Citation Nr: 21032901 Decision Date: 05/28/21 Archive Date: 05/28/21 DOCKET NO. 16-27 447A DATE: May 28, 2021 ORDER Entitlement to service connection for a skin disorder, to include as due to herbicide exposure, is remanded. REASONS FOR REMAND The Veteran served in the United States Army from July 1966 to July 1968, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a January 2015 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge during a videoconference hearing in July 2019, and a transcript of that hearing is associated with the record. This matter was previously before the Board in September 2019, at which time the Board remanded this claim in order to obtain a VA examination. This matter has since returned to the Board for further appellate review. 1. Entitlement to service connection for a skin disorder, to include as due to herbicide exposure, is remanded. The Veteran contends that his skin condition is due to his service, to include exposure to herbicide agents, during his service. The record establishes the Veteran served in Vietnam. If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases shall be service-connected if the requirements of § 3.307(a)(6) are met, even though there is no record of such disease during service, provided that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). The Secretary of Veterans Affairs has determined that there is no positive association between exposure to herbicide agents and any other condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. Id. Although a veteran may not be entitled to a regulatory presumption of service connection for a given disability, the claim must be reviewed to determine whether service connection can be established on a direct basis. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). The Veteran was afforded a VA examination in October 2020. In this examination, he was diagnosed with dermatitis and chronic urticaria, which is not listed in 38 C.F.R. § 3.309(e). The examiner opined that the Veteran's skin condition was less likely than not related to service because the medical literature does not support an etiological connection between chronic urticaria and herbicide exposure. Although the examiner opined on whether the Veteran's skin condition was due to his herbicide exposure on a direct basis, the examiner failed to address whether his skin condition was due to any of the other potential causes she listed in her opinion, to include infection, insects, parasites, sunlight exposure, and exercise. Additionally, the examiner did not address the Veteran's report of continuous symptoms, which he has consistently reported began during his time in Vietnam and have continued ever since. The examiner also did not address the Veteran's July 2019 hearing testimony where he described his skin being covered in a fungus while in Vietnam, as well as his statement that he did not have a skin condition before he arrived in Vietnam. Because the examiner failed to address other potential etiologies of his skin condition, the Board finds that the opinion is inadequate, and an addendum opinion is required to address these issues. Once VA undertakes the effort to provide an examination when developing a claim, it must provide an adequate exam. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Thus, the Board must again remand the Veteran's claim. Accordingly, this matter is REMANDED for the following action: Obtain an addendum opinion from the October 2020 examiner or other qualified examiner regarding the etiology of the Veteran's skin condition. If the examiner determines the Veteran should be given another examination (including via telehealth if an in-person examination is not possible) to answer the below question, one should be scheduled. The examiner is asked to provide a thorough, well-reasoned opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's skin condition had its onset in service or is otherwise related to active service. In rendering this decision, the examiner must specifically discuss each of the following: (a). The October 2020 examiner's list of potential causes of chronic urticaria, to include infection, insects, parasites, sunlight exposure, and exercise, including discussion of whether the Veteran likely experienced each such risk factor while deployed to the Republic of Vietnam or otherwise during his period of service. (b). The January 20, 1968 service treatment record note describing a rash, located on page 46 of the service treatment records submitted into evidence on October 7, 2004. (c). The Veteran's competent and credible reports of continuous symptoms starting during his deployment in Vietnam and continuing since he left the service. (d). The Veteran's competent and credible July 2019 testimony specifically describing how he had a rash during his time in Vietnam, along with a fungus on his skin, and how those same symptoms have persisted from his time in Vietnam to the present. A complete rationale for all opinions must be provided. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Gabrielle Ongies, 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.