Citation Nr: 21062468 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 17-36 414 DATE: October 7, 2021 REMANDED Entitlement to service connection for a skin condition is remanded. Entitlement to service connection for a bilateral foot condition, claimed as hammer toes and feet smashed in basic training, is remanded. Entitlement to service connection for tophaceous gout with loss of appetite, loss of weight, and lack of sexual activities due to gout medication is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Marine Corps from December 1986 to November 1991, to include service in Southwest Asia. The Veteran died in October 2017 and the appellant is the Veteran's surviving spouse. The appellant has been accepted as a substitute claimant for purposes of processing the claims to completion pursuant to 38 U.S.C. § 5121A. See Appeal Substitution Review, received April 2018. This matter comes before the Board of Veterans Appeals (Board) on appeal from a September 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for a skin condition is remanded. 2. Entitlement to service connection for a bilateral foot condition, claimed as hammer toes and feet smashed in basic training, is remanded. 3. Entitlement to service connection for tophaceous gout with loss of appetite, loss of weight, and lack of sexual activities due to gout medication is remanded. The Board finds that additional development is needed prior to adjudication to the issues on appeal. The record shows the Veteran had been diagnosed with psoriasis and tophaceous gout. The record also reflects that the second toe of each foot deviated medially and overlapped the first toe, for which he seeks service connection. The Veteran asserted that his claimed disabilities were caused by his active duty service. He stated his skin condition was due to well fire exposure in Iraq and anti-gas pills and injections. He reported injuring his feet during basic training and attributed his gout and side-effects of gout treatment medication to service. The Veteran stated symptoms began within months of his honorable discharge from active duty service. See Form VA 21-4138 Statement in Support of Claim, received March 2016. There is insufficient evidence, however, for the Board to render a determination on his claims, as a VA opinion has not been obtained. VA has a duty to provide an examination or obtain a medical opinion on an issue of service connection when the record 1) contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, 2) indicates that the disability or signs and symptoms of a disability may be associated with active service, and 3) the record does not contain sufficient information to make a decision on the issue. 38 U.S.C. § 5103A(d) (West 2014); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The threshold for determining whether the evidence "indicates" that there "may" be a nexus between a current disability and an in-service event is a low one. McLendon, 20 Vet. App. at 83. As such, based on the record before the Board, a remand for VA opinion is necessary to determine the nature and etiology of the Veteran's skin condition, bilateral foot condition, and tophaceous gout. 4. Entitlement to a total disability rating based on individual unemployability is remanded. The issue of entitlement to TDIU must also be remanded as it is inextricably intertwined with the issues on appeal. In a March 2016 statement, the Veteran stated the symptoms of the above conditions made him unemployable. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are "inextricably intertwined" when the adjudication of one issue could have "significant impact" on the other issue). Therefore, the Board finds it necessary to remand this issue. The matters are REMANDED for the following action: Obtain a VA opinion to determine the nature and etiology of the Veteran's skin condition; bilateral foot condition, claimed as hammer toes and feet smashed in basic training; and tophaceous gout with loss of appetite, loss of weight, and lack of sexual activities due to gout medication. The examiner is requested to review all pertinent records associated with the claims file, including a copy of this remand, the Veteran's service treatment records, post-service medical records, and statements. It should be noted that the Veteran was competent to attest to factual matters of which he had first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran or the appellant, the examiner should provide a fully reasoned explanation. After specifically considering the Veteran's pertinent medical history and lay statements regarding his reported symptoms, the examiner should opine as to: Whether it is at least as likely as not (a 50 percent probability or greater) that his skin condition, bilateral foot condition, and tophaceous gout were incurred in, aggravated by, or etiologically related to his military service. The examiner should specifically consider and discuss the Veteran's contentions of in service onset for his bilateral foot condition, onset within a year of separation from service for his skin condition and gout, and the impact of the Veteran's gout medication. A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Javed, 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.