Citation Nr: 21015033 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 08-06 579A DATE: March 16, 2021 REMANDED Entitlement to separate rating for boils of the buttocks area is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from September 1986 to February 1989. This matter comes before the Board of Veterans Appeals (Board) on appeal of a May 2008 rating decision issued by a regional office (hereinafter agency of original jurisdiction or AOJ) of the Department of Veterans Affairs (VA). This matter was remanded by the Board for further development in July 2012 and March 2017. The Board denied the Veteran’s claims in a March 2018 decision, which he appealed to the Court of Appeals for Veterans Claims (Court). The Court granted a Joint Motion for Remand in December 2018, and the Board again denied the claims in a June 2019 decision, which the Veteran appealed. The Court granted an additional JMR in March 2020, and the Board remanded the claims to the AOJ for a new medical examination in compliance with the terms of the JMR. The claims have now been returned to the Board. 1. Entitlement to separate rating for recurrent boils of the buttocks area is remanded. The March 2020 JMR vacating the Board’s denial of entitlement to a separate rating for boils of the buttocks noted that the decision relied on inadequate VA medical opinions. In denying a separate rating, the Board primarily cited to an April 2016 examiner opinion and associated September 2016 addendum opinion. The Court determined that neither of these opinions contained adequate supporting rationale and instructed the Board to provide an adequate medical examination for the Veteran’s recurrent boils. In a June 2020 decision, the Board remanded the issue to the AOJ in order to afford the Veteran a new VA skin examination and obtain a new medical opinion with adequate rationale. The Board directed the AOJ to obtain an opinion on whether the Veteran’s recurrent boils of the buttocks were at least as likely as not related to his perianal cyst, a manifestation of steatocystoma multiplex, or were an entirely separate and distinct condition. The examiner was instructed to review the Veteran’s entire medical record and to provide “all findings, along with a complete rationale for his or her opinion(s) in the examination report.” The AOJ afforded the Veteran a new skin examination in October 2020. After reviewing the Veteran’s medical history, the examiner noted diagnoses of atopic dermatitis, steatocystoma multiplex, intertrigo, as well as recurrent boils of the buttocks area covering less than five percent of his body. The examiner stated that a “review of the medical record indicates that boils on the buttocks are due to perianal cyst, and concluded “therefore, it is at least as likely as not that the recurrent boils of the buttocks are related his perianal cyst, are manifestations of steatocystoma multiplex.” No further rationale was provided. The Court vacated the June 2019 Board denial due to reliance on medical opinion without adequate supporting rationale, which the prior Board remand sought to rectify. The Board finds that the October 2020 VA opinion suffers from the same defect, as the examiner provided no reasoning other than stating “a review of the medical record indicates” that the Veteran’s recurrent boils of the buttocks were due to his perianal cyst. The examiner also concluded that the boils were related to his steatocystoma multiplex but did not supply further rationale explaining the nature of the relationship. As such, the Board finds this opinion inadequate and remand is required for an opinion in compliance with the prior Board remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (a Court or Board remand confers upon the Appellant the right to compliance with that order.). 2. Entitlement to a TDIU is remanded. As the Board is remanding the issue of entitlement to a separate rating for recurrent boils, the Board errs on the side of caution and finds that the adjudication of this issue could significantly change the adjudication of entitlement to a TDIU. See Harris v. Derwinski, 1Vet. App.180, 183 (1991) (issues are “inextricably intertwined” when a decision on one issue would have a “significant impact” on a veteran’s claim for the second issue). Consideration of the issue of entitlement to a TDIU, therefore, will be deferred until the intertwined issue regarding the Veterans’ separate rating for recurrent boils of the buttocks area is resolved. The matters are REMANDED for the following action: 1. Forward the Veteran’s claims file to a qualified VA examiner for an addendum opinion regarding the nature and etiology of his recurrent boils of the buttocks. The need for a new examination is left to the discretion of the examiner. After reviewing the claims file, the examiner is asked to opine whether it as at least as likely as not (50 percent probability or greater) that his recurrent boils of the buttocks are related to his perianal cyst, or are manifestations of steatocystoma multiplex, or represent an entirely separate and distinct condition. The examiner is asked to explain the basis for this opinion. In formulating the requested opinion, the examiner should specifically discuss the following: •The Veteran’s claim during a December 2011 VA examination that his recurrent boils are due to a past perianal cyst removal procedure. •April 2014 and September 2016 VA examiner opinions that the Veteran’s recurrent boils are at least as likely as not related to his diagnosis of perianal abscess. •September 2020 VA treatment records in which the Veteran denied prior treatment for buttock boils and the dermatologist stated they were “likely separate entity compared to steatocystoma multiplex.” •October 2020 VA examination in which the examiner opined the Veteran’s recurrent boils of the buttocks were at least as likely as not a manifestation of his perianal cyst and steatocystoma multiplex. The examiner must provide all findings, along with a complete rationale for his or her opinion(s). If a requested opinion cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. C. Schumacher, 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.