Citation Nr: 21022122 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 14-19 962 DATE: April 14, 2021 REMANDED Entitlement to a compensable rating for tinea cruris is remanded. REASONS FOR REMAND This claim was denied by the Board in August 2018, see 08/17/2018 BVA Decision, and the Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (CAVC). CAVC granted a Joint Motion for Remand (JMR) which vacated the August 2018 Board decision and remanded the claim for further review by the Board consistent with the JMR. See 09/10/2019 CAVC Decision. Pursuant to the Court remand, the Board remanded the case to the Agency of Original Jurisdiction (AOJ) for additional development. See 03/27/2020 Remand BVA. As discussed further below, the Board finds less than substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). As just noted, the August 2018 Board decision denied a compensable rating for tinea cruris, and that is the issue which the Court remanded to the Board. The March 2020 remand, however, characterizes the issue on appeal as, “Entitlement to a compensable rating for diabetes type II with tinea cruris.” That is erroneous, as there was no appeal of an evaluation of the Veteran’s diabetes before the Board. The claims file reflects that service connection for the skin disability was granted as due to service-connected type II diabetes mellitus (DM2). Otherwise, the Veteran’s DM2 is not at issue in this case. Subsequent styling of this appeal should not include the evaluation of the DM2. (Emphasis added). Entitlement to a compensable rating for tinea cruris is remanded. The consensus of the parties in the JMR was as follows: 1) VA did not fully comply with the duty to assist the Veteran in that treatment records of his non-VA physician for the period December 2006 forward were not obtained; 2) the August 2018 Board decision did not fully discuss the extent of the Veteran’s disability, in that entries in the Veteran’s VA outpatient records noted his report that the rash had spread to stomach and arms; and, 3) the Board did not discuss whether any of the topical medications prescribed for treatment of the Veteran’s skin disability meet the Court’s criteria for acting like a corticosteroid or other systemic or immunosuppressive drug. See Burton v. Wilkie, 30 Vet. App. 286, 290 (2018). Thereafter, the AOJ obtained the private treatment records and arranged an examination of the Veteran. The Board notes, however, that additional clarification is needed from the examiner. The examiner noted that the Veteran reported that the rash developed at his groin region at the time of his separation from service, and that it had continued intermittently ever since. It appears 3 to 4 times a year but was not present the day of the examination. See 02/09/2021 C&P Exam, 4th Entry, P. 3. In an effort to comply with the Board remand, the AOJ asked the examiner to answer certain questions. In response to the query of how much of the Veteran’s body surface is affected, the examiner noted that he based his assessment on the Veteran’s reports at the examination and a review of the claims file. Id., 2nd Entry, P. 4. The examiner then set forth entries in the Veteran’s VA outpatient records dated in 2010 and 2017 that noted the affected areas as the groin, both sides of the scrotum, the gluteal cleft, and sometimes under the breasts but never the armpits. Id. The examiner did not note the Veteran’s report in April 2010 that the rash was spreading from his legs and buttocks to his stomach and arms, see 05/28/2010 Medical Treatment-Government Facility, P. 35, which was specifically noted in the JMR, or an entry that in November 2019 there were hyperpigmented patches on both arms, and in July 2020 the Veteran complained that the rash was on his arms, back, left chest, and appeared to be spreading. See 09/16/2020 CAPRI, 2nd Entry, P. 1, 18. Consideration of those entries may impact the assessment of the percentage of the Veteran’s total body area, to include exposed areas, affected. The AOJ also asked the examiner to opine on whether any of the Veteran’s prescribed topicals act similar to a corticosteroid. The examiner’s answer suggests that topical medications categorically are not like or similar to corticosteroids or other immunosuppressive drugs. See 02/09/2021 C&P Exam, 4th Entry, P. 4. To comply with Burton, the medical examiner must address how a particular topical works and impacts the body to determine if it works on a large enough scale to be like a corticosteroid. See Burton, 30 Vet. App. at 291-92. The matters are REMANDED for the following action: Obtain any related treatment records generated since February 2021 and add them to the claims file. (Continued on the next page)   After the above is complete, send the claims file to the examiner who conducted the February 2021 examination and provided the requested opinions, or another comparably qualified clinician if he is no longer available. Direct the examiner’s attention to the VA outpatient entries that note involvement of the Veteran’s arms, back, stomach, and chest. Ask the examiner to state whether consideration of those entries changes his assessment that the Veteran’s skin disability affects less than 5 percent of his total body area. Please explain why or why not. Also ask the examiner to opine whether involvement of the arms constitutes an exposed area? If so, what is the percentage? Ask the examiner to note all of the topical medications prescribed to treat the Veteran’s skin disability. Do any or all affect the entire body in treating the skin disability when symptomatic? For example, if ketoconazole cream, pimecrolimus cream, or hebiclens solution is applied to an outbreak on the legs, will it also impact or treat an outbreak on another part of the body without direct application to the other body part? Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board W. T. Snyder 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.