Citation Nr: 18153159 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 16-57 129 DATE: November 27, 2018 REMANDED Entitlement to service connection for tinea corporis is remanded. Entitlement to an initial compensable disability rating for calluses of the bilateral feet is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1983 to March 1984 and September 1990 to July 1991, to include service in Southwest Asia. 1. Entitlement to service connection for tinea corporis is remanded. In December 2011, the Veteran was afforded a VA examination to determine the etiology of his claimed rash disability. He was diagnosed with tinea corporis. The examiner noted a date of diagnosis of 1990, presumably, reflecting the Veteran’s reports of the date of onset of his symptoms. The examiner provided a negative nexus opinion that was based solely on the absence of in-service documentation of a skin condition while the Veteran was on active military service and does not address the Veteran’s lay reports of symptoms dating back to active service. It is continuity of symptomatology, rather than continuity of treatment, that is important. The discussion of the underlying medical rationale of an opinion, not just review of the claims file, is where most of the probative value of an opinion is derived. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). On remand, the record should be returned to the December 2011 VA examiner for a more responsive opinion on the etiology of the Veteran’s diagnosed tinea corporis that specifically considers his lay statements concerning the onset and progression of his symptoms and specifically addresses evidence in the record favorable to his claim. 2. Entitlement to an initial compensable disability rating for calluses of the bilateral feet is remanded. The Veteran was last afforded a VA examination to evaluate the severity of his bilateral foot calluses in September 2016. However, the examination report provides no information on what, if any, functional impairments the Veteran experienced as a result of this service-connected disability. Rather, the examination report generally noted the functional impairments of the Veteran’s feet due to his calluses, as well as nonservice-connected pes planus, metatarsalgia and hallux valgus. In light of this deficiency, the Veteran should be scheduled for a new examination. Since the claims file is being returned it should be updated to include any outstanding VA treatment records. See 38 C.F.R. § 3.159 (c)(2); see also Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all outstanding treatment records regarding the Veteran dated from November 2016 to the present. 2. Return the claims file to the examiner who conducted the Veteran’s December 2011 VA examination (or another appropriate examiner if that examiner is unavailable) for supplemental comment on the etiology of the Veteran’s diagnosed tinea corporis. The claims file, to include a copy of this Remand, must be made available to the examiner for review prior to the exam. If the examiner determines that an addendum opinion cannot be provided without an examination, the Veteran should be scheduled for an appropriate examination. Any indicated evaluations, studies, and tests should be conducted. Based on the examination, if deemed necessary, and review of the record, the examiner is requested to address the following question: Is it at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s diagnosed tinea corporis had its onset in service or is otherwise related to active duty, to include service in Southwest Asia? The examiner should provide a complete rationale for any opinion provided and should specifically comment on the Veteran’s lay statements concerning the onset and progression of his rash problems. In attempting to comment on this determinative issue of causation, the December 2011 VA examiner impermissibly relied on the seeming absence of indication or actual treatment for skin problems during active duty service, such as would be reflected in the treatment records. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected calluses of the bilateral feet. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to calluses of the bilateral feet alone and discuss the effect of the Veteran’s calluses of the bilateral feet on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner does not have the knowledge or training. M. E. Larkin Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jack S. Komperda, Counsel