Citation Nr: 22014089 Decision Date: 03/11/22 Archive Date: 03/11/22 DOCKET NO. 10-49 112 DATE: March 11, 2022 REMANDED Entitlement to service connection for seborrheic keratosis is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1968 to December 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a May 2010 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2019, July 2020, and June 2021, the Board remanded the issue for further development. The case has since been returned to the Board for appellate review. Upon review, the Board finds that additional development is necessary prior to final adjudication of the claim. In the June 2021 remand, the Board noted that the claims file indicated that since the Veteran's November 2009 claim, he has been diagnosed with various skin conditions, including seborrheic keratosis. After a shave biopsy, a January 2010 VA treatment record shows that the Veteran was diagnosed with seborrheic keratosis with hyperkeratosis. A January 2012 VA treatment record also indicated that the Veteran had an ulcer on his right cheek and scaly bumps on his arms, with the assessment being seborrheic keratosis and diffuse actinic damage. In December 2016, a VA examiner noted that the Veteran had problems with seborrheic keratosis. A January 2017 VA treatment record also showed that the Veteran had a diagnosis of seborrheic keratosis. During a VA examination in October 2019, the Veteran reported having a long-standing history of seborrheic keratosis. During a March 2021 VA examination, the examiner noted a diagnosis of seborrheic keratosis. In the June 2021 decision, the Board found a remand was necessary because although the March 2021 VA examiner diagnosed the condition, she did not provide an opinion as to whether it was incurred in or otherwise related to service, and only provided an opinion as to actinic keratosis, a separate condition. The Veteran was subsequently afforded a VA examination for his seborrheic keratosis in October 2021. The VA examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In so finding, the examiner stated that there is no evidence of a significant skin condition of any kind while in service or at separation and that there is no evidence of a skin condition until around 2016. The examiner also opined that the Veteran was incorrectly service-connected for basal cell carcinoma. The examiner's opinion seemed to focus on providing a negative nexus opinion for the Veteran's basal cell carcinoma. Regarding seborrheic keratosis, the examiner stated that this is not thought to be related to sun exposure and may have an autoimmune or familial component. The Board finds that, since the examiner's primary focus was on the Veteran's basal cell carcinoma, his rationale was incomplete and somewhat speculative in nature. Therefore, as there has not been substantial compliance with the prior remand directives, the Board finds that a remand is necessary to obtain an addendum medical opinion. See Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand confers on the claimant, as a matter of law, the right to compliance with the remand order). The matter is REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for seborrheic keratosis. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the case file. The AOJ should also obtain any outstanding VA medical records. 2. After the above development has been completed, the AOJ should obtain an addendum medical opinion from a different suitably qualified examiner to determine the nature and etiology of any seborrheic keratosis that may be present. A physical examination is not needed unless the examiner determines that one is necessary. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. It should be noted that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should opine as to whether it is at least as likely as not that the Veteran has seborrheic keratosis that is causally or etiologically related to his military service, to include any injury or symptomatology therein, to include sun exposure and/or herbicide exposure. (The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important "that each disability be viewed in relation to its history [,]" 38 C.F.R. § 4.1, copies of all pertinent records in the Veteran's claims file, or in the alternative, the claims file, must be made available to the examiner for review. 3. After the above development is completed, the AOJ should review the medical opinion to ensure that it is in compliance with this remand. If the report is deficient in any manner, the AOJ should implement corrective procedures. 4. The AOJ should conduct any other development as may be indicated. B. G. LeMoine Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. DeVerter, 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.