Citation Nr: 18151832 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 06-34 306 DATE: November 20, 2018 ORDER An extraschedular rating of 40 percent, in addition to the current schedular 30 percent rating for recurrent perianal abscesses and hidradenitis suppurativa, is granted, subject to controlling regulations governing the payment of monetary awards An effective date of September 27, 2002 for the assignment of a 60 (extraschedular rating of 40 percent and schedular of 30 percent) disability evaluation for recurrent perianal abscesses with hidradenitis suppurative is granted. Entitlement to a TDIU from September 27, 2002, through January 6, 2009, is granted. Entitlement to an effective date of September 27, 2002 for the award of Dependents' Educational Assistance (DEA) benefits under Chapter 35, Title 38, United States Code is granted. REMANDED Entitlement to an initial disability evaluation for coronary artery disease in excess of 10 percent prior to February 22, 2010; in excess of 30 percent from February 22, 2010 to November 21, 2011; and in excess of 60 percent from November 22, 2011 is remanded. Entitlement to an increased schedular disability evaluation for recurrent perianal abscesses and hidradenitis suppurativa, currently rated as 30 percent disabling, is remanded. Entitlement to special monthly compensation based upon housebound criteria is remanded. FINDINGS OF FACT 1. The impairment caused by the Veteran's recurrent perianal abscesses and hidradenitis suppurativa most nearly approximates an additional 40 percent extraschedular rating, beyond the current schedular rating of 30 percent, making it equivalent to the highest available schedular rating. 2. The Veteran’s February 2004 statement in support of claim can be reasonably construed as a substantive appeal with his claim for an increased evaluation for recurrent perianal abscesses on September 27, 2002; thus, the initial claim has remained pending since September 27, 2002, and serves as the effective date for the assignment of a 60 percent disability evaluation for recurrent perianal abscesses with hidradenitis suppurative. 3. The Veteran's service-connected disabilities have precluded substantially gainful employment consistent with his education and occupational experience from September 27, 2002, through January 6, 2009. 4. Entitlement to basic eligibility for DEA benefits under Chapter 35, Title 38, United States Code arose on September 27, 2002, the effective date for the award of a TDIU. CONCLUSIONS OF LAW 1. The criteria for an extraschedular rating of 40 percent for recurrent perianal abscesses with hidradenitis suppurativa have been met. 38 U.S.C. §§ 1155, 5107 (West 2014); 38 C.F.R. §§ 3.321, 4.118, Diagnostic Code (DC) 7806 (2017). 2. The criteria for an effective date of September 27, 2002, for the assigment of 30 percent schedular and 40 percent extraschedular evaluations for recurrent perianal abscesses with hidradenitis suppurativa have been met. 38 C.F.R. § 3.400 (2017). 3. The criteria for a TDIU from September 27, 2002 through January 6, 2009, have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.16 (2017). 4. The criteria for an effective date of September 27, 2002, for DEA benefits under Chapter 35, Title 38, United States Code are met. 38 U.S.C. §§ 3500, 3501, 5110 (2012); 38 C.F.R. § 3.400, 3.807 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from September 1967 to February 1969. Entitlement to an Evaluation in Excess of 10 Percent for Perianal Abscesses and Hidradenitis Suppurativa on an Extraschedular Basis Generally, disability ratings are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in VA's Rating Schedule. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. However, to accord justice in the exceptional case where the criteria in VA's Rating Schedule are found to be inadequate, an extraschedular rating that is commensurate with the average earning capacity impairment caused by the service-connected disability is warranted. 38 C.F.R. § 3.321(b)(1). Such a rating is warranted when the case presents such an unusual disability picture with related factors such as marked interference with employment as to render impractical the application of the regular schedular standards. Id. When the Board finds that an extraschedular rating may be warranted based on the above factors, it cannot grant an extraschedular rating in the first instance. Anderson v. Shinseki, 23 Vet. App. 423, 428-429 (2009). Rather, it must remand the claim to the AOJ for referral to the Director. See Thun v. Peake, 22 Vet. App. 111 (2008), aff'd sub nom. Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). The Board did so in this case in December 2014. The AOJ referred the claim for an extraschedular rating to the Director. In an October 2015 decision, the Director assigned a 10 percent extraschedular disability evaluation. The Director's decision is not evidence, but, rather, the de facto AOJ decision, and the Board must conduct de novo review of this decision. Wages v. McDonald, 27 Vet. App. 233, 238-39 (2015) (holding that the Board conducts de novo review of the Director's decision denying extraschedular consideration). The Court reaffirmed that the Board has jurisdiction to review the entirety of the Director's decision denying or granting an extraschedular rating and elaborated that the Board is authorized to assign an extraschedular rating when