Citation Nr: 18142652 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 14-08 365 DATE: October 17, 2018 REMANDED Entitlement to service connection for paranasal sinusitis is remanded. Entitlement to service connection for bilateral plantar fasciitis is remanded. Entitlement to service connection for bilateral pes planus is remanded. Entitlement to service connection for hallux valgus is remanded. Entitlement to a higher rating for pseudofolliculitis barbae, from November 5, 2014, forward, is remanded. ISSUE REFERRED In April 2014, the Veteran submitted a formal claim of service connection for multiple bilateral foot disabilities, to include tinea pedis. In August 2014, the RO adjudicated all issues except tinea pedis. Regarding tinea pedis, a note in the relevant codesheet indicates that this issue was on appeal at the time. A review of the record reflects that a November 2011 rating decision denied service connection for tinea pedis (athlete’s foot), among multiple other issues. While the Veteran appealed several of these issues, the Board finds no indication that he appealed the denial of service connection for tinea pedis. The record does reflect that shortly after the November 2011 rating decision, the Veteran raised the issue of service connection for pseudofolliculitis barbae. Service connection for this disability was established via a January 2012 rating decision, which assigned a noncompensable rating. Soon thereafter, the Veteran appealed the assigned rating. This issue was on appeal in April 2014, when the Veteran again raised the issue of tinea pedis. Thus, it is plausible that that this sequence of events could have generated some confusion, leading the RO to conclude that tinea pedis was on appeal. In this regard, it should also be noted that both tinea pedis and pseudofolliculitis barbae are evaluated under the same diagnostic code (DC 7813). In view of the above, the Board refers the issue of service connection for tinea pedis to the RO for appropriate action. If the RO determines that the Veteran did in fact appeal the November 2011 denial of service connection for tinea pedis, the RO should issue a statement of the case. Otherwise, the RO is to adjudicate the Veteran’s April 2014 claim of service connection for tinea pedis, as appropriate. REASONS FOR REMAND The Veteran served on active duty from August 1976 to August 1980. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from January 2012, May 2013, and August 2014 rating decisions. The Veteran testified at a Board hearing in March 2017. The Board remanded this matter in December 2017. The Board’s remand decision included the issues of service connection for PTSD and bilateral hearing loss. Service connection for these issues was established via a May 2018 rating decision. As such, these issues are no longer on appeal. 1. Entitlement to service connection for paranasal sinusitis is remanded. The Veteran seeks service connection for sinusitis. He asserts that this disability began in service. As noted in the Board’s November 2017 remand decision, service treatment records show symptoms relating to the sinuses on several occasions. In January 1977, the Veteran reported that he could not breathe at night. He was diagnosed with a simple cold. The Veteran reported another head cold in June 1977. In November 1977, he reported a sore throat, as well as cold symptoms and coughing. He was assessed with pharyngitis and a common cold. In December 1977, the Veteran once again reported a sore throat and cold symptoms. He was assessed with a viral cold. In November 1978, the Veteran reported a head cold with sinus congestion and a runny nose. Pursuant to the Board’s December 2017 remand decision, the Veteran underwent a VA examination in March 2018. The report reflects diagnoses of allergic rhinitis and paranasal sinusitis. The VA examiner opined that the Veteran’s sinusitis was less likely than not incurred in, or otherwise related to, service. The examiner stated that service and post-service treatment records did not show a chronic illness. Rather, the examiner indicated that service treatment records showed multiple episodes of common cold, and an acute episode of sinusitis in November 1978. The examiner further noted that there was no evidence that the Veteran continued to have symptoms or required treatment prior to 2006. In July 2018, the Veteran submitted a statement, recounting his sinus symptoms in service. He also indicated that over the years he had continued to suffer prostrating attacks related to his sinus symptoms, to include sinus headaches. The Veteran also submitted a statement from his spouse, confirming that the Veteran had chronic sinusitis in and after service. Chronic sinusitis is a diagnostic assessment and there is no indication that the Veteran’s spouse has the required medical expertise to diagnose a condition such as sinusitis. Nevertheless, her statement suggests that the Veteran has had continuous sinus symptoms since service. As mentioned, the March 2018 VA examiner based her conclusion on the absence of evidence of post-service symptoms prior to 2006. This conclusion renders the examiner’s opinion incomplete, as it does not show adequate consideration of the lay evidence, to include the recently received lay statements. On remand, the Board finds that the Veteran is to be scheduled for a new VA examination. The examiner should elicit the Veteran’s full history of sinus symptoms and treatment, and issue an opinion as to whether the claimed sinusitis was incurred in, or related to, service.   2. Entitlement to service connection for bilateral plantar fasciitis is remanded. 3. Entitlement to service connection for bilateral pes planus is remanded. 