BVA9508318 DOCKET NO. 93-17 250 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Entitlement to service connection for venous insufficiency with venous stasis dermatitis with ulceration. 2. Entitlement to an increased (compensable) evaluation for fungal infection. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J. W. Loeb, Counsel INTRODUCTION The veteran served on active duty from December 1945 to January 1947. This case came before the Board of Veterans' Appeals (Board) on appeal from a March 1990 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California. REMAND Since the veteran's most recent VA dermatological examination for rating purposes in August 1991, December 1991 and August 1992 statements from David M. Trask, M.D., reveal subsequent treatment for chronic tinea pedis of the right foot. According to Dr. Trask, although the veteran's tinea pedis was being treated with topical medication, it appeared to be getting more and more resistant to treatment. Consequently, there is a question as to the current severity of the veteran's service-connected fungal infection. Additionally, Dr. Trask indicated in September 1990 that the veteran had experienced cellulitis on occasion and noted in August 1992 that the veteran could develop cellulitis as a result of an inability to control his tinea pedis, which, in turn, could aggravate his venous ulcer. It was implied on behalf of the veteran in August 1994, based on the evidence from Dr. Trask, that he has cellulitis due to his service-connected fungal infection. The issue of entitlement to service connection for cellulitis secondary to the veteran's service-connected fungal infection is inextricably intertwined with the certified issue of entitlement to an increased evaluation for fungal infection. Therefore, the issue of entitlement to service connection for cellulitis must be adjudicated prior to the Board's consideration of the previously noted certified issue. Harris v. Derwinski, 1 Vet.App. 180 (1991). Based on the above, the Board finds that additional development is required prior to final disposition of this case. Therefore, this case is being REMANDED to the RO for the following actions: 1. The veteran should be permitted to submit any additional evidence in his possession that is pertinent to the issues on appeal. He should also be requested to provide the complete names, addresses, and dates of treatment of any physicians or facilities that have treated him for a skin disorder or venous insufficiency since service discharge. Any medical provider identified should be asked by the RO for copies of the veteran's clinical records not currently on file. Any records obtained should be associated with the claims folder. The veteran should be asked to sign any necessary consent forms for release of his private medical records. 2. After obtaining any necessary authorization, the RO should obtain from Dr. Trask, 691 Murphy Road, Suite 115, Medford, Oregon 97504, copies of all of the veteran's clinical records, which should be associated with the claims file. 3. The veteran should be given a special dermatological examination, in accordance with the VA Physician's Guide for Disability Evaluation Examinations, to determine the current severity of his service-connected fungal infection and to determine whether he has developed chronic cellulitis, and any resulting disability, due to his fungal infection. The claims folder must be made available to the examiner for review prior to the examination. If cellulitis is found, the examiner should provide an opinion whether it is at least as likely as not that the additional disorder is causally related to the veteran's fungal infection. All necessary tests and studies should be conducted, and all findings should be reported in detail. A complete rationale for any opinion expressed must be provided. 4. The RO should then readjudicate the issues on appeal, to include consideration of all appropriate law and regulations, such as the provisions of 38 U.S.C.A. § 5107(b) (West 1991), 38 C.F.R. §§ 3.321(b)(1), 4.130 and 4.7 (1994). The RO should also adjudicate the additional intertwined issue of entitlement to service connection for cellulitis as secondary to the veteran's fungal infection, to include consideration of the Court of Veterans Appeals decision in Allen v. Brown, No. 93- 245 (U.S. Vet.App. Mar. 17, 1995) (en banc). With respect to the additional intertwined issue, if it is denied and a timely notice of disagreement is filed, the issue should be addressed in a supplemental statement of the case. When the above actions have been completed, unless the issues are granted to the satisfaction of the veteran, the veteran and his representative should be provided with a supplemental statement of the case on all issues in appellate status and given the applicable time period to respond. The case should then be returned to the Board, if otherwise in order. The veteran need take no action until notified. THOMAS J. DANNAHER Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This action has been taken in accordance with the Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 303, 108 Stat. 4645, ___ (1994), and is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1994).