Citation Nr: 21031283 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 17-65 181 DATE: May 21, 2021 REMANDED Entitlement to a rating in excess of 10 percent for tinea pedis to include tinea unguium (claimed as bilateral foot condition) prior to February 15, 2021, and in excess of 0 percent from that date, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1979 to July 1982. He served honorably in the U.S. Army, including service in Germany. The Board thanks the Veteran for his service to our country. The Board previously remanded this case in December 2020 for additional development. The case has now returned to the Board for further appellate review. The Board notes that in the December 2020 remand, the appeal was initially characterized as contesting a February 2016 rating decision which granted service connection for tinea pedis to include tinea unguium and assigned a 10 percent rating effective October 12, 2015. However, on further review, the Board concludes that the matter arises from a March 2017 rating decision denying a rating in excess of 10 percent for the disability, as the Veteran withdrew the appeal to the February 2016 decision in December 2016, stating, "I ... would like to withdraw my notice of disagreement for ... tinea pedis to include tinea [unguium] condition from the appeals stream and have it handled by the [Fully Developed Claim] program and be completed under the traditional process." Further, the rating for tinea pedis to include tinea unguium was reduced to 0 percent effective February 15, 2021 in a February 2021 rating decision. Entitlement to a rating in excess of 10 percent for tinea pedis to include tinea unguium (claimed as bilateral foot condition) prior to February 15, 2021, and in excess of 0 percent from that date, is remanded. A remand is warranted to ensure substantial compliance with the December 2020 Board decision. The Board errs when it fails to ensure substantial compliance with a Board remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). In the December 2020 Board remand, the Board directed the examiner to report whether the disability required use of medications constituting systemic therapy and/or whether any of the medications or treatments used for the disability act as corticosteroids or other immunosuppressive drugs and, if so, the total duration required over the past 12 months. The Board also directed the examiner to record a detailed clinical history referable to the manifestations if an examination could not be conducted during a period of flare-up of the service-connected skin disability. In a February 2021 VA examination report, the Veteran reported that his tinea pedis had worsened; specifically, he reported that itching and burning had worsened. He reported taking a cream from VA and that over the years he had been treated with anti-fungal cream. The examiner stated that he had not been treated with medication in the past 12 months for any skin condition and remarked, with respect to his reports of worsening tinea pedis, that the report was subjective and that there was no evidence of current or past treatment in the past 12 months on examination or in the medical records. However, in a mid-February 2020 private provider prescription, within the year prior to the February 2021 VA examination, the Veteran had been prescribed 120 grams of triamcinolone cream, 120 mL of 10% urea lotion, menthol, and camphor to be applied twice daily and as needed for itching, indicating that he may have been treated with medication for his disability during the preceding 12 months. As the examiner did not address whether these medications to treat itching were for the Veteran's service-connected disability or, if so, whether they act as corticosteroids or immunosuppressive drugs for the service-connected disability or the duration required over the past 12 months, a remand is necessary, the Board is unable to make a determination as to whether there has been substantial compliance with December 2020 remand. The matters are REMANDED for the following action: 1. Please secure for the record (the Veteran's electronic benefits file) copies of complete updated clinical records (any not already of record) of all VA and non-VA treatment the Veteran has received for the disability on appeal. Please ask the Veteran to provide the releases necessary for VA to secure private treatment records. 2. After the action requested in paragraph 1 is complete, please refer the claim to an appropriate clinician for an opinion as to the severity of the Veteran's tinea pedis including tinea unguium disability. The Veteran's claims file must be made available to and reviewed by the clinician. The clinician is requested to opine as to the following: (a.) Please identify any medications used to treat the Veteran's service-connected tinea pedis or tinea unguium during the period on appeal. Please address (1) a January 9, 2017 VA note including terbinafine in a list of active outpatient medications; and (2) a February 17, 2020 private prescription for 120 grams of triamcinolone cream, 120 mL of 10% urea lotion, menthol, and camphor to be applied twice daily and as needed for itching (see Medical Treatment Record - Non Government Facility document received on February 19, 2020). (b.) For each identified medication used to treat the service-connected disability, if any, please explain whether the medication is a corticosteroid or other immunosuppressive drug and, if so, the total duration of use over the past 12 months. If use of said medication has been discontinued, please opine as to the total duration of use over a 12 month period during which it was used. (c.) For each identified medication used to treat the service-connected disability, if any, if the clinician determines the medication is topical rather than systemic, the clinician is requested to provide an explanation for the determination. ONLY IF the clinician determines that an examination is necessary for the addendum opinion, the Veteran should be scheduled for an appropriate VA examination to determine the severity of the disorder. The clinician must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. The clinician should take into consideration that the Veteran is competent to report in service and post-service symptom experiences; other witnesses are competent to report observable symptoms. If the clinician cannot provide an opinion without resorting to speculation, the clinician should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. M. C. GRAHAM Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Vashaw, 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.