Citation Nr: 21071443 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 08-10 190 DATE: November 30, 2021 ORDER Entitlement to service connection for cutaneous coccidioidomycosis is denied. Entitlement to an initial evaluation in excess of 10 percent for external hemorrhoids prior to December 11, 2014, is denied. Entitlement to an initial 20 percent evaluation for external hemorrhoids for the period from December 11, 2014, to December 11, 2015, is granted. Entitlement to an initial evaluation in excess of 10 percent for external hemorrhoids for the period from December 11, 2015, to August 24, 2020, is denied. REMANDED Entitlement to an initial evaluation in excess of 10 percent for lumbosacral strain from prior to July 3, 2007, is remanded. Entitlement to an initial evaluation in excess of 20 percent for lumbosacral strain on or after July 3, 2007, is remanded. Entitlement to a total disability evaluation based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. During the appeal period, the Veteran has not been shown to have cutaneous coccidioidomycosis or any residuals thereof. 2. Prior to December 11, 2014, the Veteran's external hemorrhoids were not productive of persistent bleeding and with secondary anemia, or with fissures. 3. From December 11, 2014, to December 11, 2015, the Veteran's external hemorrhoids were productive of persistent bleeding, and there were two anal fissures present. A 20 percent evaluation is the maximum schedular rating available for that disability. 4. From December 11, 2015, to August 24, 2020, the Veteran's external hemorrhoids were not productive of persistent bleeding and with secondary anemia, or with fissures. CONCLUSIONS OF LAW 1. Cutaneous coccidioidomycosis or residuals thereof were not incurred in active service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for an initial evaluation in excess of 10 percent for external hemorrhoids prior to December 11, 2014, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 34.1-4.14, 4.114, Diagnostic Code 7336. 3. The criteria for an initial 20 percent evaluation external hemorrhoids for the period from December 11, 2014, to December 11, 2015, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 34.1-4.14, 4.114, Diagnostic Code 7336. 4. The criteria for an initial evaluation in excess of 10 percent for external hemorrhoids for the period from December 11, 2015, to August 24, 2020, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 34.1-4.14, 4.114, Diagnostic Code 7336. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1989 to September 2004. This case comes before the Board of Veterans' Appeals (Board) on appeal from July 2006 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In the July 2006 rating decision, the RO denied service connection for cutaneous coccidioidomycosis. Although the Veteran did not appeal the denial of that issue, relevant service treatment records were obtained since that decision. Therefore, new and material evidence is not needed, and the claim will be considered on a de novo basis. 38 C.F.R. § 3.156(c). In the July 2006 rating decision, the RO also granted service connection for a hemorrhoidectomy and lumbosacral strain and assigned separate 10 percent evaluations for both disabilities effective from December 13, 2005. In a July 3, 2007, notice of disagreement (NOD), the Veteran disagreed with the evaluations assigned in the July 27, 2006, rating decision. Following continuations of his evaluations in August 2007 and September 2008 rating decisions, the Veteran submitted another NOD in December 2007. The RO issued a statement of the case (SOC) in March 2008, and the Veteran appealed the hemorrhoidectomy and lumbosacral strain evaluations to the Board in April 2008. During the pendency of the appeal, in a July 2008 rating decision, the RO increased the evaluation for a lumbosacral strain to 20 percent effective July 3, 2007. As this was not a full grant of benefits sought, the issue remained on appeal. See A.B. v. Brown, 6 Vet. App. 35 (1993). The Veteran testified at a hearing before the undersigned Veterans Law Judge in October 2018. A transcript is of record. The Board remanded the case for a hearing in May 2013 and for additional development in April 2020. That development was completed, and the case has since been returned to the Board for appellate review. In September 2020, the RO increased the evaluation for the Veteran's service-connected external hemorrhoids from 10 percent to 20 percent effective from August 24, 2020. A 20 percent evaluation is the maximum schedular evaluation available under the rating criteria for hemorrhoids. Therefore, the award of a 20 percent evaluation is considered a full grant of benefits as of August 24, 2020. Law and Analysis Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist with the issues decided herein. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board...to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to service connection for cutaneous coccidioidomycosis or residuals thereof. The Veteran testified at the October 2018 hearing that he had a really bad bump on the right side of his nose with a large scaling rash. He stated that he was not receiving any current treatment, but that he had residuals consisting of joint aches, headaches, fatigue, and emotional problems because the condition had previously disfigured him. In a September 2008 statement, the Veteran claimed that he has progressive coccidioidomycosis affecting his shoulders, back, and other joints. The Veteran's service treatment records show he was seen for an infection and swelling on the right side of his nose from October 1992 to December 1992. He was assessed as having cutaneous coccidiomycosis in December 1992. However, a radiologic consultation report on that same day shows there was no acute disease and no evidence of granulomatous lesions to suggest coccidiomycosis. A subsequent medical record dated in December 1992 has a notation of "resolved" with a recommendation to follow-up in the dermatology clinic in two months. Subsequent service treatment records are negative for any complaints, treatment, or diagnosis of cutaneous coccidiomycosis, and in May 1996, the Veteran's skin was evaluated as normal. During a July 2006 VA examination, the Veteran reported that he was diagnosed with cutaneous coccidiomycosis in late 1992 and began antifungal treatments for several months with complete resolution by 1994. He stated that he was currently asymptomatic. Although the examiner documented a diagnosis of cutaneous coccidiomycosis, it was noted that no active disease was found. Upon examination, there was no cardiac or pulmonary involvement, facial swelling, scars on his face, disfiguring rash, or residuals in the area of the cutaneous coccidiomycosis. Post-service treatment records show that the Veteran has been prescribed a treatment for a fungal infection; however, it was noted that he had seborrheic dermatitis for which he is already service-connected. The evidence of record does not show that the Veteran currently has cutaneous coccidioidomycosis or residuals thereof. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. §§ 1110, 1131; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). Evidence must show that the Veteran currently has a disability for which benefits are claimed. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran's claim for service connection for cutaneous coccidioidomycosis. Accordingly, the claim is denied. Increased Evaluation Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2 ; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where a veteran appeals the denial of a claim for an increased disability rating for a disability for which service connection was in effect before he filed the claim for increase, the present level of the veteran's disability is the primary concern, and past medical reports should not be given precedence over current medical findings. Francisco v. Brown, 7 Vet. App. 55, 57-58 (1994). However, where the question for consideration is a higher initial rating since the grant of service connection, evaluation of the medical evidence since the grant of service connection to consider the appropriateness of "staged rating" (assignment of different ratings for distinct periods of time, based on the facts found) is required. Fenderson v. West, 12 Vet. App. 119, 126 (1999); see also Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran is currently assigned a 10 percent evaluation for external hemorrhoids prior to August 24, 2020, pursuant to 38 C.F.R. § 4.114, Diagnostic Code 7336. Under Diagnostic Code 7336, external or internal hemorrhoids are assigned a noncompensable evaluation when they are mild or moderate. A 10 percent evaluation is contemplated when hemorrhoids are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences. A 20 percent evaluation is contemplated for hemorrhoids with persistent bleeding and with secondary anemia, or with fissures. In considering the evidence of record under the laws and regulations as set forth above, the Board finds that that the Veteran is not entitled to a higher initial evaluation for external hemorrhoids prior to December 11, 2014. The evidence does not show that the Veteran had persistent bleeding with secondary anemia or with fissures prior to December 11, 2014. In fact, a June 2006 VA examination revealed no signs of anemia or fissures, and there was no current bleeding reported. A May 2008 VA examination also found no bleeding or fissures. A March 2009 VA examiner noted the Veteran's report that the toilet paper might occasionally have streaks of blood, but found no signs of anemia. In addition, there are no treatment records during this time period showing such symptomatology or manifestations. Nevertheless, a December 11, 2015, VA treatment record does show that the Veteran reported noticing bleeding on a weekly basis for one year. It was also noted that there was hematochezia probable from two anal fissures. The Veteran was advised to use stool softener, take a sitz bath, and consume fiber and that he should follow-up if there was no improvement. Thus, the Veteran was shown to have persistent