Citation Nr: 21066249 Decision Date: 10/29/21 Archive Date: 10/29/21 DOCKET NO. 20-26 045 DATE: October 29, 2021 ORDER The petition to reopen a claim for service connection for dermatitis, claimed as undiagnosed skin condition is granted. Entitlement to an initial rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is granted. REMANDED Entitlement to service connection for dermatitis, claimed as undiagnosed skin condition is remanded. FINDINGS OF FACT 1. The claim for entitlement to service connection for a skin condition was initially denied in December 1981. The Veteran was notified of the decision, but did not appeal, thus it became a final decision. 2. Evidence received since the December 1981 notification relates to a previously unestablished fact necessary to substantiate the claim for entitlement to service connection for a skin disability. 3. The Veteran's PTSD has been productive of occupational and social impairment with deficiencies in most areas, such as work, family relations, judgment, thinking, and mood; however, total occupational and social impairment has not been shown. CONCLUSIONS OF LAW 1. New and material evidence to reopen the claim for service connection dermatitis, claimed as undiagnosed skin condition has been received. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a)(2020). 2. The criteria for a rating in excess of a 70 percent rating for PTSD have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.10, 4.130, Diagnostic Code (DC) 9411(2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1965 to August 1968. The Veteran initially requested a hearing before a Veterans Law Judge in his substantive appeal. See May 2020 VA Form 9. However, the Veteran's representative submitted correspondence withdrawing his request for a hearing and requesting a 90-day extension until October 14, 2021 to submit additional evidence, stating "[p]lease issue a stay . . . until such time as this office can gather and submit additional materials . . . . PROVIDED THAT SUCH MATERIALS WILL NOT BE SUBMITTED MORE THAN 90 DAYS AFTER THE DATE OF MAILING OF THIS LETTER." See July 16, 2021 Correspondence. Accordingly, in interpreting the representatives request, the Board of Veterans' Appeals (Board) held the record open for the requested 90 days not to surpass 90 days of the date of the representative's letter. Given such, the extension period has elapsed. Thus, the Board may proceed in adjudication of the issues on appeal without prejudice to the Veteran. The Board has characterized the Veteran's claim for dermatitis, claimed as an undiagnosed skin condition as one for reopening the claim for entitlement to service connection for a skin disability. The Veteran initially filed a claim for service connection for feet fungus in September 1981. The claim was subsequently denied and became final as discussed further below. However, in order to establish its jurisdiction to review the merits of the previously denied claim, the Board must find new and material evidence has been submitted to reopen the claim. See Barnett v. Brown, 83 F. 3d 1380, 1383 (Fed. Cir. 2001) (the Board is under the statutory obligation to conduct a de novo review of the new and material issue). Thus, the title page includes the issue of whether new and material evidence has been presented to reopen the claim for service connection for a skin condition. 1. The petition to reopen a claim for skin condition Generally, a claim that has been denied in a final unappealed decision may not thereafter be reopened and allowed. An exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, VA shall reopen the claim and review the former disposition of the claim. New and material evidence is defined as evidence not previously submitted to agency decision makers that bears directly and substantially upon the specific matter under consideration; such new and material evidence can neither be cumulative nor redundant of the evidence previously of record, and must raise a reasonable possibility of substantiating the claim. 38 U.S.C. § 3.156(a); Hickson v. Shinseki, 23 Vet. App. 394, 398 (2010). The Board will generally presume the credibility of the newly submitted evidence for determining whether new and material evidence has been presented. Duran v. Brown, 7 Vet. App. 216, 220 (1994). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is "low." Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). In deciding whether new and material evidence has been submitted, the Board looks at the evidence submitted since the last final denial of the claim on any basis. Hickson v. West, 12 Vet. App. 247, 251 (1999). The petition to reopen the claim for entitlement to service connection for a skin disability is granted. Here, the claim for entitlement to service connection for was denied in the December 1981 notification letter because the Veteran failed to attend a scheduled examination. The Veteran was notified but did not appeal the decision, thus it became a final decision. See 38 U.S.C. §§ 7105, 38 C.F.R. § 20.1103. At the time of the last final decision, the December 1981 notification letter, the evidence of record included: an August 1978 VA Form 10-19, Medical Certificate and History and a November 1981 Request for Physical Examination, which indicated that the Veteran failed to report to the scheduled examination. As such, a current disability, in-service occurrence, and nexus was not established. The evidence received since the December 1981 notification letter, includes the Veteran's service treatment records (STRs), his service personnel records, and VA treatment records from July 2011 to November 2012. Notably, a July 2011 VA dermatology record noted the Veteran reported his skin rash has been present since Vietnam, and the Veteran was assessed with likely seborrheic dermatitis. See July 2011 VA Dermatology Consult in CAPRI received February 2017. The Board finds that the evidence is new as it was not previously before the agency and it is relevant because it relates to the issues of a current disability and in-service occurrence, both of which are unestablished facts. Accordingly, the Veteran's claim for a skin is reopened based on new and material evidence. 2. Entitlement to an initial rating in excess of 50 percent for posttraumatic stress disorder The Veteran seeks a higher initial rating than the currently assigned 50 percent rating for his service-connected PTSD. See March 2017 Notice of Disagreement (NOD). Legal criteria The Veteran is seeking an initial rating in excess of 50 percent for the PTSD disability, rated under DC 9411, 38C.F.R. §4.130. The Veteran has been rated at 50 percent, effective from September 28, 2016, the date he was granted service connection. Therefore, the relevant temporal focus for PTSD is from the date of receipt of the claim, thus from September 28, 2016. 38 C.F.R. § 3.400. VA regulations employ a "General Rating Formula for Mental Disorders," such as PTSD with compensable ratings of 10 percent, 30 percent, 50 percent, 70 percent, and 100 percent. 38 C.F.R. § 4.130. The criteria for a 50 percent rating requires occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. See 38 C.F.R. § 4.130, DC 9400, General Rating Formula for Mental Disorders. A 70 percent rating is warranted where the veteran exhibits occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. Id. A total schedular rating of 100 percent is warranted when the disorder results in total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of mental and personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. Assessing whether a particular rating is warranted "requires a two-part analysis." Emerson v. McDonald, 28 Vet. App. 200, 212 (2016). It requires an "initial assessment of the symptoms displayed by the veteran, and if they are of the kind enumerated in the regulation, [and] an assessment of [the extent] those symptoms result in occupational and social impairment []." Id. More generally, the rating analysis for psychiatric disorders is symptom driven. Golden v. Shulkin, 29 Vet. App. 221, 225 (2018); Vazquez-Claudio, Shinseki, 713 F.3d 112, 116 (Fed. Cir. 2013) ("The regulation's plain language highlights its symptom-driven nature."). The symptoms listed do not form an exhaustive list but rather serve as examples of the type and degree of symptoms that would justify the associated rating. See Bankhead v. Shulkin, 29 Vet. App. 10, 1819 (2017). And the "'frequency, severity, and duration' of a veteran's symptoms must play an important role in determining his disability level." Vazquez-Claudio, 713 F.3d at 117. Factual Background The Veteran was provided a VA examination in connection with his claim in February 2017. See February 2017 VA Initial PSTD Disability Benefits Questionnaire (DBQ). The examiner found that the Veteran had combat related PTSD. Id. He also concluded that the Veteran's PTSD was mild in severity. Regarding his ability to work, the examiner noted that Veteran was retired but that he was able to understand complex and simple commands and serve in a leadership role if necessary. Regarding the Veteran's occupational and social impairment due to PTSD, the examiner found that while he was diagnosed with a psychiatric disability, his symptoms were not severe enough to interfere with occupational and social functioning or to require continuous medication. Id. At the time of the February 2017 VA examination, the Veteran denied any current psychiatric treatment, however, he was previously prescribed psychotropic medication around 2010. See February 2017 VA Initial PTSD DBQ. Occupationally, the Veteran worked at General Motors following active service and retired in 2009. He has not worked since his retirement. He reported he was withdrawn and irritable during his employment. Regarding his social