Citation Nr: 18141549 Decision Date: 10/10/18 Archive Date: 10/10/18 DOCKET NO. 16-02 070 DATE: October 10, 2018 REMANDED Entitlement to a compensable rating for right great toe onychomycosis with right palm contact dermatitis/tinea manum (also claimed as two foot-one hand syndrome and tinea pedis) is remanded for additional development. REASONS FOR REMAND The Veteran had active service with the United States Navy from November 1980 to August 1982. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an August 2012 rating decision from a Department of Veterans’ Affairs (VA) regional office (RO) in Roanoke, Virginia. Entitlement to a compensable rating for two foot-one hand syndrome and tinea pedis is remanded. The Board sincerely regrets the delay that inevitably will result from the remand of this claim, but it is necessary to ensure there is a complete record and so the Veteran is afforded every possible consideration. The Veteran has asserted that a rating higher than the noncompensable rating currently assigned is warranted for his service-connected two foot-one hand syndrome and tinea pedis. He asserts that this condition has worsened. In conjunction with his claim for an increased rating, the Veteran underwent a VA skin examination in January 2012. See January 2012 VA Skin Diseases Disability Benefits Questionnaire. The examiner opined that the Veteran did not currently have a skin condition; that he had a skin infection that affected less than 5 percent of his exposed skin area; that she noted no skin disease during the examination; and that there were no records available for her to review that would verify documentation of the Veteran’s claim. Id. However, subsequent treatment records submitted by the Veteran indicate that the Veteran was diagnosed with onychomycosis and “contact dermatitis vs tenia” on both feet. See May 2012 Salem VA Medical Center (VAMC) Primary Care Note (reporting that the Veteran had an itchy fungal infection present on both of his feet that had spread to his buttocks). The Veteran’s treating physician prescribed trial topical terbinafine, and further noted that if the Veteran’s skin condition did not respond, then oral medication may be required. Id. Accordingly, given the evidence that the Veteran’s current disability picture has possibly changed, and considering that his last VA examination concerning this condition occurred over six years ago, the Board finds that the most recent VA examination does not adequately reveal the present state of the Veteran’s service-connected skin disability. See Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991) (where the record does not adequately reveal the current state of the claimant’s disability, a VA examination must be conducted); see also Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (wherein the Court determined the Board should have ordered a contemporaneous examination of the Veteran because a 23-month old exam was too remote in time to adequately support the decision in an appeal for an increased rating). The Board finds, therefore, that a contemporaneous examination is required to ascertain the current severity of the Veteran’s service-connected two foot-one hand syndrome and tinea pedis. Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); VAOPGCPREC 11-95 (1995). As the case is being remanded, the Veteran should be given another opportunity to identify any records of private medical treatment that he would like to submit or have VA obtain, since it appears that he has undergone private medical treatment for his claimed condition. The matter is REMANDED for the following action: 1. Send a letter to the Veteran requesting him to identify any relevant outstanding private treatment records and any other relevant evidence pertaining to his claims. He should be invited to submit this evidence himself or to request VA to obtain it on his behalf. Authorized release forms (VA Form 21-4142) should be provided for this purpose. If the Veteran properly fills out and returns any authorized release forms for private records identified by him, reasonable efforts should be made to obtain such records and associate them with the VBMS virtual file. At least two such efforts should be made unless it is clear that a second effort would be futile. If attempts to obtain any records identified by the Veteran are not successful, he must be notified of this fact and all efforts to obtain them must be documented and associated with the claims file. 2. Obtain any outstanding VA treatment records and service personnel records (to include the Veteran’s VA Form DD-214) associate them with the claims file. All attempts to secure any identified records and any response received must be documented in the case file. 3. After completion of the above development, schedule the Veteran for an additional VA examination in the appropriate specialty to determine current severity of the Veteran’s service-connected skin disability. The electronic claims file, including a copy of this remand, must be made available for the examiner to review. The examination report must include a notation that this record review took place. The Veteran must be interviewed. It should be noted that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. The examiner must provide a clear explanation for the opinion, to include any comment on any credibility issues raised by the record from a medical perspective. The examiner should specifically address the relevant evidence as well as Veteran’s statements and regarding post-service manifestations and treatment of his skin disability. The examination should also include any necessary diagnostic testing or evaluation and all clinical findings should be reported in detail, including specifically the size and location of any affected areas, identification and description of any related scarring, the types of therapy and treatment required, whether any medication prescribed during the pendency of the appeal can be classified as a “systemic” therapy, and any functional impairment caused. See Warren v. McDonald, 28 Vet. App. 194, 197 (2016) (holding that the types of systemic treatment that are compensable under DC 7806 are not limited to “corticosteroids or other immunosuppressive drugs”; rather, compensation is available for “all systemic therapies that are like or similar to corticosteroids or other immunosuppressive drugs”); see also Johnson v. Shulkin, 862 F.3d 1351, 1354-56 (Fed. Cir. 2017) (finding that “[t]he structure and content of DC 7806 make clear that it contemplates two types of therapy, “systemic therapy” and “topical therapy”; and noting that “the use of a topical corticosteroid could be considered either systemic therapy or topical therapy based on the factual circumstances of each case”). The RO must make an effort to schedule the examination during an active stage of the claimed condition. See Ardison v. Brown, 6 Vet. App 405, 407 (1994) (holding that that when a claimant’s medical history indicates that his condition undergoes periods of remission and recurrence, VA is required to provide a medical examination during the period of recurrence in order to provide a proper disability rating and further finding that an examination during the remission phase of the condition did not ‘accurately reflect the elements of the present disability.’). DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Raj, Associate Counsel