Citation Nr: 21021500 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 16-20 696 DATE: April 13, 2021 REMANDED Entitlement to service connection for a skin condition, to include psoriasis, claimed as due to herbicide exposure and/or an in-service malaria diagnosis, is remanded. Entitlement to service connection for malaria, to include malaria residuals, is remanded. REASONS FOR REMAND Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran’s claim so that he is afforded every possible consideration. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The Veteran had active military service from September 1965 to September 1967. This matter comes before the Board of Veterans’ Appeals (Board) from the February 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in January 2020 and was remanded for further development. 1. Entitlement to service connection for a skin condition, to include psoriasis, to include as due ot herbicide exposure and an in-service malaria diagnosis, is remanded. The Veteran contends that his current skin conditions, as noted in his VA treatment records as seborrheic dermatitis and psoriasis, are related to his military service. Specifically, the Veteran has stated throughout the record that his skin conditions are related to his in-service malaria diagnosis, or alternatively, his exposure to herbicides. In an August 2019 Joint Motion for Partial Remand by the Court of Veterans Appeals (Court), the parties agreed that the Veteran’s September 2011 VA examination was inadequate because the examination report is internally inconsistent and did not contain sufficient detail for rating purposes. Additionally, the Court stated that the Board did not discuss whether it was possible or necessary to schedule the Veteran for an examination during a flare up. Finally, the Court noted that the September 2011 VA examination did not provide an opinion as to whether any skin condition could be caused or aggravated by in-service exposure to herbicides or malaria. Therefore, in the Board’s January 2020 remand, the Agency of Original Jurisdiction (AOJ) was directed to schedule the Veteran for an examination to determine the etiology of any skin disorder the Veteran has had during the pendency of this appeal and to try and schedule an examination during a flare up. The AOJ directed the examiner to provide a secondary opinion. Subsequently, in March 2020, the Veteran underwent a VA skin examination. The examiner noted that the Veteran is diagnosed with psoriasis. However, the examiner opined that the Veteran’s skin condition is less likely than not related to his military service. The examiner explained that the Veteran reports that in 1966 he was a combat medic and was hospitalized for malaria for over a 6 week period. During that 6 week period, the Veteran stated that he had a rash on his chest and back that resolved but would return several times during his active duty and has returned on and off ever since. The examiner stated that the Veteran currently did not have a rash on his chest or back but did have a rash behind his left ear. The examiner stated that a rash is not listed as a complication of malaria and that “it is extremely uncommon for malaria to cause skin lesions or rash.” However, no other explanation was provided regarding whether the Veteran’s psoriasis was caused or aggravated by the Veteran’s in-service malaria diagnosis. Additionally, the examiner stated that a nexus has not been established for malaria or herbicide exposure to have caused the Veteran’s complaint of a chronic rash. Furthermore, the examiner has stated that there is no nexus for aggravation. The examiner references the Veteran’s dermatology records, however the examiner states that the records do not provide a description of the rash on the Veteran’s back and that the Veteran was rash-free on the day of the examination. The examiner concluded that he was at a loss to formulate a diagnosis without clinical evidence and recommended that the Veteran submit a photograph of the rash when it occurs in the future. The Board finds that March 2020 opinion to be inadequate as the examiner does not specifically address whether or not the Veteran’s psoriasis was caused by the Veteran’s herbicide exposure. The examiner discusses the Veteran’s “rash” but ultimately concludes that he cannot form a diagnosis. However, the Veteran’s treatment records note that he is diagnosed with psoriasis as well as seborrheic dermatitis, which the examiner does not discuss. Therefore, an addendum opinion must be obtained. 2. Entitlement to service connection for malaria, to include malaria residuals, is remanded. The Board finds the Veteran’s claim for entitlement to service connection for malaria or malaria residuals is inextricably intertwined with the above remanded skin condition claim. Specifically, the Veteran contends that his currently diagnosed skin disorder is related to his in-service malaria diagnosis. Furthermore, the August 2019 Court remand directed the Board to remand the Veteran’s claim for service connection for malaria in conjunction with his claim for service connection for a skin disorder. Therefore, consideration of this matter must be deferred pending resolution of the Veteran’s skin condition claim. See Henderson v. West, 12 Vet. App. 11, 20 (1998); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain an addendum opinion by an appropriate clinician to determine the nature and etiology of the Veteran’s skin condition, to include psoriasis and seborrheic dermatitis. The examiner must opine whether it is at least as likely as not (50 percent or greater probability) that any of the Veteran’s skin conditions, to include psoriasis and seborrheic dermatitis, are related to an in-service injury, event, or disease, including herbicide exposure and an in-service malaria diagnosis. A new examination is not required unless deemed necessary by the examiner. If so, the examination should be scheduled during an active phase of the skin disorder. All opinions provided must be thoroughly explained and an adequate rationale for any conclusions reached must be provided. The examiner should not solely rely on the absence of evidence of in-service treatment or injury in the Veteran’s service treatment records as a basis for any given opinion. If any requested opinion cannot be provided without resort to speculation, the medical professional should state and explain why an opinion cannot be provided without resort to speculation. (Continued on the next page)   2. Following completion of the above, and a review of any additional evidence received, the RO should also undertake any other development it deems to be necessary, to include, if warranted, an addendum medical opinion which considers any newly received evidence. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Mountford, 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.