Citation Nr: 18150845 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 16-19 326A DATE: November 15, 2018 REMANDED Entitlement to an annual clothing allowance for the calendar year 2015 is remanded. REASONS FOR REMAND The Veteran contends that her bilateral knee braces, back brace, right ankle brace/boot, portable traction machine, heating pad, and rubbing cream results in damage to her clothing. She has explained that the heating pad used to treat her low back pain discolors her clothing over time, as does cream used to treat pain caused by bulging discs in her low back. She also asserts that the orthopedic appliances described by the Agency of Original Jurisdiction (AOJ) in the April 2016 statement of the case (SOC) does not accurately reflect the actual appliances prescribed to her by VA to treat her service-connected disabilities. A veteran is entitled to one clothing allowance if either (i) a VA examination or a hospital or examination report from a facility specified in 38 C.F.R. §3.326(b) establishes that the veteran, because of a service-connected disability, wears or uses a qualifying prosthetic or orthopedic appliance that tends to wear or tear clothing; or (ii) the Under Secretary for Health or a designee certifies that the veteran, because of a service-connected disability or disabilities, wears or uses a qualifying prosthetic or orthopedic appliance that tends to wear or tear clothing, or the veteran uses medication prescribed by a physician for a skin condition, which is due to a service-connected disability, that causes irreparable damage to the veteran’s outer garments. 38 C.F.R. § 3.810(a)(1). A veteran is entitled to two annual clothing allowances if a veteran uses more than one prosthetic or orthopedic appliance, (including, but not limited to, a wheelchair), medication for more than one skin condition, or an appliance and a medication, and the appliance(s) or medication(s): (i) Each satisfy the requirements of 38 C.F.R. § 3.810(a)(1); and (ii) Together tend to wear or tear a single type of article of clothing or irreparably damage a type of outer garment at an increased rate of damage to the clothing or outer garment due to a second appliance or medication. 38 C.F.R. § 3.810(a)(3). The Under Secretary for Health designee is the Prosthetic Representative. See VHA Handbook 1173.15 paragraph 5.c. If a clinical determination is required pursuant to VHA Handbook 1173.15 paragraph 6, then the Under Secretary for Health designee will be the appropriate clinician (e.g., VHA clinician, Prosthetist, or Orthotist, or Pharmacist). Id. To determine that a Veteran is entitled to the allowance, the Under Secretary for Health designee must find and document that: (1) The use of the prosthetic, orthopedic appliance, or skin medication is medically necessitated for a service-connected disability or disabilities; (2) The prosthetic, orthopedic appliance, or skin medication meets the definition in this Handbook; and (3) The prosthetic or orthopedic appliance tends to wear out or tear the clothing of the Veteran or the skin medication causes irreparable damage (e.g., permanent irreversible staining, bleeding or damage not removable with laundering or dry cleaning) to the Veteran’s outer garments. VHA Handbook 1173.15 paragraph 5.c (1)-(3). If insufficient medical evidence of record exists to award the claim, then a clinical review or physical evaluation of the prosthetic, orthopedic appliance, or skin medication is warranted. VHA Handbook 1173.15 paragraph 6.a. The Board finds that there is insufficient medical evidence to determine whether the Veteran’s back, knee, and braces, heating pad, portable traction machine, and topical medications cause the damage, as claimed. After the Veteran’s treatment records have been associated with the claims file, in light of the Veteran’s statements regarding the damage caused by these appliances to her clothing, the Board finds that she should be examined to address the issues on appeal. She may bring evidence of damage to clothing done reportedly done by the appliances to the examination. The matter is REMANDED for the following action: 1. Obtain and associate with the claims file all VA treatment records. Specifically, records of orthopedic treatment should be obtained, including any information as to the specific type(s) of prosthetic and/or orthopedic appliances and external medications prescribed to the Veteran for treatment of her service-connected disabilities. All attempts to obtain records should be documented in the claims folder. 2. Following completion of the above, schedule the Veteran for an appropriate examination by a designated clinician to address whether the Veteran’s heating pad, portable traction machine, back, knee, and ankle braces, and/or any other prosthetic or orthopedic appliance or topical medication prescribed to treat a service-connected disability result in wear and tear or other irreparable damage to the Veteran’s clothing. If there is wear and tear or staining due to prescribed prosthetic/orthopedic appliance or topical medications for service-connected disabilities, the examiner should certify any such wear and tear, and staining to the Veteran’s clothing was caused by her prescribed prosthetic/orthopedic appliance or topical medications for service-connected disabilities. The Veteran may, and is encouraged to bring, evidence of worn or torn or otherwise damaged clothing reportedly done by the appliances or medications. A complete rationale must be provided for all opinions expressed. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Christopher Murray, Counsel