Citation Nr: 18158027 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 16-56 060 DATE: December 14, 2018 REMANDED Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for carpal tunnel syndrome, right wrist, as secondary to service connected contact dermatitis/eczema is remanded. Entitlement to service connection for torn ligament, right wrist, as secondary to service connected contact dermatitis/eczema is remanded. Entitlement to service connection for ulnar cyst, right wrist, as secondary to service connected contact dermatitis/eczema is remanded. Entitlement to a rating in excess of 20 percent for contact dermatitis/eczema, right and left hands is remanded. Entitlement to a compensable rating for right hand scar is remanded. Entitlement to a compensable rating for left hand scar is remanded. Entitlement to a rating in excess of 10 percent for adjustment disorder with mixed anxiety and depressed mood is remanded. Entitlement to a total disability rating due to unemployability is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1975 to January 1978. This matter came before the Board of Veterans Appeals (Board) on appeal from a December 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for a low back disability is remanded. 2. Entitlement to service connection for carpal tunnel syndrome, right wrist, as secondary to service connected contact dermatitis/eczema is remanded. 3. Entitlement to service connection for torn ligament, right wrist, as secondary to service connected contact dermatitis/eczema is remanded. 4. Entitlement to service connection for ulnar cyst, right wrist, as secondary to service connected contact dermatitis/eczema is remanded. 5. Entitlement to a rating in excess of 20 percent for contact dermatitis/eczema, right and left hands is remanded. 6. Entitlement to a compensable rating for right hand scar is remanded. 7. Entitlement to a compensable rating for left hand scar is remanded. 8. Entitlement to a rating in excess of 10 percent for adjustment disorder with mixed anxiety and depressed mood is remanded. The Board also notes that the Veteran has not yet been provided a VA examination regarding his low back disability. July 2015 VA treatment records include a CT study that found degenerative changes in the spine and loss of vertebral body height. The Veteran submitted a September 2015 statement that he injured his back working in the auto shop, and December 1977 service treatment records note a back injury while working on a car. Remand for a VA examination is therefore required. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The Veteran was provided a November 2015 VA examination regarding carpal tunnel syndrome (CTS). The examiner declined to offer an opinion regarding etiology, stating that May 2015 VA treatment notes from an orthopedist stated that the CTS was of unclear etiology and she was required to defer to that provider. The examiner then opined that as the orthopedic specialist did not find a link between CTS and the Veteran’s skin disability, there was no clear etiology but not correlation between the skin disability and CTS. Upon review, the Board finds that the May 2015 treatment note cited by the examiner contains no indication that the orthopedist considered the Veteran’s skin disability and no statement that the CTS was not linked to the skin disability. The orthopedist noted the Veteran’s right wrist and hand pain and stated that it was not explained by tendonitis, arthritis or neuropathy, but made no reference to the Veteran’s dermatitis or his contention that the CTS is due to alterations in his fine motor movements required by the dermatitis. The Board therefore finds the November 2015 VA examination to be inadequate as it is based upon an inaccurate factual premise. A new examination and opinion—based on full review of the record and supported by stated rationale—is needed to fairly resolve the issue on appeal. See 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2017). The Veteran also contends that his right wrist ulnar cyst and ligament tear are due to his service-connected dermatitis, but he has not yet been afforded a VA examination regarding these disabilities. Remand for an examination regarding secondary service connection is therefore required. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The Board also notes that the October 2016 dermatology records note palmar dermatitis, but also note significant xerosis on the bilateral forearms. The most recent VA examination, in November 2015, noted xerotic eczema on the bilateral palms but did not note xerosis on the forearms. As the evidence of record suggests his service-connected disability has increased in severity since the most recent VA examination, the Board finds that the Veteran should be afforded a new examination. See Snuffer v. Gober, 10 Vet. App. 400 (1997). Finally, the Board notes that additional VA treatment records were associated with the file after the most recent SSOC of record. The Veteran has not waived AOJ consideration of this evidence and therefore, the issues should be readjudicated by the AOJ with consideration of this new evidence. 9. Entitlement to a total disability rating due to unemployability is remanded. The issue of entitlement to TDIU must also be remanded as it is inextricably intertwined with the remanded issues of increased ratings for the Veteran’s service-connected disabilities as well as with the remanded issues of service connection. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when the adjudication of one issue could have “significant impact” on the other issue). The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from October 2016 to the Present. 2. After the development above has been completed, schedule the Veteran for an appropriate VA examination, to determine the etiology of any current low back disability. The examiner should review the file and provide a complete rationale for all opinions expressed. For any current low back disability found to be diagnosed, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any such disability is related to the Veteran’s active service. In providing the opinion, the examiner should consider and discuss any lay statements of record, to include the Veteran’s statements regarding the onset and persistence of his symptoms. Attention is requested to December 1977 service treatment records regarding a back injury while working on a car. The examiner should also provide an opinion regarding the functional impact of any back disability found upon the Veteran’s ability to work. 3. After the development in (1) above has been completed, schedule the Veteran for an appropriate VA examination, to determine the etiology of any current right wrist disability, to include carpal tunnel syndrome, an ulnar cyst and a torn ligament. The examiner should review the file and provide a complete rationale for all opinions expressed. For any current right wrist disability found to be diagnosed, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any such disability is related to the Veteran’s service-connected dermatitis. In providing the opinion, the examiner should consider and discuss any lay statements of record, to include the Veteran’s statements regarding his alterations in fine motor movements due to his dermatitis. The examiner should also provide an opinion regarding the functional impact of any back disability found upon the Veteran’s ability to work. 4. After the development in (1) above has been completed, schedule the Veteran for an appropriate VA examination to determine the current level of severity of his contact dermatitis/eczema. The examiner should review the file and provide a complete rationale for all opinions expressed. The examiner should also provide an opinion regarding the functional impact of the Veteran’s dermatitis upon his ability to work. 5. If upon completion of the above action the appeal remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Arnold, Associate Counsel