Citation Nr: 21007655 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 09-13 092 DATE: February 10, 2021 ISSUE Entitlement to service for a skin disability, to include tinea (diagnosed as dermatitis bilateral lower extremities and tinea cruris), to include as secondary to an acquired psychiatric disorder. REMANDED Entitlement to service for a skin disability, to include tinea (diagnosed as dermatitis bilateral lower extremities and tinea cruris), to include as secondary to an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served in the Army November 8, 2006 to August 21, 2007. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2009 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in North Little Rock, Arkansas This matter was previously before the Board in January 2017, August 2017, February 2019 and September 2020. In the January 2017 decision, the Board, in pertinent part, remanded the claim for additional development. In the August 2017 decision, the Board, in pertinent part, remanded the matter for additional a VA examination. In the February 2019 decision, the matter was remanded for new VA examinations In the September 2020 decision, the Board, in pertinent part, remanded the claim for an additional examination to address whether the Veteran’s tinea was aggravated by his service connected acquired psychiatric disorder. The Board notes that the Veteran submitted new evidence and argument (lay statement re: diagnosis for skin condition) after issuance of the November 2020 Supplemental Statement of the Case (SSOC). See December 8, 2020 Correspondence. However, pursuant to 38 C.F.R. § 20.1304 (c), any additional evidence received after certification to the Board must be referred to the Agency of Original Jurisdiction (AOJ) for initial review, unless the claimant or his representative waives this review right or when the benefit being sought is allowed in full by the Board. Where the substantive appeal was received on or after February 2, 2013, Section 501 of the Camp Lejeune Act of 2012 provides an automatic waiver of evidence submitted by a Veteran or his or her representative with or after a Substantive Appeal received on or after February 2, 2013. See 38 U.S.C. § 7105 (e)(1); 38 C.F.R. § 20.1304 (c). In the Veteran's case, the automatic waiver does not apply as his substantive appeal was received in April 2010. Therefore, remand is warranted so that the RO can review the evidence in the first instance. See April 8, 2010, Form 9. In addition, for reasons that will discussed below, the Board finds that remand is warranted since the examination obtained in response to the Board's September 2020 remand directives requires an addendum medical opinion prior to the adjudication of this Veteran’s claim. Lastly, based on the evidence of record, and the Veteran’s contentions, the Board has characterized the Veteran’s claim as reflected on the title page. See Clemmons v. Shinseki, 23 Vet. App. 1 (2009). Entitlement to service connection for a skin disability, to include tinea (diagnosed as dermatitis bilateral lower extremities and tinea cruris), to include as secondary to an acquired psychiatric disorder, is remanded. At the outset the Board notes that the Veteran has been afforded VA examinations and medical opinions in October 2017, October 2019 and October 2020 for his skin disability. The October 2019 and October 2020 examiners found that the Veteran’s tinea, clearly and unmistakably pre-existed service. Pursuant to the Board’s September 2020 remand directives, the Veteran was afforded an October 2020 Skin Diseases Examination to determine whether the Veteran’s tinea was proximately caused or aggravated by his service-connected schizophrenia. In this October 2020 examination, addressing whether the Veteran’s tinea was aggravated by his service-connected schizophrenia, the examiner opined that it is not at least as likely or not that the Veteran’s tinea was aggravated by his service-connected schizophrenia. The examiner explained that the Veteran does not have a tinea infection and did not have one during or after service. The examiner noted that the only record of any fungal or tinea infection was at the age of 12 years (1998) old and given the only one report was more than likely an acute infection that resolved without complication. The Board notes however that the Veteran was treated for tinea in February 2009. See February 20, 2009 treatment record re: Diagnostic impression (likely tinea given location). The Veteran was treated with Nystatin cream. See Nieves-Rodriguez, 22 Vet. App. 295, 303-304 (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). Also, the Board observes that in an October 2019 VA Skin Disease examination, the examiner found that the Veteran has a tinea diagnosis. See October 18, 2019 Skin Diseases Disability Benefits Questionnaire, pgs. 1 & 3 re: diagnosis and Condition 1; See also Medical Opinion, Disability Benefits Questionnaire, pg. 1 (Evidence Review); See also, October 2017 Skin Disease Disability Benefits Questionnaire (DBQ), pg. 1. re: diagnosis (dermatitis bilateral lower extremities and tinea cruris) pg. 1. Thus, the Board finds that prior to the adjudication of this Veteran’s claim, it