Citation Nr: 21039935 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 13-06 765 DATE: July 1, 2021 REMANDED Entitlement to service connection for a skin disability is remanded. Entitlement to service connection for a right eye condition, to include as secondary to service-connected type II diabetes mellitus is remanded. REASONS FOR REMAND The Veteran had active duty service from March 1971 to February 1975. This matter is before the Board of Veterans' Appeals (Board) on appeal from a March 2011 decision by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The Veteran testified at a videoconference hearing before the undersigned in February 2016 hearing. A transcript of the hearing is associated with the claims file. This matter was previously remanded by the Board to the AOJ for additional development in July 2016 and August 2020. The August 2020 Board remand also remanded the Veteran's claim for entitlement to service connection for a left ankle/foot condition. In April 2021, the AOJ granted service connection for left ankle degenerative arthritis. As the benefit sought on appeal as to this issue has been granted in full, the issue is no longer in appellate status and therefore, is no longer before the Board. 1. Service connection for a skin disability is remanded. The Veteran contends that his skin disability is etiologically related to his service in the Republic of Vietnam. The August 2020 Board remand requested that the AOJ provide the Veteran with a VA examination and obtain medical opinions related to the Veteran's skin condition. Specifically, the Board directed the AOJ to obtain an opinion as to whether the Veteran's disability was caused by the Veteran's active service, to include his exposure to a herbicide agent and to address the Veteran's statement that his current skin disability is the same one he had in service. In April 2021, the Veteran underwent a VA skin examination. The examiner diagnosed the Veteran with eczema. During the examination the Veteran reported that his condition began in 1971 to 1972. The Veteran stated that his rash comes and goes, and he had current symptoms of a rash on the chest and back that was also intermittent. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that the Veteran had nonspecific dermatitis, with periods of disappearance. The examiner noted that the Report of Medical History examination in January 1974 indicated that there were no skin symptoms and signs. The examiner found he did not have chloracne per the physical examination to connect him to the Vietnam era. The examiner noted the first claim of a skin rash in the VA treatment records was in 2010. The examiner further opined that the clamed condition is less likely than not proximately due to or the result of the Veteran's service-connected condition. The examiner provided the same rationale noted above. The examiner further noted that the Veteran's skin disorder is less likely than not aggravated beyond its natural progression. The examiner stated the Veteran most likely developed dermatitis sometime after leaving the military service and the condition was not aggravated by the military service. The Board finds that the April 2021 examiner's opinions are not adequate for adjudication. First, the Board notes that the Veteran failed to address the Veteran's statement that his current skin disorder is the same disorder he had in service. The Board finds this is particularly important given the Veteran's statement and examiner's finding that his dermatitis had periods where the rash reportedly was not active. Second, the Board finds that the examiner did not adequately address whether exposure to a herbicide agent caused the Veteran's skin disorder. The Board notes that record reflects that the Veteran does not have chloracne, which is a presumptive skin disorder for herbicide exposure. See 38 C.F.R. § 3.309(e). However, this claim must also be reviewed to determine whether service connection can be established on a direct basis as due to herbicide exposure. See Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed. Cir. 1994). The April 2021 examiner failed to provide an adequate rationale as to why exposure to a herbicide agent was not directly related to the Veteran's current dermatitis. Finally, the April 2021 VA examiner's secondary service connection opinions were also not adequate as no clear rationale was provided other than the examiner stated that he reviewed the VA chart and in his opinion the claimed condition was less likely than not proximately due to or the result of the Veteran's service-connected disabilities to include treatment thereof, and as the Veteran most likely developed the dermatitis sometime after leaving the military, the condition was not aggravated by service. The examiner failed to explain why the Veteran's service-connected disorders (not his service) did not cause or aggravate his dermatitis. Thus, the April 2021 VA examiner's opinions are inadequate for adjudication and a remand is required. Upon remand, VA must obtain an addendum medical opinion related to the Veteran's diagnosed dermatitis. The examiner must provide an opinion that addresses whether the Veteran's skin disorder began in service taking into account the Veteran's statement that he had the same skin disorder since leaving service. Further, the examiner must determine if the Veteran's skin disorder was caused by his exposure to a herbicide agent. Finally, the examiner must opine as to whether the Veteran's skin disorder was caused or aggravated by any of his service-connected disabilities and treatment for such disabilities. 