life, the Veteran reported that he was socially withdrawn and quickly becomes agitated and irritable. Id. He endorsed fleeting non-specific thoughts of harm to himself or others. However, he denied any overt suicidal or violent acts. The Veteran's first marriage ended in divorce. He remarried in 1990 and separated from his second wife in 2009. He has two adult children who live away from home. During the February 2017 VA examination, the Veteran reported that he currently lived with his brother in Virginia Beach, Virginia. See February 2017 VA Initial PTSD DBQ. He denied any legal problems. He spends his free time gardening and driving his brother to appointments. He does not participate in any social activities. The examiner found the Veteran's PTSD symptoms included: suspiciousness; flattened affect; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; and difficulty in adapting to stressful circumstances, including work and social relationships. On mental status examination (MSE), the Veteran appeared his stated age, maintained eye contact, and demonstrated goal directed speech and thought processes. Id. The Veteran submitted a private psychiatric evaluation from November 2018. See November 2018 Private Psychiatric Evaluation. The private clinician noted review of the claims file including the February 2017 VA examination report. The Veteran reported his current living situation involves traveling around in a nomadic fashion. For instance, he reported he visits his brother in Virginia, and "[g]oes to South Carolina to see friends, Florida to see Michigan, back to Florida, ect." Id. The Veteran reported that his second wife passed away in March 2018. He noted that they were married 27 years and were separated for the past 10 years before her death. Regarding his employment, the Veteran stated that he retired in 2006 but had interpersonal problems on the job including "a few fights." The private clinician noted that the Veteran "was working in the past and reports his impairment from PTSD symptoms as moderate and as to PTSD symptoms affecting other important parts of his life rates that as severe impact but I would consider that to be more moderate impairment with aspects of functioning still intact." The Veteran reported past legal history including being arrested for domestic violence and assault, but noted no current legal problems. See November 2018 Private Psychiatric Evaluation. The private clinician found the Veteran had the following PTSD symptoms: depressed mood; anxiety; suspiciousness; chronic sleep impairment; mild memory loss; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances; impaired impulse control; grossly inappropriate behavior; and persistent danger of hurting self or others. On MSE, the Veteran was cooperative and spoke rapidly. He displayed fair attention and short concentration, and had increased psychomotor activity. The private clinician noted the Veteran's "[a]bility to abstract was somewhat impaired. The patient states that an ax and a saw both cut (tools). That a dog and a lion are not alike (animals). And that North and West are 'opposite' (directions). Calculation was unimpaired." Id. The Veteran described his mood on the day of the evaluation as "crazy." He notes his mood was usually "fairly good." However, he endorses mood swings, and emotional lability with temper problems and crying swells. Although the Veteran denied any mania, the private clinician noted the Veteran "appears to be in a sort of chronic hypomaniac pressure of activity state." The Veteran endorsed anxiety and fear of people, and stated he experienced episodes once or twice a month lasting from about an hour to all day. The private clinician stated the Veteran has irritability "rated as severe. He also has engaged in reckless or self destructive [sic] behavior. States "run across the road in front of cars, cross on the edge of a dam. He is constantly seeking change and adrenaline." See November 2018 Private Psychiatric Evaluation. The Veteran endorsed thoughts of harming others such as dreaming about killing people. He further reported "I thought of blowing places up." Id. The Veteran denied hallucinations and displayed average fund of information. He was partially oriented to time but did not know date, month, or year. He displayed intact recent, intermediate, and remote memory. Id. In October 2020, the Veteran submitted a lay statement dated March 2017 from Ms. K.K., his wife, who died a year after the statement. Mrs. K.K. indicated that the Veteran had an erratic temper and that "[h]is temper at times went from zero to one thousand in an instant and were totally unpredictable." Id. She described the marital problems they had including the Veteran's violent outbursts which led to his arrest for domestic violence. She further noted that they attempted marital counseling, which was unsuccessful, and that they separated in 2014. The