Citation Nr: 21021224 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 18-06 917 DATE: April 12, 2021 REMANDED The issue of entitlement to service connection for a skin condition to include as a manifestation of undiagnosed illness or other qualifying chronic disability, pursuant to 38 U.S.C. § 1117, or as a result of exposure to environmental hazards during service in Southwest Asia, is remanded. REASONS FOR REMAND The Veteran had active duty service in the United States Air Force from January 1985 to February 1992, including service in Southwest Asia. This appeal arose from a September 2017 rating decision. The Board remanded the claim on appeal to the Agency of Original Jurisdiction (AOJ) in February 2019 and September 2020. The Board and the AOJ also disposed of other service connection claims as delineated in the September 2020 remand. This appeal has been advanced on the Board’s docket pursuant to 38 U.S.C. § 7107 (a)(2) and 38 C.F.R. § 20.902(c). Regrettably, after thorough consideration of the evidence, the Board finds that another remand is necessary prior to the adjudication of the Veteran’s claim. Initially, the Board notes that the Veteran originally sought service connection for an undiagnosed illness or other qualifying chronic disability, pursuant to 38 U.S.C. § 1117, as related to exposure to environmental hazards while serving in Southwest Asia. He has verified service in Southwest Asia during the Gulf War era; thus, exposure to environmental hazards is established. After multiple VA examinations, however, the evidence thus far has showed that the Veteran’s claimed symptoms were the result of conditions with known diagnoses and etiologies. In particular, in a September 2016 VA examination report, the examiner identified the Veteran’s claimed skin symptoms as dermatitis. At that time, the Veteran reported noticing symptoms on his lower extremities in 1992 while on active duty. He denied seeking treatment during service. As identified skin symptoms thus far have been associated with a clinical diagnosis, the Gulf War Veteran presumption of service connection under 38 U.S.C. § 1117, and 38 C.F.R. § 3.317 appear to be inapplicable in this matter. Regardless, service connection may still be warranted for the claimed skin disability on a direct basis. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994) In the September 2020 remand, the Board directed the AOJ to obtain an opinion regarding the nature and etiology of the Veteran’s skin condition, diagnosed as dermatitis. In a December 2020 report, a VA examiner opined that it was less likely than not that the Veteran’s dermatitis was due to his service. The examiner relied on an absence of evidence in the claims file regarding the diagnosis or treatment of dermatitis. The examiner’s rationale was inadequate, however, where the examiner did not provide reasons as to why the Veteran’s established exposure to environmental hazards did not at all contribute to the development of his dermatitis, and where the examiner did not consider the Veteran’s lay statements regarding experiencing symptoms in service and since his separation from active service. See Buchanan v. Nicholson, 451 F.3d 1331, 1336, n. 1 (Fed. Cir. 2006) (a VA’s examiner’s opinion relying on an absence of contemporaneous medical evidence, and not considering lay statements, is inadequate). In an additional January 2021 report, another VA examiner also opined that current dermatitis was less likely than not incurred in or caused by a claimed in-service injury, event, or illness. In providing this opinion, the examiner again relied on an absence of documentation of a skin condition between his discharge and later diagnosis in 2016. The examiner also did not address the Veteran’s reports of record of having symptoms of dermatitis which appeared in 1992, and his reported self-medication of the condition since that time, as documented in the September 2016 VA examination report. See id. Thus, there is still no adequate opinion of record as to the etiology of the Veteran’s identified skin disability. See 38 U.S.C. § 5103A (d); McLendon v. Nicholson, 20 Vet. App. 79 (2006); 38 C.F.R. § 3.159. Therefore, remand is necessary in order to obtain an adequate medical opinion addressing the nature and etiology of the Veteran’s skin condition. The matter is hereby REMANDED for the following action: 1. Provide the Veteran with an opportunity to identify any pertinent treatment records for his skin condition (dermatitis). The AOJ should secure any necessary authorizations. If identified records cannot be obtained, inform the Veteran of the records that could not be obtained, including what efforts were made to obtain them. The Veteran should also be notified that he may submit any such records. All efforts should be recorded in the claims folder. Additionally, all updated VA treatment records should be obtained. If any requested outstanding records cannot be obtained, the Veteran should be notified of such. 2. Once all available, relevant medical records have been received and associated with the claims file, the AOJ should refer the Veteran's entire claims file to a medical professional of appropriate expertise to provide an addendum opinion (or, if the VA examiner determines that it is necessary, schedule the Veteran for a VA examination) to address the nature and etiology of the Veteran's skin condition, diagnosed as dermatitis. The claims file and a copy of this REMAND should be made available to the examiner for review. After record review and/or examination, the VA examiner should offer an opinion, with supporting rationale, as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s skin condition, diagnosed as dermatitis, was incurred in, caused by, or etiologically related to the Veteran’s service, to include exposure to environmental hazards while serving in Southwest Asia In rendering these opinions, the examiner should specifically address the Veteran’s reports of having skin symptoms beginning in 1992 on his lower extremities, as described in the September 2016 VA examination report. The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If the Veteran’s lay statements are discounted, the examiner should provide a reason for doing so. Solely relying on the lack of medical documentation is not sufficient in this matter. The examiner must consider and discuss the likelihood that the Veteran’s skin condition is related to his exposure to environmental hazards, given the particulars of this Veteran’s medical history, family history, and the absence or presence of other risk factors, etc. A fully articulated medical rationale for each opinion expressed must be set forth in the medical report. The examiner should discuss the particulars of this Veteran's medical history, pertinent lay evidence, and the relevant medical literature or studies as applicable to this case, which may reasonably explain the medical analysis in the study of this case. 3. Then, review the record, conduct any additional development deemed necessary, and readjudicate the claim. Thereafter, if indicated, the case should be returned to the Board for the purpose of appellate disposition. Michael L. Wilson Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Middleton, 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.