appropriate. Kuppamala v. McDonald, 27 Vet. App. 447, 457 (2015). In its December 2014 remand, the Board noted that the schedular rating criteria for the Veteran's service-connected recurrent perianal abscesses with hidradenitis suppurativa of the groin area did not include abscesses which regularly rupture, chronically draining sinus tracts with a foul odor, and pain, symptoms of which have been shown in this case. Thus, the rating criteria were inadequate to describe the severity and symptoms of the service-connected recurrent perianal abscesses with hidradenitis suppurativa of the groin area. Moreover, the case showed an unusual disability picture, as the evidence of record showed that this skin disorder had interfered with the Veteran's employment. See, e.g., January 2010 report by a vocational consultant. The Board concluded that the Veteran's skin disorder presented an exceptional or unusual disability picture so as to render impractical the application of the regular schedular standards such that referral to the appropriate officials for consideration of an extraschedular rating was warranted. In a January 2010 vocational assessment report prepared by E. C., it was noted that the Veteran had a history of perianal abscesses since 1968 which had become progressively worse over time resulting in numerous surgeries, symptoms adversely affecting his ability to be on his feet or sit for any length of time, to be around people due to incontinence, and an inability to work since early 2003. He noted that review of the medical records for the period leading up to August 2002 showed a continued pattern of the perianal abscesses which led to the Veteran's steady reduction in work hours and eventual removal from the work force entirely due to his inability to stand or sit without lying down, needing to be close to his home for underwear changes, and unstable bodily functions creating an unpleasant situation when around other people. He indicated that while the Veteran may have acquired skills from his past work, these symptoms and residual limitations rendered him incapable of functioning in any type of work setting. He further stated that although he had reviewed the entire claims file and considered all of the Veteran's other conditions and disabilities, both service-connected and non-service connected, it was his opinion, within a reasonable degree of vocational certainty, that the Veteran’s perianal abscesses resulted in his inability to secure or follow a substantially gainful occupation since August 2002, and that he continued to be unemployable due solely to his service-connected perianal abscess condition. In a December 2016 opinion, the Director indicated that the available medical evidence did show that the Veteran’s perianal abscesses have likely been severe enough to occasionally interfere in prior employment. The Director indicated that the condition was documented in detail in the available medical evidence. She noted that outpatient treatment records revealed topical medication and occasional surgical procedures to treat the condition. She stated that objective evidence did not support the allegation that this condition prevented all work at any time, but did include consistent reports from the Veteran of some interference with his work as a barber. The Director indicated that extra-schedular evaluations were assigned in cases where an exceptional or unusual disability picture was presented with such related factors as marked interference with employment or frequent periods of hospitalization that rendered application of regular rating schedular standards impractical. She noted that the evidentiary record demonstrated that the symptomatology consistently associated with the service-connected perianal abscesses under diagnostic code 7806 was not wholly contemplated by the criteria utilized to assign the current evaluation. The Director indicated that entitlement to an extra-schedular evaluation for the service-connected perianal abscesses was established and that an additional 10 percent was warranted for this condition on an extra-schedular basis. As noted above, the service-connected schedular criteria for rating the recurrent perianal abscesses with hidradenitis suppurativa of the groin area do not include abscesses which regularly rupture, chronically draining sinus tracts with a foul odor, and pain, symptoms of which have been shown in this case. Moreover, the reports of records show that the Veteran’s service-connected disorder has caused hospitalizations and subsequent convalescence to treat the condition as well as marked interference with employment. The evidence thus shows symptoms not contemplated by the rating criteria that cause marked interference with employment. Therefore, the Board finds that an extraschedular rating is warranted. The only remaining question is what rating should be assigned. As noted by the Court, "[b]ecause the nature of extraschedular consideration requires that the disability picture be unique and not contemplated by the rating schedule, there logically is no guidance as to the specific rating that should be assigned in any particular case." Kuppamala, (citing Floyd v. Brown, 9 Vet. App. 88, 97 (1996)). The criteria for rating the Veteran’s current disorder provides for a maximum schedular rating of 60 percent. As demonstrated above, the Veteran’s recurrent perianal abscesses have caused both