claims file includes VA treatment records from 2011 and from August 2020. There were no additional VA treatment records available for the intervening period between 2011 and 2020. In August 2020, the Veteran reported passive suicidal thoughts such as "occasional thoughts of 'not wanting to wake up'," and a history of homicidal ideations, but denied any intent or plans. See August 2020 VA Geropsychology Consult in CAPRI received August 2020. In October 2020, the Veteran denied any current suicide ideation and was alert an oriented. See October 2020 VA Psychology Progress Note in CAPRI received October 2020. Analysis Based on the evidence of record, the Board grants an initial rating of 70 percent for his service-connected PTSD, because the Veteran's symptoms more closely approximate those contemplated by a 70 percent rating, rather than a 100 percent rating. See 38 C.F.R. § 4.130, DC 9400. In this regard, the November 2018 private clinician opined that the Veteran's PTSD results in occupational and social impairment with deficiencies in most areas, which is contemplated by the 70 percent rating criteria. See November 2018 Private Psychiatric Evaluation. Notably, the private clinician found the Veteran's PTSD was moderately severe. Id. The February 2017 VA examiner found that the Veteran's PTSD did not interfere with occupational and social impairment, and/or did not require medication, which is consistent with a 10 percent rating. During the appeal period, the Veteran demonstrated the following PTSD symptoms: suspiciousness; depressed mood; anxiety; flattened affect; chronic sleep impairment; mild memory loss; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; and difficulty in adapting to stressful circumstances, including work and social relationships, and suicide ideation. See February 2017 VA Initial PTSD DBQ; November 2018 Private Psychiatric Evaluation. These symptoms are consistent with the rating criteria for 30, 50 and 70 percent disability ratings. The Board notes that the Veteran did not exhibit all the symptoms for a 70 percent rating. The evidence of record did not demonstrate that the Veteran had obsessional rituals which interfered with routine activities, or speech intermittently illogical, obscure or irrelevant. Nevertheless, the Board finds that the Veteran's functional impairment due to his PTSD more nearly approximates the criteria for a 70 percent rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002) (symptoms recited in the rating schedule for mental disorders are to serve as examples of the type and degree of the symptoms and not an exhaustive list). Based on the foregoing, and resolving reasonable doubt in the Veteran's favor, the Board finds the Veteran's demonstrated symptoms that are generally consistent with the symptoms contemplated by the 70 percent rating including impaired suicidal ideation, impaired impulse control, inability to establish and maintain effective relationships. In determining whether a higher rating was warranted, the Board considered the November 2018 private psychiatric evaluation which notes that the Veteran experienced symptoms of impaired abstract thinking, grossly inappropriate behavior, and persistent danger of hurting self or others. See November 2018 Private Psychiatric Evaluation. However, impaired abstract thinking is not as severe as gross impairment in thought processes or communication, which is a symptom of the 100 percent rating criteria. Notably, the private clinician notes the Veteran's "[a]bility to abstract was somewhat impaired" based on the Veteran's responses to a few questions during the examination while noting that his ability to perform calculation was unimpaired. Id. This assessment indicates that while his thought process was impaired, his thought processes were not grossly impaired. Moreover, the evidence of record does not show he has any gross impairment in communication as demonstrated in the February 2017 VA examination report which notes that the Veteran's speech and thought processes were goal directed. Notably, the November 2018 private clinician states that "I would consider [the Veteran's PTSD to be [] moderate impairment with aspects of functioning still intact." See November 2018 Private Psychiatric Evaluation. Regarding the symptoms of grossly inappropriate behavior or being a persistent danger of hurting self or others noted in the November 2018 private psychiatric evaluation, the Board finds these symptoms are inconsistent with the evidence of record. For instance, during the February 2017 VA examination, the Veteran endorsed fleeting thoughts of harming self or others, but denied any overt acts of violence. See February 2017 VA Initial PTSD DBQ; see August 2020 VA Geropsychology Consult in CAPRI received August 2020 (denying any intent or plan to harm self or others). As such, the evidence does not demonstrate that the Veteran was a