Citation Nr: 18155850 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 08-03 340 DATE: December 6, 2018 REMANDED Entitlement to an initial rating in excess of 10 percent for fungal infection of both hands and feet is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1967 to March 1970. This appeal comes before the Board of Veterans’ Appeals (Board) from a September 2005 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. In a January 2009 substantive appeal, the Veteran requested a hearing before the Board. In October 2009, he withdrew the request in writing. In a decision dated August 2017, the Board denied entitlement to an initial rating in excess of 10 percent for fungal infection of both hands and feet and entitlement to a TDIU. The Veteran appealed the Board’s decision to the U.S. Court of Appeals for Veterans Claims (Court). In April 2018, VA's General Counsel and the Appellant filed a Joint Motion for Remand (JMR) with respect to the appealed claims. By an Order dated May 2018, the Court granted the JMR, vacated the August 2017 Board decision, and remanded the issues of entitlement to an initial rating in excess of 10 percent for fungal infection of both feet and hands and entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) to the Board for action consistent with the JMR. 1. Entitlement to an initial rating in excess of 10 percent for fungal infection of both hands and feet is remanded. The JMR granted by the Court noted that the Board, while acknowledging the Veteran’s use of oral (systemic) antifungal medications, but not steroid or immunosuppressive drugs, failed to consider or discuss the implications of Warren v. McDonald, 28 Vet. App. 194, 197 (2016), which held that 38 C.F.R. § 4.118, Diagnostic Code (DC) 7806 does not limit systemic therapies to “corticosteroids or immunosuppressive drugs.” Accordingly, the Board finds it appropriate to obtain a clarifying opinion as to whether any of the systemic therapies the Veteran received were like or similar to Corticosteroids or immuno suppressive drugs. See Warren, 28 Vet. App. at 197. (noting that compensation is available for all systemic therapies that are like or similar to corticosteroids or other immunosuppressive drugs. 2. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU). is remanded. Also, consistent with the findings outlined in the JMR, the Court held that the Board provided an inadequate statement of reasons or bases for its finding that a TDIU evaluation was not warranted. Specifically, the JMR found that the Board’s discussion of the December 2014 VA examination appears incomplete. In addition, it was found that the VA examiner did not adequately address the Veteran’s ability to work, in that the examiner did not check any of the boxes relating to the type of work the Veteran was able to perform. The JMR noted that the Board did not reconcile the fact that the examiner concluded that the Veteran was able to perform some work during an eight-hour day, with the other findings in the examination. Accordingly, the Board finds that another VA medical opinion is necessary before the TDIU claim can be decided on the merits. Stegall v. West, 11 Vet. App. at 268, 271 (explaining that a remand by the Court or Board "confers on the veteran ... as a matter of law, the right to compliance with the remand orders") and Barr v. Nicholson, 21 Vet. App. 303, 310-11 (2007). In addition, the claim for a TDIU is inextricably intertwined with the Veteran's claim for entitlement to an increased rating for fungal infections of both feet and hands and the decisions on that issue remanded herein may impact the Veteran's claim for TDIU. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (the prohibition against the adjudication of claims that are inextricably intertwined is based upon the recognition that claims related to each other should not be subject to piecemeal decision-making or appellate litigation). The matters are REMANDED for the following action: 1. Obtain all pertinent VA and non-VA medical records not yet associated with the appellate record. 2. After the above development, forward the record and copy of this remand to the examiner who conducted the December 2014 exam, or if the examiner is unavailable, to another suitably qualified examiner, to determine the current nature and level of severity of his service-connected fungal infections of the hands and feet, the types of therapy and treatment required, the extent of involvement and any functional impairment caused. The examination report must reflect that a review of the Veteran’s claims file, including a copy of this Remand, was undertaken. The examiner must also specifically opine as to: (a.) Whether any of the systemic therapies that the Veteran received were like or similar to corticosteroids or immunosuppressive drugs. Rationale must be provided for the opinion proffered. (b.) Whether service-connected disability, to include pes planus and fungal infection of both feet and hands, result in functional impairment which precludes occupational activities including sedentary work, light work, medium work or strenuous heavy work. Rationale must be provided for the opinion proffered. In rendering the requested rationale, the examiner should reconcile his/her findings with the December 2014 VA examination report findings that the Veteran’s hands were “painful to touch the tip,” that his nails are tender, that his hands limit his ability to wear gloves, and that he avoids certain activities with his hands, that he had pain in both feet even with sitting, that it hurt to wear shoes that covered his whole feet, that he could not wear dress shoes, that he had flare-ups at least every six weeks which lasted two to seven days and caused him to walk with a limp and that he spent most of the day sitting during those periods, and that his feet impacted his ability to perform tasks such as standing, walking, lifting and sitting. 3. Thereafter, the AOJ should readjudicate the issues on appeal and determine whether an increased rating for service-connected hand and foot fungus and entitlement to a TDIU may be granted. If any benefit sought remains denied, furnish the Veteran and his representative with a supplemental statement of the case and an appropriate period for response. U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S.E. Leary, Associate Counsel