Citation Nr: 21013392 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 08-30 058A DATE: March 9, 2021 REMANDED A compensable rating for tinea pedis and tinea unguium prior to February 1, 2016; and in excess of 30 percent thereafter.   REASONS FOR REMAND The Veteran served on active duty for training (ACDUTRA) from October 1980 to March 1981 and on active duty from November 1990 to May 1991 (including deployment to Southwest Asia in support of Operations Desert Shield/Desert Storm), from February 1999 to October 1999, and from March 2003 to March 2004. He also served on ACDUTRA and inactive duty training (INACDUTRA) with the Army Reserve and National Guard. The case is on appeal from an October 2007 rating decision. In March 2011, the Veteran testified at a Board hearing. In October 2018, the matter was remanded for additional development. The Board has recharacterized the issue as reflected above to comport with the evidence. A compensable rating for tinea pedis and tinea unguium prior to February 1, 2016; and in excess of 30 percent thereafter. Pursuant to the Board’s October 2018 remand, the Veteran was afforded a VA examination in October 2019. The examiner clarified that tinea unguium involved only the Veteran’s toenails and not the legs. Although the examination report reflects the only medication was a topical (non corticosteroid) for neurodermatitis of the neck, noting tinea pedis of the lower extremities was quiescent, the opinion does not address the Veteran’s report of flare-ups due to heat in the summer. See July 2013 private treatment record; September 2020 Disability Benefits Questionnaire (DBQ). See also Ardison v. Brown, 6 Vet. App. 405, 408 (1994) (examination must be provided during active phase that lasts weeks to months at a time); Voerth v. West, 13 Vet. App. 117, 123 (1999) (examination is not required during active phase that lasts “only for a few days out of a year”). In addition, and although the VA opinion notes that the Veteran’s skin conditions affect less than 5 percent of total body area affected, the DBQ reflects more than 5 percent of total body area affected, as well as constant or near-constant use of topical corticosteroids. Based on the above, the VA examination is not completely adequate, and, as there is an indication that the Veteran’s skin conditions are worse, VA examination is warranted. See Snuffer v. Gober, 10 Vet. App. 400 (1997) (noting that a Veteran is entitled to a new VA examination where there is evidence that the condition has worsened since the last examination). The Board notes that, although the September 2020 DBQ reflects constant or near-constant use of biologics, the opinion does not indicate the route of administration (orally, injection, suppository, intranasally). Further, the opinion does not indicate whether the examination was being conducted during a flare up or describe the Veteran’s condition during a flare up. As such, the opinion is not completely adequate with respect to whether a rating higher than 30 percent is warranted. As noted in the prior remand, effective August 13, 2018, VA amended its regulations governing skin disabilities, and thus, in readjudicating the claim, both the old and new rating criteria (effective August 13, 2018), whichever is more favorable to the Veteran, are to be considered. Additionally, and even though the Veteran stated that he no longer received VA treatment for his service-connected skin conditions, see July 2020 Correspondence, VA treatment records in October 2020 reflect fee-based treatment for the conditions. On remand, the RO should attempt to obtain outstanding dermatology treatment records since the issuance of the August 2020 supplemental statement of the case. The matter is REMANDED for the following action: 1. Attempt to obtain outstanding dermatology treatment records since August 2020. 2. Schedule the Veteran for an examination (or telehealth interview, records request, etc. if an in-person examination is not feasible) by an appropriate clinician to assess the severity of the service-connected skin conditions, for the period from August 2007 to the present. If possible, the examination should be conducted during an active stage of the skin conditions. The examiner should provide an opinion as to: (1) the type of treatment for the neurodermatitis of the neck, tinea pedis of the lower extremities with tinea unguium of the toenails, and stasis dermatitis with pigmentation of the legs, including whether it is topical, whether it is a corticosteroid, and whether it is systemic and/or immunosuppressive in nature or the equivalent; and (2) the percentage area covered for neurodermatitis of the neck, tinea pedis of the lower extremities with tinea unguium of the toenails, and stasis dermatitis with pigmentation of the legs, to include as follows: a) Is constant or near-constant systemic therapy, including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over a 12-month period? b) If any medication is topical, the examiner should then provide a medical opinion as to whether the topical medication affects the entire body like a systemic therapy, such as through the bloodstream. If not, please explain why this is so. c) Is more than 40 percent of the Veteran’s entire body or more than 40 percent of his exposed areas affected by neurodermatitis of the neck, tinea pedis of the legs with tinea unguium of the toenails, and/or stasis dermatitis with pigmentation of the legs, or any other associated skin condition? If the examination is not conducted during a flare up, the effects of a flare-up should be estimated, to include entire body and exposed areas affected during a flare up, including at the time of the VA examinations in November 2017, February 2016, February 2012, and September 2007. If they cannot be, it should be explained why this is so. In rendering the opinions, the evidence should be considered, including the September 2020 DBQ. 3. In readjudicating the claim, consider both the old and new rating criteria (effective August 13, 2018), whichever is more favorable to the Veteran. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Taylor 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.