Citation Nr: 21015801 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 16-01 906 DATE: March 18, 2021 REMANDED Entitlement to service connection for vitiligo, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from August 1999 to August 2003. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This matter previously came before the Board in November 2018, January 2020, and again in July 2020. In the most recent decision, the Board issued a remand for further development, to include obtaining a VA examination and medical opinion for the Veteran’s claim for service connection for vitiligo. The matters have now come back before the Board. The Board notes that the Veteran was previously represented by a private attorney. In January 2021, prior to March 2021 certification of the appeal to the Board, that attorney notified VA that he was withdrawing from the case. Under 38 C.F.R.§ 14.631(c), the Veteran’s attorney may withdraw representation before an agency of original jurisdiction if such withdrawal would not adversely impact the Veteran’s interests. Such a withdrawal requires notification in writing to the Veteran, the agency of original jurisdiction, and the VA organization in possession of the Veteran’s claims file. In this case, the January 2021 correspondence was sent to the RO, who was both the agency of original jurisdiction and the VA organization in possession of the Veteran’s claims folder. The letter indicates that it was also sent to the Veteran. In addition, there is no indication, and the Veteran has not asserted, that the withdrawal would adversely affect her interests. Thus, the Board finds the requirements of 38 C.F.R. § 14.631(c) were satisfied. Unfortunately, the Board finds that a remand is warranted for further development. The Board finds the November 2020 VA medical opinion to be inadequate. Specifically, the examiner opined that it was less likely than not that the Veteran’s vitiligo was caused or aggravated by a service-connected disability. The examiner further supported the opinion stating that vitiligo occurs when pigment producing cells die or stop producing melanin and it is unclear what causes these pigment cells to die or fall. The Board finds that the examiner failed to specifically address the Veteran’s claim that her vitiligo was caused or aggravated by her service-connected PTSD. The Veteran contends that her service-connected PTSD caused or aggravated her vitiligo due to the stress that her service-connected disability causes. See September 2013 Correspondence, September 2013 Buddy Statement. This contention was not specifically addressed by the examiner, and, therefore, the Board finds a remand is necessary to determine whether stress could cause or aggravate the Veteran’s vitiligo. In addition, the Board notes that the issue of entitlement to TDIU still cannot be adjudicated until the service connection issue is addressed, as they are intertwined. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. The RO should obtain an addendum opinion regarding the Veteran’s service connection claim. In-person examination is not necessary unless the examiner determines it must be conducted to address the questions below. The examiner is asked to specifically address the following, with a rationale provided: Whether the Veteran’s currently diagnosed vitiligo is at least as likely as not (50 percent or greater probability) caused by her service-connected PTSD. Whether the Veteran’s currently diagnosed vitiligo is at least as likely as not (50 percent or greater probability) aggravated by her service-connected PTSD. The examiner must consider and discuss the Veteran’s contention that her vitiligo is caused or aggravated by the stress induced by her service-connected PTSD. An opinion without reference to PTSD will not be considered adequate. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Glaeser, 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.