Citation Nr: 21002940 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 10-40 314 DATE: January 19, 2021 REMANDED Entitlement to service connection for a bilateral foot disorder (claimed as flat feet and bunions) is remanded. Entitlement to an initial evaluation in excess of 30 percent for pseudofolliculitis barbae is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1973 to January 1975. This case comes before the Board of Veterans’ Appeals (Board) from July 2009 and April 2018 rating decisions by the Department of Veterans Affairs (VA). A hearing was held before a hearing officer of the agency of original jurisdiction (AOJ) in June 2010 for the claims on appeal at that time, including the bilateral foot disorder claim. A transcript of the hearing is of record. The Veteran also requested a hearing before the Board in his September 2010 substantive appeal; however, he cancelled that request in an April 2011 telephone call with the AOJ and has not since requested a hearing. See also February 2018 Board decision (outlining hearing request history). Thus, his hearing request is considered withdrawn. In February 2018, December 2018, and August 2020 decisions, the Board addressed other claims that were on appeal and remanded one or both of the above claims for further development. These issues have now returned to the Board for appellate review. In a January 2020 rating decision, the AOJ increased the evaluation for pseudofolliculitis barbae to 30 percent (now evaluated under Diagnostic Code 7806) effective from the date of service connection. Because that evaluation does not represent the highest possible benefit, the issue remains in appellate status as stated above. AB v. Brown, 6 Vet. App. 35 (1993). On review, the Board finds that additional development is necessary prior to final adjudication of the Veteran’s claims. Regarding the bilateral foot disorder claim, the Board requested an additional VA medical opinion in the 2020 remand to consider the complete history of the development of the Veteran’s foot problems, including his contentions, as well as all of the current diagnoses. The August 2020 VA examiner determined that the Veteran’s bilateral foot disorders (hallux valgus (bunions) and hammertoes) were not related to any in-service injury, event, condition, disease, or exposure. In so finding, he indicated that combat boots do not cause the disorders because they are specifically designed to protect the feet and minimize the occurrence of lower extremity injury or pain. The examiner did not address all current diagnoses, and he did not provide an opinion considering the Veteran’s reported in-service foot pain. Based on the foregoing, an additional VA medical opinion is needed. Regarding the pseudofolliculitis barbae claim, the Board requested an updated VA examination. The record shows that the AOJ ordered the examination. The VA examiner opted to provide an August 2020 medical opinion based on review of recent VA treatment records without a contemporaneous examination; however, the opinion does not provide all of the findings necessary to rate the disability based on Diagnostic Code 7806 or the alternative criteria for scars if found to be the predominant disability. In this regard, the Veteran’s representative suggested that the pseudofolliculitis barbae had increased in severity in the February 2020 substantive appeal, inasmuch as the Veteran reported that it was spreading around to the back of his neck. A March 2020 VA treatment record shows that the Veteran reported intermittent bumps on his scalp and beard, and the treatment provider listed multiple diagnoses for these problems (acne keloidalis nuchae on occipital scalp, irritant folliculitis on frontal scalp, and inactive pseudofolliculitis barbae in the beard area). In an August 2020 VA treatment record, another treatment provider noted the same complaints from the Veteran referable to the scalp and beard and only provided a pseudofolliculitis barbae diagnosis – suggesting that the pseudofolliculitis barbae may not be limited to the beard area, but extending to other parts of the head. The findings in the most recent VA examination in February 2018 are limited to the beard area. The August 2020 VA examiner determined that there were no scars present in the beard area based on those VA treatment records, but it does not appear that the treatment records provide enough information to make that determination. Based on the foregoing, the Veteran should be scheduled for this examination. The case is REMANDED for the following actions: 1. Refer the Veteran’s claims file to a suitably qualified VA examiner for a clarifying opinion as to the nature and etiology of any current left and/or right foot disorder that may be present. An additional examination of the Veteran should only be performed if deemed necessary by the individual providing the opinion. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment and personnel records, post-service medical records, and statements. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. Prior diagnoses included bilateral foot degenerative joint disease with flat feet, hallux valgus and hammertoes. For each diagnosis identified, the examiner should state whether it is at least as likely as not that the disorder manifested in or is otherwise related to the Veteran’s military service, including any symptomatology or circumstances therein. In providing this opinion, the examiner should address: (1) The Veteran’s contention that he first had foot problems in service as the result of ill-fitting steel toed boots, walking on steel decks, and using steel ladders in performing shipboard duties. See, e.g., January 2010 VA treatment record and June 2010 hearing transcript (including reports of in-service foot pain). The post-service evidence shows that the Veteran worked in various jobs for several years after service (machinist on a submarine, then working in a cemetery, warehouse, and hotel) before beginning his VA hospital janitorial job that he has worked at for many years. See, e.g., October 1979 VA general medical examination report and July 2019 VA mental health examination report; August 2006 private treatment record. (2) In providing this opinion, the examiner should discuss medically known or theoretical causes of any currently diagnosed disorder and describe how such a disorder generally presents or develops in most cases, in determining the likelihood that the current disorder is related to in-service events as opposed to some other cause. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 2. Schedule the Veteran for VA examination to ascertain the current severity and manifestations of his service-connected pseudofolliculitis barbae. Any studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file. The examiner should report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. In particular, he or she should specify the location and extent of the disability in terms of percentage of the body affected; percentage of exposed areas affected; the frequency that systemic therapy has been required during the past 12 months; and, whether there are any resulting scars, providing a description of the scars under the rating criteria. Any medications used to treat the disease should be identified. The examiner should also address whether any symptomatology on the Veteran’s head and neck other than in the beard area is a manifestation of his pseudofolliculitis barbae, as opposed to a nonservice-connected skin disorder, or whether it is not possible to make this distinction. See, e.g., March 2020 and August 2020 VA treatment records; February 2020 substantive appeal (Veteran reported skin disability was spreading around to back of his neck). A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Postek, 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.