Citation Nr: 21032745 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 13-18 159 DATE: May 27, 2021 REMANDED Entitlement to service connection for skin fissures is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1969 to April 1972. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an August 2010 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2018 and September 2020, the Board remanded this issue for further evidentiary development. Service connection for skin fissures In the most recent remand dated September 2020, the Board directed the RO to obtain updated treatment records and to obtain an addendum opinion regarding the etiology of the Veteran's claimed skin fissures condition. The Board requested that the examiner assume a current diagnosis of skin fissures, as a diagnosis had been noted in March 2010, and was asked to consider July 1969 and March 1970 service treatment records (STRs) notes recording skin complaints. A remand by the Board confers on the claimant a legal right to compliance with the remand order. Stegall v. West, 11 Vet. App. 268, 271 (1998). Compliance with a remand is not discretionary, and failure to comply with the terms of a remand necessities remand for corrective action. Id. Substantial compliance with the remand order, not strict compliance, is required. Donnellan v. Shinseki, 24 Vet. App. 167, 176 (2010); Dyment v. West, 13 Vet. App. 141, 147 (1990). Failure of the Board to ensure compliance with remand instructions constitutes error and warrants the vacating of a subsequent Board decision. Stegall, 11 Vet. App. at 271. Updated treatment records were added to the claims file in September 2020 and December 2020. The Board finds substantial compliance with this portion of the September 2020 Board remand. Stegall, 11 Vet. App. at 271. An addendum opinion was obtained in November 2020 and signed in December 2020. In responding to the Board's request, the examiner indicated that a STR dated in July 1969 was not found. However, the record clearly includes a July 1969 STR entry of the Veteran's entrance examination. This entry noted a scar on the Veteran's right thumb, but no defects were noted upon entrance to his service. Accordingly, the Board finds that the Veteran's physical condition was normal on entry into active duty. Further, the examiner opined that it was less likely than not that the Veteran's skin fissures disability was related to his active service. The examiner relied heavily on the absence of any diagnosis of skin fissures on the prior examination dated in June 2019 and in the examiner's experience reviewing and examining the Veteran. This was so despite the instruction from the Board that the examiner was to assume a current diagnosis of skin fissures, based on the disability being diagnosed in March 2010. The examiner indicated it would be "mere speculation" to opine on the etiology of skin fissures diagnosed 10 years earlier as the examiner did not examine the Veteran at the time and as no fissures were present when the Veteran was currently examined by the examiner. It is not clear why, given the clear instructions from the Board, the examiner discounted the Board's instruction and the Veteran's previously diagnosed skin fissures. The examiner additionally relied on the absence of diagnosed skin fissures in the Veteran's STRs, despite the request from the Board that the examiner address the Veteran's other skin disability complaints documented in his STRs in March 1970, October 1970, and October 1971. In addressing the Veteran's in-service skin disability complaints, the examiner only stated that the diagnosis given during service was urticaria (hives) and not fissures. In providing rationale, the examiner only stated that urticaria does not cause fissures. The examiner did not address whether the Veteran's presently diagnosed skin fissures are consistent with the manifestations of skin complaints noted during service. The Board finds that the November 2020 addendum opinion is inadequate and, as such, there has not been substantial compliance with the Board's September 2020 remand directives. Stegall, 11 Vet. App. at 271. The examiner inappropriately relied on the absence of skin fissures observed by the examiner despite the direction from the Board of diagnosed skin fissures found in March 2010 and did not adequately explain why an opinion could not be offered regarding the etiology of his skin fissures. Additionally, the examiner relied on the absence of skin fissures in the Veteran's STRs and did not adequately address whether the Veteran's complaints of and treatment for skin conditions during service were consistent with his now diagnosed skin fissures. Accordingly, a remand is warranted for corrective action, to include obtaining an adequate VA medical opinion addressing the etiology of the Veteran's diagnosed skin fissures disability. Accordingly, this matter is REMANDED for the following action: Accord the Veteran an appropriate VA examination addressing the nature and etiology of the Veteran's diagnosed skin fissures disability. The claims file, to include a copy of this remand, must be made available to and be reviewed by the examiner. The examiner should opine whether it is at least as likely as not (i.e., at least a 50 percent probability ot greater) that the Veteran's diagnosed skin fissures disability onset in, or is otherwise related to, his service or any incident therein. In other words, is the Veteran's diagnosed skin fissures consistent with, or related to, his active duty? In providing this opinion, the examiner is: a. advised that the Veteran was diagnosed with skin fissures at a March 2010 VA examination and b. directed to review the Veteran's skin complaints noted in his STRs in March 1970, October 1970, and October 1971. The examiner is advised that the Veteran is competent to report his symptoms and history and that such reports must be acknowledged and considered in formulating the opinion requested herein. A clear explanation for all opinions would be helpful, as well as a rationale for the opinions rendered, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner is unable to provide an opinion, he or she should explain why. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Goreham 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.