Citation Nr: 1306596 Decision Date: 02/26/13 Archive Date: 03/01/13 DOCKET NO. 08-16 897 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina THE ISSUES 1. Entitlement to an initial, compensable rating for left carpal tunnel syndrome, prior to May 7, 2012. 2. Entitlement to a rating in excess of 10 percent for left carpal tunnel syndrome, from May 7, 2012. 3. Entitlement to an increased (compensable) rating for tinea pedis. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD A. Lindio, Counsel INTRODUCTION The Veteran served on active duty from July 1954 to September 1979. This appeal to the Board of Veterans' Appeals (Board) arose from an August 2007 rating decision in which the RO granted service connection and assigned a 0 percent (noncompensable) rating for left carpal tunnel syndrome. effective August 31, 2006, as well as denied a compensable rating for tinea pedis. In October 2007, the Veteran filed a notice of disagreement. A statement of the case (SOC) was issued in May 2008, and the Veteran filed a substantive appeal (via a VA Form 9, Appeal to the Board of Veterans' Appeals) in June 2008. In March 2011, the Board remanded the claims on appeal to the RO, via the Appeals Management Center (AMC) in Washington, DC,, for additional development. In February 2012, a Deputy Vice Chairman of the Board granted the motion of the Veteran's representative to advance this appeal on the Board's docket, pursuant to 38 U.S.C.A. § 7107(a)(2)(C) (West 2002) and 38 C.F.R. § 20.900(c) (2012). In an October 2012 rating decision, the AMC granted a 10 percent disability rating for carpal tunnel syndrome, left, from May 7, 2012. However, inasmuch as a higher rating is available for left carpal tunnel syndrome and the Veteran is presumed to seek the maximum available benefit for a disability, the Board has now characterized the appeal pertaining to carpal tunnel syndrome as encompassing the first and second matters set forth on the title page. See Fenderson v. West, 12 Vet. App. 119, 126 (1999); AB v. Brown, 6 Vet. App. 35, 38 (1993). The AMC has associated additional evidence, specifically, additional VA medical records and reports of May 2012 VA examinations for higher ratings for carpal tunnel syndrome and tinea pedis, which were considered in the October 2012 supplemental SOC (SSOC). The Board's decision on the claims for higher ratings for left carpal tunnel syndrome is set forth below. The remaining claim on appeal is addressed in the remand following the order; this matter is being remanded to the RO, via the AMC. VA will notify the Veteran when further action, on his part, is required. FINDINGS OF FACT 1. All notification and development actions needed to fairly adjudicate each claim herein decided have been accomplished. 2. The Veteran is right-hand dominant. 3. From the August 31, 2006 effective date of the award of service connection through May 6, 2012, the Veteran's left carpal tunnel syndrome was manifested by subjective complaints of pain, without objective evidence of median nerve involvement or functional impact, and included medical findings of normal strength, reflexes and sensation. 4. Since May 7, 2012, the Veteran's left carpal tunnel syndrome has been manifested by subjective complaints of numbness and objective findings of normal sensation, almost normal strength and numbness into two fingers. 5. The applicable rating criteria are adequate to rate the Veteran's left carpal tunnel syndrome at all pertinent points. CONCLUSIONS OF LAW 1. The criteria for an initial, compensable rating for left carpal tunnel syndrome, for the period prior to May 7, 2012, are not met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8515 (2012). 2. The criteria for a rating in excess of 10 percent for left carpal tunnel syndrome, from May 7, 2012, are not met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8515 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002 & Supp. 2012)) includes enhanced duties to notify and assist claimants for VA benefits. VA regulations implementing the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2012). Notice requirements under the VCAA essentially require VA to notify a claimant of any evidence that is necessary to substantiate the claim(s), as well as the evidence that VA will attempt to obtain and which evidence he or she is responsible for providing. See, e.g., Quartuccio v. Principi, 16 Vet. App. 183 (2002) (addressing the duties imposed by 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b)). As delineated in Pelegrini v. Principi, 18 Vet. App. 112 (2004), after a substantially complete application for benefits is received, proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim(s); (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claim(s), in accordance with 38 C.F.R. § 3.159(b)(1). The Board notes that, effective May 30, 2008, 38 C.F.R. § 3.159 has been revised, in part. See 73 Fed. Reg. 23,353-23,356 (April 30, 2008). Notably, the final rule removes the third sentence of 38 C.F.R. § 3.159(b)(1), which had stated that VA will request that a claimant provide any pertinent evidence in his or her possession. A January 2007 pre-rating letter provided notice to the Veteran regarding what information and evidence was