Citation Nr: 18147773 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 16-31 631 DATE: November 6, 2018 REMANDED Entitlement to a rating in excess of 10 percent for service-connected seborrheic dermatitis of the nasolabial fold, ear, and sternum is remanded. Entitlement to a compensable rating for service-connected malaria is remanded. REASONS FOR REMAND 1. Entitlement to a rating in excess of 10 percent for service-connected seborrheic dermatitis of the nasolabial fold, ear, and sternum is remanded. The Veteran contends that he is entitled to an increased rating for his service-connected seborrheic dermatitis of the nasolabial fold, ear, and sternum (skin condition). In connection with his claim for an increased rating, he was afforded a VA examination in September 2013. However, the Board finds that the examiner failed to adequately discuss the Veteran’s symptoms related to his skin condition. The examiner indicated that the Veteran was diagnosed with seborrheic dermatitis and noted that the Veteran reported a rash on his forehead, nose, and upper chest at night, which he treated with petroleum jelly to keep moist. The examiner stated that the Veteran did not have any active dermatitis on his face or chest noted at the examination and indicated that he did not have any of the specific skin conditions listed on the examination report sheet. The examiner indicated that his dermatitis did not affect any of his total body area. The Board finds that the examiner’s report does not reflect consideration of the Veteran’s level of disability he experiences during the “active” phase of his skin condition. It is noted that the Court has recognized that some conditions, by their inherent nature, wax and wane and accordingly are sometimes active and other times not. See Ardison v. Brown, 6 Vet. App. 405, 408 (1994). Thus, to adequately assess the severity of the Veteran’s skin condition, he should be afforded a VA examination during a period when his condition is “active” if that can be arranged. Further, the medical evidence of record indicates that the Veteran was prescribed a topical medication to treat his skin condition since the September 2013 VA examination, indicating that the condition worsened during the pendency of the appeal. The Board acknowledges the difficulties in attempting to schedule a compensation examination during a period when the Veteran’s skin condition is “active,” and the AOJ should therefore consult the Veteran in its attempt to schedule a VA examination during the “active” phase of his skin condition. 2. Entitlement to a compensable rating for service-connected malaria is remanded. The Veteran contends that he is entitled to an increased rating for his service-connected malaria. In connection with his claim for an increased rating, he was afforded a VA examination in September 2013. However, the Board finds that the examiner failed to adequately discuss the Veteran’s symptoms related to his malaria. The examiner noted that the Veteran was hospitalized in 1968 and treated for malaria and indicated that the condition had long resolved without any residuals. The examiner stated that the Veteran was not currently receiving any treatment for the condition and listed it as inactive. The examiner stated that the Veteran did not have any symptoms or residuals related to the disease and that there were no other pertinent physical findings, complications, conditions, signs, and or symptoms related to his malaria. No diagnostic testing was conducted in connection with the examination. The examiner did not provide any discussion further detailing the conclusions rendered in the examination report. However, VA treatment records in 2016 and 2017 reference reports by the Veteran indicating that he experienced symptoms which he believed were related to his malaria every few years. He indicated in a June 2016 VA primary care note that he was hospitalized the month before and treated for elevated blood pressure, but stated that he told the doctors that he passed out due to malaria. The Veteran submitted a disability benefits questionnaire (DBQ) dated June 2016 in which the examiner noted he claimed to periodically experienced episodes of chills, fatigue, and fever. The examiner indicated that it was possible his reported symptoms could be attributed to his malaria, but no diagnostic testing was conducted. A December 2016 VA mental health note also indicated a report by the Veteran that he experienced “fainting spells” associated with his flare-ups related to malaria. The Board finds that the September 2013 VA examination does not adequately address the symptoms that the Veteran claims are related to his malaria. Additionally, the June 2016 DBQ does not provide a sufficient level of clarity regarding the relationship between the Veteran’s reported symptoms and his service-connected malaria. Therefore, a new examination is necessary in order to decide the instant claim. The Board encourages the Veteran to tell the examiner what residuals of malaria he believes that he has, so that VA may examine them. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). The AOJ should also obtain any relevant, outstanding VA treatment records. The matters are REMANDED for the following action: 1. Obtain any relevant, outstanding VA treatment records and associate them with the claims file. 2. Schedule the Veteran for a VA examination by an appropriate medical professional to determine the current extent and severity of symptoms associated with his service-connected seborrheic dermatitis. The examination should be conducted during a flare-up or active phase of the skin condition, if possible, in coordination with the Veteran. The entire claims file, to include all electronic files, and this remand, must be reviewed by the examiner and the examiner should indicate such review was completed in the examination report. The examiner should describe the nature frequency and severity of symptoms reported/and or found. 3. Schedule the Veteran for a VA examination by an appropriate medical professional to determine the current severity of his malaria, to include serological testing for active malaria if appropriate. The entire claims file, to include all electronic files, and this remand, must be reviewed by the examiner and the examiner should indicate such review was completed in the examination report. The examiner should describe the nature, frequency and severity of symptoms reported and/or found. The respective examiners should provide a detailed rationale for any opinion expressed. If an examiner is unable to provide a requested opinion without resorting to speculation, the examiner should state whether the inability to provide the opinion is due to the limits of the examiner’s medical knowledge, the limits of medical   knowledge in general, or there is missing evidence that would enable the examiner to provide the opinion. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Ferguson, Associate Counsel