Citation Nr: 21007037 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 14-08 154 DATE: February 8, 2021 REMANDED Entitlement to a higher initial staged rating for tinea pedis, currently rated as 10 percent disabling from January 19, 2010 until October 12, 2012; 30 percent disabling from October 12, 2012 until June 7, 2016 and 10 percent thereafter is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1991 to November 1991 and from February 2003 to April 2004, including service in Southwest Asia. This case initially came before the Board of Veterans' Appeals (Board) on appeal from a November 2012 rating decision by a Regional Office (RO) of the Department of Veterans Affairs (VA) that granted service connection for tinea pedis and assigned an initial 10 percent rating from January 19, 2010. The case was most recently the subject of a January 2020 Board remand. The requested development has not been sufficiently completed and another remand is necessary. Entitlement to a higher initial staged rating for tinea pedis, currently rated as 10 percent disabling from January 19, 2010 until October 12, 2012; 30 percent disabling from October 12, 2012 until June 7, 2016 and 10 percent thereafter is remanded. Although the Board regrets the delay, another medical opinion from a dermatologist is needed to comply with the January 2020 Board remand and obtain information about tinea pedis medication use since January 2010. See Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (it is only substantial compliance, rather than strict compliance, with the terms of a remand that is required). The Court has provided guidance about categorizing medication as systemic therapy under the pre-amended Diagnostic Code (DC) 7806 criteria. Warren v. McDonald, 28 Vet. App. 194, 197 (2016); Burton v. Wilkie, 30 Vet. App. 286, 291-95 (2018); 38 C.F.R. § 4.118, DC 7806. Specifically, in Warren, the Court held that DC 7806 provides compensation for all systemic therapies that are like or similar to corticosteroids or immunosuppressive drugs. Id. In Burton, the Court explained that systemic therapy included any treatment that affected the entire body in its treatment of the condition at issue. Id. The January 2020 Board remand instructed the AOJ to furnish an examination to assess the current severity of the Veteran’s service-connected tinea pedis with onychomycosis in response to the applicable rating criteria. From the Court guidance, the Board also requested that the clinician provide a retrospective medical opinion about the characteristics for each medication the Veteran had used to treat service-connected tinea pedis since January 19, 2010. Specifically, for each tinea pedis medication used since January 19, 2010, the examiner was to assess the following: (a) whether it affected the body as a whole; (b) whether it was characterized as “topical therapy” or “systemic therapy” in accordance with prevailing medical understanding; and (c) whether it could be considered a corticosteroid or other immunosuppressive drug, and if so, whether it operated by affecting the body as a whole. In August 2020, the AOJ uploaded a comprehensive VA medication list for the Veteran spanning from approximately September 2009 through July 2020. The AOJ obtained February 2020 and October 2020 examination reports and medical opinions. The February 2020 VA physician reported on medication use within the past 12 months and did not provide the detailed assessments for each tinea pedis medication use since January 2010 as instructed above. Similarly, the October 2020 VA-contract physician reported on medication use within the past 12 months. He identified a different medication, Naftin cream, as the relevant treatment without further detail. The tinea pedis medication history responses from the February 2020 VA physician and October 2020 VA-contract physician are not in substantial compliance with the January 2020 Board remand. Id. Neither physician confirmed review of prior tinea pedis medications from VA treatment records starting from January 2010 or review of the comprehensive VA medication report obtained in August 2020. Their medication use comments appear to be based upon recent history. Then, for the identified medications, neither physician addressed all the medication characteristics as requested in the January 2020 remand. Given these limitations, another medical opinion is needed as instructed below. The matter is REMANDED for the following action: 1. Obtain an addendum medical opinion from a dermatologist about the Veteran’s service-connected tinea pedis medication use history starting from January 19, 2010. The dermatologist must conduct a complete review of the claims folder. Following a complete review of the claims folder, the dermatologist must perform the following: (a) Identify each tinea pedis medication used for treatment from January 19, 2010 to present and the approximate dates of such treatment. Note, the evidence includes August 2020 VA medication history reports that summarize all medications ordered for the Veteran beginning in September 2009. (b) For each identified tinea pedis medication, whether it is either: (i) a corticosteroid or immunosuppressive drug or (ii) a systemic therapy like or similar to a corticosteroid or immunosuppressive drug. (c) For each identified tinea pedis medication, indicate whether the treatment is expected to affect the body as a whole in its treatment of tinea pedis. All opinions expressed must be accompanied by a complete rationale. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. D. Simpson, 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.