Citation Nr: 23008167 Decision Date: 02/08/23 Archive Date: 02/08/23 DOCKET NO. 19-15 750A DATE: February 8, 2023 REMANDED Entitlement to service connection for a skin disorder is remanded Entitlement to service connection for a left shoulder disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1974 to February 1978. These matters are before the Board of Veterans' Appeals (Board) on appeal from a January 2019 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This case was most recently before the Board in May 2022, at which time it was remanded for further development, as discussed below. The Board finds that the remand directives were not substantially complied with and thus another remand is warranted. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for a skin disorder is remanded A May 2022 Board decision found the November 2021 VA medical opinion to be inadequate because the rationale relied on incorrect premise in reaching the medical opinion. Specifically, the rationale was based on a finding that there is no evidence of a rash to hands or feet during service, and that the Veteran's chest rash had been quiescent. However, the service treatment records show treatment for skin problems on the hands, feet, and chest, as well as other medical records showing treatment for a chest rash. The Board remanded the claim and directed the Agency of Original Jurisdiction (AOJ) to obtain another addendum medical opinion. Additionally, the AOJ was directed to ask the Veteran to provide further information regarding his contention that he was exposed to harmful substances during his service at McGuire and Homestead Air Force Bases. The AOJ was also directed to obtain complete treatment records from the Asheville VA Medical Center where the Veteran reports treatment for blistering of the hands and peeling of skin in 1978. 05/02/2022, BVA Decision. In August 2022, the AOJ notified the Veteran that an attempt was made in May 2022 to obtain records from the Asheville VA Medical Center regarding treatment for blistering of the hands and peeling of skin in 1978, but the response stated that no records were available. 08/16/2022, Final Attempt Letter. In an October 2022 VA addendum opinion, the clinician was unable to provide an opinion regarding skin conditions on the chest, back, and feet without an additional examination because the 2021 VA examination only revealed a diagnosis of bilateral hand dermatitis. The clinician also indicated that a bilateral hand rash was not noted in the service treatment records. 10/07/2022, C&P Exam. However, the service treatment records reveal that the Veteran was treated for skin problems on his hands during active service. 04/23/1985, STR Medical, page 51. As such, the Board finds that the remand directives were not substantially complied with and, therefore, another remand is warranted. Stegall, 11 Vet. App. at 271. Specifically, the October 2022 addendum opinion relied on incorrect premise in reaching the medical opinion and also did not provide an opinion as to whether the Veteran's diagnosed skin conditions, including on his hands, are related to his period of active service. Based on the foregoing, the Board finds the October 2022 addendum opinion to be incomplete and that another addendum medical opinion is warranted. 2. Entitlement to service connection for a left shoulder disorder is remanded. A May 2022 Board decision found the November 2021 VA medical opinion to be inadequate because the rationale relied solely on the lack of in-service complaints regarding the left shoulder. The Board remanded the claim and directed the Agency of Original Jurisdiction (AOJ) to obtain another addendum medical opinion. 05/02/2022, BVA Decision. In an October 2022 VA addendum opinion, the clinician opined that the Veteran's left shoulder condition is less likely than not related to his period of active service. Rather, the clinician indicated that the condition is likely due to aging. The rationale was based on the left shoulder condition having been diagnosed in 2021. 10/07/2022, C&P Exam. However, the VA treatment records reveal that the Veteran had been complaining of left shoulder pain as early as October 2004. 12/08/2018, CAPRI, page 39. As such, the Board finds that the remand directives were not substantially complied with and, therefore, another remand is warranted. Stegall, 11 Vet. App. at 271. Specifically, the October 2022 addendum opinion relied on incorrect premise in reaching the medical opinion. Based on the foregoing, the Board finds the October 2022 addendum opinion to be incomplete and that another addendum medical opinion is warranted. These matters are REMANDED for the following actions: 1. Obtain any outstanding VA treatment records. Additionally, request the Veteran to submit any relevant private treatment reports or provide VA with authorization to obtain any such records. 2. Ask the Veteran to provide further information regarding his contention that he was exposed to harmful substances during his service at McGuire and Homestead Air Force Bases. After completing directives # 1 and 2, schedule the Veteran for in-person physical examination to determine the nature and etiology of any diagnosed skin condition, including but not limited to bilateral hand dermatitis. If the Veteran is deemed unavailable for the in-person examination, then a physician is requested to review the virtual file, including a copy of this Remand. The clinician is to provide opinions as to: (a.) Whether the Veteran's pre-existing skin disorder (noted as a "skin rash on chest and back") underwent a worsened during service. (b.) If so, then is there clear and unmistakable evidence (i.e., undebatable) that the increase in disability was due to the natural progress of the condition? (c.) Whether any of the Veteran's skin complaints during service (regarding his hands, and feet) were separate and distinct conditions from the "skin rash on chest and back" noted at entry. If any of these were distinct conditions, is it at least as likely as not (probability of approximately 50 percent or more) they indicate in-service incurrence of the Veteran's current dermatitis condition? (d.) Whether the Veteran's current skin condition diagnosis, including but not limited to bilateral hand dermatitis, is at least as likely as not (probability of approximately 50 percent) related to an in-service injury, event, or disease. A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). 3. After completing directive # 1, obtain an addendum opinion from an appropriate physician to determine the nature and etiology of any diagnosed left shoulder condition. An in-person examination is not required unless deemed necessary by the physician. The physician is to review the virtual file, including a copy of this Remand. The physician is to provide an opinion as to whether the Veteran's current left shoulder condition is at least as likely as not related to an in-service injury, event, or disease (Continued on the next page) A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board David Han 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.