needed to substantiate what were then claims for service connection for left carpal tunnel syndrome, as well as what information and evidence must be submitted by the appellant, and what information would be obtained by VA. This letter also provided the Veteran with general information pertaining to VA's assignment of disability ratings and effective dates (in the event service connection was granted), as well as the type of evidence that impacts those determinations. The August 2007 rating decision reflects the initial adjudication of the claims after issuance of the January 2007 letter. After the award of service connection, and the Veteran's disagreement the initial rating assigned, the May 2008 SOC set forth the pertinent rating criteria for evaluating left carpal tunnel syndrome (the timing and form of which suffices, in part, for Dingess/Hartman). The Board acknowledges the record does not include any letter explaining what is needed to support any higher rating for left carpal tunnel syndrome. However, on these facts, the absence of such a letter is not shown to prejudice the Veteran. In addition to the pre- and post-rating notice identified above, the claims file reflects that the Veteran had actual knowledge of the information and evidence necessary to substantiate his claims for higher ratings. In this regard, in his October 2007 NOD, he took issue with the status of his condition. In his June 2008 substantive appeal, the Veteran made clear that he understood that higher ratings were available based upon demonstrated symptomatology. Additionally, in the January 2012 written brief presentation, the Veteran's representative reported that the nature of the Veteran's condition was worse. Accordingly, on these facts, the omission of a notice letter specific to the matters of higher ratings is not shown to prejudice the Veteran and is, thus, harmless. See Dalton v. Nicholson, 21 Vet. App. 23, 30-31 (2007). The record also reflects that VA has made reasonable efforts to obtain or to assist in obtaining all relevant records pertinent to the matters herein decided. Pertinent medical evidence associated with the claims file consists of service, VA and private treatment records, and VA examination reports. Also of record and considered in connection with the appeal are various written statements provided by the Veteran, and by his representative, on his behalf. The Board finds that no additional RO action on either action, prior to appellate consideration, is required. Consistent with the March 2011 Board remand, the AMC requested that the Veteran identify his private medical providers in a March 2012 letter. The Veteran did not provide the requested information. Also, the AMC associated with the claims file VA medical records from the Fayetteville VA Medical Center, and arranged for the Veteran to undergo VA examinations in May 2012, the reports of which have been . An October The Board notes that, after the issuance of the October 2012 supplemental SOC, additional VA medical records were associated with the claims file. Although it does not appear that the AMC does not appear to have reviewed those records and the Veteran has not waived initial RO consideration of that information. the Board finds that those records are not relevant to the current carpal tunnel syndrome claims. They do not include any information for rating left carpal tunnel syndrome and the evidence is consistent with previous evidence of record; the newly submitted evidence is not considered pertinent additional evidence warranting a remand for initial RO consideration in connection with these claims.. In summary, the duties imposed by the VCAA have been considered and satisfied. Through various notices of the RO, the Veteran has been notified and made aware of the evidence needed to substantiate the claims decided herein, the avenues through which he might obtain such evidence, and the allocation of responsibilities between herself and VA in obtaining such evidence. There is no additional notice that should be provided, nor is there any indication that there is additional existing evidence to obtain or development required to create any additional evidence to be considered in connection with the claim. Consequently, any error in the sequence of events or content of the notice is not shown to prejudice the Veteran or to have any effect on the appeal. Any such error is deemed harmless and does not preclude appellate consideration of any of the matters herein decided, at this juncture. See Mayfield v. Nicholson, 20 Vet. App. 537, 543 (2006) (rejecting the argument that the Board lacks authority to consider harmless error). See also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). II. Analysis Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. A veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the question for consideration is entitlement to a higher initial rating assigned following the grant of service connection, evaluation of the medical evidence since the effective date of the grant of service connection and consideration of the appropriateness of 'staged rating' (assignment of different ratings for distinct periods of time, based on the facts found) is required. Fenderson, 12 Vet. App. at 