Citation Nr: 21016214 Decision Date: 03/22/21 Archive Date: 03/22/21 DOCKET NO. 15-39 288 DATE: March 22, 2021 REMANDED The issue of an initial compensable rating for spongiotic dermatitis with a history of cutaneous T-cell lymphoma prior to August 11, 2020, and a rating in excess of 10 percent, thereafter, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 2007 to February 2012. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a December 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran’s appeal was last before the Board in April 2020. The appeal has been returned for further appellate review. The issue of an increased rating for spongiotic dermatitis with a history of cutaneous T-cell lymphoma is remanded. The matter is REMANDED for the following action: 1. BACKGROUND FOR THE RO ADJUDICATOR: Substantial compliance with the Board’s previous remand directives regarding the appeal has not been completed. Stegall v. West, 11 Vet. App. 268, 271 (1998). In April 2020, the Board instructed the agency of original jurisdiction (AOJ) to obtain a new VA examination to determine the current severity of the Veteran’s skin disability. The examiner was instructed to interview the Veteran in detail about the manifestations of her skin disability regarding the severity, frequency and duration of any flare-ups and the degree of any functional loss during flare-ups. Review of both the August and September 2020 VA examinations reveal these instructions were not completed. Both examiners focused on the one incident occurring in August 2020 without soliciting further details on the severity, frequency or duration of the Veteran’s flare-ups. Additionally, the August 2020 VA examination was not performed by a VA dermatologist as instructed by the Board. Thus, remand is required to afforded the Veteran an adequate VA examination. 2. Schedule the Veteran for a VA skin disorders examination with a dermatologist to obtain an opinion as to the current nature of her spongiotic dermatitis. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must interview the Veteran in detail about the manifestations of her skin disability. The examiner must attempt to gain information regarding the severity, frequency, and duration of any flare-ups, and the degree of any functional loss during flare-ups. A detailed summary of that interview must be included in the examination report. The examiner should address the following: (a.) Whether the Veteran has any disfigurement of the head, face, or neck as a result of his spongiotic dermatitis. (b.) Whether the Veteran has any scars as a result of her spongiotic dermatitis. (c.) The percentage of the Veteran’s entire body affected by the spongiotic dermatitis. (d.) The percentage of the Veteran’s exposed areas affected by the spongiotic dermatitis. (e.) Whether the Veteran (1) uses topical therapy and, if so, (2) whether she uses a topical corticosteroid on a large enough scale to affect the body as a whole. (f.) Whether the Veteran (1) uses systemic therapy and, if so, (2) whether the treatment is like a corticosteroid or other immunosuppressive drug. (g.) The total duration of use of any systemic therapy in the previous 12 months. (h.) Whether, at any point since February 29, 2012, the answers to any of the above questions would have indicated worse symptoms than she has currently. For example, at any point did her spongiotic dermatitis cover a larger percentage of her entire body or exposed areas? Or, did she use systemic therapy, if she is currently only using topical therapy that is not systemic? Or, did she use systemic therapy for a longer duration than she does currently? The examiner’s attention is drawn to the following: *February 2012 VA examination report states that the Veteran was given tropical ointment applied 1 to 2 times a day. *July 2013 VA treatment records note the Veteran had chronic eruption on her lower legs, arms and rarely trunk and face. She had a few slightly scaly, atrophic appearing nummular patches on the arms and legs and several hyperpigmented nummular patches on the arms and legs. *February 2014 VA treatment records note the Veteran had lesions with a waxing and waning course. The Veteran used topical ointments, but lesions would still breakthrough. The Veteran had weekly drenching night sweats that required a towel and sheet changes. There were also several hyperpigmented nummular patches on the arms and legs. *December 2014 VA examination report states that the Veteran was prescribed topical hydrocortisone and clobetasol applied to the body daily. The Veteran was noted to have 1 to 3-centimeter nummular shaped scaly thin plaques with a few scattered hyperpigmented patches. *October 2015 VA treatment records noted the Veteran had chronic eruption on her lower legs, arms and rarely trunk and face and several biopsies favored a spongiotic process. *October 2015 statements submitted by the Veteran’s husband notes the Veteran applied topical creams on her face, legs and but area daily. The usage of these creams stained their bedroom sheets. He also noted the Veteran has a lot of scaly dark spots all over her legs and butt area. *At the June 2019 Board hearing, the Veteran testified that her skin disability affected her face, legs and butt area and covered about 25 percent of her legs and butt and she used topical steroids to treat these areas. *August 2020 VA examination report reflects the Veteran reported continuing to have skin breakouts. She continued to use topical corticosteroids on a constant to near constant basis. It also noted the Veteran was prescribed oral prednisone for an outbreak in August 2020. *August 2020 VA treatment records note the Veteran went to the ER complaining of hives all over her body for 4 days. They were very itchy, and she took Benadryl intermittently without relief. The Veteran was diagnosed with urticaria. *September 2020 VA examination report reflects the Veteran suffered from mild flare ups on the arms and legs. The Veteran continued to use topical corticosteroids on a constant to near constant basis and she was still taking oral prednisone for her August 2020 flare-up. 3. Readjudicate the issue on appeal. If the benefit sought on appeal remains denied, the Veteran and her representative should be provided a supplemental statement of the case (SSOC). An appropriate period should be allowed for response before the case is returned to the Board. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. McDuffie, 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.