Citation Nr: 18159793
Decision Date: 12/20/18	Archive Date: 12/19/18

DOCKET NO. 14-38 971A
DATE:	December 20, 2018
REMANDED
Entitlement to service connection for asthma is remanded.
Entitlement to an initial rating higher 10 percent for pseudofolliculitis barbae is remanded.
REASONS FOR REMAND
The Veteran served on active duty from August 1971 to September 1973. 
The Board regrets further delay, but additional development is necessary before adjudicating the claims. 
The Veteran contends that his asthma was aggravated while he was in the military. After review of the September 2009 VA examination report opinion and an addendum, the Board finds that an additional opinion is necessary, as the wrong standard of proof was used. Although a history of asthma was discussed upon the Veteran’s entrance into service, the entrance examination did not note an abnormality of the lungs or current asthma disability in the physical examination (versus a history), and therefore, the presumption of soundness applies. 
As to the claim for increase rating for pseudofolliculitis barbae, a November 2017 Disability Benefits Questionnaire (DBQ) reflects that the Veteran uses tretinoin, topical medications on constant or near constant bases to treat the condition.  A remand is necessary to clarify whether this cream can be considered as a systemic therapy.  See Burton v. Wilkie, CAVC 16-2037 (Sept 23, 2018).
The matters are REMANDED for the following action:
1. Schedule the Veteran for an examination regarding asthma. The examiner should review the claims file in its entirety and provide an opinion answering the following questions:
(a)	Did asthma clearly and unmistakably (that is, it is undebatable) pre-exist the Veteran’s service?  
(b)	If the answer to (a) is yes, it is undebatable that the asthma was not aggravated beyond its natural progression by service?
The examiner should note and comment on the Veteran’s lay statements regarding the impact of physical activity during service on asthma he discussed having prior to service and his treatment for respiratory infections during service.  
A complete rationale should be provided for all opinions. If an opinion cannot be provided without resorting to speculation, the examiners must explain why this is the case.
2. Schedule the Veteran for an appropriate examination to determine the current severity of the Veteran’s pseudofolliculitis barbae. The examiner should provide findings regarding all related symptoms and describe the severity of these symptoms. It is imperative that the record be made available to the examiner for review in connection with the examination. Any medically indicated tests should be accomplished. All findings should be described in detail.
The examiner should also answer the following questions:
How does tretinoin work to treat the Veteran’s pseudofolliculitis barbae, and is it “like” a corticosteroid or other immunosuppressive drug?
Does the tretinoin affect the body as a whole in the treatment of the Veteran’s pseudofolliculitis barbae? 
The examiner should note, for example, a treatment may be said to affect the body as a whole if it circulates through the bloodstream. 

 
Nathaniel J. Doan
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	S.SOLOMON