Citation Nr: 21030492 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 11-25 315 DATE: May 19, 2021 REMANDED Entitlement to service connection for a skin disability is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1969 to January 1971. This matter is before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in October 2009 by a Department of Veterans Affairs (VA) Regional Office (RO). The Board most recently remanded the issues on appeal for additional development in August 2020, and the requested opinion was obtained in November 2020. As such, the directives have been substantially complied with and the appeal is again properly before the Board. D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) in July 2013. A transcript of the hearing is included in the claims file. 1. Entitlement to service connection for a skin disability. VA obtained an opinion concerning the etiology of the Veteran's skin disability in November 2020. The examiner initially stated that it was less likely than not that the disability was related to service, noting that there was no evidence of treatment during service, at separation or within the first post-service year, and that the first evidence of treatment was in March 1995, twenty-five years after separation. However, the examiner then noted that the Veteran's skin disability, alternatively diagnosed as pityriasis alba or progressive macular hypomelanosis, is potentially caused by an immune response to local irritants. The examiner then further noted that asbestos is a known irritant, and that direct contact with materials that either contain or have been contaminated with asbestos is the most likely risk for asbestos skin exposure. Based on these factors, the examiner stated that "it is within the realm of possibility" that the skin disability was causally related to the reported asbestos exposure, as the asbestos could have results in skin irritation that predisposed the Veteran to pityriasis alba. While seemingly positive, the use of the words "possible," "may," or "can be" make a doctor's opinion speculative in nature. See Bostain v. West, 11 Vet. App. 124, 12728 (1998) (quoting Obert v. Brown, 5 Vet. App. 30, 33 (1993)). It is well established that medical opinions that are speculative, general, or inconclusive in nature do not provide a sufficient basis upon which to support a claim. McLendon v. Nicholson, 20 Vet. App. 79, 85 (2006). As the examiner's conclusion concerning a relationship between asbestos exposure and the Veteran's disability is speculative, the Board cannot rely on the opinion to grant the current claim. Instead, the Board must remand the claim for an additional opinion addressing the etiology of the claimed skin disability. The matters are REMANDED for the following action: 1. Obtain a medical opinion addressing the etiology of the claimed skin disability. The examiner should answer the following: Is it at least as likely as not (a fifty percent probability or greater) that the pityriasis alba or progressive macular hypomelanosis began in service, was caused by service, or is otherwise related to the Veteran's active service? Attention is invited to (1) an August 2003 private treatment record in which the Veteran reports an onset of the skin disability in 1995 (labelled "Medical Treatment Record - Non-Government Facility" pg. 24 uploaded 8/6/2008); (2) the Veteran's November 2010 statement that he wore asbestos lined firefighting suits while in service (labelled "Correspondence" uploaded 12/1/2010); and, (3) the November 2020 VA opinion noting that a potential cause of pityriasis alba or progressive macular hypomelanosis is an immune response to irritants, asbestos is a known irritant, and that it is "within the realm of possibility" that asbestos exposure predisposed the Veteran to pityriasis alba or progressive macular hypomelanosis (labelled "C&P Exam" pgs. 5 to 6 uploaded 11/16/2020). A detailed rationale for the opinion must be provided. The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. ROBERT C. SCHARNBERGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Wendell, 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.