Citation Nr: 21010572 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 14-39 176 DATE: February 25, 2021 REMANDED Entitlement to an initial compensable rating in excess of 30 percent for pseudofolliculitis barbae (PFB) is remanded. Entitlement to an initial rating in excess of 10 percent for a papulosquamous disorder, previously characterized as acne keloidalis nuchae (AKN), is remanded. Entitlement to service connection for a disorder manifested by chest pain is remanded. REASONS FOR REMAND The Veteran had active service from November 1996 to October 2006. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2018, the Board remanded the claims of entitlement to increased ratings for PFB and papulosquamous disorder for additional development. The Board also denied the claim for entitlement to service connection for chest pain. The Veteran appealed the denial of service connection for chest pain to the Court of Appeals for Veterans Claims (CAVC). In December 2018, CAVC granted a Joint Motion for Partial Remand that vacated and remanded the Board’s decision regarding entitlement to service connection for chest pain. In July 2019, the Board remanded the issue for additional development. Following the recertification of all three issues to the Board, in June 2020 the Board remanded the entire appeal for further evidentiary development. The Board notes that a September 2020 VA medical opinion stated that the disability that was previously diagnosed as AKN should in fact be characterized as a papulosquamous disorder. This disorder is discussed under Diagnostic Code 7822 rather than 7828. However, both diagnostic codes refer back to the generic skin rating guidelines so no change to the rating code is necessary. 1. Entitlement to increased rating for PFB is remanded to obtain private treatment records. 2. Entitlement to increased rating for Papulosquamous Disorder is remanded to obtain private treatment records. The June 2020 Board remand instructed the AOJ to obtain all records from Pariser Dermatology. The Board indicated that two such attempts must be made. As noted in the previous remand, Pariser Dermatology was the provider that the Veteran initially saw regarding his skin issues before switching to the VA and contained his original treatment records. For this reason, his increased rating claims would be enlightened by a review of these medical records. There is no indication in that record that any attempts were made to obtain these records following the June 2020 remand. Compliance with remand directives is not discretionary, and failure to comply with the terms of a remand necessitates remand for corrective action. Stegall v. West, 11 Vet. App. 268 (1998). If the above-described records are obtained, the AOJ should obtain an addendum opinion that discusses the additional evidence. 3. Entitlement to service connection for a disorder manifested by chest pain is remanded for a new examination. The July 2019 Board remand instructed the AOJ to obtain a VA examination to address the nature and etiology of the Veteran’s chest pain, and to assess whether the Veteran’s chest pain results in functional impairment. The Veteran received a VA examination in November 2019, but the Board finds that it is inadequate for adjudication purposes. See Barr v. Nicholson, 21 Vet. App. 302, 312 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). Here, the November 2019 VA examiner noted the Veteran’s reports of chest pain during and since service, and noted that it caused shortness of breath. However, there is no indication from the examination report that any diagnostic tests or studies were performed. The examiner noted a negative stress test, but the last stress test of record is in 2012. Accordingly, a remand is required to afford the Veteran a full examination. The matters are REMANDED for the following action: 1. After obtaining any necessary authorization from the Veteran, request all records from Pariser Dermatology. Make at least two (2) attempts to obtain records from any identified sources. If such records are unavailable, inform the Veteran and afford him the opportunity to submit any copies in his possession. 2. If additional records are obtained, provide these documents to the VA examiner who conducted the September 2019 skin examination. The Veteran’s entire record as well as a copy of this remand must be provided to the examiner. If the September 2019 examiner is not available, the record should be provided to an appropriate medical professional to render the requested opinion. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. Following a review of the record, the examiner should offer an opinion as to whether the new records change the diagnosis of the maximum area impacted by both PFB and the papulosquamous disorder. A rationale for any opinion offered should be provided. 3. Schedule the Veteran for a VA heart conditions examination to determine the nature and etiology of the claimed chest pain. The Veteran’s claims file, to include a copy of the remand, must be made available to the examiner along with any other information the medical professional deems pertinent. Any diagnostic tests deemed necessary should be performed. Following examination of the Veteran and review of the claims file, to include a copy of this REMAND, the examiner should determine whether the Veteran has a current diagnosed disorder manifested by chest pain. For any diagnosed disorder, the examiner must provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the claimed condition had onset in service or is directly linked to the Veteran’s time on active duty. Regardless of whether a disability relating to the Veteran’s chest pain is diagnosed, the examiner should determine whether the Veteran’s chest pain with associated shortness of breath constitutes functional impairment such that it may qualify as a disability. 4. Then, readjudicate the remaining issues on appeal. If a decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then return the case to the Board. Roya Bahrami Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Andrew Ledman II 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.