Citation Nr: 21011393 Decision Date: 03/01/21 Archive Date: 03/01/21 DOCKET NO. 12-18 305 DATE: March 1, 2021 REMANDED Entitlement to compensation under 38 U.S.C. § 1151 for dermatitis (claimed as a skin condition of the body, hands, and feet) is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1967 to November 1970. The claim was most recently before the Board in December 2019 when it was remanded for additional development. There has not been substantial compliance with the remand directives and the claim must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to compensation under 38 U.S.C. § 1151 for dermatitis (claimed as a skin condition of the body, hands, and feet) is remanded. The claim must be remanded again because the November 2020 VA examination did not substantially comply with the Board’s December 2019 remand directives by providing an in-person examination before obtaining an opinion by a specialist pertaining to a § 1151 claim for a skin condition. The November 2020 remand specifically stated that the February 2014 opinion did not appear to have been prepared by a medical professional with any expertise in dermatological disorders and, without an in-person examination, the conclusion or suggestion that there is no additional disability seems in contradiction to the VA treatment records, which indicated the Veteran had dermatitis as a reaction to Humira per his treating dermatologists. A new VA examination is warranted. Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: The Veteran should be scheduled for an in-person VA examination by a dermatologist not employed with the Cleveland VA Medical Center. A complete medical history should be obtained. All skin disorders should be diagnosed to include the date of onset, to the extent feasible. Copies of all pertinent records must be made available to the examiner for review. The physician should answer the following questions: (a) Does the Veteran have or has the Veteran had “additional disability” due to treatment with the prescribed medication Humira, to include dermatitis of the body, hands and/or feet, at any time since Humira was first prescribed? Note: “Additional disability” is determined by comparing the Veteran’s condition immediately before the beginning of treatment to the Veteran’s condition after such care-and each involved body part must be considered separately. 38 C.F.R. § 3.361. (b) If yes, then is the additional disability due to treatment with Humira a direct result of carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on VA? (c) If yes, then did VA treatment proximately cause additional disability, and (i) did VA fail to exercise the degree of care that would be expected of a reasonable health care provider; or (ii) did VA furnished the medical treatment without the Veteran’s informed consent. As part of his/her response, the physician should specifically address the following: (a) Whether there was in fact disclosure to the Veteran of the possible side effects from the medication Humira, to include before it was initially prescribed. (b) Whether prescribing the medication Humira involved carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault; the physician should address the Veteran’s theory that VA’s prescribing him the drug Humira was improper given that he is diagnosed and treated for heart disease. The physician should specifically state whether Humira is contraindicated for patients with heart disorders. A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training) and note what, if any, additional evidence would permit such an opinion to be made. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. G. Perkins, 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.