2. Service connection for a right eye condition is remanded. The Veteran contends his right eye disability is etiologically related to his service. The Board's August 2020 remand requested that the AOJ obtain an opinion to, in part, address whether any right eye disability was at least likely as not caused by the Veteran's active service to include exposure to a herbicide agent. The Board also directed the AOJ to obtain an opinion as to whether any eye disability was caused or aggravated by the Veteran's service-connected type II diabetes mellitus. In March 2020, the Veteran underwent a VA eye examination. The examiner diagnosed the Veteran with bilateral cataracts and bilateral pinguecula. The examiner opined that the Veteran's right eye condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that as to the Veteran's nuclear sclerosis cataract, a cataract is a cloudy or opaque area in the normally clear lens of the eye. Depending upon its size and location, it can interfere with normal vision. The examiner explained that most cataracts develop in people over the age of 55 years. The Veteran was 68 years of age. The examiner found the Veteran's cataracts were found to occur during the time which they are usually associated with the natural aging of the lens. The examiner noted that while the Veteran was treated in service for acute hordeolum, that condition resolved. The examiner stated that it is an acute issue and not related to his pingueculae. The examiner explained that those were cell growths on the white of the eye caused by sun exposure and aging. Therefore, neither the condition was caused by or exacerbated by the Veteran's diabetes or any chemical exposure and are unlikely to be caused by his service. The examiner further opined that the claimed condition is less likely than not proximately due to or the result of the Veteran's service-connected condition. The examiner provided the same reasoning as her negative direct service connection opinion. The examiner also opined that the claimed condition is less likely than not aggravated beyond its natural progression by the Veteran's service-connected disabilities. The examiner used the same rationale as provided for her negative direct service connection opinion. The Board also finds that the examiner did not provide an adequate rationale for her opinion. While the causation of the Veteran's eye condition appears to be the Veteran's age the examiner did not provide an adequate explanation as to why the Veteran's service-connected disabilities including his diabetes mellitus did not aggravate the Veteran's eye condition. See Atencio v. O'Rourke, 30 Vet. App. 74, 90, 91 (2018). A clear aggravation opinion should be obtained upon remand addressing both, causation and aggravation with appropriate rationale. See id (citing El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013)). Thus, a remand is required. Upon remand an addendum medical opinion must be obtained to provide an adequate opinion as to whether the Veteran's eye disability was aggravated by his service-connected disabilities including type II diabetes mellitus. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from an appropriate examiner regarding the Veteran's skin disability. The examiner must provide the following opinions: (a.) Is it as likely as not (a 50 percent probability or greater) that the Veteran's skin disability was caused by the Veteran's active service, to include the exposure to herbicide agents therein? The examiner is asked to specifically address the Veteran's competent testimony that he currently has a recurrent skin condition that appears to be consistent with the one that began in Vietnam. (b.) Is it as likely as not (a 50 percent probability or greater) that the Veteran's skin disability was caused or aggravated beyond the natural progression of the disorder by the Veteran's service-connected disabilities, to include the treatment thereof? (c.) A complete medical rationale must be provided for all opinions. 2. Obtain an addendum medical opinion from an appropriate examiner regarding the Veteran's right eye disability. The examiner must provide the following opinions: (a.) Is it at least as likely as not the Veteran's right eye disability was aggravated beyond its normal progression by his service-connected disabilities to include type II diabetes mellitus? (b.) A complete medical rationale must be provided. S. L. Kennedy Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Robert Batten 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.