Citation Nr: 21021451 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 15-38 319 DATE: April 13, 2021 REMANDED Entitlement to a rating in excess of 60 percent for seborrheic dermatitis is remanded. Entitlement to service connection for an additional skin disorder manifested by skin pigment fading, to include as secondary to service-connected seborrheic dermatitis with tinea versicolor, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1967 to February 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Lincoln, Nebraska. In September 2018, the case came before the Board. The Board remanded the Veteran’s increased rating claim in order for him to attend an additional VA examination because he was last examined in April 2012. The Board also found that a remand was necessary in order to address the flareups that the Veteran experiences. Lastly, the Board remanded the Veteran’s claim for entitlement to service connection for an additional skin disorder in order for a medical examiner to provide a medical opinion regarding the Veteran’s additional skin disorders. 1. Entitlement to a rating in excess of 60 percent for seborrheic dermatitis is remanded. In its September 2018 remand, the Board directed the examiner to provide an analysis of the Veteran’s flareups and provide estimates as to how much of the Veteran’s body is impacted during a flareup. In August 2019, the Veteran attended a VA examination. The examiner’s report reflects that while the Veteran experiences no functional impairments during a flareup, the Veteran’s flareups result in the Veteran developing a scaly and itchy rash and the examiner’s report did not include any estimates regarding the area of the Veteran’s body that is impacted during a flareup. Accordingly, the Board finds that there has not been substantial compliance with the remand orders; therefore, the matter must be remanded once again for compliance with the previous order/completion of the actions sought. Stegall v. West, 11 Vet. App. 268 (1998) (holding that where the remand orders of the Board are not satisfied the Board itself errs in failing to ensure compliance). 2. Entitlement to an additional skin disorder manifested by skin pigment fading, secondary to service-connected seborrheic dermatitis with tinea versicolor is remanded. In August 2019, the examiner found that the Veteran exhibited hair loss and Idiopathic Guttate Hypomelanosis (IGH), a skin disorder that decreases pigment in skin cells. The examiner opined that these disorders were separate and distinct from the Veteran’s service-connected skin disorder. Following the examination, the examiner opined that the etiology of IGH is unknown. The examiner also stated that topical steroid use or use of ketoconazole shampoo is not known to be associated with the development of IGH based on medical literature, and the Veteran’s hair loss is not secondary to topical steroid use or his service-connected disability. The Board finds this opinion is inadequate. The Board has reached this conclusion because the examiner stated that he was unable to determine the etiology of the IGH but was still able to conclude that this disorder was not related to the medications that the Veteran was prescribed. Moreover, the examiner discussed the Veteran’s medications only in a general sense and did not specifically address the medication label submitted by the Veteran which indicated that this medication was found to have side effects similar to the symptomology the Veteran is currently exhibiting. For the above stated reasons, a remand is required to obtain a more complete medical opinion as to the nature and etiology of the Veteran’s additional skin disorders. See 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.310; Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records from August 12, 2019, to the present. 2. Schedule the Veteran for an additional VA examination that addresses the severity of the Veteran’s service-connected seborrheic dermatitis. The examiner should provide an assessment of the percent of the entire body areas affected and percent of exposed body areas affected by the seborrheic dermatitis with tinea versicolor during a flareup. The examiner should also provide a discussion regarding the frequency and severity of the Veteran’s skin disorder during a flareup. 3. Schedule the Veteran for an appropriate VA examination that addresses the nature and etiology of the Veteran's additional skin disorders. The electronic claims file must be reviewed by the examiner. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. After a review of the claims file, the examiner should provide answers to the following questions: Identify all of the Veteran’s diagnosed skin disorders other than seborrheic dermatitis with tinea versicolor. For each identified disorder provide an opinion for the following: (A). Is at least as likely as not (50 percent or greater probability) that any of the Veteran’s diagnosed skin disorders had its onset in service or was caused by or related at least in part to his active service? (B). Is at least as likely as not (50 percent or greater probability) that any of the Veteran’s diagnosed skin disorders are caused or aggravated by his service-connected seborrheic dermatitis with tinea versicolor or the medications prescribed to treat the Veteran’s seborrheic dermatitis with tinea versicolor. The examiner’s report must specifically address the medication label that was submitted in February 2013. The examiner’s opinion must include a complete rationale for all opinions expressed. In providing all of the requested opinions, the examiner should consider the Veteran’s competent lay claims regarding the observable symptoms he has experienced. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Rescan, 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.