Citation Nr: 18140980 Decision Date: 10/09/18 Archive Date: 10/09/18 DOCKET NO. 15-20 874 DATE: October 9, 2018 REMANDED Entitlement to service connection for pseudofolliculitis barbae is remanded. Entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 2002 to March 2011. He served three tours in Iraq and received multiple medals, citations, and awards for his service. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that additional VA treatment records and a VA examination for the Veteran’s service-connected PTSD were associated with the claims file since the April 2015 Statement of the Case was issued. Although the Veteran’s substantive appeal was filed after February 2, 2013, these records were obtained by the VA rather than the Veteran, and thus there is no automatic waiver of AOJ review. 38 C.F.R. §§ 19.31, 20.1304(c). Additionally, in a July 2018 statement, the Veteran confirmed he did not choose to waive AOJ consideration in the first instance. Accordingly, remand for AOJ review is required. 1. Service connection for Pseudofolliculitis Barbae. A June 2013 VA examination is of record that states the Veteran has “no objective evidence of folliculitis as per current exam.” It also implies that the Veteran had one single episode of folliculitis while in service, which was “treated and resolved.” The Board notes that the Veteran’s service treatment records (STRs) include multiple instances of treatment for skin complaints on his face, head, and neck for outbreaks between 2006 and 2010. Descriptions of the skin condition used by physicians included “follicular rash,” “folliculitis,” “pustular lesions,” “acne on scalp,” and similar language. The Veteran also had a pilar cyst removed from behind his left ear in November 2010. Accordingly, the Board finds the examiner’s characterization of the Veteran’s in-service medical history inaccurate. Additionally, in his May 2014 Notice of Disagreement (NOD) and June 2015 Form 9, the Veteran stated that the examiner failed to take note of the minor bumps and lesions on his hairline at the time of his examination because he was not having a bad outbreak when the examination occurred. Further, he states that the bumps he gets on his head, face and neck “come and go, but more than not are present” and “are large, red, and they hurt.” Thus, the Board finds that the June 2013 VA examination was based upon an inaccurate factual premise in that it failed to take into account the extent of the Veteran’s in-service medical record or the Veteran’s description of his continuing symptoms since service. Accordingly, the Board finds that the examination can be afforded no probative value, and a new examination is necessary. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (concluding that a medical opinion is only as good and credible as the history on which it was based, and if based on an inaccurate factual premise it has no probative value). 2. Increased Rating for PTSD. In the Veteran’s NOD and Form 9, he argued that the VA examiners with whom he spoke ignored symptoms he reported. Specifically, he stated that he “mentioned that I do get flattened affect, panic attacks more than once a week, disturbances of motivation and mood, stereotyped speech, forgetting to complete tasks, and impaired abstract thinking.” He argues that the exam was inadequate, and the rating assigned in error, because those symptoms are noted as examples in the 50 percent rating, but his rating was continued at 30 percent even though he reported them to the examiner. The Board notes that some of the symptoms reported by the Veteran are not capable of lay observation because they have specific, medical meanings and must be determined by a medical professional. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). For instance, it is necessary for a medical professional to diagnose the Veteran with panic attacks before it can be determined that he experiences them more than once a week. Additionally, while the Veteran may feel as though his affect is flattened when he speaks, a medical professional is specifically trained to determine if a patient displays an appropriate range of affect based on the topics discussed or emotions displayed. However, the Veteran is competent to report forgetting to complete tasks. The Board notes that the Veteran received a new VA examination for his PTSD in July 2018. The new examination notes the Veteran’s reported anxiety and difficulty remembering to complete tasks. It also makes specific findings as to the Veteran’s affect, speech, mood and motivation, and abstract thinking. Accordingly, the Board finds that the new examination addresses the concerns set forth by the Veteran in his appeal, and an additional examination is not necessary on remand. The matters are REMANDED for the following action: 1. Associate with the claims file any outstanding VA and non-VA treatment records, including at the Pontiac Vet Clinic or through the Veteran’s Henry Ford primary care physician. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any skin condition on the Veteran’s head, face, or neck. To the extent possible, the examination should be scheduled during an outbreak. If the Veteran is not experiencing a current outbreak at the time of the examination, the examiner must elicit information from the Veteran about symptoms, severity, and frequency of outbreaks before rendering an opinion. The examiner must opine whether any current condition is at least as likely as not related to an in-service injury, event, or disease, including repeated treatments for “acne on scalp,” “papules and pustules,” “erythema,” “lesions on scalp,” “folliculitis,” “follicular rash,” “pustular lesions to back of neck,” “contact dermatitis,” a pilar cyst, and similar descriptions of skin conditions on the Veteran’s head, face or neck between 2006 and 2010. 3. After completing the above development, and in accordance with the Veteran’s July 2018 request for initial review of all evidence by the AOJ, both issues on appeal should be readjudicated. The appellant has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all   claims that are remanded by the Board 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. §§ 5109B, 7112. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Anderson, Associate Counsel