Citation Nr: 21021548 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 14-06 909 DATE: April 13, 2021 REMANDED Entitlement to service connection for a scalp disorder, to include as a manifestation of a Persian Gulf War-related illness, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1990 to April 1991, which included service in the Persian Gulf. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In February 2015, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. The Board remanded this matter in October 2015 and June 2018 for additional development. In December 2020, the Veteran indicated that he “will be requesting a hearing.” A hearing clarification letter was sent to the Veteran in February 2021. The Veteran did not respond to the February 2021 letter. The Board notes that the right to a hearing does not preclude the development or attempted development of a record found to be inadequate for decisional purposes. See 38 U.S.C. § 7107(f)(2). The Board finds that a second hearing at this juncture is premature, as the current evidentiary record indicates that an additional medical opinion is necessary. Thus, to not afford the second hearing at this juncture is harmless. If the Veteran wishes to request another hearing after such development is completed, he is welcome to do so. The Veteran was last afforded a VA examination in October 2020. The examiner opined that the scalp disorder was less likely as not incurred in or caused by service. In providing a negative nexus opinion, the examiner noted that there were no scalp issues, folliculitis, or alopecia found proximate to service. Unfortunately, the examiner failed to provide an etiology opinion with regard to any causal link to exposures during his active service in Southwest Asia, or consideration of whether the Veteran’s scalp disorder may constitute a medically unexplainable chronic multi-symptom illness, which may also be linked to such exposures, or address the Veteran’s reports of cysts during service. Therefore, a remand is necessary in order to obtain an addendum opinion addressing such matters. Any outstanding treatment records should also be secured. The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain all outstanding private treatment records. If any records are unavailable, notify the Veteran pursuant to 38 C.F.R. § 3.159(e). 3. Then obtain an addendum opinion regarding the etiology of the Veteran’s scalp disorder. No additional examination of the Veteran is necessary unless the reviewing examiner deems otherwise. After a review of the claims file, the examiner is requested to provide a specific opinion as to: (a) Please state whether the Veteran’s scalp symptoms are attributable to a known clinical diagnosis. If so, please state the diagnosis or diagnoses present since February 2011, even if resolved, to include dissecting folliculitis and related scarring alopecia, seborrheic dermatitis, folliculitis, dermatophytosis, and painful cysts. (b) Is the Veteran’s disability pattern consistent with: (1) a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology, (2) a diagnosable chronic multisymptom illness with a partially explained etiology, or (3) a disease with a clear and specific etiology and diagnosis? In addressing this question, the examiner is advised that the key question is whether the etiology is known in the Veteran’s particular case, not in general. Thus, if an etiology is known, please state that etiology. (c) Is the Veteran’s disability pattern consistent with: (1) a diagnosable but medically unexplained chronic multisymptom illness of unknown pathophysiology, (2) a diagnosable chronic multisymptom illness with a partially explained pathophysiology, or (3) a disease with a known diagnosis and pathophysiology? (d) If, after examining the Veteran and reviewing the claims file, you determine that the Veteran’s disability pattern is either a diagnosable chronic multi-symptom illness with a partially explained etiology ((b)(2) above), or a disease with a clear and specific etiology and diagnosis ((b)(3) above), then for each condition diagnosed in subpart (a) above, please opine as to whether it is at least as likely as not (50 percent or greater probability) that such condition had its onset during active service, or is otherwise etiologically related to the Veteran’s active duty service, to include his presumed exposure to environmental hazards consistent with his service in Southwest Asia therein. In offering such opinions, the examiner must concede the Veteran’s reports of purulent discharge from cysts on the scalp and hair loss beginning shortly after his return from the Gulf War and its continuance since such time, even despite the absence of “objective documentation,” and determine whether a nexus to service is “medically plausible” based on the same. (e) If, in answering sub-part (d) above, you determine that a condition is less likely than not due to service because it pre-existed service, then please opine whether the condition (1) clearly and unmistakably pre-existed service and (2) clearly and unmistakably was not aggravated by the Veteran’s service, conceding the Veteran’s reports of purulent discharge from cysts on the scalp and hair loss beginning shortly after his return from the Gulf War and its continuance since such time. A rationale for any opinion offered should be provided. If unable to opine without resorting to speculation, please provide a basis for reaching this conclusion. S. BUSH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Forde, 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.