Citation Nr: 21032761 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 18-14 713 DATE: May 27, 2021 REMANDED Entitlement to service connection for gastroesophageal reflux disease (GERD), to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for rosacea is remanded. Entitlement to service connection for skin rashes is remanded. Entitlement to service connection for cysts is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1971 to September 1975, and from October 1976 to April 1979. As an initial matter, the Board notes that the Veteran specifically indicated on his March 2018 VA Form 9 appeal submitted with regard to the January 2018 statement of the case (SOC) that he only wished to appeal the issue of entitlement to service connection for GERD. This substantive appeal did not indicate that the Veteran wished to appeal the other issues listed on the SOC. However, the Veteran also submitted a statement in March 2018 discussing why he believes VA decided his case incorrectly with regard to his skin rashes, rosacea, and cysts claims. In November 2020, the Veteran submitted a copy of a VA Form 9 appeal signed in February 2018 appealing the issues of entitlement to service connection for skin rashes, rosacea, and cysts. The facsimile transmission attached to this form indicated that the document had been received at VA on March 1, 2018. That transmission indicates that 17 pages were received; while the file contains a 15-page statement from the Veteran on that date, the VA Form 9 is not part of that document for some reason. This was discussed at the November 2020 hearing, and the undersigned Veterans Law Judge (VLJ) indicated that she would take jurisdiction over the skin condition claims. As such, these issues are considered to be on appeal before the Board. Moreover, the Board notes that the Veteran was initially denied service connection for rosacea, skin rashes, and cysts in a January 2012 rating decision. In a February 2012 statement, the Veteran identified the January 2012 denial of his claim for benefits and submitted a statement requesting reconsideration of his denied claims for service connection for cysts and skin rashes. The Veteran proceeded to submit related medical records. In March 2013, the Regional Office (RO) reopened and denied the claims for service connection for skin rashes, rosacea, and cysts. The Board notes that, effective March 24, 2015, VA amended 38 C.F.R. § 20.201 to require that any notice of disagreement (NOD) be submitted via a standardized form (VA Form 21-0958). See 79 Fed. Reg. 57660 (Sept. 25, 2014). The Board acknowledges that the Veteran did not submit a NOD with regard to the January 2012 denial on the standardized form within 1 year of the rating decision. However, as the Veteran immediately expressed his disagreement with the January 2012 denial of these claims; it was not required at this time that he submit a NOD via a standardized form; and he proceeded to submit medical evidence related to this claim within the year after the January 2012 denial, the Board finds that the January 2012 denial did not become final. As such, the Board will construe these claims as entitlement to service connection on the merits as opposed to applications to reopen previously denied claims. 1. Entitlement to service connection for GERD, to include as secondary to service-connected PTSD, is remanded. The Veteran is seeking service connection for GERD. Specifically, the Veteran testified at the November 2020 hearing that he experienced gastritis in service and that he suffered gastrointestinal symptoms following an in-service motor vehicle accident. The Veteran has also asserted that his GERD could be associated with medications he has taken for his service-connected disabilities, to include high doses of ibuprofen and NSAIDs, as well as medications he takes for his PTSD. A review of his service treatment records reveals that the Veteran was involved in a motor vehicle accident on April 30, 1973. An April 1978 service treatment record noted vomiting, sharp pain, constipation, and chills. He was diagnosed with gastroenteritis. In a February 2013 VA examination report, the examiner opined that the Veteran's GERD is not due to or the result of PTSD. The examiner essentially found that GERD was reported several months after discharge and is not related to the claimed PTSD. In a December 2017 Disability Benefits Questionnaire (DBQ) Medical Opinion, a VA examiner determined that the Veteran's GERD is less likely than not due to or proximately the result of the Veteran's service-connected condition treatment. The examiner noted that Lexapro can cause nausea and indigestion. Usually, if the patient complains, the physician changes the medication to one that is better tolerated, but there was no medical documentation of any such complaints. Lexapro does not cause relaxation of the lower esophageal sphincter or gastritis. The examiner also concluded that the Veteran's GERD was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. Gastroenteritis is a common, self-limited condition that was treated and did not recur; it does not cause GERD. In a March 2018 DBQ, the Veteran was noted as having GERD, diverticulosis, esophageal ring, dysphagia, and gastritis. The examiner noted that the Veteran had PTSD with stress leading to nausea and vomiting. The Board notes that the March 2018 DBQ opinion did not provide a detailed rationale for the opinion linking the Veteran's PTSD to nausea and vomiting. Moreover, at the November 2020 hearing, the Veteran suggested that his GERD could be associated with medications he takes for his service-connected disabilities, to include high doses of ibuprofen and nonsteroidal medications used to reduce inflammation (NSAIDs), not just Lexapro. The Veteran also appeared to be asserting that his digestive symptoms are in some way related to an in-service motor vehicle accident. As such, the Board finds that a new VA opinion should be obtained on this matter. 