Citation Nr: 18100716 Decision Date: 04/19/18 Archive Date: 04/19/18 DOCKET NO. 14-35 835 DATE: April 19, 2018 ISSUES DECIDED: 0 ISSUES REMANDED: 3 REMANDED ISSUES Chronic rhinitis, status post rhinoplasty; right foot keratoderma; and status post basal cell carcinoma are remanded for additional development. The Veteran served on active duty from May 1989 to May 1994 and from August 2005 to August 2009. During the latter period of service, the Veteran served as a neurosurgeon in Afghanistan. The Veteran was granted service connection for chronic rhinitis, right foot keratoderma and status post basal cell carcinoma in July 2011. A non-compensable rating (0 percent) was assigned for each of these conditions. The Veteran timely appealed the initial ratings assigned. While the record contains a March 2011 VA examination that provided a nexus opinion regarding the Veteran’s chronic rhinitis, right foot keratoderma and status post basal cell carcinoma, the examination does not address the severity of these conditions for rating purposes. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of his chronic rhinitis, right foot keratoderma and status post basal cell carcinoma. With regard to the Veteran’s chronic rhinitis, the 2011 VA examiner opined that the Veteran has 20 percent left nasal obstruction and 10 percent right nasal obstruction, with no polyps, no septal deviation, and no permanent hypertrophy. The Veteran, on the other hand, reports complete nasal obstruction in his Notice of Disagreement (NOD). These differing opinions are to be addressed by the new examiner. With regards to the Veteran’s right foot keratoderma, both the 2011 VA examiner and the Veteran indicate different topical medications have been used for the severe keratoderma on the Veteran’s right foot, with little relief noted. However, it is not known, for rating purposes, whether any of these medications are a corticosteroid or other immunosuppressive drug, or the period of time for which these medications were required. In addition, the Veteran noted in his NOD that he has pain and limited motion or function in his right foot. These matters are to be addressed by the new examiner. Lastly, as it relates to the Veteran’s status post basal cell carcinoma, the 2011 VA examiner noted the Veteran had numerous, well-healed post skin lesion excision scars on his chest, shoulder, and scapular areas; and, that there were no overt active suspicions of basal cell carcinoma lesions at the time. However, in his NOD, the Veteran contends that he also has scars on his face; has had at least 2 recurrences that required re-excision; and, that he has a depressed surface contour (scar) on his neck/shoulder from an excision that is painful on a daily basis. These matters are to be addressed by the new examiner. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected chronic rhinitis, status post rhinoplasty. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected right foot keratoderma. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected status post basal cell carcinoma. 4. For each of the examinations above, the examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. The examiner for the keratoderma should specifically indicate whether treatment for the disorder involves corticosteroids or other immunosuppressive drugs and if so, whether such treatment is topical or systemic in nature. To the extent possible, the examiner should identify any symptoms and functional impairments due to chronic rhinitis, right foot keratoderma and status post basal cell carcinoma, and discuss the effect of these conditions on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training).   5. Following the completion of the foregoing, and after undertaking any other development deemed necessary, re-adjudicate the Veteran’s claim. If any benefit remains denied, provide the Veteran with a supplemental statement of the case and allow an appropriate period of time for response. Thereafter, return the case to the Board. Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Jiggetts, Associate Counsel