Citation Nr: 21024410 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 14-24 738A DATE: April 22, 2021 REMANDED Entitlement to service connection for iron deficiency anemia, to include as due to herbicide exposure and/or secondary to Crohn’s disease is remanded. Entitlement to service connection for a skin condition, to include as due to herbicide exposure is remanded. Entitlement to service connection for a lumbar spine condition is remanded. Entitlement to service connection for a cervical spine condition is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1969 to May 1972. The Veteran testified before the Board of Veterans’ Appeals (Board) in September 2016. The Board remanded the matters for further development in February 2018 and August 2019. 1. Entitlement to service connection for iron deficiency anemia, to include as due to herbicide exposure and/or secondary to Crohn’s disease is remanded. The Veteran, through his representative, asserted that the anemia was secondary to the Veteran’s Crohn’s disease. See September 2016 Hearing Testimony. The appeal was previously remanded because the Veteran’s service connection for Crohn’s disease was pending before another Veteran’s Law Judge. Although service connection to Crohn’s disease was denied by the Board in September 2019, in May 2012 Correspondence, the Veteran did assert that he knew “for a fact that it all boils down to Agent Orange,” after listing several disabilities to include iron deficiency. This statement is reasonably raised the theory of direct service connection due to herbicide exposure. The Veteran has current evidence of being diagnosed with anemia. See February 2016 VA treatment records. The Veteran contends the anemia was caused by exposure to herbicides. He served in the Republic of Vietnam during the applicable time period to be afforded the presumption of exposure to herbicides. The Veteran has not been provided a VA examination, and due to the evidence of an in-service injury and evidence of a diagnosis, the Board will remand for an examination to determine the nature and etiology of the Veteran’s anemia. See McClendon v. Nicholson, 20 Vet. App. 79 (2006). 2. Entitlement to service connection for a skin condition, to include as due to herbicide exposure is remanded. The Veteran was provided with a VA examination in February 2020. The examiner noted a current diagnosis for atopic dermatitis, with a date of diagnosis of 1970 in both Section I and Section II of the examination. The examiner provided a negative nexus opinion, noting the earliest evidence of atopic dermatitis found in the claims file was in 2011 and the current examination was absent for any sign of atopic dermatitis. The Board finds the date of diagnosis in the examination and rationale for a negative nexus opinion conflicting. A diagnosis of 1970 would mean the atopic dermatitis incurred during active duty service. Additionally, the examiner diagnosed the Veteran with herpes zoster of the back and chest. This constitutes a current diagnosis for which the examiner should provide a nexus opinion. Accordingly, addendum opinions are necessary to determine the nature and etiology of the skin condition. 3. Entitlement to service connection for lumbar and cervical spine conditions. The Veteran contends his degenerative disc disease (DDD) was caused by carrying a rucksack during his military service. In the February 2018, the Board remanded the claims to provide the Veteran with an addendum opinion which addressed the lay contentions of in-service causation. In May 2018, the Veteran was afforded VA back and neck examinations, and the examiner provided a negative nexus opinion. The examiner simply restated the Veteran’s contention that the rucksack caused his DDD, but, once again, there was no discussion as to why carrying a rucksack during service did not cause the Veteran’s DDD. The Board remanded the claims in August 2019 for an addendum opinion. The Veteran was provided with new VA examinations and opinion in February 2020, yet once again, the examiner failed to address the Veteran’s contentions of in-service causation due to carrying the rucksacks. Additionally, the examiner noted the objective examination of the back and neck to be normal in the rationale, yet the examiner also noted the imaging studies found arthritis in both the back and neck, which would constitute as objective evidence of chronic conditions. The Board finds the examination inadequate for adjudication purposes and not in compliance with the prior remand directives, and another remand is required. See Dalton v. Nicholson, 21 Vet. App. 23 (2007); Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: 1. Forward the claims file to a qualified VA medical professional to provide an examination to determine the current nature and etiology of the Veteran’s anemia. The claims file, to include a copy of this Remand, must be made available to and be reviewed by the examiner. The examiner is asked to address the following: Provide a current diagnosis for any anemia condition which may have manifested at any time during the period on appeal (since March 27, 2012 to the present); If the Veteran does not now have, but previously had, any diagnosed anemia condition, when did that condition resolve; and Provide an opinion as to whether any diagnosed anemia condition at least as likely as not (a 50 percent or greater probability) is etiologically related to service, to include presumed herbicide exposure. A complete rationale for all opinions expressed should be provided. 2. Forward the claims file to a qualified VA medical professional to provide an addendum opinion to determine the current nature and etiology of the Veteran’s skin conditions. The claims file, to include a copy of this Remand, must be made available to and be reviewed by the examiner. The examiner is asked to address the following: Provide a current diagnosis for any skin condition which may have manifested at any time during the period on appeal (since March 27, 2012 to the present), including that for which the Veteran was treated in April 2012; If the Veteran does not now have, but previously had, any diagnosed skin condition, when did that condition resolve; and Provide an opinion as to whether any diagnosed skin condition at least as likely as not (a 50 percent or greater probability) is etiologically related to service, to include in-service rashes and presumed herbicide exposure. A complete rationale for all opinions expressed should be provided. 3. Also, forward the Veteran’s claims file to a qualified VA medical professional to provide an addendum opinion to determine the current nature and etiology of the Veteran’s lumbar and cervical spine conditions. The claims file, to include a copy of this Remand, must be made available to and be reviewed by the examiner. The examiner is asked to provide an opinion as to whether any diagnosed lumbar or cervical spine condition at least as likely as not (a 50 percent or greater probability) is etiologically related to service, to include the Veteran carrying a rucksack during service. A complete rationale for all opinions expressed should be provided. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. N. Quarles, 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.