Citation Nr: 18151048 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 14-09 548 DATE: November 16, 2018 REMANDED Entitlement to service connection for a skin disorder, other than service-connected post-radiation dermatitis of the neck (hereafter referred to as dermatitis), is remanded. Entitlement to a disability rating in excess of 30 percent for dermatitis prior to November 6, 2017, and to a compensable rating thereafter, to include whether the rating reduction from 30 to zero percent was proper, is remanded. Entitlement to a disability rating in excess of 20 percent for diabetes mellitus type II (DM II) on an extraschedular basis is remanded. Entitlement to a total disability rating for individual unemployability due to service-connected disabilities (TDIU) is remanded. Entitlement to a disability rating in excess of 60 percent for diabetic nephropathy with hypertension (HTN) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1966 to September 1968, which includes service in the Republic of Vietnam. Issues 1-2: Entitlement to service connection for a skin disorder other than dermatitis; and to a disability rating in excess of 30 percent for dermatitis prior to November 6, 2017, and to a compensable rating thereafter, to include whether the rating reduction from 30 to zero percent was proper, is remanded. The claims for service connection for a skin disorder, other than dermatitis, and for increased ratings for dermatitis are remanded for a new VA examination. Pursuant to the March 2016 Board remand, the Veteran was provided a VA examination in May 2017, which reflects diagnoses of radiation dermatitis associated with squamous cell carcinoma of the left side of the larynx, and alopecia. Unfortunately, when the examiner provided an opinion regarding etiology, she only addressed the diagnosis of discoid lupus erythematosus and did not specifically discuss the nature or etiology of the Veteran’s alopecia. Additionally, the Veteran was provided another VA examination in November 2017, which reflects only a diagnosis of post-radiation dermatitis of the neck, and the Board notes that this report actually contradicts the May 2017 VA examination report. For example, although the May 2017 VA examiner found a diagnosis of alopecia, the November 2017 VA examiner found that the Veteran did not have alopecia. Additionally, in May 2017, the examiner noted that the Veteran used topical corticosteroids on a constant or near-constant basis, but the November 2017 examiner stated that the Veteran did not require any oral or topical medications for any skin condition. These discrepancies must be resolved, and the examiner must clearly address whether any such treatment is related to the Veteran’s service-connected post-radiation dermatitis or to a different skin disorder. The Board notes that a September 2018 rating decision reduced the rating from 30 to zero percent, effective November 6, 2017. The Veteran submitted a notice of disagreement (NOD) in October 2018. However, the Agency of Original Jurisdiction (AOJ) has yet to issue a statement of the case (SOC) subsequent to the NOD. The issuance of subsequent rating decisions does not abrogate the AOJ’s duty to render an SOC, and failure to provide the Veteran with an SOC would be prejudicial. The propriety of the reduction in rating for the Veteran’s dermatitis should also be readjudicated by the AOJ as part of the instant appeal. 3. Entitlement to a disability rating in excess of 20 percent for DM II on an extraschedular basis is remanded. In March 2016, the Board remanded the claim for a disability rating in excess of 20 percent for DM II on an extraschedular basis. Unfortunately, it did not provide any remand instructions to refer the claim to the Under Secretary for Benefits or the Director of the compensation and Pension for consideration. This should be accomplished on remand. 4. Entitlement to a disability rating in excess of 60 percent for diabetic nephropathy with HTN is remanded. The claim for a higher disability rating for diabetic nephropathy with HTN is being remanded for the issuance of an SOC. The Regional Office issued a September 2018 rating decision increasing the rating for diabetic nephropathy with HTN. Although an October 2018 NOD was submitted, the AOJ has yet to issue a SOC subsequent to the NOD. The issuance of subsequent rating decisions does not abrogate the AOJ’s duty to render an SOC, and failure to provide the Veteran with an SOC would be prejudicial. Therefore, this issue must be remanded for the issuance of an SOC. See 38 C.F.R. § 19.9(c). 5. Entitlement to a TDIU is remanded. The Veteran’s claim for a TDIU is inextricably intertwined with the claims remanded herein, and the adjudication of this claim may depend on the outcome of the other remanded claims. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated). The matters are REMANDED for the following action: 1. Provide a comprehensive VA examination by an appropriate examiner to determine the nature and etiology of the Veteran’s claimed skin disorder other than dermatitis, and the current severity of his service-connected post-radiation dermatitis of the neck. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The claims file, and a copy of this remand, will be available to the examiner. After reviewing the claims file in its entirety and examining the Veteran, the examiner is asked to address the following: a) Identify all skin diagnoses, including post-radiation dermatitis of the neck, alopecia, and eczema. b) For each skin diagnosis, except for post-radiation dermatitis of the neck which is already service-connected, provide an opinion as to whether it at least as likely as not had its onset during active service or is otherwise related to it. **In doing so, the VA examiner should consider all evidence, to include conceded in-service exposure to herbicide agents, the Veteran’s report of in-service symptoms, July 1968 treatment for urticaria, private treatment records reflecting treatment of discoid lupus erythematosus from June 1996 to April 1997, and VA treatment records reflecting treatment for eczema from December 2010 to July 2011.** A complete rationale should be provided for any opinion provided. c) For the Veteran’s service-connected post-radiation dermatitis of the neck, evaluate the current severity. i) Discuss whether topical and/or systemic therapy is required. If so, describe the type and duration of such treatment, and state whether this treatment is specifically for the Veteran’s dermatitis. ii) Specifically for the Veteran’s dermatitis, identify all body areas affected, and the size of the areas affected. Provide the percent of the total body affected, as well as the percent of the exposed areas affected. 2. Refer the Veteran’s DM II claim to the Under Secretary for Benefits or the Director of Compensation and Pension Services for extraschedular consideration. See 38 C.F.R. § 4.16(b). (Continued on the next page)   3. Thereafter, readjudicate the claims on appeal. 4. Also provide the Veteran with an SOC with regard to the issue of entitlement to a higher rating for diabetic nephropathy with HTN. Clearly advise the Veteran and his attorney of the need to file a substantive appeal following the issuance of the SOC if he wishes to perfect an appeal of this issue to the Board. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jane R. Lee