Citation Nr: 21068790 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 14-35 835 DATE: November 12, 2021 REMANDED Entitlement to an initial compensable rating for right foot keratoderma (rated as a skin disease) prior to May 4, 2021; and in excess of 10 percent since May 4, 2021 is remanded. Entitlement to an initial rating in excess of 10 percent for right foot keratoderma, for pain associated with weightbearing is remanded. Entitlement to an initial compensable rating for chronic rhinitis, status post rhinoplasty (rhinitis) is remanded. Entitlement to an initial rating in excess of 30 percent for status post, basal cell carcinoma (BCC) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from May 1989 to May 1994 and in the United States Air Force from August 2005 to August 2009. This appeal arises from a July 2011 rating decision, which granted service connection for chronic rhinitis, right foot keratoderma and status post basal cell carcinoma and assigned an initial non-compensable rating (0 percent) for each of these conditions, all effective from August 12, 2009, the day after separation from active duty. The Veteran appealed for higher initial ratings. In April 2018, the Board remanded the case to the AOJ for additional development and consideration. In a May 2019 rating decision, the AOJ increased the rating for the Veteran's BCC from 0 to 30 percent, retroactively effective from August 12, 2009, the date service connection was established. In September 2019 and September 2020, the Board again remanded the case to the AOJ for additional development and consideration. 1. Entitlement to an initial compensable rating for right foot keratoderma prior to May 4, 2021; and in excess of 10 percent since May 4, 2021 2. Entitlement to an initial rating in excess of 10 percent for right foot keratoderma, for pain associated with weightbearing On remand, in a May 2021 rating decision, the AOJ increased the rating for the Veteran's right foot keratoderma from 0 to 10 percent, under 38 C.F.R. § 4.118 (skin diseases), Diagnostic Code 7813 (dermatophytosis), effective from May 4, 2021, the date of a VA examination. The AOJ also established a separate 10 percent evaluation for the Veteran's right foot keratoderma, for pain associated with weightbearing, under 38 C.F.R. § 4.71a (musculoskeletal system disabilities), Diagnostic Code 5284 (other foot injuries), effective from June 13, 2019, which the AOJ based upon the date it received a report of pain on weight bearing related to his service-connected keratoderma. The Veteran's September 2014 VA Form 9 and June 2019 letter the Veteran reported flare-ups in which the skin of his right foot cracks deeply, making weight bearing painful and difficult, and he receives medication to treat these symptoms. The May 2021 VA skin disease examiner opined that flare-ups of the right foot occur weekly, are moderate to severe, last 2 or more weeks, and are alleviated by Dermabond medication. The May 2021 VA foot conditions examiner noted functional impact of difficulty walking up more than a quarter mile without pain in his feet. The examiner opined that functional loss of keratoderma on weight bearing is at least 50 percent of the time, with no impact on sedentary activities. In this case, the Veteran has reported right foot skin condition flare-ups as September 2014, including functional limitation on weight bearing. So, the Board finds a retrospective medical opinion is warranted. 3. Entitlement to an initial compensable rating for chronic rhinitis, status post rhinoplasty (rhinitis) 4. Entitlement to an initial rating in excess of 30 percent for status post, basal cell carcinoma (BCC) The Board's previous remand directives repeatedly requested the AOJ to elicit and assess the Veteran's complaints of flare-ups of both rhinitis and BCC. See, e.g., September 2019 Board remand. A remand by the Board confers on a Veteran the right to substantial compliance with the remand orders. Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008). On remand, the May 2021 VA skin diseases examiner only considered flare-ups of his right foot keratoderma. However, the May 2021 VA skin diseases examiner did not appear to assess any flare-ups specifically of his BCC, which was noted to manifest as nonhealing plaques on his arms, back and chest. The Veteran's rhinitis has been assigned an initial 0 percent rating under 38 C.F.R. § 4.97 (respiratory system diseases), Diagnostic Code 6522, for allergic or vasomotor rhinitis. Under DC 6522, a minimal compensable rating of 10 percent is warranted for allergic rhinitis that manifests without polyps, but with greater than 50-percent obstruction of nasal passage on both sides or complete obstruction on one side; and a higher 30 percent rating is warranted "with polyps." Notably, the Veteran stated in June 2019 that his nasal passages are "at least 50% functionally obstructed" in general, and he asserted "the point is my breathing is obstructed when I breath"; and during flare-ups of allergic rhinitis, he asserted his nasal passages are "essentially 100% obstructed." However, on remand, the May 2021 VA sinus examiner provided only vague comments that are not responsive to the inquiry on flare-ups of allergic rhinitis. Rather, the examiner comments included that the "Veteran has allergic rhinitis seasonally therefore his passages are not obstructed at least 50 percent at all times." The Board finds that additional clarification is needed to help resolve the claim and comply with the Board's remand directive. In particular, the examiner did not additionally comment on the severity, frequency, and duration of the Veteran's allergic rhinitis. Moreover, the examiner provided a finding that there is not greater than 50 percent obstruction of nasal passage on both sides due to rhinitis; and no complete obstruction of either side due to rhinitis. However, the examiner provided no rationale for these critical findings. Inadequate medical examinations include examinations that contain only data and conclusions, do not provide an etiological opinion, are not based upon a review of medical records, or provide unsupported conclusions. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). When VA undertakes to examine a Veteran, VA is obligated to ensure that that examination is adequate. See Barr v. Nicholson, 21. Vet. App. 303 (2007). Thus, the Board finds a remand is necessary for another VA examination of the Veteran's rhinitis and BCC. The matters are REMANDED for the following action: 1. Obtain a retrospective medical opinion from the May 2021 VA skin disease examiner, or an appropriate clinician if not available, to determine the severity of the Veteran's right foot keratoderma, as a skin disease, prior to May 4, 2021. Obtain a retrospective medical opinion from the May 2021 VA foot conditions examiner, or an appropriate clinician if not available, to determine the severity of the Veteran's right foot keratoderma, including pain associated with weightbearing, prior to June 13, 2019. After reviewing the record, the examiner should comment whether there was any increased functional impairment due to his right foot keratoderma in the time period since August 2009, when service-connection was established for the right foot keratoderma disability (as a skin disease). The examiner should provide a retrospective medical opinion that identifies any symptoms and functional impairments due to his service-connected right foot keratoderma alone and discuss the effect of the disability on any occupational functioning and activities of daily living. A complete rationale should be provided for all opinions rendered. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected rhinitis. On review of the record, the examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disabilities under the rating criteria. The examiner should attempt to elicit and discuss in detail information regarding severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. A complete rationale should be provided for all opinions rendered. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected status post, basal cell carcinoma. On review of the record, the examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disabilities under the rating criteria. The examiner should attempt to elicit and discuss in detail information regarding severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. A complete rationale should be provided for all opinions rendered. C. CRAWFORD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Chatterjee, B. 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.