Citation Nr: 21005132 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 12-33 413 DATE: January 29, 2021 REMANDED Entitlement to service connection for a skin disability, to include shingles, to include as a residual of service-connected viral meningitis and recurrent cold sores is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from May 1953 to April 1955. The Veteran died in May 2018. In June 2018, the Appellant, as surviving spouse of the Veteran, became the substitute claimant. In February 2018, prior to his death, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.902 (c)(1). This appeal has been before the Board on several prior occasions, including when it was remanded in May 2017 in accordance with a February 2017 Memorandum Decision by the United States Court of Appeals for Veteran Claims (CAVC). Most recently, in June 2020, the appeal was remanded by the Board for an addendum opinion. Unfortunately, for the reasons described below, there has not been substantial compliance with the Board’s remand directives and another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for a skin disability, to include shingles, to include as a residual of service-connected viral meningitis and recurrent cold sores is remanded. The claim must be remanded because the September 2020 addendum opinion obtained after the June 2020 remand is inadequate. The Board remanded for a medical opinion to identify all skin disabilities diagnosed from August 2008 until the Veteran’s death and provide an etiology opinion for any identified conditions, with consideration of specific evidence identified by the Board. The September 2020 medical opinions are inadequate for several reasons. The opinion provider did not consider the Veteran’s lay testimony that he had recurrent shingles in service and until his death or the March 2018 private medical opinion. The examiner also impermissibly relied upon an absence of a record of treatment or complaints for a skin condition in service. The examiner also did not discuss the September 2019 VA opinion that referenced “acute” flares, although specifically instructed to do so. Further, the standard of aggravation considered in the opinion is incorrect. The correct legal standard applicable to aggravation here is any increase in disability. On remand, a new addendum opinion must be obtained. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician other than the September 2020 opinion provider. Copies of all pertinent records, including a copy of this remand, must be made available to the opinion provider for review. Based on the record, the examiner should answer the following: (a.) Identify all skin disabilities diagnosed from August 2008 until the Veteran’s death, to include the Veteran’s facial rash, lesions on his body, and whether there was a flare-up of his tinea corporis or shingles during this period. (b.) For each diagnosed skin condition, is it at least as likely as not (50 percent or greater probability) it is related to an in-service injury, event, or disease? (c.) For each diagnosed skin disability, is it at least as likely as not (50 percent or greater probability) it is: (i) proximately due to the Veteran’s service-connected viral meningitis and recurrent cold sores, or (ii) aggravated (defined as any increase in disability) his service-connected viral meningitis and recurrent cold sores? The examiner must consider and discuss the following: (i) the Veteran’s lay statements that he had recurrent shingles that began during service and had continued since, (ii) the March 2018 medical opinion by the Veteran’s private treatment provider, Dr. G.H., and (iii) the September 2019 VA medical opinion that referenced “acute” flare. All provided opinions must be supported by complete rationale that considers and discusses both the lay and medical evidence of record. If the opinion provider cannot provide a requested opinion without resort to speculation, they should say why. 2. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.D. Collins, 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.