Citation Nr: 21042379 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 16-23 679 DATE: July 12, 2021 REMANDED Entitlement to an initial compensable evaluation for hidradenitis suppurativa is remanded. Entitlement to an initial compensable evaluation for left knee surgical scar is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1975 to March 1978. This matter comes before the Board of Veterans' Appeals (Board) from a January 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to an initial compensable evaluation for hidradenitis suppurativa is remanded. 2. Entitlement to an initial compensable evaluation for left knee surgical scar is remanded. The Veteran contends that her hidradenitis suppurativa is more disabling than 0 percent. She also contends that her left knee surgical scar is more disabling than 0 percent. In December 2013, the Veteran attended two VA examinations completed by the same examiner: one for skin diseases and another for knee and lower leg conditions. See December 2013 VA Examinations. The examiner noted that the Veteran was diagnosed with hidradenitis suppurativa in 1975. At the time of diagnosis, the Veteran had boils on her inner buttocks. Since then, the Veteran alleges that the boils have recurred intermittently on her inner buttocks and under her breasts. The Veteran also reported that her skin condition worsened in hot weather and usually responded well to antibiotics. At the time of the examination, the examiner found that none of the Veteran's body was covered with infection and that the Veteran had not been treated with oral or topical medications in the past 12 months for any skin condition. The examiner additionally noted that the Veteran had a left knee arthroscopic scar that was not painful or unstable with a total area of less than 39 square cm. In March 2016, the Veteran attended a VA examination for scars. See March 2016 VA Examination. The examination states that the Veteran was diagnosed with scars secondary to hidradenitis suppurativa. The examiner noted the Veteran had scarring without pain on her right and left upper thighs and breasts. The Veteran again alleged that she has intermittently recurring boils in her inner buttocks and under her breasts, sharing that her dermatologist believes her condition is exacerbated by her diabetes. The examiner opined that there was no change to the VA established diagnoses. The most recent VA examination in connection with the Veteran's service-connected skin condition was conducted more than 7 years ago and the most recent VA examination in connection with the Veteran's scar condition was conducted more than 5 years ago. In correspondence submitted to the Board, the Veteran contends that her hidradenitis suppurativa appears all over her body including her underarms, groin area, buttocks, and thighs. See Form 9. She further alleges that her skin condition causes sores in her vaginal area and that her scars are painful, especially the ones on her stomach, her buttocks, and groin area. As the Veteran indicates that her symptoms may have worsened since her last examinations and there is no recent VA examination of record, the Board finds that new VA examinations are appropriate to assess the current severity of the Veteran's hidradenitis suppurativa and left knee surgical scar. See Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (VA has a duty to provide the Veteran with a thorough and contemporaneous medical examination) and Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (an examination too remote for rating purposes cannot be considered "contemporaneous"). The matters are REMANDED for the following action: 1. In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. 2. Schedule a VA compensation examination to determine the current nature and severity of hidradenitis suppurativa. The examiner should review the claims folder. In a report detailing the nature and severity of the disorder, the examiner should comment on the following: (a). What area of the skin is affected by hidradenitis suppurativa? (b). Does the Veteran treat the disorder with systemic therapy such as corticosteroids or other immunosuppressive drugs? In all opinions rendered, the examiner is advised that the Veteran is competent to report her symptoms and treatment history including her reports of pain. A rationale for all opinions offered should be provided. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 3. Schedule the Veteran for a VA medical examination to determine the current severity of her service-connected left knee surgical scar. The electronic claims file must be reviewed in conjunction with the examination. Any appropriate evaluations, studies, and testing deemed necessary by the examiner should be conducted, and the results included in the examination report. The examiner should consider and address the Veteran's contentions that her scar(s) is painful and impacts her ability to walk. A complete rationale should be given for all opinions and conclusions rendered. (Continued on the next page) If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Schmidt 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.