Citation Nr: 22010109 Decision Date: 02/22/22 Archive Date: 02/22/22 DOCKET NO. 13-26 713 DATE: February 22, 2022 REMANDED Entitlement to service connection for bilateral lower extremity skin disorder, to include as due to herbicide exposure and/or as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1969 to August 1971, to include verified service in the Republic of Vietnam from August 1970 to August 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In that rating decision, the RO denied entitlement to service connection for bilateral lower extremity rash. In August 2017, the Board denied the claim. The Veteran appealed this determination to the United States Court of Appeals for Veterans Claims (Court). In October 2018, the Court vacated the Board's August 2017 decision and remanded the claim for action consistent with a Joint Motion for Remand (JMR). The Board remanded this claim in May 2019, January 2021, and May 2021 to the agency of original jurisdiction (AOJ) for additional development. The Board's remand directives have been substantially completed. See Stegall v. West, 11 Vet. App. 268, 271 (1998). To more accurately reflect the scope of the Veteran's claim, the issue has been recharacterized as shown on the title page. Entitlement to service connection for bilateral lower extremity skin disorder, to include as due to herbicide exposure /or as secondary to service-connected PTSD The evidence of record shows that the Veteran has been diagnosed with or has had residuals of left lower extremity rash, to include lichen simplex chronicus (LSC), nummular eczema, and psoriasis during the appeal period. See September 2006 and September 2009 private treatment records, April 2018 VA treatment record, and December 2019 VA examination. In an October 2012 statement, the Veteran's wife reported that "[t]o deal with his nervousness and rages he would drink excessively and scratch his legs until they bleed." The Veteran is service connected for PTSD. At a May 2012 VA examination for PTSD, the Veteran reported that his legs are shaking and itching from service. The Veteran's VA treatment records show that his skin condition on left lower extremity sometimes itches and bleeds when the dry skin peels off. See April 2018 VA treatment record. In light of this evidence suggesting that the Veteran's bilateral lower extremity skin disorder may be related to his service-connected PTSD, a secondary VA opinion is needed. Accordingly, while the Board regrets the additional delay, a remand is needed to fully address the Veteran's claim. The matter is REMANDED for the following action: 1. Obtain an addendum VA medical opinion from a qualified clinician. A full examination should not be scheduled unless it is deemed necessary by the examiner or otherwise required by the evidence. The examiner must review the claims file, including a copy of this Remand and should note so in the report. 2. Thereafter, the examiner is asked to provide an opinion with respect to the following: a) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's bilateral lower extremity skin disorder is caused by or aggravated by his service-connected PTSD. The term "aggravation" means "made worse." In providing this opinion, the examiner must address the October 2012 statement from the Veteran's wife, May 2012 VA examination for PTSD with the Veteran's reports of shaking and itching legs from service, and April 2018 VA treatment record showing that the Veteran's skin condition on left lower extremity sometimes itches and bleeds when the dry skin peels off. The examiner must set forth a complete rationale for any conclusion reached, citing to the examiner's own expertise, medical literature, and/or evidence in the Veteran's claims file as necessary. If an opinion cannot be reached without resorting to speculation, the examiner must fully explain why that is so. CLAIRE M. DAVIDOSKI Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Kuzniar, 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.