bleeding with fissures for one year prior to December 11, 2015. Therefore, the Board finds that a 20 percent evaluation is warranted for the Veteran's service-connected external hemorrhoids for the period from December 11, 2014, to December 11, 2015. A 20 percent evaluation represents the maximum schedular rating available under Diagnostic Code 7336. Therefore, an evaluation in excess of 20 percent cannot be granted under that diagnostic code. There are no treatment records indicating that the Veteran sought follow-up treatment after being seen on December 11, 2015, or that he had subsequent persistent bleeding with secondary anemia or fissures. A January 2019 VA examiner acknowledged the Veteran's report that that he has the occasional spotting of blood, which was usually accompanied by a bout of diarrhea or constipation, but it was also noted that he has nonservice-connected irritable bowel syndrome. Nevertheless, there was no secondary anemia or fissures found during that examination. Similarly, the Veteran told the August 2020 VA examiner that that he had bleeding in his stool, but the examination did not reveal secondary anemia or fissures. A March 2021 VA examination also did not reveal anemia. As such, the Veteran has not been shown to have persistent bleeding with secondary anemia or fissures since he was seen in December 2015. Therefore, the Board finds that the Veteran is not entitled to an initial evaluation in excess of 10 percent for external hemorrhoids for the period from December 11, 2015, to August 24, 2020. The Veteran and his representative have not raised any other issues with regard to increased evaluation issue decided herein, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND In the April 2020 remand, the Board found that an additional VA examination was needed for the issue of entitlement to an increased evaluation for a lumbosacral strain to ensure compliance with Correia v. McDonald, 28 Vet. App. 158 (2016). Although the Veteran was provided a VA examination in August 2020, the report does not include the range of motion test results for active motion, passive motion, weight-bearing, and nonweight-bearing. Therefore, the Board finds that an additional VA examination is needed. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand confers on the claimant, as a matter of law, the right to compliance with the remand order). The Board further finds that the issue of entitlement to TDIU is inextricably intertwined with the increased evaluation issue being remanded herein, as that issue could affect the outcome of the TDIU claim. For this reason, the increased evaluation issue must be resolved prior to resolution of the issue of entitlement to TDIU. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (noting that the prohibition against the adjudication of claims that are inextricably intertwined is based upon the recognition that claims related to each other should not be subject to piecemeal decision-making or appellate litigation). Therefore, a remand is required for the AOJ to adjudicate the inextricably intertwined issues. The matters are REMANDED for the following action: 1. The Veteran should be afforded a VA examination to ascertain the current severity and manifestations of his service-connected lumbosacral strain. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner should report all signs and symptoms necessary for rating the lumbar spine disability under the rating criteria. In particular, the examiner should provide the range of motion in degrees of the lumbar spine in active motion, passive motion, weight-bearing, and nonweight-bearing. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain so in the report. The examiner should also comment on whether there is any form of ankylosis. In addition, the examiner should state the total duration of incapacitating episodes over the past 12 months and identify all neurological manifestations of the disability, to include any radiculopathy. The presence of objective evidence of pain, excess fatigability, incoordination and weakness should also be noted, as should any additional disability (including additional limitation of motion) due to these factors. Further, the VA examiner should comment as to whether range of motion measurements for active motion, passive motion, weight-bearing, and/or nonweight-bearing can be estimated for the other VA examinations conducted during the appeal period. If the examiner is unable to provide a retrospective opinion as to these specific range of motion findings, he or she should clearly explain so in the report. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important "that each disability be viewed in relation to its history[,]" 38C.F.R. §4.1, copies of all pertinent records in the appellant's claims file, or in the alternative, the claims file, must be made available to the examiner for review. 2. The AOJ should conduct any other development as may be indicated. J.W. ZISSIMOS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Kuczynski, 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.