Citation Nr: 21042178 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 16-02 814 DATE: July 12, 2021 REMANDED Entitlement to service connection for nodules under the skin (hereinafter referred to as skin nodules), including as due to exposure to Gulf War environmental hazards, is remanded. REASONS FOR REMAND Service Connection for Skin Nodules is Remanded. The Veteran served on active duty from February 1984 to September 1994, including service in Southwest Asia. This matter comes before the Board of Veterans' Appeals (Board) from an April 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran filed a notice of disagreement in August 2013 and a statement of the case was issued in December 2015. The Veteran filed a substantive appeal (VA Form 9) in January 2016. The Veteran testified at a Board videoconference hearing in February 2019 in Waco, Texas. The hearing transcript has been associated with the record. The judge who held that hearing is no longer at the Board. The matter was previously before the Board in October 2020. The Board remanded the matter in order to obtain a VA medical opinion. The Board found that a prior March 2013 VA opinion was inadequate because the VA examiner did not provide an opinion on whether the Veteran's skin nodules, diagnosed as dermatofibromas and lipomas, could have been caused by the anthrax vaccine. A new VA examination was conducted in January 2021 and VA medical opinions were provided in January 2021 and February 2021. Upon review of the record, the January 2021 and February 2021 VA medical opinions do not address the dermatofibromas diagnosis. As such, the Board finds that there is insufficient evidence of record to adjudicate this issue; a remand is warranted to obtain a VA examination addendum opinion to assist in determining service connection for skin nodules, including as due to exposure to Gulf War environmental hazards. The matters are REMANDED for the following action: Return the January 2021 and February 2021 VA medical opinions to the January 2021 VA examiner for an addendum opinion. If the January 2021 VA examiner is not available, a VA addendum opinion may be obtained from a similarly qualified medical professional. Examination of the Veteran is not required unless the examiner determines that an examination is necessary to provide a reliable opinion. A rationale for all opinions and a discussion of the facts and medical principles involved should be provided. The VA examiner should provide the following opinion: Is it at least as likely as not (50 percent probability or greater) that the current skin nodules, diagnosed as dermatofibromas and lipomas, had their onset during service or is otherwise related to an in-service injury, event, or disease, to include as due to the in-service anthrax vaccination and subsequent reaction to the vaccination. Please specifically address both diagnoses, dermatofibromas and lipomas. The term "at least as likely as not" does not mean merely within the realm of medical possibility, but rather that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of causation as it is to find against it. A rationale should be given for the provided opinion and conclusions rendered. The opinion should address the particulars of this Veteran's medical history and the relevant medical science as applicable to this claim. E. CHOI Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Costantino, 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.