Citation Nr: 21029727 Decision Date: 05/14/21 Archive Date: 05/14/21 DOCKET NO. 16-37 052 DATE: May 14, 2021 REMANDED Entitlement to service connection for a skin disability, to include seborrheic dermatitis, folliculitis, and skin lesion, to include as due to exposure to chemicals and/or toxins, is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army from February 1967 to June 1967 and from May 1968 to September 1969, with additional service in the Army Reserve. This matter is before the Board of Veterans' Appeals (Board) on appeal from a November 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in December 2019. In December 2019, the Board granted entitlement to service connection for tinnitus, denied entitlement to service connection for bilateral hearing loss, remanded the issue of entitlement to service connection for a skin disability, to include seborrheic dermatitis, folliculitis, and skin lesion, for additional development. The issue of entitlement to service connection for a skin disability is once again before the Board. Although further delay is regrettable, the Board finds a remand is necessary to ensure due process is followed and there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The Veteran's claim of entitlement to service connection for seborrheic dermatitis, folliculitis, and skin lesions have been recharacterized as reflected on the title page, to include consideration of all skin disabilities reasonably raised by the record. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Entitlement to service connection for a skin disability, to include as due to exposure to chemicals and/or toxins, is remanded. The Veteran asserts his skin disability is related to military service. Specifically, he contends that while stationed at Fort Carson [Colorado] he was exposed to chemicals and/or toxins while serving in support of a special testing program called METOXE. Additionally, he stated he has attempted to obtain information regarding the METOXE, or METOXE II program, with little success. See June 2014 Correspondence. In his December 2014 correspondence, the Veteran provided additional details regarding his alleged exposure to chemicals and/or toxins while stationed at Fort Carson, Colorado. The Veteran stated he performed a special assignment where he worked with a special detachment assisting in a U.S. Army program called "Operation METOXE II." He recalled being assigned the duty of gathering the tests field-contaminated uniforms and laundering them for the next day's testing. He stated he was not told what the METOXE II program was studying, nor what exposure to the uniforms might later manifest. Additionally, he recalled he was not offered any protective gear to wear while handling the test-contaminated uniforms. The Veteran also referenced a document titled "Final Report: METOXE II Troop Test, 5th Infantry Division." The Veteran states this report reflects that the METOXE II operation was designed, in pertinent part, to "ascertain the tactical acceptability of chemical defensive doctrine, techniques, and procedures, for troops under the threat of a toxic attack and in a contaminated environment." The Veteran further states, it was noted that "chemical training agents were used extensively," and that "[a]ll troops wore protective overgarments." The Veteran's service personnel records confirm his military occupational specialties were that of Light Vehicle Driver and Heavy Vehicle Driver. See DD Forms 214. During his military service, he was stationed at Fort Carson, Colorado. See Chronological Record of Military Service. The Veteran's service personnel records confirm the Veteran was attached to HHC 5th Inf Division (Mech) (ANGA) as of August 21, 1968, for approximately 120 days, "for duty with METOXE Evaluation Board." Additionally, his personnel records confirm he was appointed to "CBR Survey Party," effective December 10, 1968, "to monitor and report contaminated areas; [t]o be trained and familiarized with CBR Survey Procedures." Pursuant to the Board's December 2019 remand, a Veterans Evaluation Services (VES) examination was conducted in July 2020. In the July 2020 examination report, the examiner diagnosed seborrheic dermatitis, actinic keratosis, and folliculitis. The VES examiner provided a negative nexus opinion stating, in part, "I do not have enough information to support that the Veteran's folliculitis, actinic keratosis, and seborrheic dermatitis are related to the Veteran's military service, including chemical exposure. There is also the limit of medical knowledge, as we do not know exactly what the Veteran was exposed to, and whether or not it caused these skin conditions." See July 2020 VES examination report. Thus, the seminal question, is whether the Veteran had exposure to chemicals and/or toxins while on active duty as Fort Carson. Here, the record does not show adequate development of the Veteran's claim with respect to the alleged exposure to