Citation Nr: 18146737
Decision Date: 11/01/18	Archive Date: 10/31/18

DOCKET NO. 10-20 701
DATE:	November 1, 2018
REMANDED
Entitlement to service connection for a skin (body rash) disability, to include as secondary to service-connected depressive disorder is remanded.
Entitlement to total disability based on individual unemployability (TDIU) is remanded.
REASONS FOR REMAND
The claims were most recently before the Board in September 2017 when they were remanded for additional development.  That development was not conducted adequately; the claims must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998).
1.  Entitlement to service connection for a skin (body rash) disability, to include as secondary to service-connected depressive disorder is remanded.
The Board cannot make a fully-informed decision on the issue of entitlement to serivce connection for skin condition because no VA examiner has adequately opined whether the Veteran’s skin condition is secondary to medication associated with service-connected depressive disorder.
The Board’s previous remand sought an addendum opinion addressing entitlement to service connection for a skin disability on a secondary basis to service-connected depressive disorder, specifically the medications associated with the Veteran’s service-connected depressive disorder.  However, the addendum opinion provided was inadequate as it failed to provide adequate supporting rationale, specifically to the question of aggravation.  The examiner appears to indicate that aggravation could not have occurred because the Veteran’s skin condition manifested prior to even the earlies medication prescribed for the Veteran’s service-connected depressive disorder without explaining this rationale further. 

Additionally, the addendum opinion was provided by a Certified Physician’s Assistant.  The Board finds that given the specific nature of the question it is necessary to obtain an opinion from a Dermatologist.
2.  Entitlement to TDIU is remanded.
Over the course of the appeal the Veteran’s service-connected disabilites have increased in severity.  However, the record does not contain a VA examination an opinion assessing the collective impact of the Veteran’s service-connected disabilities on the Veteran’s capacity to obtain substantially gainful employment.  The AOJ should develop the issue.
The matter is REMANDED for the following action:
1.  Schedule the Veteran for an examination by a dermatologist to determine the nature and etiology of any skin disability.  The examiner must opine whether it is at least as likely as not (1) proximately due to service-connected disability, to specifically include medications associated with service-connected depressive disorder, or (2) aggravated by service-connected disability, specifically medications associated with service-connected depressive disorder.
The examiner is informed that aggravation here is defined as any increase in disability.  If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation.
2.  Ask the Veteran to complete a TDIU claim form.  Then, schedule the Veteran for an examination by an appropriate clinician regarding the current severity of his service-connected disabilities.  The examiner should elicit from the Veteran his complete educational, vocational, and employment history and should note his complaints regarding the impact of service-connected disabilities on employment.  The examiner should identify all limitations or functional impairment caused solely by the Veteran’s service-connected disabilities.

 
M.E. Larkin
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	P.S. McLeod