Citation Nr: 21009120 Decision Date: 02/19/21 Archive Date: 02/19/21 DOCKET NO. 18-36 503 DATE: February 19, 2021 REMANDED The issue of service connection for skin disease is remanded. The issue of a rating greater than 30 percent for service-connected left knee is remanded. The issue of a total disability rating due to individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service from May 1962 to September 1966. These matters come before the Board of Veterans’ Appeals (Board) from a December 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran submitted a Notice of Disagreement (NOD) in January 2017 and a Statement of the Case (SOC) was issued in May 2018. The Veteran perfected an appeal by submitting a timely VA Form 9 in June 2018. The Veteran and his spouse testified at a September 2020 Board hearing. A transcript of that hearing has been associated with the record. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.902(c). 38 U.S.C. § 7107(b). 1. The issue of service connection for skin disease is remanded. In December 2020, the Veteran and his spouse testified that the Veteran has had problems with his skin since service. The Veteran believed that the skin problems were caused by his two-year assignment in Camp Lejeune, but first noticed it during boot camp in Parris Island. VA Medical Center treatment records from July 2012 show the Veteran reporting that he has had “flaky skin” on the face and ears since Vietnam. In September 2014, VA Medical Center noted history of seborrheic dermatitis, and July 2014, the Veteran was assessed as having seborrheic dermatitis and was prescribed shampoo and cream. VA’s duty to assist also includes obtaining a medical examination or opinion when such is necessary to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). An examination or medical opinion is necessary if the evidence of record (1) contains competent evidence that the claimant has a current disability, or persistent or recurrent symptoms of disability; and (2) establishes that the claimant suffered an event, injury, or disease in service; or has a presumptive disease or symptoms of such a disease manifesting during an applicable presumptive period; and (3) indicates that the claimed disability or symptoms may be associated with the established event, injury, or disease in service; but (4) does not contain sufficient medical evidence for the Secretary to make a decision on the claim. Id.; see also McLendon v. Nicholson, 20 Vet. App. 79 (2006). With respect to the claim of service connection for skin disease, the statutory duty to assist has been triggered, as the Veteran contended that his current skin disability is causally related to his service, to include exposure to contaminated waters in Camp Lejeune. He has not yet been afforded an examination for this claim. The Board thus finds that the Veteran should be afforded an appropriate examination with respect to his service connection claims for a skin disability. 2. The issue of a rating greater than 30 percent for service-connected left knee is remanded. The Veteran contends that he is entitled to a rating greater than 30 percent for his service-connected left-knee disability. Since his last VA examination in July 2017, VA Medical Center treatment records show that the Veteran fell numerous times in 2019. At the time, the Veteran reported that his right knee buckled, causing him to fall. Although the Veteran has problems with both knees, he reported in August 2017 that his left leg gives out without warning more often than his right leg. In November 2019, the Veteran was identified as a fall risk. The Veteran and his spouse testified in December 2020 that his knee was the cause of the falls as it gives out. In light of the Veteran’s statements and treatment records showing worsening symptoms, to include instability of the left knee causing falls, the Board finds that the Veteran should be afforded a new VA examination to obtain contemporaneous, pertinent information to assess the current nature and severity of his service-connected left knee disability. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994). 3. The issue of an entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. The claim for a TDIU is inextricably intertwined with the remanded claims of service connection for a skin disability and the issue of a rating greater than 30 percent for a left knee disability as the decisions will affect the TDIU claim. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (noting that two issues are “inextricably intertwined” when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). Thus, consideration of the appeal regarding entitlement to a TDIU will be deferred. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by a VA clinician to determine the nature and etiology of the skin disability. The examiner should review the virtual file. The examiner is to address whether it is at least as likely as not (50 percent or greater probability) that a skin disability manifested during or is otherwise related to the Veteran’s period of active service, to include assignment at Camp Lejeune. Rationales for all opinions are to be provided. All pertinent evidence, including both lay and medical, should be considered. The examiner may not rely on the absence of complaints, treatments, or diagnoses in the service treatment records. 2. Schedule the Veteran for a new VA examination as to the severity of his service-connected left knee disability. All necessary tests should be conducted. The claims file must be sent to the examiner for review. The examiner should examine the Veteran and render findings in accordance with the currently applicable disability benefits questionnaire. All opinions must be supported by a detailed rationale. 3. After the AOJ develops and readjudicates the Veteran’s claims of service connection for skin disability and a rating greater than 30 percent for his left knee disability and completes any additional development deemed necessary, readjudicate the Veteran’s TDIU claim based on a review of the entire evidentiary record. If the benefits sought are not granted in full, the Veteran and his representative should be furnished an appropriate SSOC and be afforded an opportunity to respond. Thereafter, the case should be returned to the Board for appellate review. JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Yun 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.