4. Entitlement to service connection for hallux valgus is remanded. The Veteran seeks service connection for multiple bilateral foot disabilities. An April 2014 DBQs completed by the Veteran’s private podiatrist, Dr. B.C., shows diagnoses of bilateral pes planus and plantar fasciitis, and hallux valgus. In July 2018, the Veteran submitted a statement from Dr. B.C., expressing her opinion that the Veteran bilateral foot conditions are a direct result of his military service. See also Dr. B.C.’s statements from November 2014 and January 2016, in VBMS: 07/13/2018, Medical Treatment Record – Non-Government Facility, at 9 & 11. Pursuant to the Board’s December 2017 remand decision, the Veteran underwent a VA examination in March 2018. The examination report shows diagnoses of bilateral flat foot, bilateral hammer toes, bilateral hallux valgus, bilateral plantar fasciitis, and bilateral degenerative arthritis. The VA examiner, a nurse practitioner, opined that the flat feet, hallux valgus, and plantar fasciitis were less likely than not related to service. Having reviewed the March 2018 VA opinion, the Board finds that it is incomplete. Significantly, the VA examiner did not discuss Dr. B.C.’s April 2014 DBQ, as requested by the Board in its December 2017 remand directive. Additionally, since the March 2018 VA examination, the Veteran has submitted new favorable evidence that needs to be addressed by a VA examiner. The Board also finds that the March 2018 VA opinion does not show adequate consideration of the Veteran’s contention that his current foot disabilities are related to the physical demands of service, specifically, marching and running in military boots. Any future opinion should address whether the Veteran’s current disabilities are due to the cumulative effect of such type of military activity. Finally, the Board notes that the VA opinion focused on the Veteran’s flat feet, hallux valgus, and plantar fasciitis. The examination report, however, shows additional diagnoses of hammer toes and degenerative arthritis. The scope of a disability claim includes any disability that may reasonably be encompassed by the claimant’s description of the claim, reported symptoms, and the other information of record. Clemons v. Shinseki, 23 Vet. App. 1, 4-6 (2009). As such, any future VA opinion should address the etiology of all currently diagnosed foot disabilities. 5. Entitlement to a higher rating for pseudofolliculitis barbae, from November 5, 2014, forward, is remanded. The Veteran seeks a higher rating for his pseudofolliculitis barbae (PFB). In December 2017, the Board adjudicated the issue of a higher rating for the period prior to November 5, 2014, and remanded the issue of a higher rating thereafter. As such, only the period since November 5, 2014, is currently for consideration. For the period since November 5, 2014, the Veteran’s PFB is rated as 30 percent disabling under 38 C.F.R. § 4.118, DC 7806. For the Veteran to be entitled to the next and maximum rating of 60 percent under DC 7806, the evidence must show/more nearly approximate symptoms affecting more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or requiring constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the prior 12-month period. Id. Pursuant to the Board’s December 2017 remand decision, the Veteran underwent a VA examination in March 2018. The examination report indicates that the Veteran’s PFB was not active at that time. As such, the examination focused on scars associated with the PFB. The relevant DBQ describes a first scar on the left side of the neck and a second scar on the right side of the neck. Both scars had hyperpigmentation and irregular abnormal texture, covering a total area of 16 cm2. A prior November 2014 VA examination indicates that the Veteran’s PFB was treated with a 30-day course of oral steroids (Prednisone) in February 2014. In July 2018, the Veteran submitted evidence of pharmacy orders for multiple medications. These pharmacy orders show additional Prednisone treatment in November 2014 (10 days), January 2015 (15 days), December 2016 (30 days). Additionally, handwritten notes identify several antibiotic and skin medications. As there is an indication that the Veteran has received treatment for his PFB during the relevant rating period, the Board finds that the March 2018 VA examination is incomplete. Significantly, the VA examiner only completed the DBQ for scars and disfigurement, and this DBQ does not elicit relevant information regarding treatment requirements. On remand, VA must provide a new VA examination that documents all relevant symptoms, to include treatment requirements. The matters are REMANDED for the following actions: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any sinus disability. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including his sinus symptoms in service. The examiner’s opinion must show adequate consideration of the relevant evidence, to include the lay statements from the Veteran and his spouse. The opinion is to include a comprehensive medical rationale for any conclusion reached and should not be solely based on the absence of evidence. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of all current bilateral foot disabilities. The examiner must is to provide an opinion (for each current foot disorder) whether it is at least as likely as not related to an in-service injury, event, or disease, including the Veteran’s reports of foot pain in service. The examiner’s opinion must show adequate consideration of the Veteran’s contention that his current foot disabilities are related to the physical demands of service, specifically, marching and running in military boots. The opinion is also to address whether the Veteran’s current disabilities are due to the cumulative effect of this military activity. The opinion is to include a comprehensive medical rationale for any conclusion reached and should not be solely based on the absence of evidence. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected skin disability. The examiner is to provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria, **to include the nature and extent of any required skin treatment.** The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the skin disability alone and discuss the effect of the Veteran’s skin disability on any occupational functioning and activities of daily living.   If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. López, Associate Counsel