Citation Nr: 20003606 Decision Date: 01/15/20 Archive Date: 01/15/20 DOCKET NO. 17-50 431 DATE: January 15, 2020 REMANDED Entitlement to service connection for vaginal psoriasis, to include as secondary to service-connected vaginitis, is remanded. Entitlement to an initial compensable rating for service-connected vaginitis is remanded. Entitlement to special monthly compensation (SMC) for loss of use of a creative organ is remanded. REASONS FOR REMAND The Veteran had active service from September 1988 to July 1994. These matters come before the Board of Veterans’ Appeals (Board) from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The Board must consider entitlement to SMC when raised by the record. See Akles v. Derwinski, 1 Vet. App. 118 (1991). In November 2019, the Veteran raised the issue of entitlement to SMC based on loss of use of a creative organ in the context of her request for a compensable rating for vaginitis. As a result, the Board has added entitlement to SMC as an issue on appeal. 1. Entitlement to service connection for vaginal psoriasis, to include as secondary to service-connected vaginitis, is remanded. The Veteran seeks service connection for vaginal psoriasis, to include as secondary to her service-connected vaginitis. According to a DBQ and correspondence from the Veteran’s private provider, the Veteran was diagnosed with psoriasis in February 2007, which is a condition that cannot be fully cured. He indicated that psoriasis was not diagnosed until after the Veteran was treated for vulvovaginal candidiasis and thus, he found it very possible that the vaginal psoriasis occurred in response to vaginitis. Unfortunately, the language of the opinion, which notes a “possible” nexus between vaginal psoriasis and the service-connected vaginitis speculative in nature. Therefore, on remand, an opinion must be obtained addressing whether the Veteran’s vaginal psoriasis related to service or is otherwise due to or has been aggravated by her service-connected vaginitis. The Board notes that causation and aggravation are independent concepts and should have separate findings and rationales. See Atencio v. O’Rourke, 30 Vet. App. 74 (2018). As such, the examiner must provide separate findings and rationales relating to causation and aggravation. 2. Entitlement to an initial compensable rating for vaginitis is remanded. The Veteran seeks an initial compensable rating for her service-connected vaginitis, which has been rated under 38 C.F.R. § 4.116, Diagnostic Code 7699-7611, using the General Rating Formula for Disease, Injury, or Adhesions of Female Reproductive Organs. For a compensable 10 percent rating, the evidence must show symptoms that require continuous treatment. For a 30 percent rating, the evidence must show symptoms that are not controlled by continuous treatment. In November 2019, the Veteran submitted a disability benefit questionnaire (DBQ) from a private provider, which documents her report of using steroid cream for her chronic vulvovaginitis and vulvar psoriasis. The provider also noted the Veteran used a topical steroid for itching as needed. While the Veteran reported using these medications, it is unclear from the record when she started using them. It is also unclear whether her symptoms have required continuous treatment at any time during the pendency of the claim, and if so, whether the treatment has controlled her symptoms. Notably, the Veteran did not report using medications during the March 2016 VA examination and available treatment records do not indicate prescription of such medications. Accordingly, a remand is necessary to schedule a VA examination to determine the current severity of the Veteran’s vaginitis. The examiner should be asked to determine whether the Veteran has had symptoms requiring continuous treatment at any time during the pendency of the claim and if so, whether her symptoms have been controlled by such treatment. 3. Entitlement to SMC for loss of use of a creative organ is remanded. In November 2019, the Veteran raised the issue of entitlement to SMC for loss of use of a creative organ. Loss of use of a creative organ is “shown by acquired absence of one or both testicles (other than undescended testicles) or ovaries or other creative organ.” 38 C.F.R. § 3.350(a)(1). On remand, an examination and opinion must be obtained addressing whether the Veteran’s service-connected vaginitis constitutes loss of use of a creative organ. The matters are REMANDED for the following actions: 1. Obtain updated VA treatment records, if any, and allow the Veteran the opportunity to submit any outstanding private treatment records. 2. After receipt of any outstanding records, schedule the Veteran for an examination to determine the nature and etiology of her vaginal psoriasis as well as the current severity of her vaginitis. The examiner must be provided access to the electronic claims file and he or she must indicate review of the claims file in the examination report. All necessary testing and all symptoms related to both conditions must be documented in detail. (a) Regarding vaginal psoriasis, the examiner must provide opinions indicating whether the Veteran’s vaginal psoriasis is at least as likely as not (50 percent or greater probability) (i) related to service, (ii) due to her service-connected vaginitis, or (iii) has been aggravated by her service-connected vaginitis. Separate opinions with supporting rationale must be provided for each request. In rendering the opinions, the examiner must address the November 2019 correspondence from Dr. C.B. indicating that psoriasis is a chronic condition and can never be fully cured and that the Veteran’s psoriasis very possibly occurred in response to vaginitis. (b) Regarding vaginitis, the examiner is asked to review the claims file and indicate whether the Veteran has required continuous treatment of her vaginitis for any period since January 2016. If so, the examiner should indicate the dates of such treatment and whether her symptoms were controlled with treatment. In making these findings, the examiner should consider the Veteran’s lay statements reporting use of topical creams as documented in the November 2019 DBQ. (c) The examiner should also provide an opinion indicating whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s service-connected vaginitis, to include any medications prescribed to treat vaginitis, constitutes or causes loss of use of a creative organ. If the examiner finds that vaginal psoriasis is related to service or the service-connected vaginitis, the examiner must also consider this condition when providing the opinion. The examiner must support the opinion with rationale. (Continued on the next page)   3. Then, readjudicate the Veteran’s claims on appeal. If the benefits sought on appeal remain denied, provide the Veteran and his representative a supplemental statement of the case and allow an appropriate period for response. L. CHU Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Amanda G. Alderman 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.