persistent danger to himself or others. Although, the Veteran reported past arrests for assault and domestic violence and reports of engaging reckless behavior, it appears these incidents occurred prior to the appeal period as he did not report these incidents during the February 2017 VA examination or subsequent VA treatment records. Thus, this evidence of past arrests or incidents cannot be considered to determine the Veteran's current severity of his PTSD. Aside from the Veteran's reported reckless behavior which was only noted during the November 2018 private psychiatric evaluation, the evidence of record does not demonstrate that the Veteran's behavior was grossly inappropriate during the appeal period. Finally, the Board notes that the Veteran reported he was partially oriented to time but did not know date, month, or year during the November 2018 private psychiatric evaluation. Here, while disorientation to time is a symptom of the 100 percent rating criteria, the record indicates the Veteran only reported disorientation to time at the November 2018 private evaluation. See i.e., October 2020 VA Psychology Progress Note in CAPRI received October 2020 (noting Veteran was alert and oriented). As such, it does not rise to the frequency, severity, or duration necessary for a 100 percent rating. Even assuming arguendo that it did rise to the frequency, severity, and duration level, there is no evidence that it caused total social and occupational impairment. Significantly, the Veteran has not established the following symptoms, such as those associated with a 100 percent rating: persistent delusions or hallucinations, inability to perform activities of daily living, memory loss of names of close relatives, current or former occupation, or own name. Id. The U.S. Court of Appeals for the Federal Circuit has explained that evaluation under § 4.130 is "symptom driven," meaning that "symptom[s] should be the fact finder's primary focus when deciding entitlement to a given disability rating" under that regulation. "[A] veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. "To qualify for a particular disability rating, § 4.130 requires "not only the presence of certain symptoms[,] but also that those symptoms have caused occupational and social impairment in most of the referenced areas." For instance, the February 2017 VA examiner found the Veteran had normal speech and thought processes, whereas to be consistent with a 100 percent rating, it would require gross impairment in communication and thought processes. Notably, while the private clinician noted that the Veteran had rapid speech, he also stated that the Veteran's speech patterns were coherent, relevant and appropriate. See November 2018 Private Psychiatric Evaluation. Additionally, the Veteran denied persistent hallucinations and homicidal or suicidal ideations, whereas to be consistent with a 100 percent rating it would require persistent hallucinations and persistent danger of hurting one-self and others. Moreover, even if the symptoms were exhibited, they do not reach the frequency, severity, and duration as noted under the 100 percent rating criteria. There has been no delusions or hallucinations that are persistent, behavior that has been grossly inappropriate, or that there is an inability to perform activities of daily living, or that he has memory loss that reaches a level where he does not remember his own name. Additionally, there is no evidence that the Veteran was disoriented to time or place, because his VA treatment records, and VA examination reflect that he was alert and oriented. Thus, for the reasons discussed above, the Board finds that the preponderance of the evidence is against a finding that the Veteran's overall level of social and occupational impairment due to his PTSD more nearly approximates the level contemplated by a 100 percent rating. Additionally, the Veteran's symptoms have been consistent throughout the appeal period. See Fenderson v. West, 12 Vet. App. 119, 126 (1999) (finding that at the time of an initial rating "separate ratings can be assigned for separate periods of time based on facts found", a practice known as "staged" rating). Here, however, the evidence warrants a uniform 70 rating. In deciding the claim, the Board considered the lay statements from the Veteran, and his deceased wife, and finds that they are competent and credible evidence of the Veteran's PTSD which they either experienced or observed. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); see also Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, these statements are not competent evidence as to a specific level of disability according to the appropriate diagnostic codes. See Robinson v. Shinseki, 557 F.3d 1355 (2009). Evidence concerning the nature and extent of the Veteran's PTSD has been provided by the medical personnel who have examined him at various times during the current appeal and who have rendered pertinent opinions in conjunction with the physical evaluations. The medical findings as provided in the examination reports directly address the criteria under which this type of disability is evaluated. The Board, therefore, finds the medical findings to be of a greater probative value as to the current severity of the Veteran's PTSD. Therefore, the Board finds that the preponderance of the evidence supports a rating of 70 percent. Accordingly, the claim for an initial rating in excess of 50 percent is granted. To the extent that any higher level of compensation is sought, the preponderance of the evidence is against the claim. Hence the benefit-of-the-doubt rule does not apply. Gilbert v. Derwinski, 1 Vet. App. 49 (1991); 38 U.S.C. § § 5107(b); 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND 1. Entitlement to service connection for dermatitis, claimed as undiagnosed skin condition The Board finds that a remand is warranted to provide the Veteran a VA examination to determine the etiology of his claimed skin condition. The Board notes that he was not provided a VA examination for his claimed disability. Specifically, the Board finds an examination is appropriate in light of McLendon v. Nicholson, 20 Vet. App. 79 (2006). VA is obliged to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service; and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A (d); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The threshold for finding a link between current disability and service is low. Locklear v. Nicholson, 20 Vet. App. 410 (2006); McLendon v. Nicholson, at 83. Here, the evidence demonstrates the McLendon requirements have been met. First, the Veteran has a current disability because he was assessed with seborrheic dermatitis in July 2011. See July 2011 VA Dermatology Consult in CAPRI received February 2017. He also reported that he had his skin rash since his service during the Vietnam war. As such, the Veteran has demonstrated a current disability that may be associated with active service. However, a medical professional has not provided a nexus or etiology opinion addressing his skin condition. Thus, the record contains insufficient information to decide the claim. Accordingly, the claim for a skin condition is remanded to provide the Veteran a VA examination and to obtain an etiology opinion. The Board notes the claims file reflects that the Veteran has been receiving treatment from the Ann Arbor VA Medical Center (VAMC), C.W. Bill Young Department of VAMC to include the Bay Pines Division, and that records dated through August 2020 are associated with the file; however, more recent records may exist. The Board emphasizes that records generated by VA facilities that may have an impact on the adjudication of a claim are considered constructively in the possession of VA adjudicators during the consideration of a claim, regardless of whether those records are physically on file. See Sullivan v. McDonald, 815 F.3d 786, 793 (Fed. Cir. 2016). The matters are REMANDED for the following action: 1. Obtain the Veteran's comprehensive VA treatment records for the period from August 2020 to the present, to include from VA medical centers, clinics, counseling centers, hospitals, and outpatient treatment centers. See 38 C.F.R. § 3.159(c)(3) (2020). The Board observes that the Veteran has been treated at Ann Arbor VAMC, and C.W. Bill Young Department of VAMC. 2. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of his claimed skin disorder, identified as likely seborrheic dermatitis. All diagnostic testing deemed to be necessary by the examiner should be accomplished. The examiner should provide the following: 3. Identify all currently diagnosed skin disabilities, including confirming whether the Veteran currently has seborrheic dermatitis. 4. Based on the review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present dermatitis had its onset during his active service, or is otherwise etiologically related to such service. The examiner must consider the Veteran's lay statements regarding the onset and continuity of his symptoms. The examiner should elicit and consider the Veteran's lay statements on the history of his related problems. A rationale for all opinions expressed should be provided in the examination report. If medical literature is relied upon in rendering any opinion(s), the VA examiner should identify and specifically cite each reference material utilized. 5. THE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL. IF ANY DEVELOPMENT IS INCOMPLETE, APPROPRIATE CORRECTIVE ACTION MUST BE IMPLEMENTED. IF ANY REPORT DOES NOT INCLUDE ADEQUATE RESPONSES TO THE SPECIFIC OPINIONS REQUESTED, IT MUST BE RETURNED TO THE PROVIDING EXAMINER FOR CORRECTIVE ACTION. YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Lilly, 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.