Citation Nr: 21041337 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 16-61 189 DATE: July 8, 2021 REMANDED Entitlement to a compensable rating for service-connected skin condition, to include dermatitis and erythema intertrigo is remanded. REASONS FOR REMAND The appellant is a Veteran who had active service from April 1987 to October 1995. This matter is before the Board of Veterans' Appeals (Board) on appeal from the March 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2019, the issue was before the Board and remanded for further development, to include obtaining any outstanding records and examination discussing percentage of body area covered by skin disability and the use of corticosteroids or immunosuppressive drugs as treatment. In Stegall v. West, 11 Vet. App. 268, 271 (1998), the United States Court of Appeals for Veterans Claims (Court) held that a remand by the Board confers upon the Veteran the right to compliance with the Board's remand order. Moreover, the Court held that the Board itself errs when it fails to ensure compliance with the terms of its remand. The Board finds that the AOJ did not substantially comply with the remand directives because the examination was inadequate for rating purposes. While additional delay is regrettable, the Board finds that another remand is required to fairly decide the Veteran's claim. Entitlement to a compensable rating for service-connected skin condition, to include dermatitis and erythema intertrigo The Veteran asserts that a compensable rating is warranted because his skin condition affects more than 5 percent of his body and has resulted in facial scarring. His wife reported that he gets rashes and big red spots under his arms, on his rear end, between his legs, around his ankles, up and down his legs, and on his face. She described it as looking like raw meat. The Board notes that in June 2020, the Veteran was awarded service connection for tinea unguium, right foot. A review of the evidence of record reveals a March 2015 VA examination report reflects that the Veteran reported having red, itchy rash on his feet, ankles, groin area, sides and axilla; an almost constantly itching rash on his faces that has not improved with prescribed medication; and small skin growths. The examiner indicated that the Veteran had seborrheic dermatitis and tinea cruris. The examiner noted that the Veteran used topical corticosteroids for his body rash and other topical mediations for his ace and groin. Additionally, the examiner noted that there was no evidence during the examination of the claimed rash on the thighs, sides or axilla, only on the face. A November 2015 private treatment record notes that the Veteran had a face rash described as flaking, red, itchy and moderate in severity; a trunk and leg rash described as painful, itchy, flaking, red and burning moderate in severity; bilateral underarm skin lesions described as asymptomatic and mild in severity; and left forehead skin lesion described as irregular and irritated, mild in severity. The examiner's impression was dermatitis-well demarcated geometric eczematous patches and pseudovessiculation distributed on the leg, arm, trunk, and left proximal posterior upper arm; erythema intertrigo erythematous patches distributed on the axilla and left axillary vault; and xerosis cutis: dry skin distributed on the feet and right plantar forefoot overlying 1st metatarsal. A topical steroid was prescribed daily as needed for rash. A December 2015 private treatment record notes that the Veteran had dermatitis unspecified on the leg, arm, trunk, and left proximal posterior upper arm; face, right medial malar cheek and chin; and intertrigo on the axillae and left axillary vault. Topical cream, antifungal, steroid cream and steroid ointments were listed as current medications December 2016 photographs submitted by the Veteran include photos of rash on right side of nose with scarring, on left side of nose with scarring, around mouth and chin, on forehead, cheek, and around nose, on left leg from knee to ankle, on right leg from knee to ankle, on left upper thigh, right buttock, on inner left leg from groin to buttocks, on inner right leg from groin to buttocks, on left side of upper body, on right side of upper body, and on lest side under arm. A January 2018 VA treatment note reflects that the Veteran had a rash on the back of the left thigh and right foot. An April 2019 VA treatment note reflects that the Veteran had dry erythemic rash to face and scalp, across abdomen and under axilla and lower extremities. In response to the January 2019 remand directives, the Veteran was afforded a September 2019 VA examination. The September 2019 VA examination report indicated a diagnosis of dermatitis; tinea unguium; xerosis right foot; and intertrigo (axilla). Examination revealed erythemic rash on both side of nose; and intertrigo on right and left axilla. The examiner indicated the use of corticosteroids or other immunosuppressive medications: 6 weeks or more, but not constant; and other medication: 6 weeks or more, but not constant. The examiner did not include discussion of the December 2016 photos showing breakouts on the buttocks, legs, trunk and face; approximate measurements during breakouts; the November 2015 description of rashes during breakouts to include severity and pain; and or the lay statements of the Veteran and his wife. A November 2019 VA treatment note reflects that the Veteran had rashes to face and axillary and over various places on body; and erythematous rash with scaling on nasolabial fold and between upper eyebrows. Topical creams and ointments, to include corticosteroids and antifungals were listed as current medications prescribed for skin conditions. A January 2020 VA treatment note for right foot pain notes that the Veteran had rash, nodules, lesions, and ulcers but did indicate where they were located on the Veteran's body. As the September 2019 was not in compliance with the January 2019 directives and the evidence of record reflects that the Veteran has outbreaks on various areas of his body at different times, as well as continuous prescriptions for steroidal creams/ointments and other topical medications, the Board finds that a remand is necessary in order to obtain an examination and opinion as to the current severity of the Veteran's skin conditions. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination in order to determine the current severity of his skin condition. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. Specifically, the examiner should discuss the percentage of total body area covered and exposed body area covered by the Veteran's skin conditions, to include, dermatitis and erythema intertrigo. The examiner should additionally discuss what types of treatment he uses for his skin disability, to include whether he requires or has ever required systemic therapy such as corticosteroids or immunosuppressive drugs, and if so, the frequency of such systemic treatment during a 12-month period throughout the appeal period. The examiner should consider the December 2016 photos showing breakouts on the buttocks, legs, trunk and face; approximate measurements during breakouts; the November 2015 description of rashes during breakouts to include severity and pain; and or the lay statements of the Veteran and his wife. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. R. Erdheim Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Camille NeSmith, 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.