Citation Nr: 21041682 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 10-04 207A DATE: July 9, 2021 REMANDED Entitlement to a rating in excess of 30 percent for psoriasis prior to August 12, 2020 is remanded. Entitlement to a rating in excess of 60 percent since August 12, 2020 for the psoriasis, on an extra-schedular basis, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1968 to November 1972. The Veteran testified during a hearing before the undersigned Veterans Law Judge (VLJ) in January 2013. A transcript of the hearing is of record. While the issue of entitlement to service connection for a skin disorder was not on appeal at that time, the Veteran testified about his skin disorder during that hearing, and this claim subsequently was reopened by the Department of Veterans Affairs (VA) Regional Office (RO) and service connection for psoriasis granted in an August 2015 rating decision (it was claimed as various skin conditions, including eczema). This appeal to the Board of Veterans' Appeals (Board) ensued since the Veteran timely contested the 30 percent rating initially assigned for this skin disorder. See Fenderson v. West, 12 Vet. App. 119 (1999) (indicating that, in this circumstance, VA must consider whether to "stage" the rating, meaning assign different ratings at different times since the effective date of the award if there have been occasions when the disability has been more severe than at others). In August 2018, the Board remanded this claim back to the RO for further development and consideration including to obtain all outstanding treatment records relevant to this claim and then to have the Veteran reexamined to reassess the severity of his psoriasis. In an October 2020 decision since issued, on remand, the RO increased the rating for the psoriasis from 30 to 60 percent, so the rating has been "staged" as contemplated in Fenderson. However, the rating increase is only effective as of August 12, 2020. Thus, this appeal now concerns whether an initial rating higher than 30 percent was warranted prior to August 12, 2020, and whether a rating higher than 60 percent has been warranted since August 12, 2020. See AB v. Brown, 6 Vet. App. 35, 38-39 (1993) (receipt of a higher rating, but less than maximum possible rating and for all periods at issue, does not abrogate a pending appeal). The Board again remanded this claim back to the RO in March 2021 since still more medical comment was needed. However, there has not been the required compliance or acceptable substantial compliance with those more recent remand directives. Thus, the Board is again remanding this claim. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions); but see also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only "substantial" rather than strict or exact compliance with the Board's remand directives is required under Stegall); accord Dyment v. West, 13 Vet. App. 141, 146-47 (1999). 1. Entitlement to a rating higher than 30 percent for the psoriasis prior to August 12, 2020 is remanded. 2. Entitlement to a rating higher than 60 percent for the psoriasis, on an extra-schedular basis, since August 12, 2020 is remanded. The August 2015 rating decision granting service connection for the Veteran's psoriasis and precipitating this appeal acknowledged that it had been claimed as various skin conditions, including as eczema. Further, the rating decision noted that his skin condition had been variously diagnosed over the years as dermatitis, eczema, and psoriasis. The Board's prior March 2021 remand directed the RO to obtain more needed medical comment, including discussion of which medicines the Veteran took for his psoriasis and whether any corticosteroid, immunosuppressive, or similar medications constituted systemic therapy. In April 2021, to this end, a VA doctor did a records review. In addressing that March 2021 remand directive, this VA examiner stated that the Veteran had "no known treatment for [his] psoriasis from 10/9/14 to 8/11/20." In explaining this, this examiner stated that the Veteran had treatment for eczema, not psoriasis. This examiner then pointed out specific medical records showing treatment for various skin conditions, including eczema, but did not comment on whether any treatment constituted systemic therapy. Since, however, the Veteran was awarded service connection for "psoriasis (claimed as various skin conditions and eczema)," the Board finds that still more medical comment is needed before deciding this appeal including in terms of whether the medicines specified by the April 2021 examiner constitute systemic therapy, regardless of whether they were prescribed for psoriasis or instead eczema seeing as though the service-connected disability for all intents and purposes encompasses both. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Accordingly, this claim for higher ratings for the psoriasis both prior to and since August 12, 2020, is again REMANDED back to the RO for the following still additional development and consideration: 1. If there are outstanding records concerning this claim, obtain them and appropriately notify the Veteran if unable to obtain any additional records that he identifies with the required amount of information. 38 C.F.R. § 3.159(c) and (e). 2. After obtaining all additional treatment or other records relevant to this claim, also obtain a supplemental clinical opinion to the April 2021 opinion specifying the medication used to treat the Veteran's psoriasis and eczema from October 9, 2014 to August 11, 2020. To this end, the examiner should state whether any corticosteroid, immunosuppressive, or other similar medication, to include when used topically, constitutes systemic therapy either by (1) the method by which the topical treatment works, or (2) its side effects irrespective of whether it was prescribed for psoriasis, specifically, or instead for eczema seeing as though the service-connected disability for all intents and purposes encompasses both. If any medication is a systemic corticosteroid, immunosuppressive, or similar medication, the examiner should state when the medication was first prescribed, the reason it was prescribed (and cite to the Veteran's clinical records), and the duration of the treatment (i.e., the number of weeks in a 12-month period). KEITH W. ALLEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Pak 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.