Citation Nr: 21030190 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 17-13 027 DATE: May 18, 2021 REMANDED Entitlement to service connection for skin disorders to include atopic eczema, skin rash, and lumps on face, to include as due to exposure to herbicide agents, exposure to biological or chemical exposure during Project SHAD, or exposure to contaminated water in Camp Lejeune is remanded. Entitlement to an initial compensable rating for left hand scar residuals of a shrapnel wound is remanded. REASONS FOR REMAND The Veteran had active service in the U.S. Marine Corps from August 1968 to July 1970, to include service in Vietnam. His decorations include the Purple Heart Medal. These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2013 rating decision. These matters were previously denied by the Board in January 2019. Those denials were vacated and remanded by the United States Court of Appeals for Veterans Claims (Veterans Court) in September 2020. 1. Entitlement to service connection for skin disorders to include atopic eczema, skin rash, and lumps on face, to include as due to exposure to herbicide agents, exposure to biological or chemical exposure during Project SHAD, or exposure to contaminated water in Camp Lejeune is remanded. The Veterans Court determined that the Board had previously provided an inadequate statement of reasons and bases for its previous denial. Upon consideration of the evidence, the Board has determined that a remand is required in order to fully adjudicate the Veteran's claim for service connection for a skin condition. The Veteran has advanced several theories as to how his skin condition is related to his service. First, the Veteran has repeatedly insisted that he was treated for a skin condition during his service. It is not clear from the record what the Veteran is referring to when he states that he was treated for a skin condition during service. However, it appears that he was treated for immersion foot in November 1969. One of the symptoms of the skin condition that the Veteran is claiming is related to a rash that he states appears on his foot. Consequently, a remand is required in order to determine if there is a connection between the Veteran's claimed skin condition and his in-service treatment for immersion foot. Second, the Veteran has also asserted that his skin condition is a result of his exposure to biological or chemical substances during his participation in Project Shipboard Hazard and Defense (SHAD). This theory was the subject of a previous opinion in December 2012 which indicated that there was no reliable medical evidence of a link between atopic dermatitis and the chemicals the Veteran was to have been exposed to during project SHAD even though the Project SHAD fact sheet of record indicates that animal studies demonstrated acute mild skin irritation in animal studies. Third, the Veteran has also asserted entitlement to service connection for a skin condition as a result of his presumed exposure to tactical herbicide agents in the Republic of Vietnam. No VA examiner has opined as to this theory. Finally, the Veteran's service treatment records indicate that the Veteran was at Camp Lejeune on at least two occasions. However, the records associated with the claims file do not make it clear precisely how long the Veteran served in this location. Consequently, a remand is required to conduct an appropriate records search to determine how long the Veteran served at Camp Lejeune. Then, an opinion is required to determine whether the Veteran's skin condition is at least as likely as not related to the contaminated water at this location. 2. Entitlement to an initial compensable rating for left hand scar residuals of a shrapnel wound is remanded. The Veterans Court determined that the Board had previously provided an inadequate statement of reasons and bases for its previous denial. Upon consideration of the evidence, the Board has determined that a remand is required in order to fully adjudicate the Veteran's claim for a compensable rating for his left hand scar, particularly in order to evaluate the functional loss claimed by the Veteran during flareups. The matters are REMANDED for the following actions: 1. Conduct an appropriate records search to determine how long the Veteran was located at Camp Lejeune during service. 2. After the foregoing development has been completed to the extent possible, schedule the Veteran for a VA examination for his claimed disability. The examiner must review the claims file. The examiner is asked to provide a response to the following: (1) Is the Veteran's claimed skin condition at least as likely as not related to service, including the Veteran's in-service treatment for immersion foot. (2) Additionally, is the Veteran's claimed skin condition at least as likely as not related to the Veteran's in-service exposure to biological or chemical agents as part of his participation in Project SHAD? In providing this opinion, the clinician should address any known association between the agents the Veteran is known to have been exposed to and skin irritation in human or animal studies. See Project SHAD Fact Sheet. (3) Additionally, the clinician should opine as to whether the Veteran's claimed skin condition is at least as likely as not related to the Veteran's in-service exposure to tactical herbicide agents or to exposure to water contaminants at Camp Lejeune. In providing this opinion, it is not sufficient simply to note that a particular condition is not itself presumed to be a cause of a particular condition by VA regulations. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left hand scars. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). Additionally, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 4. Once the development requested above, and any additional development that may be indicated as a result, has been completed, readjudicate the claims on appeal. If the claims are not granted to the Veteran's satisfaction, provide the Veteran with an appropriate Supplemental Statement of the Case (SSOC) and allow the requisite time to respond. Then, if the matters are otherwise in order, return these matters to the Board for additional appellate review. Richard Kettler Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Steven H. Johnston, 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.