Citation Nr: 19171561 Decision Date: 09/17/19 Archive Date: 09/16/19 DOCKET NO. 14-20 963 DATE: September 17, 2019 REMANDED Entitlement to service connection for chronic dermatitis, including chloracne, skin rash and eruptions, is remanded. Entitlement to service connection for mycotic toenails, claimed as frostbite of the bilateral feet and peripheral neuropathy, is remanded. REASONS FOR REMAND The Veteran had active service from May 1968 to December 1969. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a July 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In October 2017, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a videoconference Board hearing. A copy of the transcript has been associated with the Veteran’s electronic claims folder. All claims are remanded. At a November 2010 VA dermatological consultation, the Veteran reported that he suffered from symptoms of a rash on his trunk and back for 40 years. The dermatological physician noted that Dr. Belsito diagnosed the Veteran with chronic dermatitis. On his March 2012 VA Form 21-526 (Veteran’s Application for Compensation), the Veteran stated that he has suffered from a rash and skin eruption since 1969 and was treated at “Presidio.” In a May 2012 correspondence, the Veteran stated that he sought a dermatologist shortly after service discharge due to his symptoms of excessive itching. He stated that the itching had also spread to other areas, such as legs and toes. At the October 2017 Board hearing, the Veteran testified that he first sought treatment for his claimed disabilities from Dr. Persito in 2000 or 2001. See Board Hearing Transcript, pp. 7-8. He said Dr. Persito moved to California and then the Veteran started treatment with the VA. Based on the foregoing, there is evidence that the Veteran sought treatment from private providers before starting treatment with the VA. There are no private treatment records during the times the Veteran has alleged treatment. As there is evidence of missing relevant private treatment records, they should be obtained on remand. Specifically, the Veteran should be requested to complete a VA Form 21-4142, Authorization and Consent to Release Information to VA, for the release of the private records. Also, the Veteran was afforded VA examinations in October 2018 where the examiner opined that the Veteran’s claimed conditions were less likely than not related to service or a service-connected disability. However, in response to the question of whether the Veteran’s skin, toenail or peripheral neuropathy were secondary to his service-connected multiple myeloma, the examiner wrote, “If the rater is working on the 50/50 criteria then, according to current data, then no. I agree with the October 2017 letter which indicated that rashes may be secondary to multiple myeloma. However, the incidences of rashes are far below the 50/50 used as criteria by the VA.” The Board finds the aforementioned opinion to be confusing, at best. The examiner stated that he agreed with the October 2017 letter from Dr. V.C.P. that the Veteran’s rashes may be related to his service-connected myeloma but also stated that it does not meet the 50/50 criteria. Therefore, the Board finds that a remand is necessary to obtain an addendum which clearly opines on the etiology of the claimed disabilities and their relationship to service or a service-connected disability. The matters are REMANDED for the following action: 1. Contact the Veteran and request that he provide or authorize the release of records from any private facility where the Veteran has been assessed or treated for his claimed skin and toenail disabilities. See March 2012 VA Form 21-526 where he states he was treated at Presidio; May 2012 correspondence where he stated that he sought a dermatologist shortly after service discharge due to his symptoms of excessive itching; October 2017 Board Hearing Transcript where he stated he first sought treatment for his claimed disabilities from Dr. Persito in 2000 or 2001. If, after making reasonable efforts to obtain private records the Agency of Original Jurisdiction (AOJ) is unable to secure same, the AOJ must notify the Veteran and (a) identify the specific records the AOJ is unable to obtain; (b) briefly explain the efforts that the AOJ made to obtain those records; (c) describe any further action to be taken by the AOJ with respect to the claim; and (d) inform the Veteran that he is ultimately responsible for providing the evidence. The Veteran must then be given an opportunity to respond. 2. Then, obtain an addendum opinion from the October 2018 examiner (or an appropriate medical professional) regarding the etiology of the Veteran’s claimed disabilities. The Veteran’s electronic claims folder, including a copy of this remand, should be provided to the examiner. The examiner is requested to provide an opinion as to the following: (a) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s claimed skin disabilities were incurred in or otherwise related to service, to include due to herbicide exposure. The examiner is requested to address the following: (i) the Veteran’s lay statements that he has experienced itching continuously since service although he did not seek treatment immediately; (ii) 2006 medical treatment records which show that the Veteran complained of a rash on his chest and back in the shape of the letter “v;” (iii) the 2006 diagnosis of lichen amyloidosis (and whether his amyloidosis diagnosis is associated with his service-connected multiple myeloma; See Amyloidosis: introduction, https://www.cancer.net/cancer-types/amyloidosis/introduction, last visited Sept, 11, 2019); (iv) the Veteran’s testimony that the rash on his back was the shape of a backpack radio, which he carried during service. See October 2017 Board Hearing, p. 5. (b) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s claimed skin disabilities were caused or aggravated by his service-connected multiple myeloma. (c) If aggravation is found, provide the baseline manifestations, and the increased manifestations due to the service-connected multiple myeloma. The examiner is requested to address the October 2017 opinion from Dr. V.C.P. which states that, “[The Veteran] was exposed to Agent Orange in North Korea between 1968 and 1969 and later on developed rashes and eventually multiple myeloma.” (d) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s claimed toenail disability was incurred in or is otherwise related to service, to include due to exposure to cold weather while stationed in Korea or herbicide agents during service. A complete rationale for all opinions reached must be provided. Michael A. Pappas Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Baskerville 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.