Citation Nr: 21027410 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 15-41 255 DATE: May 5, 2021 REMANDED Service connection for a skin condition, to include herpes, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1972 to June 1976. This matter originally came before the Board of Veterans' Appeals (Board) from a July 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado. This matter has previously been remanded by the Board for further development, most recently in June 2020. This matter is again before the Board. Service connection for a skin condition, to include herpes, is remanded. The Veteran believes that service connection for a skin condition, such as herpes, is warranted. See November 2015 Form 9. A June 2020 Board decision remanded the matter for an addendum opinion. See June 2020 BVA Decision. The addendum opinion took place in March 2021. See March 2021 C&P Exam. The addendum opinion did not find that the Veteran had a current diagnosis of dermatophytosis, including tinea cruris, but rather found that the Veteran did not have any other current skin diagnoses besides genital herpes. The addendum opinion also found that the Veteran's genital herpes was not related to service because a review of the service treatment records showed gonorrhea but not herpetic lesions. The Board finds the addendum opinion inadequate for multiple reasons. First, the addendum opinion is inadequate because it was based solely upon the lack of evidence of herpes during service. See Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007). Second, the addendum opinion is inadequate because it did not consider/was unable to consider all the relevant evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Specifically, among other things, the addendum opinion did not consider/was unable to consider a medical record showing a diagnosis of herpes simplex in 1974; the Veteran's report that he had dealt with herpes during and ever since service; and medical records from 2013 showing orchitis, epididymitis, tinea cruris, and dermatophytosis. See May 2019 C&P Exam; November 2015 Form 9; February 2014 Medical Treatment Records. Therefore, a remand is needed for a new VA examination. Finally, the Veteran reported that he served in the Reserve/National Guard following active duty service. See June 2012 Veterans Application for Compensation. Therefore, a remand is also needed to attempt to obtain these records. See 38 C.F.R § 3.159. The matter is REMANDED for the following action: 1. Provide the Veteran with an opportunity to identify any relevant outstanding private and/or VA treatment records. After obtaining any necessary authorizations from the Veteran, make all reasonable attempts to obtain the outstanding records in accordance with 38 C.F.R. § 3.159. 2. Update VA and private treatment records. VA treatment records appear current up to March 2020. 3. Contact all appropriate sources to obtain the Veteran's Reserve/National Guard service treatment and personnel records. All efforts to obtain these records should be documented, and if the records cannot be located, a formal finding of unavailability should be associated with the Veteran's claims file. The record suggests that the Veteran had Reserve/National Guard service from June 1976 to June 1978. 4. Make a formal finding for all periods of active service, ACDUTRA, and/or INACDUTRA in terms of specific dates. If this cannot be accomplished, provide an explanation. 5. Schedule one or more appropriate VA examinations for the Veteran's skin disabilities. The need for an in-person examination of the Veteran is left to the discretion of the examiner. Following a review of the claims file and a copy of this Remand, the reviewing examiner is requested to furnish an opinion with respect to the following: (A) Identify all skin related disabilities existing at any point during the pendency of the appeal (i.e. since June 2012), even if they are currently asymptomatic or have resolved during the pendency of the appeal. (B) For each identified disability, is it at least as likely as not (a 50 percent or greater probability) that the disability is related to service, including but not limited to, if it had its onset during service? (C) For each identified disability, is it at least as likely as not (a 50 percent or greater probability) that the disability is/was caused by any or all of the Veteran's service-connected disabilities (including any medications taken for the service-connected disabilities)? (D) For each identified disability, is it at least as likely as not (a 50 percent or greater probability) that the disability is/was aggravated beyond its natural progression by any or all of the Veteran's service-connected disabilities (including any medications taken for the service-connected disabilities)? State whether there is/was a medically ascertainable increase in disability regardless of permanence. Any increase in disability should be described in terms of diagnosis, severity, and duration. The permanence of the aggravation is not at issue. (E) Is it at least as likely as not (a 50 percent or greater probability) that any or all of the Veteran's service-connected disabilities (including any medications taken for the service-connected disabilities) caused or aggravated the Veteran's obesity/being overweight including whether there is/was any incremental increase in disability or aggravation as a result of service? State whether there is/was a medically ascertainable