Citation Nr: 22018656 Decision Date: 03/30/22 Archive Date: 03/30/22 DOCKET NO. 16-03 831 DATE: March 30, 2022 REMANDED Entitlement to service connection for psoriasis is remanded. Entitlement to service connection for psoriatic arthritis is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1968 to December 1970. He subsequently served in the Army National Guard with various periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA) through August 1, 1979. This matter is before the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The case was previously before the Board in October 2018, March 2021, and August 2021 when it was remanded for further development. While the Board sincerely regrets the further delay in resolution of these matters, unfortunately, a remand for an addendum opinion is unavoidable in this case. The August 2021 remand directed that an addendum opinion be obtained regarding the claims for service connection for psoriasis and psoriatic arthritis. It was also directed that all periods of active duty, ACDUTRA, and INACDUTRA should be clarified in the directive to the examiner. The examiner was then asked to opine whether psoriasis and psoriatic arthritis at least as likely as not began in or are otherwise related to service, and whether it is at least as likely as not that the Veteran's psoriasis and psoriatic arthritis arose from a disease or injury incurred or aggravated in the line of duty during a period of ACDUTRA, or from an injury incurred or aggravated in the line of duty during a period of INACDUTRA. In a January 2022 opinion, the examiner opined that it was less likely than not that the Veteran's psoriasis arose from a disease or injury incurred or aggravated in the line of duty during a period of ACDUTRA, or from an injury incurred in or aggravated in the line of duty during a period of INACDUTRA. The examiner stated there was no definite diagnosis of psoriasis during service and post-service medical records do not identify psoriasis until 1975, five years after discharge. There was also no clear evidence to suggest that in-service exposure to Agent Orange had any significant impact on the development of psoriasis. It does not appear from a review of the examination that all periods of active duty, ACDUTRA, and INACDUTRA was clarified in the directives to the examiner. Service personnel records obtained in December 2021 indicate that the Veteran served periods of active duty, ACDUTRA, or full-time training duty in May 1975 and June 1975. The examiner did not take into account this information when rendering the opinion. Also, the examiner did not provide an explanation for the conclusion that there was no clear evidence to suggest that in-service exposure to Agent Orange had any significant impact on the development of psoriasis. Therefore, the opinion is inadequate, and the Board must remand for an addendum opinion in this case. When VA provides an examination or obtains an opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). The matters are REMANDED for the following action: Return the claims file to the VA examiner who provided the January 2022 VA opinion for an addendum medical opinion. The examiner must review the entire claims file, including a copy of this Remand. If the VA examiner who provided the January 2022 VA opinion is not available, then forward the claims file to another appropriate specialist to obtain the below requested medical opinion. **All periods of active duty, ACDUTRA, and INACDUTRA should be clarified in the directive to the examiner. See Service personnel records received in December 2021. The examiner must render opinions, consistent with sound medical judgment, as to: a) Whether the Veteran's psoriasis and psoriatic arthritis at least as likely as not (approximately a 50 percent or greater probability) began in or are otherwise related to service, in light of his lay statements describing in-service exfoliative lesions on his fingers and hands during active duty and a contended diagnosis of psoriasis approximately one year after active duty. b) Whether it is at least as likely as not (approximately a 50 percent or greater probability) that the Veteran's psoriasis and/or psoriatic arthritis arose from a disease or injury incurred or aggravated in the line of duty during a period of ACDUTRA, or from an injury incurred or aggravated in the line of duty during a period of INACDUTRA. The examiner must consider and discuss the December 1978 service flight physical examination noting a history of psoriasis since 1975, as well as service personnel records which show that the Veteran served periods of active duty, ACDUTRA, or full-time training duty in May 1975 and June 1975. In offering any opinion, the examiner must consider the full record, to include the Veteran's lay statements and prior medical records. Specifically, the examiner must address the Veteran's lay statements that he experienced rashes in-service rash that continued after leaving service. A complete rationale for all opinions must be provided. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. D. Ware Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Bonnie Yoon, 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.