chemicals and/or toxins. Thus, the Board finds remand is warranted to verify, to the extent possible, whether the Veteran was exposed to chemicals and/or toxins during his service at Fort Carson. In ordering remand in the instant case, the Board is not making a preliminary formal finding as to the credibility of the Veteran's lay reports regarding onset of his skin disability. Rather, the Board is merely requesting that the clinician on remand consider the Veteran's own descriptions of the history of his skin disability. See Smith v. Wilkie, 32 Vet. App. 332 (2020). The matters are REMANDED for the following action: 1. Afford the Veteran an additional opportunity to submit or identify any outstanding pertinent evidence that has not already been associated with the claims file. The Agency of Original Jurisdiction (AOJ) should then attempt to obtain those records if the appropriate authorization is provided. 2. Ensure all outstanding VA treatment records are associated with the claims file. 3. Undertake appropriate efforts to attempt to verify the Veteran's exposure to chemicals and/or other toxins while at Fort Carson, Colorado, considering his experiences at the military base. In particular, the AOJ should contact the appropriate records repository(ies) to request verification of: (a.) Development to obtain any records available to verify whether the Veteran's duties exposed him to chemicals and/or toxins while stationed at Fort Carson. (b.) The presence of chemicals and/or other toxins at Fort Carson from May 1968 to September 1969. (c.) The presence and type of all contaminants known or suspected to have been present at Fort Carson prior to October 1969. Specific information regarding the extent and nature of any contamination, sites of contamination in relationship to the military base, and the likelihood of exposure to the Veteran would be beneficial in deciding the claim on appeal. 4. The AOJ should conduct any additional action necessary for independent verification of the Veteran's purported exposure to chemicals and/or toxins at Fort Carson, to include follow-up action or the submission of additional requests for any information to any other appropriate entity (e.g., the National Personnel Records Center (NPRC); the Records Management Center (RMC); Joint Services Records Research Center (JSRRC); the Defense Personnel Records Information Retrieval System (DPRIS); the U.S. Army Medical Research, Institute of Chemical Defense; and/or the Headquarters, Department of the Army (HQDA), Surgeon General), should be accomplished, consistent with VA Adjudication Procedures Manual, M21-1. All requests and responses MUST be associated with the claims file. If the search for corroborating information and/or records leads to negative results, the AOJ MUST notify the Veteran and his representative and afford them the opportunity to respond. If there is still insufficient information to verify exposure, issue a Formal Finding outlining the steps taken to assist the Veteran and notify the Veteran of VA's inability to verify the alleged in-service exposures. 5. After the above development has been completed, return the record to the VES examiner who conducted the July 2020 skin diseases examination, or an appropriate substitute if the VES examiner is not available, to determine the nature and etiology of the Veteran's skin disability. The claims file and a copy of this Remand must be made available to the examiner. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. Following a review of the record the examiner should address the following: (a.) Whether the Veteran's skin disability is at least as likely as not (i.e., probability of 50 percent or greater) related to an in-service injury or disease, including any exposure to chemicals and/or toxins. In providing the requested opinion, the examiner must consider and discuss the Veteran's lay statements regarding exposure to chemicals and/or toxins at Fort Carson at the time of the Veteran's service in Colorado. (The Board reminds the Veteran that in asking the examiner to accept the history he provides, the Board is not, at this time, assessing the credibility of his statements.) The clinician's opinion must include a discussion of the etiological relationship between the Veteran's skin disability and how it relates, if at all, to potential exposure to chemicals and/or toxins identified. A complete rationale for the opinion must be provided. All pertinent evidence, including both lay and medical, should be considered. If the examiner cannot provide an opinion without resorting 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. 6. The AOJ must review the addendum opinion to ensure compliance with the Remand directives. If the addendum report is deficient in any manner, take corrective action prior to returning the case to the Board. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Grace Johnk, 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.