increase in disability regardless of permanence. Any increase in disability should be described in terms of diagnosis, severity, and duration. The permanence of the aggravation is not at issue. (F) If yes, is it at least as likely as not (a 50 percent or greater probability) that the obesity/being overweight caused or aggravated any or all of the Veteran's skin related disabilities including whether there is/was any incremental increase in disability or aggravation as a result of service? State whether there is/was a medically ascertainable increase in disability regardless of permanence. Any increase in disability should be described in terms of diagnosis, severity, and duration. The permanence of the aggravation is not at issue. If yes, which ones? In addition to the other relevant evidence of record, the examiner is asked to consider the following information with a caution that this list is not a substitute for a review of the record: (1) A list of the Veteran's service-connected disabilities. See July 2013 Rating Decision Codesheet. (2) A medical record from 2019 showing the Veteran's report that his genital herpes began in the winter of 1974 during service. In March 1975 after returning from South Korea, the Veteran developed an outbreak of sores with significant pain and itching in the genital area. He was evaluated in Hawaii, diagnosed with genital herpes, and prescribed Acyclovir. Around the same time, he also developed penile discharge and burning sensations during urination, which occurred multiple times during service. He was diagnosed with gonorrhea and medically treated. Outbreaks continued over the years, occurring two to three times per year. See March 2021 C&P Exam. (3) Medical records from 2017 showing a body mass index of 32.78. See April 2020 CAPRI. (4) The Veteran's report of service in Okinawa, Japan; Munson Town (which was a small village south of the DMZ), Korea; and Hawaii. During service, the Veteran did not want to be classified as a whiner, complainer, etc., and he served during a time when people generally did not seek health assistance. Further information is provided. See October 2019 VA 21-0781a. (5) A medical record from 2019 showing that the Veteran's herpes simplex was diagnosed in 1974 and that he had episodes of genital herpes about every three months. See May 2019 C&P Exam. (6) The Veteran's report that he had dealt with herpes ever since service. He could not find any documentation of herpes in the service records even though he brought it up to the doctors as soon as it happened. On the first examination, he was told that an ingrown hair was causing his distress. The doctors treating the Veteran during service apparently did not understand much about the condition and the Veteran did not completely understand what he was dealing with at the time either. The Veteran remembered the exact time and place where he contracted the condition. He was on temporary additional duty in a city in South Korea for three months where he was interacted with the local population. See November 2015 Form 9. (7) A medical record from 2015 showing that the Veteran had gonorrhea and non-specified urethritis during service. See June 2015 C&P Exam. (8) Medical records from 1999, 2000, 2001, 2006, 2007, 2008, 2011, 2012, and 2013, among other years, showing herpes. Medical records from 2013 showed treatment for orchitis and epididymitis, a diagnosis of painful testicles, a rash in the groin area, an erythematous rash, an assessment of tinea cruris, and a diagnosis of dermatophytosis of the groin and perianal area. Further information is provided. See February 2014 Medical Treatment Record. (9) The Veteran's report that during service, he contracted the herpes virus and saw several doctors for the condition. The doctors did not understand the condition very well and nothing was done to treat it. It was not until many years later that the Veteran understood what was going on. See July 2013 Statement in Support of Claim. (10) Service records showing that upon entrance into service, the Veteran had never had VD, syphilis, gonorrhea, etc. During service, the Veteran reported burning pain upon urination, hematuria, discharge, urethral discharge, penile discharge, and green discharge. There were impressions of NSU and G.C. Further information is provided. See July 2012 STR. (11) The Veteran's report of having herpes since he left service. When he was released back then and based on history, he did not seek treatment at first. See July 2012 Authorization for Release of Information. (12) The Veteran's report of being treated for herpes in Hawaii. See June 2012 Veterans Application for Compensation. (13) All other relevant lay and medical evidence. A complete rationale for all opinions offered should be provided. Address the Veteran's documented history and assertions. All necessary tests and studies should be conducted. If the examiner cannot provide an opinion without resorting to mere speculation, the examiner should provide an explanation stating why. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is due to the limits of the medical community's knowledge or due to the limits of the examiner's medical knowledge. The Veteran is competent to attest to factual matters of which the Veteran has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. 6. Readjudicate the issue on appeal. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Dougan, 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.