Citation Nr: 21069047 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 17-17 499 DATE: November 17, 2021 REMANDED Service connection for a lower back disability is remanded. Service connection for a left knee disability is remanded. Service connection for a right knee disability is remanded. An initial disability rating in excess of 10 percent for eczematous dermatitis (claimed as chronic rash bilateral hands) is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Air Force from December 1992 to May 1993, from January 2003 to August 2003, from December 2003 to May 2004, and from January 2005 to April 2005. These matters come to the Board of Veterans' Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO) made in April 2015 to October 2015. This appeal is being adjudicated under the legacy appellate framework. The Veteran testified at a personal hearing before the Board in February 2020, and a transcript of the hearing is of record. These matters were previously before the Board, and, in May 2020, the Board remanded this matter for further development. 1. Service connection for a lower back disability is remanded. 2. Service connection for a left knee disability is remanded. 3. Service connection for a right knee disability is remanded. At issue is whether the Veteran is entitled to service connection for a lower back disability and a bilateral knee disability. In May 2020, the Board having observed that the Veteran's current treatment records indicated that the Veteran was manifesting a lower back disability and a bilateral knee disability and that the Veteran testified that he injured both his back and his knees during service found that an examination was necessary in order to determine whether or not a medical nexus existed between a current diagnosis and an in-service incurrence. The Veteran was provided a VA examination in October 2020. The examiner opined that a medical nexus did not exist, because there was no corroboration of the Veteran's reported in-service incurrence memorialized in the Veteran's treatment records. Unfortunately, this is inadequate, because ultimately the Board as the finder of fact is empowered to determine the credibility of the Veteran's lay reports of an in-service incurrence; and, what the Board requires, is for the examiner to discuss the medical significance of the Veteran's lay reports including to the extent that the Board potentially finds them to be credible. Once VA undertakes the effort to provide the Veteran with a VA examination, it must provide the Veteran with an adequate one, and an adequate examination is sufficiently detailed to ensure that VA's evaluation of the Veteran's claim is fully formed. Barr v. Nicholson, 21 Vet. App. 303 (2007). Therefore, this matter must be remanded for a new VA examination in order to address these concerns. 4. An initial disability rating in excess of 10 percent for eczematous dermatitis (claimed as chronic rash bilateral hands) is remanded. At issue is whether the Veteran is entitled to an increased initial disability rating for eczematous dermatitis. In May 2020 the Board remanded this matter in order to provide the Veteran with a new VA examination. The Veteran underwent a VA examination in October 2020. The Veteran reported that he treated his condition with ultraviolet light. Nevertheless, the examiner opined that the Veteran did not treat his condition with any systemic therapy such as phototherapy such as ultraviolet-B light or photochemotherapy such as psoralen with long wave ultraviolet-A light. It is unclear from the record whether or not the examiner simply filled out the examination report incorrectly or whether or not the examiner is explicitly opining that the ultraviolet light treatment described by the Veteran is not considered systemic therapy. Once VA undertakes the effort to provide the Veteran with a VA examination, it must provide the Veteran with an adequate one, and an adequate examination is sufficiently detailed to ensure that VA's evaluation of the Veteran's claim is fully formed. See Barr. Therefore, this matter must be remanded for a new VA examination in order to address these concerns. The matters are REMANDED for the following action: 1. Arrange to provide the Veteran with a VA examination in order to address the following. Is it at least as likely as not (50 percent or more) that a medical nexus exists between an in-service incurrence and a current diagnosis of a low back disability? Why or why not? In answering this question, work under the operating assumption that the Veteran's lay reports of an in-service incurrence are accurate. 2. Arrange to provide the Veteran with a VA examination in order to address the following. Arrange to provide the Veteran with a VA examination in order to address the following. Is it at least as likely as not (50 percent or more) that a medical nexus exists between an in-service incurrence and a current diagnosis of a bilateral knee disability? Why or why not? In answering this question, work under the operating assumption that the Veteran's lay reports of an in-service incurrence are accurate. 3. Arrange to provide the Veteran with a VA examination in order to evaluate the current severity of the Veteran's eczematous dermatitis. In evaluating the severity of the Veteran's eczematous dermatitis, the examiner should specifically discuss the Veteran's reports, including during the October 2020 VA examination, of treating his disability with ultraviolet light and whether or not it is considered systemic therapy (systemic therapy includes phototherapy such as ultraviolet-B light or photochemo-therapy such as psoralen with long wave ultraviolet-A light) DAVID L. WIGHT Veterans Law Judge Board of Veterans' Appeals Attorney for the Board David R. Seaton, 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.