Citation Nr: 21031719 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 19-08 054 DATE: May 24, 2021 REMANDED Entitlement to service connection for a skin condition, to include rosacea, solar lentigo, actinic keratosis, and residuals of skin cancer, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1969 to May 1970, including verified service in the Republic of Vietnam from December 1969 to May 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2016 and February 2016 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2020, the Board remanded the issue of entitlement to service connection for a skin disorder for additional development, and regretfully, there has not been substantial compliance with the Board remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). The Veteran seeks entitlement to service connection for a skin condition, to include rosacea, solar lentigo, actinic keratosis, and residuals of skin cancer. In May 2019, the Board found etiology opinions provided in October 2009 and December 2018 were insufficient to resolve the appeal. The Board remanded this matter to obtain a new VA examination and medical opinions, which were obtained in December 2019 and October 2020. In December 2019, an examiner provided a negative nexus opinion finding the Veteran's skin conditions were not related to in-service herbicide agent exposure. However, that opinion appears to be based solely on the fact the Veteran's skin conditions are not listed under the presumptive provisions of 38 C.F.R. §3.309(e). In October 2020, an examiner stated that Agent Orange has been associated with skin conditions such as rosacea, solar lentigo, actinic keratosis, and residuals of skin cancer, but the examiner did not provide an opinion with supporting rationale based on medical principles addressing whether the Veteran's in-service exposure to herbicide agents directly caused any skin condition during the appellate period. The December 2019 examiner also stated rosacea could be triggered by sun exposure; however, she did not explain whether or not the Veteran's sun exposure during service triggered the post-service manifestation of rosacea. Similarly, the examiner stated the Veteran had a history of solar lentigo and actinic keratosis and that both are caused by ultraviolet radiation from the sun. The examiner did not explain whether the conditions are related to the Veteran's sun exposure during service. The examiner also failed to address the significance, if any, of the Veteran's in-service treatment of heat rash in June 1969. The October 2020 VA medical opinion also failed to answer these questions. Accordingly, a remand is required to obtain adequate opinions supported by rationale addressing the relationship, if any, between the Veteran's skin conditions during the appellate period and his active duty service, to include herbicide agent and sun exposure. Unfortunately, there has not been substantial compliance with the Board's previous remand directives, and another remand is required for corrective action. Stegall, 11 Vet. App. at 271. The matter is REMANDED for the following action: Ask the October 2020 examiner, or another qualified VA examiner, to provide an addendum opinion addressing the nature and etiology of any skin condition experienced by the Veteran during the appellate period, to include residuals of skin cancer, rosacea, solar lentigo, and/or actinic keratosis. The VA examiner is requested to address the following inquiry: For any skin condition present during the appeal period, the examiner must provide an opinion indicating whether it is at least as likely as not (50 percent or greater probability) that the skin disorder is related to service, to include sun exposure and exposure to herbicide agents. The examiner should address the significance, if any, of the June 1969 service treatment record showing heat rash. The examiner should be informed that the lack of a diagnosed skin condition during service is not fatal to the claim and cannot be the sole basis for a negative opinion. The examiner must specifically state whether the Veteran's sun exposure while he was stationed in Vietnam caused any subsequent skin disorder and provide a rationale for the finding. The examiner must specifically state whether the Veteran's conceded in-service exposure to herbicide agents directly caused any skin condition during the appellate period. The examiner is cautioned that a negative opinion based solely on the fact that the Veteran's skin disability(ies) is/are not included in the list of diseases presumed to be due to herbicide agent exposure is not adequate. [Continued on Next Page] The examiner must provide a complete rationale for any opinion expressed that is based on the examiner's clinical experience and medical expertise; established medical principles; and citations to the evidence of record, as appropriate. M. GALANTE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Brewer, 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.