Citation Nr: 21020737 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 14-25 407 DATE: April 8, 2021 REMANDED Entitlement to service connection for a skin condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from August 1967 to August 1969. The Board has remanded this issue several times, most recently in January 2021. 1. Entitlement to service connection for a skin condition is remanded. Unfortunately, remand is again required. The Veteran contends he has a skin condition related to in-service exposure to herbicide agents while stationed in the Korean DMZ. The Board has requested medical opinions addressing several aspects of the evidence and claim, including whether or not the Veteran’s skin condition is congenital, an article from the European Journal cited by the Veteran’s representative in the July 2017 brief, and the Veteran’s reports of having a rash since his time in service. In the January 2021 opinion, the expert explained how ichthyosis vulgaris can be genetically inherited or acquired, that the Veteran’s condition is likely acquired, but found his skin condition was less likely than not due to or aggravated by service. The expert relied on the fact that ichthyosis vulgaris is not on the list of conditions presumed associated with herbicide agents and the lack of documentation of ichthyosis vulgaris in service. However, the examiner did not adequately consider the Veteran’s reports of having a skin condition since service, the European Journal article, or the positive conclusion rendered by the October 2019 medical expert. The Board notes that even if a disease is not presumed to be associated with herbicide agents, service connection can still be proven on a direct basis by a medical nexus. See Combee v. Brown, 34 F.3d 1039, 1042-43 (Fed. Cir. 1994). As noted in prior remands, the October 2019 expert also did not provide sufficient rationale or address all the relevant evidence of record for the Board to adequately consider that opinion. An adequate opinion is needed that considers all the relevant evidence of record, including the Veteran’s statements, European Journal article, and other opinions of record, and provides detailed explanation for the conclusions drawn from that evidence. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA treatment records. 2. Obtain a medical opinion on the Veteran’s skin condition. The medical expert should review the claims file and address whether acquired ichthyosis vulgaris, diagnosed in September 2011, is at least as likely as not related to his service, including exposure to herbicide agents. The expert should consider all relevant lay and medical evidence, particularly in-service treatment for wartlike lesions, the Veteran’s reports of having a skin condition since service, the European Journal article referenced in the July 2017 brief, and the positive opinion offered by the expert in October 2019. All opinions must be supported by detailed rationale. If the opinion cannot be provided without resort to speculation, the expert should explain why, and state whether the inability is due to the absence of evidence or limits of scientific/medical knowledge. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.P. Armstrong 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.