Citation Nr: 21002184 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 15-08 904 DATE: January 13, 2021 REMANDED Entitlement to an initial compensable rating for bilateral tinea pedis is remanded. Entitlement to an extra-schedular total disability evaluation based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from January 1974 to December 1975, and in the Marines from October 1983 to September 1997. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2017 Supplemental Statement of the Case (SSOC) which followed a March 2015 Statement of the Case (SOC), that is missing from the file, and which was followed by two more SSOC’s in April and October 2020. The Veteran testified before the undersigned Veterans Law Judge during a January 2018 videoconference hearing. A transcript of that hearing is of record. 1. Entitlement to an initial compensable rating for bilateral tinea pedis is remanded. The Veteran contends in his May 2017 Appeal to Board of Veterans’ Appeals (Form 9) that a higher evaluation of 10 percent for his tinea pedis is warranted since there is more than 20 percent of his entire body affected. The Veteran’s tinea pedis has been assigned a noncompensable (zero percent) rating under Diagnostic Code 7813-7806, indicating that dermatophytosis (tinea corporis, tinea capitis, tinea pedis, tinea barbae, tinea unguium, tinea cruris) (Diagnostic Code 7813) is rated under the criteria for dermatitis or eczema (Diagnostic Code 7806). The Veteran was service connected at 0 percent for tinea pedis by a September 1998 rating decision. Service connection was made effective the day after he exited active duty in October 1997 based on service medical records. The Board previously considered this appeal in July 2018 and remanded these issues for additional development in order to request Social Security Administration records and schedule VA examinations. After the development was completed, the case returned to the Board for further appellate review. During the appeal period, the Veteran had two VA examinations for his claimed skin condition. The Veteran had a VA examination in July 2019 and an earlier November 2015 VA tinea pedis examination that was not made part of the file until September 2020. According to the November 2015 VA examination, the Veteran's rash on feet started in 1983 and comes and goes. The Veteran says it is better now, worse with boots, and worse with summer. The rash has a positive itch. The Veteran uses ketoconazole powder and miconazole powder and hydrocortisone 15 cream on his feet. The claimed skin condition does not cause scarring or disfigurement of the head or face or neck. The Veteran does not have any benign or malignant skin neoplasm. the Veteran has no systemic manifestations due to any skin diseases such as fever or weight loss, or with skin conditions such as erythroderma. The Veteran has treated his feet with topical medications in the past 12 months. The total duration of the medication use in the past 12 months has been six weeks or more but not constant. The Veteran has been using ketoconazole and miconazole powders constantly or nearly constantly in the past 12 months. The Veteran has had no treatments or procedures other than systemic or topical medications in the past 12 months. The Veteran has had no debilitating episodes due to a skin condition in the past 12 months. The Veteran's visible skin condition has covered less than 5% of his total body area, and none of his exposed areas. The examiner also determined that none of the Veteran's skin conditions impact his ability to work. The July 2019 skin examination says the Veteran’s tinea pedis has been treated in the last 12 months with topical cream, ketoconazole, six weeks or more, but not constant. The Veteran has had no treatments or procedures other than systemic or topical medications in the past 12 months for any skin condition. Dermatophytosis has affected less than 5% of the Veteran's total body area and none of his exposed area. The Veteran has no benign or malignant neoplasm or metastases related to the diagnosis. The Veteran's skin condition causes no scarring or disfigurement of the head, face or neck. The skin condition is characterized as having scaly patches on both soles of his feet, with no interdigital maceration or drainage. The 2019 examiner also concluded that the Veteran's skin condition does not impact his ability to work. At the January 2018 Board hearing, the Veteran gave testimony about his skin conditions. He said that tinea not only affects his feet, but also his armpits and groin, “Once it’s on my arm, it lasts like three or four days to go away. When it’s on my groin, it could last two weeks. My feet, it lasts constantly, it’s there.” The Veteran also said that he uses the topical treatments on his armpits and groin every day, as a preventative measure, and he has to apply it from top to bottom in order not to spread it from his feet to the other areas. The Veteran said summers he has to wear sandals, because if he wears shoes or boots his feet are burning. None of