likely as not aggravated, i.e., worsened beyond its natural progression, by service-connected dermatitis? 9. After completing the requested actions, and any additional development deemed warranted, readjudicate the claims in light of all pertinent evidence and legal authority. If the benefits sought remain denied, furnish to the Veteran and his representative a Supplemental Statement of the Case and afford them the appropriate time period for response before the claims file is returned to the Board for further appellate consideration. C. TRUEBA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Brian P. Keeley 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.