hospitalizations and interference with employment. They also cause numerous other physical impairments not contemplated by the rating criteria. Given the foregoing, the Board finds that an extraschedular rating of 40 percent for the recurrent perianal abscesses with hidradenitis suppurativa is warranted. This will result in a combined rating of 60 percent, see 38 C.F.R. § 4.25 (2017), which will approximate the maximum schedular rating which would be warranted for recurrent perianal abscesses with hidradenitis suppurativa under DC 7806. As the preponderance of the above evidence reflects that an extraschedular rating higher than 40 percent is not warranted, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. Effective date Earlier than May 10, 2005, for the Assigment of a 40 Percent Disability Evaluation for Recurrent Perianal Abscesses with Hidradenitis Suppurativa By way of background, the RO, in a November 2016 rating determination; following an October 2016 report from the Director of Compensation Service performed in conjunction with a December 2014 Board remand, wherein the Director indicated that the Veteran’s service-connected recurrent perianal abscesses and hidradenitis suppurativa demonstrated that the symptomatology consistently associated with the service-connected perianal abscesses under diagnostic code 7806 was not wholly contemplated by the criteria utilized to assign the current evaluation warranting an additional 10 percent on an extraschedular basis; assigned a 40 percent disability evaluation from May 10, 2005. The Veteran, through his attorney, has indicated that an earlier effective date for the now 30 percent schedular and 40 percent extraschedular evaluation for recurrent perianal abscesses and hidradenitis suppurativa disability evaluation (see above) is warranted as the claim for an increased evaluation has remained on appeal since the Veteran’s initial request for an increased evaluation, received on September 27, 2002. He maintains that it has remained opened on two fronts. The Veteran has indicated his belief that the claim remained opened following the issuance of the January 2004 statement of the case due to submission of additional pertinent evidence in support of his claim following the issuance of the statement of the case. In the alternative, the Veteran has indicated that his February 2004 statement in support of claim, received within 60 days of the issuance of the January 2004 statement of the case, contained all the necessary elements to be considered a substantive appeal, thereby perfecting the issue for appeal. In this regard, a substantive appeal should set out specific arguments relating to errors of fact or law made by the AOJ in reaching the determination being appealed. The Board will construe such arguments in a liberal matter for purposes of determining whether they raise issues on appeal, but the Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. A substantive appeal must be filed within 60 days from the date that the AOJ mails the SOC to the claimant or within the remainder of the one-year period from the date of mailing of the notification of the determination being appealed, whichever comes later. 38 C.F.R. § 20.302(b)(1). In determining its jurisdiction, the Board must be cognizant that the VA adjudicative system is non-adversarial and pro-claimant in nature wherein pro se filings are liberally and sympathetically construed. Szemraj v. Principi, 357 F.3d 1370, 1373 (Fed. Cir. 2004). A review of the record reveals that in the February 2004 statement, the Veteran specifically referenced the January 2004 SOC. The Veteran also submitted several medical treatment records in support of his claim. He further noted that he was still in recovery following the October 2003 surgery. Based upon the letter, the Board finds that this serves as a substantive appeal as it relates to the increased evaluation claim filed in September 2002. As such, the issue has remained on appeal since the Veteran’s request for an increased evaluation on September 27, 2002. As such an effective date of September 27, 2002, is warranted for the service-connected recurrent perianal abscesses with hidradenitis suppurativa. Entitlement to a TDIU Prior to January 7, 2009 TDIU may be assigned when a Veteran has one service-connected disability rated at 60 percent or more, or two or more service-connected disabilities with at least one rated at 40 percent or more and he has a combined rating of at least 70 percent. 38 C.F.R. § 4.16(a). In calculating whether a Veteran meets that 60/70 percent schedular criteria, disabilities resulting from common etiology or a single accident, or disabilities affecting a single body system, are considered one disability. The record must also show that the service-connected disabilities alone result in such impairment of mind or body that the average person would be precluded from securing or following a substantially gainful occupation. 38 C.F.R. § 4.16(a). In any event, it is the policy of the VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disability shall be rated totally disabled. 