Citation Nr: 18146044 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 16-12 508 DATE: October 30, 2018 REMANDED ISSUES Entitlement to service connection for skin condition of the face, to include seborrheic dermatitis, dry and scaly, as well as erythema, is remanded. Entitlement to service connection for skin condition of the neck, abdomen, back, and legs, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1952 to October 1952. The Board previously remanded this claim in September 2017. Pursuant to the Board’s remand directives, a May 2018 opinion was obtained, where the examiner concluded that the Veteran’s skin condition is less likely than not caused or aggravated by his service-connected dermatophytosis of the bilateral feet. This opinion, however, does not substantially comply with the Board’s remand directives because the examiner did not discuss the urticaria, erythema, scales, and boils symptoms noted in the Veteran’s 2014 and 2015 VA treatment records as instructed. See Stegall v. West, 11 Vet. App. 268 (1998) (regarding legal necessity of compliance with previous Board directives). Furthermore, the examiner stated that a confirmatory test is necessary with respect to a diagnosis of onychomycosis and there was no nexus opinion offered regarding this condition. As to the issue of the Veteran’s seborrheic dermatitis, the examiner’s rational indicates that the cause of such condition is unknown and that it is not a dermatophytid reaction from tinea pedis. However, the examiner does not provide a rational to support the conclusion that the Veteran’s service-connected dermatophytosis of the bilateral feet does not aggravate seborrheic dermitis. Considering the aforementioned, the Board finds that a remand to obtain another examination and a nexus opinion is necessary before adjudicating the claims. The matters are REMANDED for the following action: 1. Update VA treatment records. 2. Thereafter, schedule the Veteran for a VA examination to determine the etiology of his skin disabilities. The claims file should be made available to the examiner, who should indicate in his/her report that the file was reviewed as part of the examination. The examiner should take a complete history from the Veteran. All indicated tests and studies should be completed. The examiner must describe all pertinent symptomatology. Following the completion of the examination, the examiner should provide an opinion answering the following questions regarding all diagnosed skin condition of the face, neck, abdomen, back, and legs. Although the examiner should review the claims file in its entirety, he/she is asked to specifically address the following: (i). Tinea cruris of the bilateral inner thighs noted in February 2012 VA exam (ii). Asteatotic eczema diagnosed during the July 2013 VA exam (iii). Abnormal skin disorder symptoms throughout the body, including pruritus, urticaria, erythema, dry scaly patches, scales, and boils noted in the November and December 2014, as well as March 2015, and 2016 VA treatment records. (A). As to any/each diagnosed skin condition of the neck, abdomen, back, and legs, is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s skin condition of the neck, abdomen, back, and legs is caused by his service-connected dermatophytosis of the bilateral feet; and (B). Is it at least as likely as not (50 percent or greater probability) that the Veteran’s skin condition of the neck, abdomen, back, and legs has been aggravated by his service-connected dermatophytosis of the bilateral feet. The examiner should consider the Veteran’s lay statement including the assertion that dermatophytosis of the bilateral feet causes dermatophytid reactions at a distant site. (C). As to any/each diagnosed skin condition of the face, is it at least as likely as not (a 50 percent or greater probability) that the condition is caused by his service-connected dermatophytosis of the bilateral feet; and (D). Is it at least as likely as not (50 percent or greater probability) that the Veteran’s skin condition of the face has been aggravated by his service-connected dermatophytosis of the bilateral feet. The term “aggravated” in the above context means a chronic worsening of his symptoms, and not temporary or intermittent flare-ups, which resolve and return to the baseline level disability. A complete rationale should be provided for all opinions. If an opinion cannot be provided without resorting to speculation, the examiners must explain why this is the case. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S.SOLOMON