2. Entitlement to service connection for rosacea, skin rashes, and cysts is remanded. The Veteran is seeking service connection for rosacea, skin rashes, and cysts. Specifically, the Veteran testified at the November 2020 hearing that his skin problems began while serving at Camp Lejeune in service. In a March 2018 statement, the Veteran indicated that his skin conditions could be related to exposure to contaminated water while serving at Camp Lejeune. A review of his service treatment records reveals that the Veteran was noted as having a cyst and a rash over his body and legs. In a December 2017 DBQ opinion, the examiner determined that the Veteran's rosacea was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran was treated for poison ivy on his face (and elsewhere) with resolution. He was also treated for herpes zoster and genital warts. All of these resolved. There were 2 instances where he had an erythematous rash on his face. He had a red rash on his jowls in 1972. The next time he was actually diagnosed with measles, which would not be common in a normal 20-year-old. However, it would be highly unusual for a patient to develop rosacea in 1972 and 1973, then no such symptoms be mentioned anywhere until 30 years later when a dermatologist diagnosed the Veteran with rosacea in 2001. The examiner also determined that the Veteran's epidermal inclusion cyst was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that an epidermal inclusion cyst is a common, self-limited condition that was treated. It recurred years later and was simply removed. This is not a chronic, debilitating condition. Further, the examiner determined that the Veteran's seborrheic dermatitis was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated she could not find any mention in the Veteran's service treatment records of a skin condition that is remotely similar to seborrheic dermatitis. He was not diagnosed until 2001, which was three years after his separation from the service. The Board finds these opinions are inadequate, in that they do not address whether the Veteran's skin conditions could be related in any way to contaminated water at Camp Lejeune. VA has acknowledged that persons residing or working at the United States Marine Corps Base Camp Lejeune, North Carolina, from August 1953 through December 1987 were potentially exposed to drinking water contaminated with volatile organic compounds (VOCs), including perchloroethylene (PCE), trichloroethylene (TCE), benzene, and vinyl chloride. 78 Fed. Reg. 55,671, 55,672 (Sept. 11, 2013). As the Veteran has asserted that that his skin conditions could be related to exposure to contaminated drinking water while serving at Camp Lejeune, the Board finds that an addendum opinion should be obtained addressing this theory of entitlement. Additionally, on remand, all outstanding VA treatment records should be associated with claims file. Specifically, the Board notes that the Veteran indicated on an August 2012 Authorization and Consent to Release Information form that he had received treatment at the Baltimore VA Medical Center (VAMC) from January 1976 to the present. Attempts should be made to obtain all outstanding treatment records from this facility. Finally, the Board notes that the claims file contains VA medical records from the Baltimore VAMC from 1999 to 2012, some of which indicate that the Veteran's health care notes may not be viewed. Some treatment records from the Memphis VAMC also indicate that they could not be viewed as well. Attempts should be made to obtain viewable copies of these records. The matters are REMANDED for the following action: 1. Associate with the claims file all outstanding treatment records from the Memphis VAMC and associated outpatient clinics from September 2020 to the present. 2. Associate with the claims file all outstanding electronic and archived treatment records from the Baltimore VAMC and associated outpatient clinics from January 1976 to April 1999. This must include a search of paper records, with a negative response documented for the file if no records are found. 3. Associate with the claims file viewable copies of the treatment records from April 14, 1999, to September 10, 2012, from the Baltimore VAMC, and from October 17, 2012, to April 1, 2016, from the Memphis VAMC that were previously noted as unable to be viewed. Some of the notes in the records indicate these visits were while the Veteran was employed by VA and reference "occupational health" or "employee health" records. 4. DO NOT OBTAIN THE FOLLOWING until the above VA records have been associated with the file, to the extent possible. 5. Obtain an addendum medical opinion regarding the etiology of the Veteran's GERD. Upon review of the claims file, the examiner should respond to the following: (a.) Opine as to whether it is at least as likely as not that the Veteran's current GERD, or any other diagnosed gastrointestinal disability, began during, or was caused or aggravated by, the Veteran's service, to include his in-service motor vehicle accident. (b.) Opine as to whether it is at least as likely as not that the Veteran's current GERD is caused or aggravated by the Veteran's service-connected disabilities, to include medications he has taken for his service-connected disabilities, such as high doses of ibuprofen and NSAIDS. The examiner should provide a complete rationale for any opinions provided. If additional examination is needed to render the above-requested opinion, such should be provided. 6. Obtain an addendum medical opinion regarding the etiology of the Veteran's rosacea, cysts, and skin rashes. Upon review of the claims file, the examiner should opine as to whether it is at least as likely as not that the Veteran has a skin condition of any kind, to include a rash, rosacea, or a cyst, that began during, or was caused or aggravated by, the Veteran's service, to include in-service exposure to contaminated water at Camp Lejeune. The examiner should provide a complete rationale for any opinions provided. If additional examination is needed to render the above-requested opinion, such should be provided. MICHELLE L. KANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Durham, 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.