126. As noted, historically, the RO granted service connection for left carpal tunnel syndrome in an August 2007 rating decision, and assigned an initial, noncompensable rating under the provisions of 38 C.F.R. § 4.124a, Diagnostic Code 8515, effective August 31, 2006. In an October 2012 rating decision, the RO granted a 10 percent disability rating, effective May 7, 2012. As the RO has already assigned staged ratings for left carpal tunnel syndrome-0 percent from August 31, 2006, and 10 percent from May 7, 2012-the Board must consider the propriety of the rating at each stage, as well as whether any further staged rating is warranted. The Veteran's left carpal tunnel syndrome has been rated under Diagnostic Code 8515. Under Diagnostic Code 8515, for rating paralysis of the median nerve, mild incomplete paralysis of the median nerve in the major or minor extremity warrants a 10 percent rating. For the major extremity, moderate incomplete paralysis warrants a 30 percent rating. Severe incomplete paralysis warrants a 50 percent rating. Complete paralysis, with the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand (ape hand), pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended, cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm, flexion of wrist weakened, and pain with atrophic disturbances warrants a maximum 70 percent rating. 38 C.F.R. § 4.124a. The rating schedule authorizes the assignment of a 0 percent (noncompensable) rating in every instance in which the rating schedule does not provide for such a rating and the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. VA medical records generally do not document findings of paralysis. For example, in a September 2006 record, the examiner found normal muscle tone, strength and coordination, as well as a non-remarkable sensory examination. In a December 2006 statement, the Veteran reported chronic pain, swelling and stiffness of both wrists with limited range of motion, which he attributed to both carpal tunnel syndrome and osteoarthritis. In a June 2007 joints VA examination report, the examiner noted that the Veteran was right hand dominant. In June 2007, the Veteran underwent a VA neurological examination, which included a review of the claims file. The examiner found the Veteran's strength and reflexes to be within normal limits for the upper extremities. The examiner also noted normal traced figures, vibrations and senses. The examiner found the left carpal tunnel syndrome to be related to his military service, but that the Veteran had no significant deficits on examination. In May 2012, the Veteran had another VA examination which included a review of the claims file. The Veteran then complained of numbness in his distal forearms and fingers, intermittently. He also reported decreased strength. The examiner found sensation to be intact to light touch, with Tine's sign positive for numbness into two fingers. The examiner noted that distribution in the median nerve would be incomplete paralysis (given the Veteran's grade 5- strength was near normal) and that the severity was mild. The Veteran did not use any assistive devices for his carpal tunnel syndrome. The examiner also noted that the Veteran owned his own plumbing business and that the carpal tunnel syndrome did not affect his occupation. Prior to May 7, 2012, the medical records do not document any findings reflective of neurological impairment of the left upper extremity. Moreover, as specifically found by the June 2007, examiner the Veteran's strength and reflexes were within normal limits for the left upper extremity. The examiner further found that the Veteran had no significant deficits on examination due to the left carpal tunnel syndrome. Considering the pertinent facts in light of the above, the Board finds that at no point prior to May 7, 2012, did the Veteran's left carpal tunnel syndrome warrant a compensable rating. The evidence indicates that the Veteran's left carpal tunnel syndrome has not been manifested by loss of strength or other neurological deficits. The Board finds that, collectively, the medical demonstrates that the Veteran's left carpal tunnel syndrome has been no more than negligible. The medical evidence prior to May 7, 2012 reflects no more than subjective complaints of pain and other subjective symptoms not contemplated in the rating criteria, without any objective evidence whatsoever of median nerve sensation, strength or reflex impairment. Indeed, the June 2007 VA examiner specifically found no significant deficits. In sum, the medical evidence does not support a finding of at least mild incomplete paralysis of either median nerve to warrant even the minimum compensable rating under Diagnostic Code 8515). As for the lay assertions of record, the Board notes that the Veteran is certainly competent to report matters within his personal knowledge, to include his own symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). In this case, the Veteran has not complained of symptoms consistent with paralysis, such as sensory or strength involvement. Even if so, however, the Board points out that, as a layperson without appropriate medical training and expertise to competently render the medical findings needed