Citation Nr: 22013101 Decision Date: 03/08/22 Archive Date: 03/08/22 DOCKET NO. 19-09 360 DATE: March 8, 2022 REMANDED Entitlement to service connection for chloracne is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1965 to April 1969. He appeals a November 2017 rating decision by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) denying entitlement to service connection for chloracne. In May 2020, the Board of Veterans' Appeals (Board) remanded the claim to obtain missing VA treatment records and a medical opinion. The Veteran has continuously stated he was treated at the VAMC in Charlestown, Massachusetts for chloracne in December 1967. See, e.g., April 1984 VA Form 21-4138 ("treated...at the Medical Center, Charlestown, Mass."); February 1991 VA Form 21-4138 ("seen as an outpatient in December 1967 at the Charlestown, Mass. VAMC for chloracne."). He then contends he was treated at the VAMC Kansas City, Missouri in 1969 and 1970. See, e.g., February 1991 VA Form 21-4138 (treated at Kansas City, MO VAMC in 1969 and 1970); April 1984 VA Form 21-4138 (treated at the medical center in Kansas City, Missouri from May 1969 to August 1982). First, in June 2017, the AOJ requested treatment records from VAMC Charleston, South Carolina, not VAMC Charlestown, Massachusetts. See June 2017 VA Form 10-7131. Unsurprisingly, in April 2020, the Charleston VAMC reported no records for the Veteran. See April 2020 VA Form 10-7131. In May 2020, the AOJ noticed the mistake and it was suggested the record request be submitted to the correct VA facility. See May 2020 VA Form 21-0820. The May 2020 Board remand also noticed this error and remanded to "obtain all treatment records from any VA facility from which the Veteran has received treatment." Upon remand, however, the AOJ did not submit a record request to the Charlestown, Massachusetts VAMC. Second, the AOJ requested records from VAMC Kansas City, Missouri from July 1983 to September 1989, but no earlier. See October 2017 VA memo. Although a few treatment records from the VAMC Kansas City, Missouri are on file, they appear to be solely from 1983 or later. See, e.g., July 1983 and March 1991 submitted treatment records. Thus, a remand is required to obtain the proper VA treatment records. Additionally, the Veteran was afforded a September 2020 VA examination. There, the examiner diagnosed the Veteran with chloracne, but opined his chloracne was less likely than not related to service as "there is no evidence found in claims file to suggest that the Veteran had an onset of chloracne during service" or "was related to exposure to herbicide agents during service." See September 2020 VA medical opinions. This opinion is inadequate as it does not provide any rationale, or consider the many service treatment records noting treatment of skin conditions in service, or acknowledge the Veteran's statements regarding his symptoms from service to the present. Additionally, chloracne is a specific disease associated with exposure to herbicide agents used during military operations in the Republic of Vietnam. VA provides a presumption of herbicide exposure for veterans who served in the Republic of Vietnam between January 9, 1962, and May 7, 1975. See 38 C.F.R. § 3.307 (a)(6)(iii). The record reflects the Veteran was aboard the U.S.S. Boston in Da Nang Harbor and around Vietnam at various times from April 1967 to September 1967. See September 2017 DPRIS response. Thus, the Veteran has conceded exposure to herbicide agents during his nautical service in the eligible offshore waters of the Republic of Vietnam. See February 2020 VA memorandum. Certain diseases, such as chloracne, are associated with exposure to certain herbicide agents used in support of military operations in the Republic of Vietnam during the Vietnam era and will be considered to have been incurred in service. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.307(a)(6). 38 U.S.C. § 1116(a)(2); 38 C.F.R. § 3.309(e). The presumption for chloracne, or any other acneform disease consistent with chloracne, requires exposure to an herbicide agent and manifestation of the disease to a degree of 10 percent or more within one year after the last date on which the Veteran was exposed to an herbicide agent during active service. 38 C.F.R. § 3.307(a)(6)(ii). Thus, if the Veteran has chloracne or any other acneform disease consistent with chloracne, which is still unclear from the record, it must have manifested by September 1968, within one year of his presumed exposure to herbicide agents in September 1967. Otherwise, the presumption does not apply, but the Veteran may still be entitled to service connection on a direct basis if the medical evidence supports a relationship between chloracne and exposure to herbicides. See Combee v. Brown, 34 F.3d 1039, 1043 (1994). As the September 2020 VA examination report is inadequate a remand is also required to obtain an adequate opinion. The matters are REMANDED for the following action: 1. Obtain any outstanding and updated relevant VA and/or private treatment records, including by not necessarily limited to all treatment records from VAMC Charlestown, Massachusetts from December 1967 to April 1969, and VAMC Kansas City, Missouri from April 1969 through 1970. If any identified records are not obtainable, or none exist, the Veteran should be notified, and the record clearly documented. 2. After the development in #1 above is complete, obtain an opinion from a qualified reviewing clinician to determine the nature and etiology of the Veteran's chloracne or any other acneform disease consistent with chloracne. The evidentiary record, including a copy of this remand, must be made available to and 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 a thorough review of the record to include all in-service and post-service treatment records, the reviewing clinician should answer the following: (a). Is it at least as likely as not that the Veteran's chloracne, or any other acneform disease consistent with chloracne, began in service? The reviewing clinician should consider the following: (i) June 1967 STR noting treatment for heat rash on forehead and shoulders; (ii) November 1967 STRs reflecting a dermatology consultation for pseudofolliculitis; (iii) February 1968 and March 1968 STRs noting growing a beard may alleviate his folliculitis and the Veteran received a shaving chit; (iv) August 1968 STRs recording "folliculitis of chin, seems to be spreading over face" and the Veteran was prescribed Fostex Cream and Sulfocin; (v) September 1968 STR stating "folliculitis of neck;" and (vi) April 1969 STRs noting to check on the Veteran's "dermatitis" and "skin disorder." (b). Is it at least as likely as not that the Veteran's chloracne, or any other acneform disease consistent with chloracne, is otherwise related to his conceded in-service exposure to herbicide agents? Please discuss the onset and history of the Veteran's chloracne or other acneform disease consistent with chloracne. The reviewing clinician should also note the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. If the reviewing clinician rejects the Veteran's reports of symptomatology, a reason for doing so should also be provided. The reviewing clinician should not mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. A full and complete rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. After the above has been completed to the extent possible, readjudicate the claim. If any benefit sought remains denied, provide the Veteran with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Bona, 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.