38 C.F.R. § 4.16(b); see 38 C.F.R. §§ 3.340, 3.341, 4.15 (2017). In this regard, in Hatlestad v. Derwinski, 1 Vet. App. 164 (1991), the Court referred to apparent conflicts in the regulations pertaining to individual unemployability benefits. Specifically, the Court indicated that there was a need to discuss whether the standard delineated in the controlling regulations was an "objective" one based on the average industrial impairment or a "subjective" one based upon a Veteran's actual industrial impairment. In a pertinent precedent decision, VA General Counsel concluded that the controlling VA regulations generally provide that veterans who, in light of their individual circumstances, but without regard to age, are unable to secure and follow a substantially gainful occupation as the result of service-connected disability shall be rated totally disabled, without regard to whether an average person would be rendered unemployable by the circumstances. Thus, the criteria for determining unemployability include a subjective standard. It was also determined that "unemployability" is synonymous with inability to secure and follow a substantially gainful occupation. VAOPGCPREC 75-91 (O.G.C. Prec. 75-91); 57 Fed. Reg. 2317 (1992). The Court has also held that a Veteran's advancing age and nonservice-connected disabilities may not be considered in the determination of whether a Veteran is entitled to a TDIU. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16(a)(b), 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). For a Veteran to prevail on a claim based on unemployability, it is necessary that the record reflect some factor which places him in a different position than other veterans with the same disability rating. The sole fact that a veteran is unemployed or has difficulty obtaining employment is not enough to prove unemployability. Additionally, it is noted that a high rating in and of itself is recognition that the impairment makes it difficult to obtain and keep employment. Thus, the question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether the veteran can find employment. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Furthermore, marginal employment shall not be considered substantially gainful employment. Marginal employment generally shall be deemed to exist when a veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment may also be held to exist, on a facts found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Consideration shall be given in all claims to the nature of the employment and the reason for termination. 38 C.F.R. § 4.16(a). As a result of the above actions, as of September 27, 2002, the date of the Veteran’s request for an increased rating for his recurrent abscesses with hidradenitis suppurativa, service connection was in effect for recurrent perianal abscesses and hidradenitis suppurative, rated as 60 percent disabling (30 percent schedular and 40 percent extraschedular) and coronary artery disease, rated as 10 percent disabling (the Board notes that although the CAD issue is in remand status, based upon the actions taken herein, which are favorable to the Veteran, assuming a 10 percent rating for CAD for TDIU purposes will have no adverse impact on the Veteran). The combined evaluation was 60 percent. Thus, the Veteran has met the criteria for consideration under 38 C.F.R. § 4.16(a) since that time. A review of the record demonstrates that the Veteran was self-employed as a barber from 1970-2003, with marginal employment in the last year of his self-employment due to his service-connected perianal abscess condition. The Veteran has indicated that he stopped working in 2003 due to his service-connected disabilities. He stated that when he was working, he was able to control his own schedule and the hours that he worked, as he was his own boss. He indicated that he often missed a lot of time from work in order to care for and to treat his conditions. He stated that he missed work for weeks at a time on many occasions as his condition only became worse over time. In support of his claim, the Veteran submitted an application showing he had last worked in 2003. Moreover, as noted in the January 2010 vocational assessment report above, it was indicated that review of the medical records for the period leading up to August 2002 showed a continued pattern of the perianal abscesses which led to the Veteran's steady reduction in work hours and eventual removal from the work force entirely due to his inability to stand or sit without lying down, needing to be close to his home for underwear changes, and unstable bodily functions creating an unpleasant situation when around other people. It was further noted that within a reasonable degree of vocational certainty, the Veteran’s perianal abscesses resulted in his inability to secure or follow a substantially gainful occupation since August 2002, and that the Veteran continued to be unemployable due solely to his service-connected perianal abscess condition. The Board observes that while the Veteran maintained employment as a barber into 2003, the hours worked during the 2003 time-frame constituted no more than marginal employment. The Board further observes that the Veteran had worked as a barber for over 30 years, acquiring almost no other skills. Given the foregoing, and resolving reasonable doubt in favor of the Veteran, the Board finds that the Veteran's service-connected disabilities resulted in his being rendered unemployable from September 27, 2002, to January 7, 2009. Earlier Effective Date for DEA under 38 U.S.C. Chapter 35 The Veteran claims an earlier effective date for DEA benefits pursuant to 38 U.S.C., Chapter 35. The Veteran was awarded eligibility to DEA in an October 2014 rating decision, effective January 7, 2009, based upon the RO's finding that he was permanently unable, as of that date, to secure or follow a substantially gainful occupation. Except as provided in subsections (b) and (c), effective dates relating to awards under Chapter 35 shall, to the extent feasible, correspond to effective dates relating to awards of disability compensation. 