Citation Nr: 21069524 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 12-33 413 DATE: November 18, 2021 REMANDED Entitlement to service connection for a skin disability, including shingles, to include as secondary to service-connected viral meningitis and recurrent cold sores is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from May 1953 until April 1955. The Veteran died in May 2018. In June 2018, the Appellant, as surviving spouse of the Veteran, became the substitute claimant. In February 2018, prior to his death, the Veteran testified at a hearing before the undersigned Veteran Law Judge. A transcript of that hearing is of record. This appeal has been advanced on the Board's docket pursuant to 38C.F.R. §20.902 (c)(1). This appeal has been before the Board on several prior occasions, including when it was remanded in May 2017 in accordance with a February 2017 Memorandum Decision by the United States Court of Appeals for Veteran Claims (CAVC). Most recently, in June 2021, the appeal was remanded for an addendum medical opinion. Unfortunately, for the reasons described below, there has not been substantial compliance with the Board's remand directives and another remand is required. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for a skin disability, including shingles, to include as secondary to service-connected viral meningitis and recurrent cold sores is remanded. The claim must be remanded because the addendum medical opinions obtained in August 2021 do not comply with the Board's June 2021 remand instructions and are inadequate for adjudication. Although specifically directed to do so, the August 2021 opinion provider failed to discuss specific, enumerated evidence of record and all skin disorder diagnoses the Veteran received from August 2008 until his death. Absent compliance with the Board's instructions and consideration of all evidence of record, the August 2021 medical opinions are inadequate for adjudication. A medical opinion that does not consider all evidence of record, including the Veteran's lay statements, is inadequate for adjudication. Dalton v. Nicholson, 21 Vet. App. 23 (2007). On remand, a medical opinion that is adequate and complies with the directives of the Board must be obtained. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from an appropriate clinician other than the September 2020, February 2021, and August 2021 opinion providers. Copies of all pertinent records must be made available to the opinion provider for review. Based on the record, the examiner should answer the following: (a.) Identify all skin disabilities diagnosed from August 2008 until the Veteran's death, to include the Veteran's facial rash, lesions on his body, and whether there was a flare-up of his tinea corporis or shingles during this period. (b.) For each diagnosed skin condition, is it at least as likely as not (50 percent or greater probability) it is related to an in-service injury, event, or disease? (c.) For each diagnosed skin disability, is it at least as likely as not (50 percent or greater probability) it is: (i) proximately due to the Veteran's service-connected viral meningitis and recurrent cold sores, or (ii) aggravated (defined as any increase in disability) by his service-connected viral meningitis and recurrent cold sores? The examiner must consider and discuss the following: (i) the Veteran's lay statements that he had recurrent shingles that began during service and had continued since, (ii) the March 2019 medical opinion by Dr. G.H., the Veteran's private treatment provider, and (iii) the September 2019 VA medical opinion that referenced "acute" flare. The examiner is notified that failure to apply the correct definition of aggravation or to consider and discuss the specific evidence enumerated above will render the provided opinion inadequate. All provided opinions must be supported by complete rationale that considers and discusses both the lay and medical evidence of record. If the opinion provider cannot provide a requested opinion without resort to speculation, they must say why. 2. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum prior to readjudicating the claim. If necessary, return the matter to the Board for further appellate review. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.D. Collins, 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.