Citation Nr: 21006672 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 17-21 154 DATE: February 4, 2021 REMANDED Entitlement to a compensable rating for tinea unguium of the bilateral toes, with tinea pedis, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1988 to May 1999. He has had a combined VA disability rating of 100 percent from June 25, 2020, along with special monthly compensation under 38 U.S.C. § 1114(s), This case comes before the Board of Veterans’ Appeals (Board) on appeal from July 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In December 2019, the Veteran testified before the undersigned Veterans Law Judge (VLJ); a transcript of the hearing is associated with the claims file. In December 2019, the Board remanded the appeal for additional evidentiary development. Entitlement to a compensable rating for tinea unguium of the bilateral toes, with tinea pedis, is remanded. To ensure that VA has met its duty to assist, remand is necessary. Under the skin criteria in effect prior to August 13, 2018, the use of a topical corticosteroid can be considered either systemic therapy or topical therapy based on the factual circumstances of each case. Johnson v. Shulkin, 862 F.3d 1351 (Fed Cir 2017). However, systemic therapy is not limited to corticosteroids or immunosuppressive drugs. Consideration is also given to whether a given treatment was “like” a corticosteroid or other immunosuppressive drug to determine whether such treatment constituted systemic therapy. Warren v. McDonald, 28 Vet. App. 194 (2016). For a treatment to be systemic, it must affect the entire body in its treatment of the condition. Consideration must be given on how a topical treatment works and how it affects the body as a whole, not the size of the skin area it is applied to. See Burton v. Wilkie, 30 Vet. App. 286 (2018). The recent, February 2020, VA examination report shows that the Veteran uses ciclopirox 8% topical solution daily for tinea unguium and ketoconazole 25 cream once a day under feet and between toes for tinea pedis. However, the examination report does not address whether any treatment prior to August 13, 2018, constitutes systemic therapy. As such, the Board finds that a remand is necessary to address this medical question. Further, clarification is required to address whether the Veteran has any diagnosed disability of the great toes or feet associated with service-connected tinea unguium of the bilateral toes, with tinea pedis. This was requested in the Board’s prior remand, but not addressed. A remand by the Board imposes upon the Secretary of VA a concomitant duty to ensure compliance with the terms of the remand. Where remand orders of the Board are not complied with, the Board errs in failing to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). The matter is REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for all non-VA medical providers, including podiatrists, seen for symptoms involving his service-connected tinea unguium of the bilateral toes, with tinea pedis. Make two requests for the authorized records from all identified sources, unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran’s VA treatment records for the period from July 2020 to the Present. 3. Obtain an addendum medical opinion from an appropriate clinician to address the Veteran’s service-connected tinea unguium of the bilateral toes, with tinea pedis. The claims file, including a complete copy of this remand, must be made available to the clinician for review. Based on a review of the record, address or provide the following:. (a.) Identify, since September 2013, what medications the Veteran has used to treat his tinea unguium of the bilateral toes, with tinea pedis. (b.) For each and every identified medication, state whether it represents a systemic therapy such as corticosteroids or other immunosuppressive drugs. (c.) Indicate whether any topical treatment operates by affecting the body as a whole in treating the Veteran's tinea unguium of the bilateral toes and tinea pedis. (d.) Indicate whether any medication used since September 2013 is “like” a corticosteroid or other immunosuppressive drug. (e.) For each medication that is “like” a corticosteroid or other immunosuppressive drug, identify the length of time that each medication was required since September 2013. Obtain an addendum medical opinion, to supplement the February 2020 VA Skin Disease Disability Benefits Questionnaire, from an appropriate clinician clarifying for the record whether the Veteran has any diagnosed disability of the great toes or feet associated with his service-connected tinea unguium of the bilateral toes, with tinea pedis. Consider his report of tenderness. Consider his December 2019 testimony that his skin conditions cause ingrown toenails causing numbness and tingling symptoms of his feet. The Veteran may be recalled for examination if deemed necessary to clarify this mater. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Edwards 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.