38 U.S.C. § 5113. Subsection (b) provides that when determining the effective date of an award under Chapter 35 for an individual described in paragraph (b)(2) of 38 U.S.C. § 5113, based on an original claim, VA may consider the individual's application as having been filed on the eligibility date of the individual if that eligibility date is more than one year before the date of the initial rating decision. For these purposes, "eligibility date" means the date on which the individual became an eligible person as defined by 38 U.S.C. § 3501(a)(1), and "initial rating decision" means a decision by VA that establishes the veteran's total disability as permanent in nature. 38 U.S.C. § 5113(3). In the case of a veteran who is alive, the conditions for basic eligibility for DEA include: (1) the Veteran's discharge from service under conditions other than dishonorable; and (2) the Veteran has a permanent total service-connected disability. 38 C.F.R. § 3.807(a). Total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. Total disability may or may not be permanent. 38 C.F.R. § 3.340(a). A permanent total disability will be taken to exist when such impairment is reasonably certain to continue throughout the life of the disabled person. 38 C.F.R. § 3.340(b). Permanent total disability ratings may not be granted as a result of any incapacity from acute infectious disease, accident, or injury, unless there is present one of the recognized combinations or permanent loss of use of extremities or sight, or the person is in the strict sense permanently helpless or bedridden, or when it is reasonably certain that a subsidence of the acute or temporary symptoms will be followed by irreducible totality of disability by way of residuals. The age of the disabled person may be considered in determining permanence. Id. The term "total disability permanent in nature" for the purpose of DEA benefits means any disability rated total for the purposes of disability compensation which is based on an impairment reasonably certain to continue throughout the life of the disabled person. 38 U.S.C. § 3501(a)(7). In light of medical evidence discussed above, the Board finds that the Veteran's disabilities are diseases that are long standing in nature, and as such, totally incapacitating. He has continued to undergo procedures and receive treatment for his various disorders for the past twenty years, and the record reflects that the probability of permanent improvement under treatment is remote. As such, the criteria for a determination of permanent total disability under 38 C.F.R. § 3.340(b) have been met. Permanent total disability having been found, the criteria for entitlement to DEA benefits have also been met. 38 C.F.R. § 3.807(a)(2). In this case, since the effective date for DEA benefits is directly related to a finding that the Veteran had a total disability that was permanent in nature by virtue of his TDIU rating, an effective date of September 27, 2002, for Chapter 35 benefits is warranted as the Veteran has been granted TDIU in this decision for the period from September 27, 2002. REASONS FOR REMAND Coronary Artery Disease As it relates to coronary artery disease, in December 2014, the Board remanded this matter for further development. The Board requested that following review of the claims file and examination of the Veteran, the examiner should: (a) address the Veteran's METs workload during the period from September 27, 2002 to February 22, 2010, and whether symptoms of dyspnea, fatigue, angina, dizziness, and syncope were present during that period. The Board also indicated that if there was left ventricular dysfunction, please provide the ejection fraction. If possible, an estimated METs workload was to be provided to address the Veteran's current METs workload and whether symptoms of dyspnea, fatigue, angina, dizziness, and syncope were present. If there was left ventricular dysfunction provide the ejection fraction. In a February 2017 report, the VA examiner indicated that she had reviewed the conflicting evidence and was providing the following opinion: Review of records include a stable CAD diagnosis of October 2003, August 2005, April 2006, August 2007, and January 2009. She noted that an estimated METs rating of greater than 5-7 was given in July 2012. No echo was available associated with the July 2012 evaluation. The examiner further noted that in a February 2010 report, echo showed objective findings of ejection fraction of 55 percent and METs of 5-7. She also noted that in February 2016, CAD was stable with an ejection fraction of 60 percent. She stated that the Veteran was obese, deconditioned, and used tobacco, so the 7-10 METs given on February 2016 was for cardiac symptoms only. In an April 2017 addendum report, the examiner indicated that she had reviewed the conflicting evidence and was providing the following opinion. She noted the most recent echocardiogram in February 2016 showed an ejection fraction of 60 percent