Citation Nr: 21006762 Decision Date: 02/05/21 Archive Date: 02/05/21 DOCKET NO. 14-31 860A DATE: February 5, 2021 REMANDED Entitlement to a compensable rating for bilateral tinea pedis and onychomycosis is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from March 1986 until his honorable discharge in August 1989. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a June 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously remanded by the Board in August 2019. The case has returned to the Board for further consideration. Although further delay is regrettable, the Board finds a remand is necessary in this case to ensure due process is followed and there is a complete record upon which to decide the Veteran’s claim, so he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The Veteran seeks a compensable rating for his service-connected bilateral tinea pedis and onychomycosis. As explained below, the medical evidence of record does not sufficiently describe the oral medications the Veteran has used to treat his bilateral tinea pedis and onychomycosis. See Warren v. McDonald, 28 Vet. App. 194 (2016); see also Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017). The Board notes the evaluation of tinea pedis and onychomycosis for rating purposes depends on, among other things, whether the treatment is oral or topical, the length of the treatment, and whether the treatment involves the use of systemic therapy such as corticosteroids or other immunosuppressive drugs. See 38 C.F.R. § 4.118, Diagnostic Codes (DCs) 7806 (dermatitis), 7813 (dermatophytosis). The record reflects the Veteran’s bilateral tinea pedis and onychomycosis treatment regimen includes prescribed oral medications. A March 2016 VA treatment record notes, “tinea pedis – toenail fungus – Lamisil 250mg tablet daily for 30 days, RTC in 1 month.” In June 2016, the Veteran “requests renewal of Terbinafine Tablet 250mg.” See VA Nursing Telephone Encounter Note: Prescription Renewal Call. A September 2016 Jackson VAMC “Active Outpatient Medications” list, confirms the Veteran was prescribed Terbinafine HCL 250mg on September 1, 2016. The Veteran was advised to “take one tablet by mouth” daily for toenail fungus infection. It is unclear from these medical records, however, the duration the Veteran was prescribed these medications and whether such constitute systematic therapies. The Board finds the VA examination reports of record are insufficient for determining the appropriate rating for the Veteran’s bilateral tinea pedis and onychomycosis. Therefore, a remand for development to ensure the record pertaining to the prescriptions for medication for the Veteran’s skin disability during the relevant period is complete, and for a medical opinion that addresses the significance of those prescriptions is necessary. The matters are REMANDED for the following action: 1. Send a written request to the Veteran for evidence (such as pharmacy records, prescription records, medical records, etc.) of all medications prescribed for treatment of his tinea pedis and onychomycosis (only) during the appellate time frame. Request a written response from the Veteran. Allow a sufficient amount of time for the Veteran to assemble and submit this information. 2. Obtain copies of the Veteran’s VA treatment records and associate them with the electronic claims file. Ensure the record of medications prescribed for treatment of the Veteran’s bilateral tinea pedis and onychomycosis during the appellate time frame is complete. 3. After the above is completed, prepare a Memorandum listing the medications prescribed that advises, for each medication: (a.) The name of the medication; (b.) The beginning and ending date (duration) of the medication prescribed; and (c.) The prescribed frequency (constancy) of use. Associate this Memorandum with the claims file. 4. After the above is complete, obtain an addendum opinion from an appropriate clinician addressing, to the extent possible: (a.) Whether the medication(s) prescribed for the Veteran’s service-connected tinea pedis and onychomycosis is a corticosteroid, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs; and (b.) The nature and frequency of the treatment regime; and, whether it includes: • intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks; • systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly; or • constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs. The examiner must provide the rationale for all opinions rendered. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Grace Johnk, 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.