Citation Nr: 21062844 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 20-27 308 DATE: October 12, 2021 REMANDED Entitlement to an initial compensable rating for service-connected actinic keratosis, basal cell skin cancer (hereinafter "skin condition") prior to October 16, 2017 is remanded. Entitlement to a rating higher than 10 percent for the service-connected skin condition from October 16, 2017 onward is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1964 to September 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran seeks an initial compensable rating for his service-connected skin condition and a rating higher than 10 percent from October 16, 2017 onward. Due to conflicting findings in the record and lack of otherwise sufficient competent medical evidence for the Board to decide the claim, remand is necessary to obtain a new VA examination and addendum medical opinion. There are two VA examinations associated with the claims file, dated May 2016 and October 2017. The May 2016 examiner determined that the Veteran's visible skin condition affected less than 5 percent of both his total body area and approximate total exposed body area (described as face, neck, and hands), but also noted that his actinic keratosis scales over his face, chest, scalp, and back, and noted in a separate section that he receives therapeutic treatment for his forearms. In contrast, the October 2017 examiner determined that the Veteran's visible skin condition affected approximately 10 percent of both his total body area and total exposed body area, noting that his actinic keratosis involves his scalp, face, neck, and hands. Based on the May 2016 and October 2017 examiners' significantly different approximations as to the Veteran's total body area and total exposed body area affected, despite similar notations as to the location of his actinic keratosis, the Board finds that an addendum medical opinion is warranted to reconcile these determinations. Additionally, the Veteran's representative has raised the issue of a retrospective opinion, and while he incorrectly stated that there was no skin examination prior to October 2017, the Board finds the argument sufficient to obtain an additional retrospective opinion, to the extent possible, to determine the severity of the Veteran's skin condition prior to May 2016. As the Veteran's most recent VA examination was in October 2017, over four years ago, the Board finds that a new VA examination is also warranted to assess the current severity of his skin condition. Separately, the Board notes that the Veteran's representative raised the issue of entitlement to an extraschedular rating based on periods of increased disfigurement resulting from treatment for the Veteran's skin condition. See June 2017 Notice of Disagreement; June 2020 VA Form 9. Upon remand, the RO should determine whether referral to the Director, Compensation and Pension Service is warranted for extraschedular consideration. Since it is necessary to remand this matter for a new examination and addendum opinion, the Board will also provide the Veteran with another opportunity to complete VA Form 21-4142 and authorize VA to obtain pertinent private treatment records documenting treatment of his skin condition since September 2014. Of note, one of the Veteran's providers, Dr. R.H., reported that the Veteran receives/received dermatologic treatment in New Jersey in a June 2015 correspondence, as well as treatment from his office. See June 2015 Correspondence. Another provider, Dr. B.D., also reported that he had treated the Veteran. See July 2015 Correspondence. However, there are no treatment records from Dr. R.H., Dr. B.D., or any New Jersey provider associated with the claims file. The RO sent letters to the Veteran in January 2016 and September 2017 requesting authorization needed to obtain any relevant records, but, to this date, the Veteran has not responded. Because it appears that the Veteran has not received any treatment at VA, there is very little evidence documenting the severity of his skin condition and/or various treatments he has received for this condition. As discussed in Wood v. Derwinski, 1 Vet. App. 190, 193 (1991), "[t]he duty to assist is not always a one-way street" and if the Veteran desires help with his claim, he must cooperate with VA's efforts to assist him. To the extent that the evidence of record is incomplete following return from this remand, that is a direct result of the Veteran's failure to cooperate. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records from September 2014 to the present (should they exist). If VA treatment records do not exist, make note of such in the claims file. 2. Send the Veteran VA Form 21-4142 and specifically request that he authorize VA to obtain his private treatment records from Dr. R.H., Dr. B.D., and his New Jersey dermatologist, as well as records from any additional medical providers that he identifies. 3. DO NOT SCHEDULE THE FOLLOWING until the above private records are obtained to the extent possible. 4. Schedule the Veteran for a VA examination to assess the current severity of his skin condition. The examiner should review the full claims file, including any newly associated treatment records, and continue with the following: (a.) Elicit from the Veteran a complete and detailed history of his skin condition since the effective date of service connection (September 2014 onward), both in general and as to the frequency and duration of any treatment he has received. (b.) To the extent possible, reconcile the conflicting determinations as to the approximate percentage of total body area and total exposed body area affected noted in the May 2016 and October 2017 examination reports. If these determinations do not need to be reconciled (e.g. the conflicting determinations were both accurate despite the similar notations as to areas affected), please clearly explain why. (Continued on the next page) (c.) To the extent possible, provide a retrospective opinion as to the severity of the Veteran's skin condition prior to May 2016 (if the May 2016 determination is deemed accurate) or prior to October 2017 (if the May 2016 determination is not deemed accurate). If it is not possible to provide a retrospective opinion, please clearly explain why. 5. Review and consider all information; then, determine whether referral to the Director, Compensation and Pension Service is warranted for extraschedular consideration. MICHELLE L. KANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Tierno 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.