with no regional wall abnormalities and left ventricular hypertrophy. She stated that between the period in question (September 2002 to February 2010) there were no echocardiograms in the record. She indicated his February 2010 exercise tolerance test was symptom limited without angina. The EKG test was non-diagnostic due to inadequate heart rate response and poor exercise capacity. His functional capacity for his age was poor. She noted that there were no records available regarding symptoms in question between the dates in question but based on the February 2010 exercise test, the Veteran’s symptoms were at least as likely as not due to generalized deconditioning complicated by obesity and smoking. Estimated METs was 7-10 based upon the 2016 echocardiogram. Unfortunately, while the examiner has provided two separate opinions, the Board is still not able to ascertain if the examiner can provide an estimated METs workload during the period from September 27, 2002 to February 22, 2010. In the February 2017 opinion, the examiner noted the METs findings in February 2010, July 2012, and February 2016. However, she did not provide any estimate for the time-period in question nor did she indicate that one could be provided. In the April 2017 addendum report, the examiner again noted the findings at the time of the February 2010 examination and the February 2016 examination. However, she again did not provide an estimated METs score for the period between September 2002 and February 2010 nor did she indicate that one could not be provided. This information is pertinent to properly rate the Veteran’s CAD disability for this time period. Moreover, neither opinion complies with the December 2014 Remand request. As such, additional development is warranted. Increased Evaluation for Recurrent Perianal Abscesses and Hidradenitis Suppurativa on a Schedular Basis As it relates to this issue, the Board notes that during the course of this appeal, the regulations relating to skin disorders were amended. VA published in the Federal Register the proposed rule for Schedule for Rating Disabilities: Skin on August 12, 2018. The final rule implements the Secretary's proposed rule with limited revisions. The effective date of this final rule is August 13, 2018. However, for this final rule, VA's intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. For applications filed on or after the effective date, only the new criteria will be applied. The Veteran has not been afforded the opportunity to have his claim rated under the new criteria or informed of the new criteria. As such, a Supplemental Statement of the Case should be issued addressing the Veteran’s claim under the new rating criteria. Furthermore, as it relates to this claim, the Veteran was last afforded a VA examination in May 2014. As this matter is in remand status, the Veteran should be afforded a VA examination to determine the current severity of the disorder. SMC Based upon Housebound Status As it relates to this issue, the Board notes that this matter is inextricably intertwined with the increased rating claim for CAD. The appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to defer adjudication of the claim on appeal pending the adjudication of the inextricably intertwined claim. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain all outstanding VA and/or private treatment records related to the Veteran's outstanding claims. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified. 2. Schedule the Veteran for a VA examination to assess the current manifestations of his service-connected recurrent perianal abscesses and hidradenitis suppurativa. All indicated tests and studies should be performed and all findings must be reported in detail. The entire record must be furnished to the examiner. The examiner must respond to the following inquiries: (a) What percentage of the Veteran's entire body is affected by the skin disorder and what percentage of the exposed areas of the body are affected by the skin disorder? (b) The examiner must also note the types of medications that have been required for the Veteran's skin condition in the year preceding the examination. The examiner must also comment on whether the Veteran uses medications for his skin disorder and whether the manifestations of his skin disorder warrant constant or nearly constant use of medication. Detailed rationale is requested for any opinion that is rendered. 3. As it relates to the CAD claim, return the file to the examiner who provided the February 2017 and April 2017 opinions. The examiner is requested to indicate whether an estimated METs workload during the period from September 27, 2002 to February 22, 2010, can be provided. If so, please provide the estimated METs load. If not, please explain in detail why one cannot be provided. If the examiner is not available please refer the file to an appropriate examiner so that the requested opinions may be obtained. Complete detailed rationale should be provided for any opinion that is rendered. 4. Ensure the required actions have been accomplished (to the extent possible) in compliance with this REMAND. If any action is not undertaken, or is taken in a deficient manner, corrective action must be undertaken before the claims file is returned to the Board. See Stegall v. West, 11 Vet. App. 268 (1998) K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T.S.Kelly, Counsel