is important to obtain a clarifying addendum medical opinion on this issue, and particularly to reconcile any conflicting opinion of record with regards to the etiology of this Veteran’s skin disability. The Board also observes that the October 2020 VA examiner found that the Veteran has a diagnosis of nummular dermatitis. It is not clear however whether this skin condition clearly and unmistakably pre-existed service and/or whether this condition is etiologically related to service. Hence, the Board finds that a clarifying addendum medical opinion regarding the Veteran’s skin disability, to include tinea, is warranted in this case for the purpose of (a) reconciling conflicting evidence of record regarding the Veteran’s skin disability and (b) to opine on the nature and etiology of this Veteran’s skin disability, to include tinea (diagnosed as dermatitis bilateral lower extremities and tinea cruris), to include as secondary to his service connected schizophrenia. The Board notes that the Veteran is already service connected for alopecia areata. Because the Board may not rely on its own unsubstantiated medical conclusions, Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991), it must rely on an informed medical opinion in order to adjudicate a claim. Accordingly, this matter is REMANDED for the following action: 1. Contact the Veteran and provide him an opportunity to identify any documents or treatment records pertinent to the issue on appeal that have not been associated with the file to date. He should be asked to provide any needed releases, and to identify any approximate dates and locations of treatment. All attempts to obtain records should be documented in the claims folder. 2. Next, return the claims file to the VA examiner who provided the October 15, 2020 Skin Disease Examination and October 21, 2020 Medical opinion. The examiner must review the claims file, including a copy of this remand. If the previous VA examiner is unavailable, an equally qualified VA examiner may be substituted. An in-person examination is not required unless deemed necessary by the examiner. The examiner is invited to review the following evidence: February 20, 2009 treatment note re: diagnostic impression, tinea. (Document type, CAPRI, Receipt Date, December 17, 2019.) October 2019 VA Skin Disease Disability Questionnaire, pg. 2 re: tinea cruris diagnosis; See also October 2019 Skin Disease Medical Opinion, pg. 1 (Evidence Review re: dermatitis bilateral lower extremities tinea cruris); See also, October 2017 Skin Disease Disability Benefits Questionnaire, pg. 1 re: diagnosis. The examiner is asked to clarify her opinion that the Veteran does not have a tinea infection and did not have one during or after service. Please reconcile any conflicting evidence of record. Next, the examiner is asked to clarify the etiology of the Veteran’s skin disability, to include tinea (previously diagnosed as dermatitis bilateral lower extremities), to include as secondary to an acquired psychiatric disorder. The examiner is asked to address the following: a) whether any skin disorder diagnosed during the pendency of this appeal clearly and unmistakably existed prior to the Veteran’s service, from November 2006. b) If so, the examiner should provide an opinion as to whether it is clear and unmistakable that any such disorder did not undergo aggravation during service beyond its natural progression. c) If the examiner concludes that any such disorder did not clearly and unmistakable exist prior to service, the examiner should provide an opinion as to whether the disorder is as likely as not, etiology related to service or was aggravated by the Veteran’s service-connected schizophrenia. d) whether it is at least as likely not that any skin disorder diagnosed during the pendency of this appeal was caused or aggravated by the Veteran’s service-connected schizophrenia. Note: The examiner is invited to review the Veteran’s December 2020 lay correspondence regarding nummular dermatitis, furuncles of the groin diagnosis. (Document Type, Correspondence, Receipt Date, December 14, 2020.) Please note review of this correspondence. The examiner(s) must also remain mindful that a recent precedent case clarified that secondary service connection does not require "permanent" worsening of the condition being claimed by the service-connected disability. See Ward v. Wilkie (16-2157, 17-1204). When responding, whether favorably or unfavorably to the claims, it is essential the examiner(s) provide explanatory rationale for the opinions, preferably citing to supporting evidence in the file and/or accepted medical authority. 3. Ensure that the examination report is adequate. If it is deficient in any manner, return the report to the examiner as inadequate. Then, after conducting any other development deemed necessary, readjudicate the Veteran's claim. If the benefit sought on appeal remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC) and allow an appropriate period of time for response. Thereafter, the claims folder should be returned to the Board. Michael A. Pappas Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Little, 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.