Citation Nr: 21040042 Decision Date: 07/02/21 Archive Date: 07/02/21 DOCKET NO. 16-09 010 DATE: July 2, 2021 REMANDED Entitlement to service connection for a skin disorder affecting the scalp is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from March 1967 to March 1970, with combat service in Vietnam. He is the recipient of a Purple Heart, Combat Infantryman Badge, and Bronze Star Medal. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2015 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). In May 2019, December 2019, and July 2020, the Board remanded this case for additional development. Unfortunately, the Board finds that there has, again, not been substantial compliance with the Board's previous remand directives regarding this issue. Therefore, another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for a skin disorder affecting the scalp. In previous remands, the Board instructed the agency of original jurisdiction (AOJ) to afford the Veteran a VA examination and obtain a medical opinion that would determine the onset and etiology of the Veteran's current skin disorder of the scalp. The examiners were specifically instructed to either confirm or rule out the diagnosis of chloracne and, for all other diagnosed disorders, determine whether they had their onset in service or are otherwise related to service, to include exposure to Agent Orange. Importantly, in rendering the opinion, the examiners have been instructed to acknowledge and discuss the Veteran's lay reports as to the onset of his skin disability. Review of the newest VA examination report completed in September 2020 reveals that the Board's previous remand directives have still not been executed properly. In this regard, as was noted in the previous remand, the February 2020 VA examiner diagnosed the Veteran with folliculitis of the scalp in 2018 during the course of the appeal but did not opine as to the nature and etiology of the folliculitis. The AOJ obtained an addendum opinion in March 2020 from a different examiner, who stated that the Veteran's previously diagnosed folliculitis of the scalp was treated in April 2015 and resolved. In the July 2020 remand, the Board found this opinion to be inadequate for adjudication purposes as this examiner noted the diagnosis of folliculitis but failed to opine as to the etiology. Since neither examiner provided a nexus opinion, the AOJ solicited an additional addendum opinion. This examiner opined that the Veteran did not suffer from any skin condition and, because there were no complaints, symptoms, or diagnosis of folliculitis noted in service treatment records, the disability was less likely than not incurred in or caused by service. The Board found this opinion did not address any of the Veteran's lay assertions as to onset or determine whether the Veteran's folliculitis was caused by Agent Orange exposure, as required by previous remand directives. Based on the foregoing, the Board remanded the claim with explicit instructions that the examiner consider all scalp skin diagnoses during the pendency of the appeal and discuss the Veteran's lay report as to the onset of his skin disorder. In this regard, the Veteran contends that the skin condition on his scalp is the same skin disorder that began in his groin area during military service. See March 2016 Form 9 and June 2021 Informal Hearing Presentation. Specifically, he stated that five years after discovering the rash in his groin area in 1970, he noticed an identical rash on his scalp and has experienced such since that time. Accordingly, upon remand, a new opinion was obtained in September 2020. While this VA examiner identified a current diagnosis of seborrheic dermatitis of the scalp, he failed to discuss whether the Veteran's previously diagnosed folliculitis was related to his military service. Furthermore, the examiner did not address the Veteran's specific contention that his current skin disorder of the scalp had its onset in 1975 and was identical to the rash of the groin area during service. Accordingly, an addendum opinion must be obtained. The matters are REMANDED for the following action: Forward the record, to include a copy of this remand, to an appropriate VA examiner, preferably a dermatologist, to provide an addendum opinion addressing the onset and etiology of any previously or current diagnosed skin disability. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. Based on the September 2020 examination results, a review of the record, and any additional examination results obtained, the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that any scalp disability, to include scalp dermatitis, follicular crusting, chloracne, folliculitis, and acrochordons, manifested in, is caused by, or is otherwise etiologically related to service, to include exposure to Agent Orange. (Continued on Next Page) The examiner is advised that the current disability requirement is satisfied when a claimant has a disability at any time during the pendency of the claim, and the prior diagnoses must be considered in the opinion. In reaching this conclusion, the VA examiner must acknowledge and discuss the folliculitis of the scalp diagnosed during the pendency of the appeal, as well as the Veteran's lay report as to the onset of his skin disorder on the scalp in 1975. A rationale must be provided for any opinion reached. TIFFANY HANSON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Breckenridge 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.