Citation Nr: 21039901 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 17-59 781 DATE: July 1, 2021 ISSUE Entitlement to an increased rating in excess of 10 percent for pseudofolliculitis barbae (PFB). REMANDED Entitlement to an increased rating in excess of 10 percent for pseudofolliculitis barbae (PFB) is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1983 to October 2003. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in May 2019 and March 2021. In the May 2019 decision, the Board, in pertinent part, remanded the issue of entitlement to increased rating for IVDS of the lumbar spine. The Board also denied entitlement to an increased rating in excess of 10 percent for pseudofolliculitis barbae. The Veteran appealed that part of the Board's May 2019 decision pertaining to entitlement to an increased rating in excess of 10 percent for pseudofolliculitis barbae to the United States Court of Appeals for Veterans Claims (Court). In May 2020, the Court granted the parties' Joint Motion for Partial Remand (JMPR), which vacated the Board's May 2019 decision with regard to the pseudofolliculitis barbae claim and remanded that portion of the appeal. See May 6, 2020 CAVC Order. In March 2021, the Board remanded the matter to obtain a new VA examination and medical opinion which would address the current severity and manifestations of the Veteran's pseudofolliculitis barbae. For reasons that will be discussed below, the Board finds that further development in the form of an addendum medical opinion is required. Entitlement to an increased rating in excess of 10 percent for pseudofolliculitis barbae (PFB) is remanded. The Board finds that additional development is required to comport with the terms of the May 2020 JMPR in the form of an addendum medical opinion to address whether any of the Veteran's medications (regardless of whether they are topical medications) are (1) systemic therapy and (2) like or similar to a corticosteroid or immunosuppressive drug. See May 6, 2020 JMPR, pgs. 2-3; See also February 9, 2021 Department of Veterans Service Correspondence. Pursuant to the Board's May 2021 remand directives, the Veteran was provided with an April 2021 Skin Conditions examination and medical opinion. In the subsequent April 2021 Skin Disease Medical Opinion, the examiner addresses whether the Veteran's Retin-A and clobetasol topical medications are (1) systemic therapy and (2) like or similar to a corticosterorod or immunosuppressive drug. See April 12, 2021 Medical Opinion, pg. 4. The April 2021 VA examiner does not address whether any of the Veteran's medications (regardless of whether they are topical medications) are (1) systemic therapy and (2) like or similar to a corticosteroid or immunosuppressive drug. In the April 2021 VA Skin Disease examination, the examiner reports that the Veteran has used isotretinoin (oral) and benzoyl peroxide (topical) medications in the past 12 months for 6 weeks or more, but not constant for his PFB. See April 12, 2021 Skin Disease examination, pgs. 4-5. The examiner does not address whether these medications are (1) systemic therapy and (2) like or similar to a corticosteroid or immunosuppressive drug. Hence, the Board finds that remand for an addendum medical opinion from the examiner who conducted the April 16, 2021 examination and medical opinion is required to address this issue and comport with the terms of the May 6, 2020 JMPR. See also, Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Accordingly, this matter is REMANDED for the following action: 1. Identify and obtain any outstanding VA treatment records and associate them with the claim file. Appropriate efforts should be made to obtain and associate with the claim file any further private medical records identified and authorized for release by the Veteran. Then, forward the claims file to the VA examiner who performed the April 2021 Skin Disease examination and rendered the medical opinion. If the April 2021 VA examiner is unavailable, forward the file to an examiner with sufficient expertise to provide the requested addendum medical opinion. The claims file, to include a copy of this Remand, must be reviewed in its entirety. Then, the VA medical examiner should provide the following addendum medical opinion addressing the following: Whether any medications prescribed to treat the Veteran's pseudofolliculitis barbae, to include oral isotretinoin and topical benzoyl peroxide, are considered systemic therapy to the same degree as corticosteroids or other immunosuppressive drugs. In answering this question, the examiner must state: (a) Whether the medication operates by affecting the body as a whole to treat pseudofolliculitis barbae; and, (b) Whether the medication is like or similar to a corticosterorod or other immunosuppressive drug. If the answer is yes, describe whether each medication was required for a total duration of: (i) less than six weeks in the 12 months before or during the appellate period; (ii). a total duration of six weeks or more, but not constantly, during the 12 months before or during the appellate period; (iii). or if the medication was constant or near-constant systemic therapy required during the 12 months before or during the appellate period. All opinions expressed should be accompanied by a detailed supporting rationale. 2. Then, the RO should readjudicate the Veteran's claim, to include a reassessment of the disability based upon the VA examiner's assessment of the Veteran's condition and characterization of his medication. If any benefit sought on appeal is not granted to the Veteran's satisfaction, the Veteran and his representative should be furnished an appropriate supplemental statement of the case and be afforded the requisite opportunity to respond. Thereafter, the case should be returned to the Board for further appellate action. This appeal must be afforded expeditious treatment. The law requires that all issues that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112 (2012). Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Little, 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.