Citation Nr: 21005520 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 16-07 981 DATE: February 1, 2021 REMANDED Entitlement to a compensable rating prior to October 9, 2020, and a rating in excess of 10 percent thereafter for bilateral palmer eczema (claimed as rash on hands) is remanded. Entitlement to service connection for residuals of a left-hand injury is remand. REASONS FOR REMAND The Veteran served on active duty from August 1967 to October 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). These issues were previously before the Board in April 2019, when it was determined that a remand was necessary in order to fulfill VA’s duty to assist the Veteran. The Board’s prior remand directives and the subsequent actions of the Agency of Original Jurisdiction (AOJ) will be discussed below. The Veteran’s appeal has been returned to the Board for further appellate consideration. 1. Entitlement to a compensable rating prior to October 9, 2020, and a rating in excess of 10 percent thereafter for bilateral palmer eczema (claimed as rash on hands) is remanded. The rating criteria applicable to the Veteran's service-connected skin disability consider use of topical and systemic therapies for treatment, such as corticosteroids or other immunosuppressive drugs. 38 C.F.R. § 4.118, Diagnostic Code 7822. The regulations prior to August 13, 2018, do not contain definitions for topical therapy or systemic therapy. Whether a medication is topical or systemic is a non-binary choice, and the determination must be made on a case-by-case basis. Warren v. McDonald, 28 Vet. App. 194 (2016); Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017). Here, the Veteran was provided with VA examinations in December 2015 and October 2020, and both examination reports reflect his usage of topical skin medications (triamcinolone and Eucerin) on a constant or near-constant basis. In each of these reports, the examiner did not make a determination as to whether the Veteran's treatment for his service-connected skin disorder constituted systemic therapy such as corticosteroids or other immunosuppressive drugs within the meaning of rating criteria. Therefore, additional medical evidence is necessary to guide the Board's analysis. Burton v. Wilkie, 30 Vet. App. 286, 292 (2018); see also Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). 2. Entitlement to service connection for residuals of a left-hand injury is remand. This claim was previously remanded by the Board for an examination and opinion to address the Veteran’s residuals of a left-hand injury. The remand instructions specifically directed that the VA examiner should address direct service connection. In addition, the remand instructions specifically directed that the VA examiner should address the Veteran’s lay assertions, including his contention of continuity of symptomology. The Veteran is competent to describe symptoms he experiences. The previous remand specifically requested that the Veteran’s contentions, in addition to a direct service connection opinion, be addressed in the addendum opinion. This opinion did not address the Veteran’s contentions. To that extent, this opinion is inadequate, and a remand is needed. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (Board remand confers a right on a claimant to compliance with the remand order); Dyment v. West, Vet. App. 141, 147 (1999) (clarifying that substantial compliance with Board remand is required). The matters are REMANDED for the following action: 1. Obtain updated VA and/or private treatment records, to the extent possible. If such records are unavailable, the Veteran’s claim file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159 (e). 2. After the above has been completed, schedule the Veteran for a VA examination to determine the nature and etiology of the Veteran’s left-hand injury. The examiner should review the claims file. Based on the examination and a review of the record, the examiner must address the following: (a.) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s left-hand injury was either incurred in, or otherwise related to the Veteran’s active duty service? The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. The examiner is advised that the Veteran is competent to report his medical history including symptoms and treatment, and that his reports must be taken into account, along with the other evidence of record. The examiner should specifically address the Veteran’s self-reported symptomology, including having continuous symptoms from the injury to the present. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should indicate this in the examination report and provide a rationale for that determination. A complete rationale must be provided for all opinions presented. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 3. Schedule the Veteran for a VA examination with an appropriate clinician regarding his appeal of an increased evaluation for bilateral palmer eczema. In addition to completing the disability benefits questionnaire (DBQ), the examiner must specifically address whether the any medications used to control the Veteran's skin condition throughout the appeal period constitute systemic therapy like a corticosteroid or other immunosuppressive drug. For topical treatments, the examiner must state (a) whether the treatment operates by affecting the body as a whole to treat his service-connected skin disabilities and (b) whether the treatment is like a corticosteroid or other immunosuppressive drug. A complete rationale must be provided for all opinions presented. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). SCOTT W. DALE Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Hughes 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.