Citation Nr: 21028716 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 11-00 177A DATE: May 11, 2021 REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU), is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1976 to December 1976 and June 1979 to July 1984 in the United States Army. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2010 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2017, November 2018, and September 2020 the Board remanded the RO's decisions. The June 2017 remand confirmed a grant for service connection for granular cell myoblastoma and asked the RO to consider the Veteran's TDIU claim. In November 2018, the Board remanded the Veteran's claim for TDIU for review by the Director of Compensation pursuant to 38 C.F.R. § 4.16(b). In September 2020, the Board remanded for a new VA examination. This matter is now properly before the Board. 1. TDIU In April 2008, the Veteran was afforded a VA examination. The examiner noted that the Veteran has been having problems with a skin condition on and off since 1985. The Veteran reported he was not able to work because of the imbalance and lack of feeling sensation in his feet. The Veteran reported that he is not able to walk more than 10 feet without having to stop and rest because of the severe burning sensation he has in his lower extremities and lack of balance. Upon physical examination the examiner found that the Veteran's skin showed multiple nodules which are very tender to palpation. The nodules were found on the Veteran's chest, chin area, posterior aspect of his cervical area, leg, thigh, and buttocks. They were also found on his back, lower abdominal wall and on his calf area. The examiner noted that the Veteran was unstable on his feet. The examiner noted that the Veteran had deformity on his right hand and that he had lost function of his right hand. The examiner determined that the Veteran's skin condition looked like it was myoblastoma. The examiner determined that the Veteran was unemployable because he is found to be very disabled from neuropathy and imbalance probably due to the neurological complaints of the skin condition. The examiner determined that the Veteran is found to be completely disabled and will not be able to engage in sedentary or active employment because of it. At the time of the April 2008 VA examination, the Veteran was not yet service connected for his myoblastoma. The Veteran was granted service connection for his granular cell myoblastoma disability effective September 2009. In September 2020, a VA examiner provided an opinion regarding the Veteran's reports of difficulty with hand grip, numbness, limitations on standing and walking, itching, and burning. The September 2020 VA examiner was asked to consider the April 2008 VA examiner's findings. The April 2008 examiner determined the Veteran was unemployable because he is found to be very disabled from neuropathy and imbalance probably due to the neurological complaints of his skin condition. The September 2020 VA examiner was specifically asked to consider this, however the examiner did not. The September 2020 examiner determined that there is no evidence that the Veteran's skin condition caused difficulty with hand grip, numbness, limitations on standing and walking. The September 2020 examiner opined that the Veteran's reports of difficulty with hand grip, numbness, limitations on standing and walking are less likely as not related to his service-connected skin disabilities to include atopic dermatitis and granular cell myoblastoma. These symptoms are likely related to one of his other medical conditions that include: diabetes, diabetic neuropathy, and liver cirrhosis to name a few. The examiner was specifically asked to address the findings of the April 2008 VA examiner as discussed in the narrative above. However, the September 2020 VA examiner failed to discuss the April 2008 VA examiner's findings and opinion as to the cause of the Veteran's neurological symptoms. While the Board sympathizes with the Veteran and regrets further delay, the Board must remand the Veteran's claim for TDIU. The Board provided specific remand instructions in which the September 2020 VA examiner did not comply. The examiner failed to address the April 2008 VA examiner's opinion as provided in the Board's September 2020 remand instructions. The September 2020 examiner formulated an independent opinion but did not address or discuss the April 2008 VA examiner's opinion. Compliance with remand directives is not optional or discretionary, and the Board errs as a matter of law when it fails to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). Therefore, remand is necessary to consider the April 2008 VA examiner's opinion. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding any functional impairments caused by the Veteran's service-connected skin disabilities (atopic dermatitis and granular cell myoblastoma), to include any associated "neurological" symptoms. The examiner is asked to specifically address the following: a. Discuss the April 2008 VA examiner's opinion that the Veteran was unemployable because he is found to be very disabled from neuropathy and imbalance probably due to the neurological complaints of his skin condition. b. Discuss whether the Veteran's atopic dermatitis or granular cell myoblastoma may cause neurological and imbalance due to neurological complaints of the skin condition. c. Specifically, the examiner should address whether the Veteran's reports of difficulty with hand grip, numbness, limitations on standing and walking, itching, and burning are at least as likely as not related to his service-connected skin disabilities to include atopic dermatitis and granular cell myoblastoma, or whether these symptoms are due to another disease and/or pathology 2. If an opinion cannot be expressed without resort ot mere speculation, the examiner should explain why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Hailu, 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.