Citation Nr: 18153978 Decision Date: 11/28/18 Archive Date: 11/28/18 DOCKET NO. 08-33 806A DATE: November 28, 2018 REMANDED Entitlement to a rating in excess of 10 percent for keloid formations of the back and hands from March 21, 2007, to November 1, 2014, is remanded. Entitlement to a rating in excess of 20 percent for keloid formations, linear from head to toe from March 21, 2007, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1964 to June 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from December 2007 and October 2011 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. The Board remanded these matters in April 2015 and October 2017. The Veteran testified at a Board hearing before the undersigned Veterans Law Judge in May 2016. A transcript of the hearing is of record. The Board finds there has been substantial compliance with its October 2017 remand directives. See D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (holding that there was no Stegall (Stegall v. West, 11 Vet. App. 268 (1998)) violation when the examiner made the ultimate determination required by the Board’s remand.) 1. Entitlement to a rating in excess of 10 percent for keloid formations of the back and hands from March 21, 2007, to November 1, 2014, and entitlement to a rating in excess of 20 percent for keloid formations, linear from head to toe from March 21, 2007, are remanded. In a written presentation dated in September 2018, the Veteran’s representative argued that the previous examinations did not contain all information necessary to rate the disabilities, as there has been no official determination as to how many keloid scars there were on the Veteran’s hands and back that are painful and unstable. The Veteran underwent VA examinations for his keloid scar formations in June 2007, July 2011, September 2012, and July 2015. Based on these examinations, the Veteran was awarded a 10 percent rating for keloid formations of the back and hands and a 20 percent rating for keloid formations, linear scars from head to toe. However, the Veteran asserts that his scar conditions are worse than the VA examinations showed. Specifically, during the May 2016 Board hearing, the Veteran asserted that he had over 70 scars altogether. He described his keloids as painful. Specifically, they were shooting, stabbing pains not constant, but he still got sharp pains 3 or 4 times per week. He said the scars in the groin were most debilitating; he said he would double over sometimes with pain. The Board notes that importantly, the most recent VA examination did not address the presence or absence of functional loss associated with the Veteran’s scars. When the medical evidence is inadequate, VA must supplement the record by seeking an advisory opinion or ordering another medical examination. Littke v. Derwinski, 1 Vet. App. 90, 93 (1990) (noting that remand may be required if record before the Board contains insufficient medical information for evaluation purposes); Colvin v. Derwinski, 1 Vet. App. 171 (1991). Overall, the Board notes that the most recent VA examination is over 3 years old. The Veteran’s testimony at the Board hearing in May 2016 suggests that his symptoms are worse than shown in the July 2015 VA examination. See Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (determining that the Board should have ordered a contemporaneous examination of the veteran because a 23-month old examination was too remote in time to adequately support the decision in an appeal for an increased rating); see also Allday v. Brown, 7 Vet. App. 517, 526 (1995) (where the record does not adequately reveal current state of claimant’s disability, fulfillment of statutory duty to assist requires a contemporaneous medical examination, particularly if there is no additional medical evidence that adequately addresses the level of impairment of the disability since the previous examination); see also VAOPGCPREC 11-95 (1995). Therefore, the Board finds that on remand, a VA examination should be provided to review the medical evidence and lay statements from the period of May 21, 2007 to November 1, 2014, for the Veteran’s keloid formations on his back and hands to determine the severity during that time period as well as assess the current severity of the Veteran’s keloid formations, linear scars from head to toe, beginning from March 21, 2007. The examiner should address the functional loss caused by the Veteran’s keloid formations for the entire period on appeal, as well as the number of painful and unstable scars 2. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. The Board finds that the Veteran’s TDIU claim is inextricably intertwined with the outcome of the Veteran’s increased rating claims. Therefore, the TDIU claim should not be adjudicated until the increased rating claims are decided. The matters are REMANDED for the following actions: 1. Obtain any outstanding VA or private treatment records. Request that the Veteran assist with locating these records, if possible. Associate these records with the claims file. 2. Then, schedule the Veteran for a VA examination with an appropriate examiner to determine the severity of the Veteran’s keloid formations of the back and hands between March 21, 2007 and November 1, 2014, as well as the severity of the Veteran’s keloid formations, linear scars from head to toe, from March 21, 2007. A copy of the claims file and this remand should be made available for review. All indicated testing must be conducted and all pertinent symptomatology and findings must be reported in detail. The examiner must measure the accurate size of the scar and indicate whether such scar is painful, unstable, deep or superficial, or linear or non-linear. The examiner is also asked to determine whether there is any disabling effect(s) caused by the Veteran’s service-connected scar. A complete rationale for any opinion offered should be provided. The examiner must consider the Veteran’s lay statements. If the examiner is unable to provide an opinion without resorting to mere speculation then the examiner must state this and provide any information needed to make an opinion, if possible. (Continued on the next page)   3. Thereafter, readjudicate the claim on appeal. If the benefit sought remains denied, issue the Veteran and his representative a supplemental statement of the case and provide a reasonable opportunity to respond before returning this matter to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Saudiee Brown, Associate Counsel