Citation Nr: 18142096 Decision Date: 10/15/18 Archive Date: 10/12/18 DOCKET NO. 15-29 332 DATE: October 15, 2018 REMANDED 1. Entitlement to a rating for skin cancer residuals (actinic keratoses of the scalp, face, and neck) in excess of 20 percent prior to December 14, 2015 and to an extraschedular rating in excess of 30 percent from that date is remanded. 2. Entitlement to a rating in excess of 10 percent for facial scars is remanded. 3. Entitlement to a compensable rating for right upper extremity scars is remanded. 4. Entitlement to a compensable rating for left upper extremity scars is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from February 1967 to February 1971. These matters are before the Board of Veterans’ Appeals (Board) on appeal of a November 2014 rating decision which granted service connection for skin cancer residuals rated 20 percent effective September 9, 2010, and a July 2015 rating decision which granted service connection for facial scars rated 10 percent, and for right and left upper extremity scars rated 0 percent, each, all also effective September 9, 2010. An interim (December 2015) rating decision increased the rating for skin cancer residuals to 30 percent effective December 14, 2015. In October 2018 a videoconference hearing was held before the undersigned; a transcript is in the record. 1., 2., 3., 4. Entitlement to increases in the (20 percent prior to December 14, 2015 and 30 percent from that date) staged ratings for skin cancer residuals, the 10 percent rating for facial scars, and the 0 percent ratings, each, for right and left upper extremity scars, is remanded. The most recent VA examination to evaluate the Veteran’s scalp, face, neck, and upper extremity scars was in December 2015. At the October 2018 videoconference hearing, he testified that the scars had since become more numerous and sore and painful to the touch. He reported very frequent visits to a provider for removal of new growths. He alleged, in essence, that the ratings assigned do not reflect the full extent and severity of the skin cancer disability. Considering the allegation of worsening and the interval since he was last examined, a contemporaneous examination to assess the severity of the skin cancer and scar residuals is necessary. The record reflects that the Veteran receives ongoing VA treatment for the disabilities on appeal. Updated records of such treatment are pertinent evidence that is constructively of record, and must be secured. The matters are REMANDED for the following: 1. Ask the Veteran to identify all providers of evaluations and treatment he received for his scars, and to provide authorizations for VA to obtain updated, to the present, records of any such private evaluations or treatment. Secure for the record complete clinical records of the evaluations and treatment identified (i.e., any not already associated with the record). If any private records identified are not received pursuant to the request, he should be so notified, and advised that ultimately it is his responsibility to ensure that private records are received. Secure for the record complete updated records of all VA evaluations and treatment the Veteran has received since May 2016 for the disabilities on appeal. 2. Then arrange for a scars examination of the Veteran to assess his scalp, face, neck, and right and left upper extremity scars. On examination of the Veteran and review of his record the examiner should: Identify all symptoms and characteristics of the Veteran’s scars, and any related functional impairment, specifically including the areas of involvement, the scars’ dimensions, whether they are deep or superficial, linear or nonlinear, and/or painful or unstable, and note any related impairment of function. Regarding head, face, and neck scars note all characteristics of disfigurement and any tissue loss found. Note also the nature and extent of any treatment provided. Note any symptoms or impairment not encompassed by schedular criteria. Include rationale with all opinions. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Bayles, Associate Counsel