Veteran’s statements about flare-ups of the groin were discussed or considered by either VA examination report. Additionally, during the examinations and treatment records, the Veteran has indicated that the condition flares-up in hot weather. As such, additional VA examination should be conducted during an active stage of infection that further discusses whether the condition of the groin or other areas of the body are related to the tinea pedis. See, e.g., Ardison v. Brown, 6 Vet. App. 405, 408-09 (1994) (where veteran’s flares last for weeks, VA must attempt to conduct adequate examination during flare to adequately determine extent of worsened condition, its duration, and its impact on employability) Entitlement to a total disability evaluation based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. The Veteran contends that his service-connected disabilities, which together have a combined disability rating of 50 percent as noted on his April 2020 rating decision make it impossible for him to get or maintain gainful employment. The record contains the following statements that describe the impact of the Veteran’s service-connected disabilities on his unemployability: The July 2019 VA skin examination says the Veteran's skin condition does not impact his ability to work. The Veteran's hemorrhoid condition does not impact his ability to work according to the VA hemorrhoid examination from July 2019. The Veteran said in his July 2019 VA hand and finger examination that because of his knees and his hands he applied for social security disability and could no longer work as a mailman - however, it was different parts of his hands - not his service connected conditions that were involved. In the work impact statement from July 2019’s knee and lower leg VA examination, the Veteran said stair climbing would be difficult as would prolonged walking and sitting – he would need to change positions due to his service-connected bilateral knee condition. In the Veteran’s July 2019 VA examination of his lower back he said, sometimes the pain is so bad he cannot go to work; he eventually retired. prolonged sitting or standing would need change of position due to service-connected lumbosacral strain and degenerative arthritis of the spine. In his July 2019 VA shoulder exam, the Veteran said he cannot perform overhead activities due to his service-connected residuals of right-side glenoid fossa fracture of the shoulder. At the Veteran’s January 2018 Board hearing testimony, the Veteran says, “I was working when I retired from the Marine Corps, but the pain in my hands, the pain in my knees is just –I couldn’t take it no more.” Because the Veteran is ineligible for schedular consideration for TDIU due to his combined 50 percent disability rating and because of the entries of record above, the Board refers the Veteran’s claim for TDIU to VA’s Director of Compensation Service for extraschedular consideration. Based on its review of the evidence, the Board finds that referral of the Veteran's claim to the Director of Compensation and Pension (C&P) Service for an extra-schedular evaluation is warranted. The evidence on file seems to be in equipoise as to whether the Veteran's service-connected disabilities make him unable to obtain and secure substantial and gainful employment. The matters are REMANDED for the following action: 1. Refer the Veteran’s claim for TDIU to VA’s Director of Compensation Service for extraschedular consideration. 2. Associate any outstanding VA treatment records with the electronic claims file. 3. Schedule the Veteran for an examination by an appropriate clinician, to determine the current severity of his service-connected skin disability on his feet and groin. If practically workable, the VA examination should be scheduled during a recurrence of active infection (during hot weather). The examiner must have the appropriate expertise and be provided access to the electronic claims file. The examiner must indicate review of the claims file in the examination report. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the disability under the rating criteria. The examiner must provide an opinion as to whether the skin condition of any other part of the body, including the groin, is the same condition or related to the service-connected tinea pedis. In doing so the examiner should discuss VA treatment records diagnosing tinea cruris and suggesting the conditions are related. The examiner must attempt to elicit information from the Veteran regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the Veteran’s skin disability alone and discuss the effect of the Veteran’s skin disability 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 based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment, to include percentage of total body area affected due to flare-ups based on the other evidence of record and the Veteran’s statements. A rationale is needed for any opinions expressed. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Black, 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.