Citation Nr: 21027883 Decision Date: 05/07/21 Archive Date: 05/07/21 DOCKET NO. 16-45 907 DATE: May 7, 2021 REMANDED Entitlement to service connection for bilateral hand arthritis is remanded. Entitlement to service connection for bilateral knee arthritis is remanded. Entitlement to service connection for bilateral foot arthritis is remanded. Entitlement to service connection for a skin disease, claimed as a rash, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1968 to January 1970. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In May of 2019, the Veteran testified at a travel Board hearing before the undersigned Veterans Law Judge. A transcript of his testimony is associated with the claims file. The Board previously remanded these claims in March 2020. 1. Entitlement to service connection for bilateral hand arthritis is remanded. 2. Entitlement to service connection for bilateral knee arthritis is remanded. 3. Entitlement to service connection for bilateral foot arthritis is remanded. The Veteran and representative assert that his bilateral hand, bilateral knee, and bilateral foot disabilities originated due to his active duty service, either due to an injury in service or due to exposure to herbicides. Although further delay is regrettable, the Board finds that additional development is necessary prior to appellate review. As noted in the March 2020 Board decision. during the May 2019 Board hearing the Veteran provided sworn testimony and explained the circumstances around his in-service injury when he jumped from a helicopter and fell 12 feet. The Veteran explained that he did not seek medical treatment as the injuries weren't incapacitating. As the Veteran is competent to report that which he perceives through his symptoms, the Board finds this sworn statement to be competent and credible evidence of what he witnessed first-hand during his active duty service. Layno v. Brown, 6 Vet. App. 465 (1994). Pursuant to the March 2020 Board remand, the Veteran was afforded VA examinations in November 2020, in which he was diagnosed with bilateral hand, bilateral knee, and bilateral foot arthritis. While noting the Veteran's assertions of in-service injuries as a part of the VA examination history, the VA examiner did not fully address the Veteran's contentions of injuries in-service and his bilateral hand, bilateral knee, and bilateral foot pain originating during service and continuing to the present. It appears that the VA examiner dismissed the Veteran's assertions entirely on the basis that the Veteran did not seek medical assistance for these disabilities until years after his active duty service. The Board finds that these medical opinions are insufficient, as these are nexus opinion conclusions that are based on inadequate rationales. Therefore, a remand is required to afford the Veteran an addendum opinion and/or another VA examination so as to determine the nature, etiology, and severity for his bilateral hand, bilateral knee, and bilateral foot disabilities. 4. Entitlement to service connection for a skin disease, claimed as a rash, is remanded. The Veteran and representative allege that his skin disability originated due to his active duty service, specifically due to exposure to herbicides. Although further delay is regrettable, the Board finds that additional development is necessary prior to further appellate review. As noted in the March 2020 Board decision. during the May 2019 Board hearing the Veteran provided sworn testimony and explained the circumstances around the onset of his rashes in service. As the Veteran is considered competent to report that which he perceives through his symptoms, the Board finds this sworn statement to be competent and credible evidence of what he witnessed first-hand during his active duty service. Layno v. Brown, 6 Vet. App. 465 (1994). Pursuant to the March 2020 Board remand, the Veteran was afforded VA examinations in November 2020, in which he was diagnosed with dermatophytosis and onychomycosis. The VA examiner noted that the Veteran provided a history of being in constantly wet weather while in Vietnam which he believes caused his rash to originate during active duty service, while admitting that he didn't' document it during service, and that it worsened over time. The Veteran also noted that he currently experiences five outbreaks a year. The VA examiner stated that the Veteran's history was plausible but proceeded to deny a link between the skin disability and his active duty service since there is no known link between the skin disability and Agent Orange exposure. The Board finds that this medical opinion is insufficient, as the nexus opinion conclusion is based on an inadequate rationale. Therefore, a remand is required to afford the Veteran an addendum opinion and/or another VA examination so as to determine the nature, etiology, and severity for his skin disability. The matters are REMANDED for the following action: 1. The Veteran must be afforded either an addendum opinion, or if additional examination is deemed warranted, a new VA examination by an examiner with appropriate expertise to determine the nature, etiology, and severity of the Veteran's diagnosed bilateral hand, bilateral knee, and bilateral foot arthritis. Any and all studies, tests, and evaluations that are deemed necessary should be conducted. The claims folder, including a copy of this remand, should be reviewed by the examiner. The examination report should note review of these records, and the VA and private treatment records. The examiner should then: (a) Provide an opinion as to whether it is at least as likely as not (i.e. a probability of 50 percent or greater) that the Veteran's diagnosed bilateral hand arthritis originated during, or is etiologically related to, active duty service. (b) Provide an opinion as to whether it is at least as likely as not (i.e. a probability of 50 percent or greater) that the Veteran's diagnosed bilateral knee arthritis originated during, or is etiologically related to, active duty service. (c) Provide an opinion as to whether it is at least as likely as not (i.e. a probability of 50 percent or greater) that the Veteran's diagnosed bilateral foot arthritis originated during, or is etiologically related to, active duty service. The examiner is advised that the Veteran is considered competent to be able to report injuries and symptoms, and that his reports must be considered in formulating the requested opinions. If the Veteran's reports are discounted, the examiner should provide a reason for doing so. A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. 2. The Veteran must be afforded either an addendum opinion, or if additional examination is deemed warranted, a new VA examination by an examiner with appropriate expertise to determine the nature, etiology, and severity of the Veteran's diagnosed dermatophytosis and onychomycosis. Any and all studies, tests, and evaluations that are deemed necessary should be performed. The claims folder, including a copy of this remand, should be reviewed by the examiner. The examination report should note review of these records, and the VA and private treatment records. The VA examiner is asked to address the November 2020 VA examiner's findings that the Veteran's medical history regarding the rash originating during his active duty service was plausible, while noting that Agent Orange does not have a known causal link to the Veteran's skin disability. The examiner should then provide an opinion as to whether it is at least as likely as not (i.e. a probability of 50 percent or greater) that the Veteran's diagnosed dermatophytosis and onychomycosis originated during, or is etiologically related to, active duty service, to include but not limited to exposure to herbicides. The examiner is advised that the Veteran is considered competent to be able to report injuries and symptoms, and that his reports must be considered in formulating the requested opinions. If the Veteran's reports are discounted, the examiner should provide a reason for doing so. A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. R. Montalvo, 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.