Citation Nr: 21026377 Decision Date: 04/30/21 Archive Date: 04/30/21 DOCKET NO. 12-23 572 DATE: April 30, 2021 REMANDED Entitlement to service connection for a skin disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from August 1967 to August 1970. These matters come before the Board of Veterans’ Appeals (Board) on appeal of a rating decision issued by the Department of Veterans Affairs (VA). The Veteran testified before the undersigned Veterans Law Judge during a hearing in August 2016. A transcript of the hearing is associated with the claims file. This matter was previously before the Board in 2016 and 2019. In April 2019, the Board remanded this matter for further development. The agency of original jurisdiction (AOJ) was asked to procure a VA examination and medical opinion discussing the nature and etiology of the Veteran’s skin disorder, to include as due to conceded exposure to herbicide agents and as secondary to service-connected psychiatric disorder and prostate cancer. See 38 C.F.R. §§ 3.303, 3.310. The AOJ obtained a VA examination and medical opinions in February and March 2021. After reviewing the opinions, the Board finds that substantial compliance with the prior remand directives is not established, and further development is necessary. Stegall v. West, 11 Vet. App. 268, 271 (2011) (holding that the Board errs when it fails to ensure substantial compliance with its own remand directives). Entitlement to service connection for a skin disorder is remanded. The Board finds that this matter must be remanded for an addendum medical opinion. See 38 U.S.C. § 5103A(d); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In April 2019, the Board requested that the examiner consider the lay evidence submitted by the Veteran, and “specifically discuss” the Veteran’s assertions that his skin disorder is related to his service-connected psychiatric disorder and/or radiation treatment for his service-connected prostate cancer. The February 2021 examiner opined that “in review of medical records, no information found to support skin condition due to [side effects] of medication. No nexus can be establish [sic].” He further opined that “there was no claim of a skin condition until 2014, years after service. Based on the current exam findings and the review of medical records the current skin condition is clearly and unmistakably not aggravated beyond its natural progression by any service connected conditions to include radiation treatment or mental health conditions.” The Board finds that such rationale is conclusory and does not fully address the issues highlighted in the prior remand order. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Moreover, the examiner did not address the Veteran’s lay testimony asserting that his skin disorder began during active service while stationed at Fort Carson. Accordingly, the Board finds that further development is necessary. The matters are REMANDED for the following actions: 1. Please secure for the record copies of complete updated clinical records of all VA and non-VA treatment the Veteran has received for the disorders on appeal. 2. Obtain an addendum medical opinion from a clinician other than the February and March 2021 VA examiner as to the nature and etiology of the Veteran’s skin disorder. ONLY IF the clinician believes that a VA examination is necessary to answer the questions below should one be scheduled. The clinician is asked to review the claims file and to opine on the following: (a) Is it at least as likely as not that the Veteran’s skin disorder had onset during or is etiologically related to military service, to include conceded exposure to herbicide agents? (b) Is it at least as likely as not that the Veteran’s skin disorder is proximately due to, a result of, or aggravated by a service-connected disorder, to include unspecified depressive disorder and radiation treatment for service-connected prostate cancer? A complete rationale should be provided for all opinions. The examiner is asked to consider and discuss relevant lay and medical evidence, to specifically include: • Medical articles received in August 2016, to include an article from WebMD titled “How Stress Affects Skin”, and an article about “Anxiety Rash” • Medical article received in August 2016, titled “Prophylaxis and management of acute radiation-induced skin reactions...” by N. Salvo, et. al. • The Veteran’s contentions that his skin disorder is related to exposure to herbicide agents and began while stationed at Fort Carson, Colorado, in 1969 • The Veteran’s lay contentions that his skin disorder is proximately due to, a result of, or aggravated by, a service-connected acquired psychiatric disorder and/or radiation treatment for a service-connected prostate cancer disorder • Service medical records, including the separation examination in July 1970, which found a normal skin and lymphatic system, and a report of medical history dated July 1970, in which the Veteran denied a history of skin diseases The clinician is advised that the Veteran is conceded to have been exposed to herbicide agents in military service. The clinician is further advised the Veteran is competent to attest to factual matters of which he has first-hand knowledge, but if there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a full explanation. The examiner is reminded that the term “at least as likely as not,” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that it is as medically sound to find in favor of the proposition as it is to find against. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Reed, 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.