Citation Nr: 1320467 Decision Date: 06/25/13 Archive Date: 07/05/13 DOCKET NO. 07-23 889 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUE Entitlement to service connection for a skin disorder, to include fungus of the bilateral hands, also claimed secondary to service connected folliculitis of the scrotum. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD S. M. Marcus, Counsel INTRODUCTION The Veteran served on active duty from March 1965 to March 1968. This matter is before the Board of Veterans' Appeals (Board) on appeal from a December 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. The appeal is remanded to the RO via the Appeals Management Center in Washington, DC. REMAND This appeal was previously remanded by the Board in July 2012 and February 2013 in attempt to ensure an adequate VA examination and opinion was of record. The Board finds the VA examination and medical opinions of record are still noncompliant with prior Board remand directives and another remand is necessary. See Stegall v. West, 11 Vet. App. 268 (1998). The Veteran claims he has chronic skin problems, especially on his hands, since service and as a result of his service-connected folliculitis of the scrotum. Specifically, he believes the disability has spread to his hands and other parts of his body because of excessive scratching of the itchy service-connected skin disability. The Veteran's Virtual VA claims folder contains a significant amount of treatment records that are not in the paper claims folder. The Veteran, further, has asserted both direct and secondary theories of entitlement to service connection. The claim has been remanded to ensure the examiner reviewed all relevant records, to include Virtual VA records, and adequately addressed all theories of entitlement in the opinion rendered. Most recently, in the February 2013 Board remand, the examiner was directed to indicate a full review of records and then proffer an opinion as to the Veteran's current skin diagnosis and likely etiology, specifically addressing whether the diagnosis was directly caused by service or, in the alternative, caused or aggravated by his service-connected folliculitis of the scrotum. The examiner who conducted the July 2012 VA examination offered an addendum opinion in March 2013 indicating the Veteran's diagnosis at the time of the July 2012 examination was "tinea, hands." With regard to etiology, the examiner opined that no diagnosed skin condition covered by the examination "is related to service including folliculitis of the scrotum." The examiner went on to say that folliculitis of the scrotum is "a bacterial infection, not tinea (fungal infection)." The opinion is inadequate in that it does not address whether the Veteran's service-connected folliculitis of the scrotum caused or aggravated his tinea of the hands. Cf. 38 C.F.R. § 3.310 (2012) (secondary service connection is established where a service-connected disability proximately caused or aggravated the claimed condition). Thereafter, the Veteran submitted a statement with internet research showing how folliculitis of the scrotum can lead to other skin conditions. The Veteran's representative further argued that folliculitis of the scrotum can be a bacterial infection, but can also be a fungal infection. The examiner did not adequately explain why the Veteran's specific disability is bacterial in nature. Accordingly, the medical opinions of record do not adequately address the Veteran's contentions nor were they responsive to the Board's prior Remand directives. A new VA examination is indicated. The VA is to also take this opportunity to obtain recent VA outpatient treatment records from January 2013 to the present. Accordingly, the case is remanded for the following action: 1. The RO must contact the Veteran and afford him the opportunity to identify or submit any additional pertinent evidence in support of his claims, to include any VA or non-VA facilities at which he received treatment for his skin disorder at issue since January 2013. Based on his response, the RO must attempt to procure copies of all records which have not previously been obtained from identified treatment sources. Regardless of his response, the RO must request all treatment records from the VA Medical Center in Oklahoma City, Oklahoma since January 2013. All attempts to secure this evidence must be documented in the claims file by the RO. If, after making reasonable efforts to obtain named records the RO is unable to secure same, the RO must notify the Veteran and (a) identify the specific records the RO is unable to obtain; (b) briefly explain the efforts that the RO made to obtain those records; (c) describe any further action to be taken by the RO with respect to the claim; and (d) that he is ultimately responsible for providing the evidence. The Veteran and his representative must then be given an opportunity to respond. 2. After all records are obtained to the extent available, the Veteran must be afforded a VA skin diseases examination to determine whether the Veteran has a skin disorder that is caused or aggravated by his service-connected folliculitis of the scrotum. Any indicated diagnostic tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. The claims file and all records on Virtual VA must be made available to the examiner, and the examiner must specify in the examination report that the claims file and Virtual VA records have been reviewed. The examiner must specify the dates encompassed by the Virtual VA records that were reviewed. Based on the clinical examination, the evidence of record, and with consideration of the Veteran's statements, the examiner must state whether any degree of any current skin disorder found, or previously diagnosed in the evidence of record, due to or aggravated by the service-connected chronic folliculitis of the scrotum. A complete rationale for all opinions must be provided. If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the examiner 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. The report prepared must be typed. 3. The RO must notify the Veteran that it is his responsibility to report for the examination and to cooperate in the development of the claim. The consequences for failure to report for a VA examination without good cause may include denial of a claim. 38 C.F.R. §§ 3.158, 3.655 (2012). In the event that the Veteran does not report for an examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. 4. After completing the above actions, and any other development as may be indicated by any response received as a consequence of the actions taken in the paragraphs above, the claim must be readjudicated. If the claim remains denied, a supplemental statement of the case must be provided to the Veteran and his representative. After the Veteran and his representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. No action is required by the Veteran until he receives further notice; however, he may present additional evidence or argument while the case is in remand status at the RO. Kutscherousky v. West, 12 Vet. App. 369 (1999). _________________________________________________ JOY A. MCDONALD Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).