Citation Nr: 21028468 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 15-02 378 DATE: May 11, 2021 REMANDED Entitlement to service connection for a skin condition, to include folliculitis, rosacea, and actinic keratoses, is remanded. Entitlement to service connection for a heart condition, other than atrial fibrillation, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1968 to February 1972. This appeal to the Board of Veterans' Appeals (Board) is from a September 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In an October 2018 decision since issued, the Board, in relevant part, denied service connection for atrial fibrillation including on the premise it was the result of exposure to Agent Orange, but instead remanded these other claims back to the RO for further development and consideration. Still more development of these remaining claims is required, however, so the Board is again remanding them back to the RO. 1. Entitlement to service connection for a skin condition, to include folliculitis, rosacea, and actinic keratoses, is remanded. 2. Entitlement to service connection for a heart condition, other than atrial fibrillation, is remanded. The Veteran claims that en route to Thailand he stopped in Da Nang, Vietnam, so it should be presumed that he was exposed to herbicides (Agent Orange), also that he was exposed to herbicides since his duties placed him on the perimeter of the base where he was stationed in Thailand, and that still additional exposure occurred as an aircraft repairman working on planes that had sprayed or transported herbicides. In September 2013, a Joint Services Records Research Center (JSRRC) Coordinator noted all three allegations of exposure to herbicides but did not offer any opinion regarding the plausibility it had occurred including in the Veteran's duties and responsibilities as an aircraft repairman. Thus, the Board remanded these claims in October 2018 to try and obtain this needed corroboration. In August 2019, to this end, a JSRRC Coordinator again reviewed the Veteran's military personnel records and found, instead, that he did have had a high probability of exposure to herbicides. Consequently, herbicide exposure is now conceded, in turn meaning addendum medical opinions are needed addressing whether the Veteran's claimed conditions are due to his conceded exposure to herbicides. Even if, as here, the Veteran is not claiming entitlement to service connection for a condition presumptively associated with exposure to Agent Orange, he may establish the required correlation ("nexus") between the condition and exposure by instead showing there is a direct connection. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994); see also McCartt v. West, 12 Vet. App. 164, 167 (1999) (indicating the principles set forth in Combee, which, instead, concerned exposure to radiation, are equally applicable in cases involving Agent Orange exposure to establish direct causation). The Board sees a skin conditions examination initially was provided the Veteran in December 2012; however, because an opinion was not rendered addressing his contention that his claimed skin conditions are due to his now conceded herbicide exposure in service, medical comment concerning this is still needed. A heart conditions examination more recently was provided the Veteran in December 2020, with an addendum in March 2021, but the examiner discussed the Veteran's atrial fibrillation which is a heart condition that is no longer at issue in this appeal since the Board already determined in October 2018 that it is not attributable to the Veteran's service, including to exposure to Agent Orange. Thus, this additional examiner did not fully address with adequate rationale the issue of whether the Veteran has any other heart condition attributable to his service, including to his now conceded exposure to herbicides. Moreover, treatment records were added to his claims file after the December 2020 heart conditions examination, therefore, the examiner needs to have opportunity to consider these additional records to the extent relevant to this claim. Accordingly, these claims are again REMANDED for the following still additional development and consideration: 1. Schedule the Veteran for a VA examination for his claimed skin conditions (including folliculitis, rosacea, and actinic keratoses). The examiner must review the claims file, including a complete copy of this remand, and is asked to list the Veteran's current skin conditions and determine whether any is as likely as not related to or the result of the Veteran's conceded exposure to herbicides (the dioxin in Agent Orange) in service? The examiner is advised that an unfavorable opinion cannot be based solely on the fact that the skin condition identified is not on the list of diseases presumptively associated with exposure to herbicide agents or just because the service treatment records (STRs) do not mention the condition, although it is permissible to consider the latter as one of the factors in determining whether the condition is attributable to the Veteran's service, provided there is the required explanation of why it is reasonable to have expectation of documentation of the condition in the way of treatment records. 2. Also, schedule the Veteran for an additional VA examination for his claimed heart condition (meaning other than atrial fibrillation). The examiner must review the claims file, including a complete copy of this remand, and is asked to list the Veteran's current heart conditions (again, meaning other than atrial fibrillation) and determine whether it is as likely as not any is related or attributable to the Veteran's service, including especially to his conceded exposure to herbicides? The examiner is advised that an unfavorable opinion cannot be based solely on the fact that the heart condition identified is not on the list of diseases presumptively associated with exposure to herbicide agents or just because the STRs do not mention the condition, although it is permissible to consider the latter as one of the factors in determining whether the condition is attributable to the Veteran's service, provided there is the required explanation of why it is reasonable to have expectation of documentation of the condition in the way of treatment records. Rationale for the opinions therefore is essential, regardless of whether favorable or unfavorable to the claims, preferably citing to evidence in the file supporting conclusions and/or accepted medical authority. KEITH W. ALLEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. B. Kucera 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.