Citation Nr: 21014314 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 14-26 920 DATE: March 11, 2021 REMANDED Entitlement to service connection for a skin disorder, claimed as singles and hives, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran had active duty service from February 1992 to December 1994, to include service in Southwest Asia from April 1994 to December 1994. This matter was previously before the Board of Veterans’ Appeals (Board) in April 2018 and March 2020, when the appeal was remanded for further evidentiary development. Service connection for a skin disorder, claimed as singles and hives, to include as secondary to service-connected disabilities After carefully considering this matter, and for reasons expressed immediately below, the Board finds that this case must again be remanded for further evidentiary development. The Board regrets the delay associated with this current remand but finds that it is necessary to ensure that the Veteran is accorded full compliance with VA’s statutory duty to assist. In accordance with the March 2020 remand, the matter was remanded for an addendum opinion to determine whether the Veteran’s recurrent shingles is proximately due to her service-connected chronic fatigue syndrome, fibromyalgia, migraines and/or psychiatric disorder—or aggravated beyond its natural progression by any of these service-connected disabilities. The examiner was specifically asked to address the Veteran’s contentions that her service-connected disabilities have caused her stress and have resulted in a compromised immune system which, in turn, caused her recurring shingles. Pursuant to this remand, a VA examiner provided an addendum opinion in April 2020 addressing these issues. Unfortunately, the Board finds this opinion to be inadequate. In this regard, the Board acknowledges that the April 2020 VA examiner noted that recurrent shingles occurs more frequently in immunocompromised and transplant patients. The examiner stated that the Veteran’s service-connected conditions are neither immunocompromising nor a result of a transplant. Instead, the examiner stated that there is an increase in recurrent shingles incidences in patients with autoimmune diseases (such as the Veteran’s nonservice-connected irritable bowel syndrome) which are treated with glucocorticoids and other therapeutics. In providing the opinion, the examiner, however, did not address the Veteran’s contentions regarding the impact of stress from her service-connected psychiatric disorder or the impact (to include by aggravation) of her weakened immune system in relation to her recurrent shingles diagnosis. As such, the Board finds that remand is necessary. Further, the March 2020 appellate brief provided a medical research resource that asserts that shingles has been medically associated with both fibromyalgia and migraines. See March 2020 Appellate Brief. This medical reference has not been discussed by a VA examiner. As such, the Board finds that a medical opinion regarding this contention is necessary. A remand by the Board confers on the claimant a legal right to compliance with the remand order. Stegall v. West, 11 Vet. App. 268, 271 (1998). Compliance with a remand is not discretionary, and failure to comply with the terms of a remand necessities remand for corrective action. Id. Substantial compliance with the remand order, not strict compliance, is required. Donnellan v. Shinseki, 24 Vet. App. 167, 176 (2010); Dyment v. West, 13 Vet. App. 141, 147 (1990). Failure of the Board to ensure compliance with remand instructions constitutes error and warrants the vacating of a subsequent Board decision.  Stegall, 11 Vet. App. at 271. Given the inadequacies of the April 2020 VA addendum opinion, a remand for corrective action is necessary, to include providing the Veteran a new medical opinion that adequately addresses the impact of stress caused by her psychiatric disorder and the effect of any aggravation of her service-connected disabilities on her immune system (resulting in the recurrence of her shingles). Accordingly, these matters are REMANDED for the following action: Obtain an addendum opinion from the examiner who provided the April 2020 addendum opinion pertaining to the Veteran’s recurrent shingles condition. If this examiner is unavailable, another appropriate examiner should provide the opinion. Then, ask the examiner to provide the following opinions: (a.) Is the Veteran’s recurrent shingles caused by or otherwise related to her service-connected chronic fatigue syndrome, fibromyalgia, migraines and/or psychiatric disorder? (b.) Is the Veteran’s recurrent shingles aggravated beyond its natural progression (worsened) by her service-connected chronic fatigue syndrome, fibromyalgia, migraines and/or psychiatric disorder? In rendering these opinions, the examiner must thoroughly address the Veteran’s contentions regarding the impact of her stress-related psychiatric disorder on her recurring shingles as well as the effect of any aggravation of her service-connected disabilities on her immune system (resulting in the recurrence of her shingles). Also, the examiner must address the medical research provided by the Veteran that asserts that shingles has been medically associated with both fibromyalgia and migraines. Complete rationale should be included for all opinions provided. No action is required of the Veteran until she is notified by VA. However, she is advised of her obligation to cooperate in ensuring the duty to assist is satisfied. Kowalski v. Nicholson, 19 Vet. App. 171 (2005). Her failure to report for a VA medical examination may impact the determination made. 38 C.F.R. § 3.655. The Veteran also is advised that she has the right to submit additional evidence and argument with respect to this matter. Kutscherousky v. West, 12 Vet. App. 369 (1999). This appeal must be afforded prompt treatment. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. R. Bobb, 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.