Citation Nr: 18157660 Decision Date: 12/13/18 Archive Date: 12/13/18 DOCKET NO. 14-23 839 DATE: December 13, 2018 REMANDED Entitlement to an increased rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is remanded. Entitlement to an increased rating in excess of 30 percent for tinea versicolor, chest, back, and crotch, is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1969 to March 1972. The Veteran testified before the undersigned Veterans Law Judge during a July 2017 Board hearing. This matter is on appeal from a March 2012 rating decision and was previously remanded by the Board of Veterans’ Appeals (Board) in December 2017. 1. Entitlement to an increased rating in excess of 50 percent for PTSD is remanded. The Veteran contends that he is entitled to a higher rating for his service-connected PTSD. He last underwent a VA examination for his service-connected PTSD in April 2018. See April 2018 VA Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire. Since that time, however, the record reflects that his PTSD symptoms may have worsened. In a July 2018 statement, the Veteran stated that his PTSD has worsened in recent months, since the April 2018 VA examination. See July 2018 Veteran’s Statement. He stated that he now locks himself in his room to stop himself from hurting someone or himself, sometimes hears voices in his head, and feels as though someone is watching him. The Veteran’s spouse submitted a July 2018 statement, in which she also provided in part that the Veteran now appears to walk around the house trying to escape the voices in his head and that he now looks behind his shoulder as if someone is trying to get him. See July 2018 Buddy Statement. These symptoms of wanting to hurt others or himself, hearing voices in his head, and feeling as though someone is watching him, were not raised or assessed at the April 2018 VA PTSD examination. Moreover, the Veteran is competent to establish the presence of such observable symptomatology. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Considering the above, the Board finds that a VA examination is necessary to ascertain the current severity of the Veteran’s PTSD. See Snuffer v. Gober, 10 Vet. App. 400 (1997). On remand, the RO should ensure that the VA examination to be obtained per this remand includes not only the Veteran’s psychiatric symptoms, but also their frequency, severity, and duration, so that the increased rating claim can be properly adjudicated. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 115 (2013). 2. Entitlement to an increased rating in excess of 30 percent for tinea versicolor, chest, back, and crotch, is remanded. In December 2017, the Board remanded the skin disorder claim to obtain a VA examination. The Board’s remand directive specifically instructed that the examining facility should communicate with the Veteran as necessary to maximize the likelihood of performing an examination during the skin condition’s active stage. See December 2017 Board Remand. According to the Veteran’s Board Hearing testimony, the examination should have therefore been scheduled in the summer months when it is hot, as that is when the Veteran testified that his skin condition tends to flare up. See July 2017 Board Hearing Transcript, p. 15 (the Veteran stated that his skin flares up in extreme heat and that it always affects him in the summer months); id., p. 16 (the Veteran’s wife also stated at the hearing that the Veteran’s skin condition is worse during the summer months and that “it’s always flaring up” especially when it’s hot). However, the examination was conducted in the early spring and not in the summer months. Moreover, at the examination, the Veteran’s skin condition was asymptomatic, which made the skin condition unable to be assessed by the VA examiner. See April 2018 VA Skin Disability Benefits Questionnaire, in which the April 2018 VA examiner stated: Today’s exam the condition is asymptomatic. No evidence [of] any flare up. Current examination shows the condition is asymptomatic as the Veteran is not experiencing a flare. The day of the exam there was no active evidence. I will be speculating describing this condition at another time therefore. I am unable to provide the description of symptoms without mere speculation. . .. Unable to describe the area(s) of the body affected by the dermatitis, to include the percentage of the entire body affected, as well as the percentage of exposed area(s) affected as the condition is currently asymptomatic and there are no findings during examination. There is also no indication in the record that a summer scheduling of the examination was not possible. Even if it were not possible to schedule the examination during the summer months, the Board remand directed that in such a circumstance, the examiner’s report should have then include documentation of the Veteran’s symptoms based on his description of symptoms during an active stage; however, the April 2018 VA examiner failed to do this. The RO should have ensured that the steps delineated in the Board remand were taken. It was not. Thus, remand is warranted for compliance with the Board’s directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (the United States Court of Appeals for Veterans Claims (Court) held that a remand by the Board confers upon the Veteran or other claimant, as a matter of law, the right to compliance with the Board’s remand order). 3. Entitlement to a total disability rating based on TDIU is remanded. The claim for entitlement to a TDIU should also be remanded. A determination on the increased rating claims being remanded could significantly impact the outcome of the TDIU issue, and therefore, the issues are inextricably intertwined. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Obtain any outstanding relevant VA treatment records. 2. After completing the above action, schedule the Veteran for a VA examination to ascertain the nature and severity of his service-connected PTSD. The examiner should review the claims file. After examining the Veteran and conducting any studies and/or tests deemed necessary, the examiner should fully describe all symptomatology and functional deficits associated with this condition. This includes not just reporting the Veteran’s PTSD symptoms, but also the FREQUENCY, SEVERITY, AND DURATION, with which these symptoms occur. The examiner should also specifically consider the Veteran’s contentions expressed in his July 2018 Veteran’s Statement, which include the contention that he is experiencing increased symptoms, such as thoughts of hurting himself or others and hearing voices in his head. 3. Schedule a new VA examination with a new examiner to determine the severity of his service-connected skin disability. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. The examiner should report all signs and symptoms necessary for evaluating the Veteran’s service-connected skin disability under the rating criteria and those not contemplated under the rating criteria. In other words, the examiner should identify all symptoms associated with the skin disability and assess the severity of each of the symptoms associated with it. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. IF POSSIBLE, THE VA EXAMINATION SHOULD BE SCHEDULED DURING AN ACTIVE STAGE OF THE VETERAN’S SKIN DISABILITY. THE EXAMINING FACILITY SHOULD COMMUNICATE WITH THE VETERAN AS NECESSARY TO MAXIMIZE THE LIKELIHOOD OF PERFORMING AN EXAMINATION DURING AN ACTIVE STAGE. If it is not possible to schedule the Veteran for a VA examination during an active stage, the examiner’s report should include documentation of the Veteran’s symptoms based on his description of symptoms during an active stage. The examiner should describe the area(s) of the body affected by the dermatitis, to include the percentage of the entire body affected, as well as the percentage of exposed area(s) affected. The examiner should specifically note whether the Veteran has been prescribed any systemic therapy, such as corticosteroids or other immunosuppressive drugs, as well as the period prescribed during the prior twelve-month period. An April 2011 VA examination described periods of flare-up which is affected by severe itching. The examiner should also express an opinion concerning whether there would be additional functional impairment during flare-ups. If not feasible to do so to any degree of medical certainty without resort to speculation, then the examiner must provide an explanation for why this is the case. The examiner should also specify whether the Veteran has any functional impairment associated with his skin disability, to include any impact of the disability on the Veteran’s employment. The Veteran’s claims folder must be reviewed by the examiner in conjunction with the examination. A rationale for all opinions and a discussion of the facts and medical principles involved should be provided. 4. After completion of the above development, readjudicate the issues on appeal, including the Veteran’s claim for TDIU. If any benefit sought on appeal remains denied, a supplemental statement of the case must be provided to the Veteran and his representative. After the Veteran and his representative have had an adequate opportunity to respond, the entire appeal must be returned to the Board for appellate review. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. J. Cho, Associate Counsel