Citation Nr: 23015196 Decision Date: 03/14/23 Archive Date: 03/14/23 DOCKET NO. 12-06 294 DATE: March 14, 2023 REMANDED Entitlement to a rating in excess of 30 percent for pseudofolliculitis barbae (PFB) and tinea versicolor is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1976 to December 1978. This matter is before the Board of Veterans' Appeals (Board) on appeal from an August 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). A Board hearing was held before the undersigned in April 2019. A transcript of the hearing is of record. This matter was previously before the Board in September 2019, January 2021, October 2021, April 2022, and July 2022 when it was remanded for further development. Entitlement to a rating in excess of 30 percent for PFB and Tinea Versicolor is remanded. In September 2022, the Veteran underwent a VA examination. The examiner diagnosed PFB and tinea versicolor. The examiner indicated that the Veteran's PFB was located on his jawline, chin, and neck. His tinea versicolor was located on his back and was characterized by flare ups causing itching, discoloration, irritation, and heat intensifying symptoms. The examiner reported that the Veteran treated his PFB with topical medication (Benadryl and magic shave) used 6 weeks or more, but not constant. The examiner did not indicate whether the Veteran's tinea versicolor required any medication for treatment. The examiner reported that the Veteran's PFB affected less than 5% of his total body area and none of his exposed area. Percentages of total body area and exposed area affected by the Veteran's tinea versicolor were not provided. The examiner estimated that the combined total body area affected by the Veteran's PFB and tinea versicolor was between 5% and 20% and that none of the combined exposed area was affected by the conditions. Although the examiner indicated that the Veteran's PFB affected none of his exposed area, the examination report defines exposed body area as being the face, neck, and hands. As noted, the examiner had indicated that the PFB was on the jawline, chin, and neck, which would be exposed areas. Thus, the September 2022 report contains inconsistent findings. In October 2022, an addendum opinion was obtained, and the examiner indicated that the Veteran's PFB and tinea versicolor were in active stages during the September 2022 examination. Specifically, the Veteran's PFB was active on his chin and jawline and the tinea versicolor was active on his head, neck, and back. The examiner indicated that the Veteran's PFB affected less than 5% of his total body area and less than 5% of his exposed area. His tinea versicolor affected between 5% and 20% of his total body area and between 5% and 20% of his exposed area. The examiner reported that the Veteran's conditions did not result in any true functional loss, noting that the Veteran only reported the appearance of his conditions is unprofessional and can take weeks to resolve during severe flare ups. Although the October 2022 addendum appears to clarify the percentage of exposed areas affected by the conditions, the findings regarding tinea versicolor are inconsistent with what was reported in the September 2022 examination. Specifically, in September 2022, the examiner indicated that tinea versicolor was only on the back, but then in the October 2022 addendum opinion, the examiner indicated that it had been active at the head, neck, and back. Additionally, while the October 2022 opinion added the percentage of total body area and exposed body area affected for tinea versicolor and increased the percentage of exposed area affected for PFB, it did not provide percentages for the combined total body area and total exposed area affected by PFB and tinea versicolor, which is needed for proper evaluation of the condition. In addition, the examiner did not report on whether the Veteran's tinea versicolor required any medication for treatment. In light of this, the Board finds remand for a new examination necessary. In addition, the Board notes that a November 2009 VA examination report reflects that the Veteran's PFB resulted in slight scarring. A more recent December 2021 examination indicates there was not any scarring from the condition. On remand, the examiner is asked to provide a retrospective opinion regarding the severity of the reported scarring in November 2009. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file updated VA treatment records from August 2022 to the present. 2. Schedule the Veteran for a VA examination with an appropriate clinician for evaluation of his service-connected PFB and tinea versicolor. To the extent possible, attempt to schedule the examination during an active stage of the Veteran's disability since skin conditions by their very nature tend to have active versus inactive periods. The electronic claims file, including this remand, must be made available to the examiner for review in connection with the examination. All indicated tests should be conducted, and the reports of any such studies incorporated into the examination reports to be associated with the claims file. The examiner should specify all symptoms and functional impairment associated with the Veteran's service-connected PFB and tinea versicolor ONLY. The nature and severity of such symptomatology should be described in detail. In addition, the examiner should: (a) Clearly note whether the examination was conducted during an active or inactive stage for both his PFB and tinea versicolor. (b) Render specific clinical findings as to the percentage of the total area of the body affected as well as the percentage of the exposed areas affected by the service-connected disability (PFB and tinea versicolor). If the examination must take place during an inactive period for either disability, separate percentages should be provided for the inactive stage and active stage, with the active stage being based on a review of the record and the Veteran's description of his symptoms during a period of exacerbation or flare ups. (c) Indicate whether the Veteran's service-connected tinea versicolor requires treatment with systemic therapy, such as corticosteroids or other immunosuppressive drugs, and identify the total duration of such required treatment during the relevant period. (d) Provide a retrospective opinion addressing the severity of the scarring associated with the Veteran's PFB reported on the November 2009 VA examination report, to include, to the extent possible, reporting signs and symptoms necessary for evaluating the scarring under applicable rating criteria in effect prior to August 31, 2018. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.J. 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. ยง 20.1303.