Citation Nr: 21040838 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 18-39 932 DATE: July 7, 2021 REMANDED Entitlement to service connection for a skin disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1968 to March 1970, to include overseas service in Vietnam. The Veteran appealed a May 2017 rating decision by the Agency of Original Jurisdiction (AOJ). The Board of Veterans' Appeals (Board) finds that further evidentiary development is necessary and remands the case to ensure compliance with the Board's prior remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The July 2019 Board decision remanded the case for a new VA opinion regarding the nature and etiology of the Veteran's current skin disorder. The Board decision noted the April 2017 VA opinion did not address nexus as to the Veteran's current skin disorders and noted the conditions of basal cell carcinoma, seborrheic keratosis, and actinic keratosis. The February 2020 VA examiner found the Veteran to have a current diagnosis of acne and a boil behind the right ear diagnosed in 1969. However, the VA examiner then stated both the right ear cyst and acne have long since resolved without any recurrences. Therefore, it is unclear whether the Veteran has a current diagnosis of acne or a right ear boil during the period on appeal. Nevertheless, the February 2020 VA examiner found the Veteran's post service diagnosis of actinic keratoses, seborrheic keratoses, and basal cell skin cancers were not due to or aggravated by Agent Orange exposure. However, a direct nexus opinion has not been rendered regarding these post service conditions. September 1969 service treatment record (STRs) noted in-service treatment for a boil. As such, direct service-connection should also be addressed. Additionally, recent treatment records noted a diagnosis of lower leg cellulitis. See August 2020 treatment records. This diagnosis has not been addressed. Therefore, remand is required for an additional opinion that addresses the nature and etiology of the Veteran's skin disorder. The Board also notes the Veteran's representative cited an article relating skin conditions to exposure to herbicide agents. See June 2021 informal hearing presentation (IHP). This should be considered when forming the etiology opinion. The matter is REMANDED for the following action: 1. Obtain any outstanding VA and/or private treatment records relevant to treatment the Veteran received for his skin disorder that are not already of record. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified, and the record clearly documented. 2. Thereafter, obtain an opinion from a qualified clinician to determine the nature and etiology of the Veteran's skin disorder. The evidentiary record, including a copy of this remand, must be made available to and be reviewed by the reviewing clinician. It is up to the discretion of the reviewing clinician as to whether a new examination is necessary to provide an adequate opinion. After the record review and examination of the Veteran, if deemed necessary, the reviewing clinician should identify all skin disorders present at any point during the period on appeal (to include acne, a right ear boil, actinic keratoses, seborrheic keratoses, basal cell skin cancers, and lower leg cellulitis). Then, for each identified condition, the reviewing clinician is asked to respond to the following inquiry: Is it at least as likely as not that the Veteran's skin disorder was incurred in, or otherwise related, to his time on active service, to include (but not limited to) in-service exposure to herbicide agents? The reviewing clinician is to consider the article noted by the Veteran's representative in June 2021 and the Veteran's in-service treatment for a boil. In rendering this opinion, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran's reports, he or she must provide an explanation for such rejection. The reviewing clinician is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. A complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 3. After the above development has been completed to the extent possible, readjudicate the claim. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board, if otherwise in order. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Zheng, 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.