to support a higher rating, his assertions would not be considered more persuasive than the findings of a qualified medical professional-here the VA examiner, See 38 C.F.R. § 3.159 (a)(1) (competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). In light of the above, the Board finds that there is no basis for assignment of a compensable disability rating prior to May 7, 2012. However, on VA examination conducted on May 7, 2012, the Veteran complained of intermittent numbness of the fingers. The examiner found sensation to be intact to light touch, but also that testing was positive for numbness into two fingers and near normal strength. The examiner assessed mild, incomplete paralysis of the median nerve, but commented that the carpal tunnel syndrome did not affect the Veteran's occupation. In the October 2012 rating decision, the RO granted a 10 percent disability rating from the date of the May 2012 VA examination. However, at no point since May 7, 2012 has the Veteran's left carpal tunnel syndrome warranted a disability rating in excess of 10 percent. The May 2012 VA examiner specifically found the Veteran's median nerve paralysis to be consistent with mild, incomplete paralysis, based on his findings. A disability rating in excess of 10 percent for moderate, incomplete paralysis or even more severe paralysis is not evidenced by the record. Again, the Board has considered the lay assertions pertinent to this period Here, the Veteran's report of decreased strength and numbness were considered and tested by the May 2012 VA examiner. Based on his testing, the VA examiner found the Veteran to have no more than mild, incomplete paralysis. For all the foregoing reasons, the Board finds that there is no basis for a disability rating in excess of 10 percent from May 7, 2012. The above determinations are based on consideration of applicable provisions of VA's rating schedule. Additionally, the Board finds that there is no showing that, at any pertinent point, the Veteran's left carpal tunnel syndrome has reflected so exceptional or so unusual a picture as to warrant the assignment of a higher rating on an extra-schedular basis. See 38 C.F.R. § 3.321(b)(1) (cited in the May 2008 SOC). There is a three-step analysis for determining whether an extra-schedular rating is appropriate. Thun v. Peake, 22 Vet. App. 111, 115 (2008). First, there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disability and the established criteria found in the rating schedule to determine whether the veteran's disability picture is adequately contemplated by the rating schedule. Id. If not, the second step is to determine whether the claimant's exceptional disability picture exhibits other related factors identified in the regulations as 'governing norms.' Id. at 115-16; see also 38 C.F.R. § 3.321(b)(1) governing norms include marked interference with employment and frequent periods of hospitalizations). If the factors of step two are found to exist, the third step is to refer the case to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for a determination whether the claimant's disability picture requires the assignment of an extra-schedular rating. Id. at 116. The Board finds that schedular criteria are adequate to rate the Veteran's disability at all times pertinent to this appeal. For the periods prior to and from May 7, 2012, the rating schedule fully contemplates the described symptomatology, and there is no medical indication or argument that the applicable criteria are inadequate to rate the disability under consideration at any pertinent point.. While the Veteran has asserted that he has difficulty working due to his carpal tunnel syndrome, the VA examiners have consistent found the carpal tunnel syndrome to not cause any functional or occupational impairment. Thus, the threshold requirement for invoking the procedures set forth in 38 C.F.R. § 3.321(b)(1) is not met. See Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). For all the foregoing reasons, there is no basis for any further staged rating of the Veteran's left carpal tunnel syndrome, pursuant to Fenderson, and each claim for higher rating must be denied. In reaching these conclusions, the Board has considered the applicability of the benefit-of-the doubt doctrine; however, as the preponderance of the evidence is against assignment of any higher rating for carpal tunnel syndrome, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). ORDER An initial, compensable rating for left carpal tunnel syndrome, prior to May 7, 2012, is denied. A rating in excess of 10 percent for left carpal tunnel syndrome, from May 7, 2012, is denied. REMAND The Board's review of the claims file reveals that further RO action on the claim remaining on appeal is warranted. In connection with the claim for higher rating for tinea pedis, the Veteran had VA examinations in June 2007, August 2008 and May 2011. In June 2007, the VA examiner found no skin lesions, scarring or tinea pedis. In August 2008, the VA examiner found no evidence of scaling, erythema or pigmentary changes to the face neck or groin, though the Veteran had xerotic hands. Based on description, the examiner diagnosed seborrheic dermatitis. In May 2011, the VA examiner found xerosis