Citation Nr: 19166808 Decision Date: 08/28/19 Archive Date: 08/28/19 DOCKET NO. 14-23 532 DATE: August 28, 2019 REMANDED Entitlement to an initial disability rating greater than 10 percent for skin disability is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1955 to October 1957. This case is before the Board of Veterans’ Appeals (Board) on appeal from a December 2012 rating decision (with notice in January 2013) by a Regional Office (RO) of the Department of Veterans Affairs (VA), which granted service connection for skin disability and assigned an initial disability rating. This appeal stems from an application to reopen a previously denied claim for service connection for skin disability, which was received by VA in October 2006, and the Board had reopened the claim for service connection in May 2012. The Veteran was afforded a Board hearing in April 2017 before the undersigned Veterans Law Judge. A copy of the hearing transcript is associated with the Veteran’s claims file. In August 2017 and March 2018, the Board remanded the claim for further development, and the case is again before the Board for further appellate proceedings. This appeal has been advanced on the Board’s docket pursuant to 38C.F.R. §20.900(c) (2017). 38U.S.C. §7107(a)(2) (2012). The appeal is REMANDED to the Agency of Original Jurisdiction (AOJ).VA will notify the appellant if further action is required. Entitlement to an initial disability rating greater than 10 percent for skin disability is remanded. During the most recent remand in March 2018, the Board directed the RO to obtain an addendum VA medical opinion to determine the area of the body affected by the skin disability during active periods; to determine the frequency and duration during the appeal period in which the Veteran was being treated with oral medications; and, to determine which of the Veteran’s reported symptoms, if any, may be attributed to his fever. The Veteran was afforded an addendum medical opinion in October 2018. In response to the first question relating to the area of the body affected by the skin disability, the examiner repeated the findings of the November 30, 2017 VA examination and stated that the Veteran had already been service connected for a skin condition. With regards to the second question which asked the examiner to determine the frequency and duration during the appeal period in which the Veteran was being treated with oral medications, the examiner indicated that the period on appeal was unclear, even though the Board had provided the period on appeal in the March 2018 remand directives. The examiner also stated that the claimant’s “recurrent urticarial/eczema skin lesions are intermittent, chronically and constantly medically treated, indicating worsening of skin condition.” However, the examiner did not provide information regarding the frequency and duration with which the Veteran was being treated with oral medications. With regards to the third question, which asked the examiner to determine which of the Veteran’s reported symptoms, if any, may be attributed to his fever, the examiner indicated that she was unable to solve this issue without resorting to mere speculation. She also stated that “none of the dermatologists that have seen this claimant throughout the years, have assessed the etiology of claimant's rash associated with fever. An infection has not been diagnosed as etiology of claimant's chronic rash.” Generally, a medical opinion that states that an opinion cannot be provided without resorting to mere speculation is inadequate. The examiner was asked to provide her own opinion rather than summarize the opinions of physicians who had examined the Veteran. Jones v. Shinseki, 23 Vet. App. 382, 390-91 (2010). If the examiner, a general practitioner, lacked the knowledge or expertise to provide the requested opinion, she should have scheduled the Veteran for a new VA examination by a more specialized physician. The Board specifically indicated in its March 2018 remand that if the examiner believed that an additional examination is necessary, then the Veteran should be scheduled for such an examination. Therefore, not only is this medical opinion inadequate, it also fails to comply with the Board’s remand directives. A previous remand confers on the claimant, as a matter of law, the right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268 (1998). As the October 2018 examiner’s medical opinions failed to comply the remand directives, in particular pertaining to the requested addendum medical opinion, a remand is warranted to new medical opinions. The matters are REMANDED for the following action: (Please note, this appeal has been advanced on the Board’s docket pursuant to 38C.F.R. §20.900(c). Expedited handling is requested.) 1. Schedule the Veteran for a new VA examination by a qualified dermatologist who has not previously examined the Veteran to determine the nature and severity of the Veteran’s skin disability. To the extent possible, such examination should be conducted at a time that the Veteran is experiencing a flare-up of his skin disability. Make the claims file available to the examiner for review of the case. The examiner should also provide a VA medical opinion to address the nature, severity, and all symptoms of the Veteran’s skin disability at all times during the entire appeal period (October 2006 to present). In so doing, please specifically address the following: a) Comment on the approximate percentage of the entire body, and the percentage of exposed areas, affected by the skin disability at any point during the entire appeal period (October 2006 to present), specifically to include when the skin disability is active. The examiner’s attention is specifically invited to the photographs submitted in March 2011 and in August 2017, as well as the Veteran’s competent lay statements regarding affected areas. b) Comment on the time period and frequency of any oral or systemic therapy for treatment of skin symptoms at any point during the entire appeal period (October 2006 to present). For instance, the VA examiner’s attention is invited to the following: The VA dermatology treatment records dating in July 2013 noted that the Veteran is prescribed ivermectin and Zyrtec; a May 2013 VA dermatology note, in which the Veteran is noted as being changed from oral antihistaminesto Zyrtec; the January 2013 VA dermatology note which noted that the Veteran has taken 2 tabs of ivermectin thus far; the June 2014 Form 9, in which the Veteran reported that he takes pills to treat his skin disability. c) Comment on the Veteran’s symptoms that are attributable to the Veteran’s fever associated with the skin disability. For instance, the VA examiner’s attention is invited to the Veteran’s report in the August 2017 Board hearing that when he gets a fever, he “gets the chills.” For purposes of the above opinions, the examiner’s attention is invited to the following evidence: (i) The Veteran’s statements throughout the appeal period (October 2006 to present) that his skin disability affects his entire body, to include his face. For instance, ina January 2007 RO hearing, the Veteran stated that his skin condition has been the same since service. He testified that he has big blotches of skin rash, redness, and bumps all over his body. (ii) The August 2017 Board hearing testimony that his skin disability affects his butt, back, arms, shoulders. (iii) The June 2012 VA examination, in which the Veteran reported that he gets blotches on his face and abdomen, and the examiner noted rash on the right flank with itching and burning. (iv) The October 2009 VA primary care note, showing that the Veteran presented with skin complaints. On examination, the Veteran was noted as having fine macular rash, lesion in hip flexural areas, but not intertriginous. It is noted that he has redden macules that are intensely pruritic and primarily truckal. It is noted that the rash is becoming less responsive to topical triamcinolone. The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. 3.Thereafter, complete any other development deemed warranted by AOJ. Then, readjudicate the claim on appeal, and furnish the Veteran and his representative a supplemental statement of the case if a matter is not resolved to the Veteran’s satisfaction. Provide an opportunity to respond before the claim is returned to the Board. Michael A. Pappas Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. White, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.