in some intermittent areas over the dorsum of the hands and feet, affecting less than 5 percent of the total body area and that the total exposed area was less than 5 percent. The Board points out that the medical evidence raises, but does not sufficiently resolve, questions pertaining to the evaluation of tinea pedis. The latter two VA examination reports do not clearly indicate whether the Veteran currently has tinea pedis, or whether any other diagnosed skin disorder represents a progression of or is otherwise medically associated with the tinea pedis for which service connection has been awarded. The examiners were unclear as to what symptoms are attributable to the service-connected tinea pedis versus any unrelated skin disorder(s). Additionally, not of record at the time of the VA examinations was the December 2007 VA medical record documenting a diagnosis of tinea pedis, indicating a flare-up of tinea pedis during a time frame pertinent to this appeal. On the basis of the above, the Board finds that the medical evidence currently of record is inadequate to evaluate the Veteran's tinea pedis, and that further VA examination, with appropriate medical findings responsive to the applicable rating criteria, is needed to fairly resolve the claim for higher rating. See 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159; McLendon v. Nicholson, 20 Vet. App. 79 (2006). Hence, the RO should arrange for the Veteran to undergo VA dermatology examination, by an appropriate medical professional, at a VA medical facility. The Veteran is hereby advised that failure to report for the scheduled examination, without good cause, may well result in denial of the claim for increased rating. See 38 C.F.R. § 3.655(b) (2012). Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant and death of an immediate family member. If the Veteran fails to report to the scheduled examination, the RO should obtain and associate with the claims file a copy of the notice of the examination sent to him by the pertinent VA medical facility. Prior to arranging for the Veteran to undergo further examination, to ensure that all due process requirements are met, and that the record before the examiner is complete, the RO should give the Veteran another opportunity to provide information and/or evidence pertinent to the claim remaining on appeal. The RO's letter to the appellant should explain that she has a full one-year period for response. See 38 U.S.C.A. § 5103(b)(1) (West 2002); but see also 38 U.S.C.A. § 5103(b)(3) (West Supp. 2012) (amending the relevant statute to clarify that VA may make a decision on a claim before the expiration of the one-year notice period).. The RO should specifically request that the appellant provide, or provide appropriate authorization for it to obtain, any outstanding private medical records. Thereafter, the RO should attempt to obtain any additional evidence for which the appellant provides sufficient information, and, if needed, authorization, following the current procedures prescribed in 38 C.F.R. § 3.159 (2012). The actions identified herein are consistent with the duties imposed by the Veterans Claims Assistance Act of 2000 (VCAA). See 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2012). However, identification of specific actions requested on remand does not relieve the AOJ of the responsibility to ensure full compliance with the VCAA and its implementing regulations. Hence, in addition to the actions requested above, the AOJ should also undertake any other development and/or notification action deemed warranted by the VCAA prior to adjudicating the remaining claim on appeal. The RO's adjudication of the increased rating claim should include consideration of whether staged rating of the disability, pursuant to Hart v. Mansfield, 21 Vet. App. 505 (2007), is appropriate, as well as whether recharacterization of the disability is warranted. As a final point, the Board notes that the October 2012 SSOC does not indicate that the AMC considered the new VA medical records associated in the Virtual VA claims file and the Veteran has not submitted a waiver of initial RO consideration of the evidence. See 38 C.F.R. §§ 20.800, 20.1304. Such records reflect a diagnosis of tinea pedis (December 2007 VA medical record) and several dermatology findings, which are pertinent to the present claim. As such, the RO's adjudication of the claims must include consideration of all pertinent evidence added to the claims file since the last adjudication of the claim. Accordingly, this matter is hereby REMANDED for the following action: 1. The RO should furnish to the Veteran and his representative a letter requesting that the Veteran provide information and, if necessary, authorization, to enable it to obtain any additional evidence pertinent to the claim for higher rating for tinea pedis that is not currently of record. The RO should specifically request that the appellant provide, or provide appropriate authorization for it to obtain, any outstanding private medical records. The RO should clearly explain to the Veteran that he has a full one-year period to respond (although VA may decide the claim within the one-year period). 2. If the Veteran responds, the RO should obtain all identified outstanding pertinent records of evaluation and/or treatment not currently of record, following the procedures set forth in 38 C.F.R. § 3.159. All records and responses received should be associated with the claims file. If any records sought are not obtained, the RO should notify the Veteran and his representative of the records that were not obtained, explain the efforts taken to obtain them, and describe further action to be taken. 3. After all records and/or responses received from each contacted entity have been associated with the claims file, the RO should arrange for the Veteran to undergo VA dermatology examination, by an appropriate medical professional, at a VA medical facility, during a period when his disease is active, if feasible. The entire claims file, to include a complete copy of the REMAND and printed paper copies of all evidence relevant to the examiner's review (if the examiner does not have access to the Veteran's paperless, electronic (Virtual VA) file), must be made available to the individual designated to examine the Veteran, and the report of examination should include discussion of the Veteran's documented history and assertions. All indicated tests and studies should be accomplished (with all results made available to the requesting examiner prior to the completion of his or her report), and all clinical findings should be reported in detail. Specifically with respect to service-connected tinea pedis, the examiner should render findings responsive to the applicable rating criteria, specifically identifying the areas of the body affected, as well as the percentage of the entire body, and the percentage of the exposed areas affected. The examiner should also clearly indicate whether the disability requires the use of systemic therapy such as corticosteroids or other immunosuppressive drugs, and, if so, the frequency of such use during the prior 12-month period. If the examiner diagnoses any skin disability other than tinea pedis, he or she should indicate the relationship, if any, between the disability and the tinea pedis for which service connection has been granted-to include whether the disability represents a progression of, or is a more accurate If the examiner diagnosis both tinea pedis and any other skin disability(ies), he or she should indicate whether it is possible to distinguish the symptoms associated with each disability; if not, he or she should clearly so state. The examiner should set forth all examination findings, along with complete rationale for any conclusions reached, in a printed (typewritten) report. 4. If the Veteran fails to report to the scheduled examination, the RO must obtain and associate with the claims file (a) copy(ies) of any notice(s) of the date and time of the examination sent to him by the pertinent VA medical facility. 5. To help avoid future remand, the RO must ensure that all requested actions have been accomplished (to the extent possible) in compliance with this REMAND. If any action is not undertaken, or is taken in a deficient manner, appropriate corrective action should be undertaken. See Stegall v. West, 11 Vet. App. 268 (1998). 6. After completing the requested action, and any additional notification and/or development deemed warranted, the RO should adjudicate the claim for increased rating for tinea pedis, If the Veteran fails, without good cause, to report to the scheduled examination, in adjudicating the claim for increased rating, the RO should apply the provisions of 38 C.F.R. § 3.655(b), as appropriate. Otherwise, the RO should adjudicate the claim in light of all pertinent evidence (to include all that associated with the claims file after the RO's last adjudication of the claim) and legal authority (to include whether staged rating of the disability, pursuant to Hart (cited above), is appropriate, as well as whether recharacterization of the disability is warranted). 7. If the benefit sought on appeal remains denied, the RO must furnish to the Veteran and his representative an appropriate SSOC that includes clear reasons and bases for all determinations , and reflects review of all pertinent evidence of record (including VA medical records in the Virtual VA file) and afford them the appropriate time period for response before the claims file is returned to the Board for further appellate consideration. The purpose of this REMAND is to afford due process and to accomplish additional development and adjudication; it is not the Board's intent to imply whether the benefit requested should be granted or denied. The Veteran need take no action until otherwise notified, but he may furnish additional evidence and/or argument during the appropriate time frame. See Kutscherousky v. West, 12 Vet. App. 369 (1999); Colon v. Brown, 9 Vet. App. 104, 108 (1996); Booth v. Brown, 8 Vet. App. 109 (1995); Quarles v. Derwinski, 3 Vet. App. 129, 141 (1992). This REMAND must be afforded expeditious treatment. The law requires that all claims remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). The RO is reminded that this appeal has been advanced on the Board's docket. ______________________________________________ JACQUELINE E. MONROE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs